Hospital lotteries should 'protect the vulnerable'

Hospital lotteries are an area in which health professionals should take the lead in minimizing harm for those susceptible to problem gambling, a Canadian medical journal proposes.

Dr. John Fletcher, editor-in-chief of the Canadian Medical Association Journal, said in an editorial published Tuesday that it's contradictory that there is legislation to ban hospitals from selling one potentially harmful, but legal, addictive product on their premises — tobacco — while hospitals can actively promote another — lotteries.

For many people, purchasing a lottery ticket is a bit of fun. For others, it is a ticket on a journey of misery. (iStock)

Lotteries use ads and websites offering prizes such as houses, cars, trips and cash to raise $10 million or more a year for research and teaching at larger hospitals and close to $1 million at smaller hospitals, Fletcher says.

The lotteries are based on the assumption that the games of chance are harmless but no one really knows, he says.

"Have we lost our moral compass to such an extent that we are blinded to our duty to 'first do no harm' by the attraction of easy revenue?" Fletcher asks.

"Hospitals should be leading the way to develop responsible lotteries that protect the vulnerable and minimize the potential harms associated with gambling; they should be at the forefront of research to identify and mitigate harm."

In 2004, Robert Williams of the Alberta Gambling Research Institute, using data from eight provinces estimated that 4.2 per cent of Canadians were problem gamblers accounting for 23.1 per cent of gambling revenue.

"Hospitals might even increase their revenues by caring for their lottery customers," Fletcher suggested. "For many people, purchasing a lottery ticket is a bit of fun made all the better when it is for a good cause. For others, it is a ticket on a journey of misery, marital breakdown and mental illness. As good corporate citizens, hospitals should show Canada what it means to run ethical lotteries."

To protect vulnerable players, the editorial recommends that hospitals:

• Require personal identification.
• Ask players to specify personal spending limits in advance, an option in the UK's national lottery.
• Limit the amount that can be spent and stop offering discounts for multiple ticket purchases.

The Princess Margaret Cancer Centre is part of Toronto's University Health Network. The hospital runs a lottery that gives people a chance to win houses, cars, trips and cash prizes worth millions of dollars in total.

Dr. Robert Bell, president and CEO of University Health Network, said a 2011 Swedish study of different forms of gambling found lotteries were far less hazardous to at-risk and problem gamblers than other games of chance, such as interactive internet gambling and casino gambling.

"So I think … the form of gambling we're talking about — that is, lotteries — is the least associated with problem gambling," Bell said.

"And, of course, the hospital lotteries do a tremendous amount of good in providing funding for enhancing patient care and certainly funding crucial research — funding that is difficult to raise in other ways."

Lotteries were illegal in Canada until 1969.

With files from The Canadian Press

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West Nile virus infects 3rd person in Windsor-Essex

The Windsor Essex County Health Unit has confirmed another human case of West Nile virus.

That brings the number to three so far this year, two men and one woman.

So far, none has needed hospitalization, and there have been no complications.

The patients are being treated and monitored.

The number of human cases is down this season.

This time last year, 22 poeple in the region were diagnosed with West Nile.

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Pharmacies, doctors fail to stop narcotic shopping spree

Two sisters in B.C. are going public to expose what they see as a big hole in the health system after a drug addict was able use their identities to get thousands of taxpayer-funded prescription narcotic pills.

Sandra Adamson, a cook from Surrey who works for the RCMP, contacted CBC's Go Public because she believes the systems meant to detect and stop prescription abuse aren't working.

"I want the doctors held accountable and I want the pharmacists held accountable — and I want them to start red flagging stuff like this when it comes up," Adamson said. "Don't you have a clue when somebody is addicted?"

Lisa and Sandra Adamson's medical and pharmacy billing records show hundreds of prescriptions from numerous doctors over a five year period — and most of the drugs were dispensed to someone else. (CBC)

Records show the huge drug-shopping spree under the Adamson sisters' names spanned five years, while no doctor or pharmacist put a stop to it.

"They just kept feeding the habit," said Sandra.

The prescriptions were written by several physicians and the pills dispensed at small and large pharmacies around B.C.'s Lower Mainland, including a London Drugs, a Wal-Mart and several Shoppers Drug Mart outlets.

"Now we know how easy it is to use somebody else's identity to get any kind of prescription drugs they want," said her sister Lisa Adamson, who works as a road construction flag person and lives in Burnaby.

High doses for years

The sisters' records show 260 individual prescriptions were dispensed — an average of 90 pills per time — most for 20 mg (per pill) of the highly addictive narcotic Oxycodone.

Pharmacists saw the long list of narcotics in the records when they filled prescriptions, but filled the prescriptions anyway. (CBC)

In all, 23,000 narcotic pills were handed out — more than 200 mg per day — between January 2007 and January 2013.

Medical experts suggest anyone who consumes 100 mg a day or more of Oxycodone is likely addicted. 200 mg per day is considered an upper limit dose, except for very ill cancer patients.

In this case, the drugs were prescribed for numerous vague ailments, including back pain, neck pain, sprains and muscle pain.

"You can tell just by looking at the paperwork here that she's an addict. And why would they keep supplying her with it?" said Sandra.

The sisters both have drug coverage through BC Pharmacare, which means the drugs and doctor visits cost taxpayers an estimated $30,000.

It didn't stop until the alleged impersonator was charged with stealing a bottle of 208 Oxycodone pills last fall at the counter of a Shoppers Drug Mart in Port Moody, B.C., after the prescription had been filled.

"If there hadn't been the theft involved, she would still be using my name and still doing it," said Sandra.

Discovered by chance

That prescription was under Sandra's name, but Port Moody police said they quickly determined she was not the woman on the Shoppers surveillance video. When police showed her the tape, Sandra recognized the woman right away — her old friend Audrey Gettings, whom she had not spoken to in years.

Audrey Gettings, seen here in a photo from several years ago, is accused of impersonating her old friend Sandra Adamson. (CBC)

Gettings has since been charged with theft and personation, the Criminal Code's term for impersonation. There is a warrant out for her arrest.

Police said that even though Gettings had not been to that Shoppers location before, she was not made to show ID or a medical card — and the pharmacist filled the prescription anyway. The pharmacist later told police the woman claimed she'd lost her wallet.

"Especially at a large chain, you would think that they would be more on the ball…and actually say…'Do you have some form of ID?'" said Sandra.

"We've seen the video surveillance. They didn't even ask her. She just walked up. Handed the prescription. They punched it up in the computer."

Professional standards require all pharmacists to ask for ID when they don't know someone.

After the theft, the sisters said they put two and two together, because Lisa had been questioned by police about a theft of a doctor's bag and prescription pad a year earlier. She had no idea what police were talking about.

The sisters realized their old friend knew their information — enough to get their personal health numbers (PHN) from any pharmacist willing to look it up.

"All she had to do was use my full name, my date of birth and my address and say, 'Oh I misplaced my care card'. Because you are already in the system, they just type it in and OK, yup, no problem," said Lisa.

The imposter could then give that PHN at any doctor's office or pharmacy to access services, claiming she lost her ID.

"How many other victims are out there whose names have been used so other people can get prescription drugs to feed their habit?" said Lisa.

System failures laid bare

"There might be a lot of people out there that are actually getting these prescriptions in other people's names so that they can sell [the pills] on the street at 20 bucks a pop."

The pharmacy at this Shoppers Drug Mart dispensed the narcotics, even though the customer couldn't produce any ID. Several Shoppers Drug Mart pharmacies are listed in the records. (CBC)

When Port Moody police realized the scope of what was happening, they asked the College of Physicians and Surgeons of B.C. to send a bulletin, warning all doctors about Gettings. The college refused, citing privacy restrictions.

The sisters requested their government doctor and pharmacist billing records.

They reveal how several pharmacists — many at Shoppers locations — viewed the history of the drug shopping repeatedly, yet failed to red flag the sisters' accounts to put a stop to it.

In B.C., pharmacists or doctors can report someone to Pharmacare, to flag them as a "restricted user", which limits them to one doctor and/or pharmacy.

"But none of them did that. They just kept filling them," said Sandra.

The records also show several prescriptions were filled when there was no corresponding doctor visit, which suggests those prescriptions were forged, likely on stolen prescription pads.

Walk-in clinics prominent

Dr. Helen Karimirad and Dr. Peter McDermick were among the top prescribers. Karimirad works at a walk-in clinic in North Vancouver, and McDermick is now retired.

This North Vancouver walk-in clinic was one where doctors wrote dozens of prescriptions. (CBC)

Between the two doctors, records show they prescribed almost 4,500 pills in two one-year periods. They both declined to comment.

Dr. Michael Davidson from North Vancouver is also prominent. He wrote prescriptions for 2,400 pills in all for the patient he thought was Lisa between April 2010 and August 2011 at a walk-in clinic. He is also the doctor who had his bag stolen.

"[Drug addicts] can fool us so easily just by their techniques," he said.

Davidson said he sees 30 to 40 patients per day when he works at the walk-in clinic, so he doesn't have time to deal with addicts properly.

Dr. Michael Davidson wrote several of the prescriptions and said walk-in clinic doctors are too busy to deal with addicts properly. (CBC)

"That's the way the system is these days — and the volume at walk-in clinics is horrendous. The doctors want to be busy — they get paid for the number they see," he said.

"We probably should just say, 'No' — and just not deal with those people."

Records show, at one point, Davidson prescribed 80 Oxycodone pills to the woman posing as Lisa, then another 60 two days later.

"Each time we see a patient we have a page to complete the history and say what we have done but there is no previous visit history. We have no file," he said.

'Don't know who anybody is'

"All we need is a Medicare number, their date of birth and a name and an active [personal health] number…we don't know who anybody is."

Susan Prins, spokesperson for B.C.'s College of Physicians and Surgeons, indicated practices at walk-in clinics are a concern.

"The College expects physicians who work in walk-in clinics to provide the same standard and quality of care to patients as physicians who work in traditional office settings, including conducting a review of a patient's Pharmanet profile (when appropriate) prior to issuing any prescription," she said.

"This type of criminal activity is widespread."

Davidson thinks the root of the problem is at the drug stores, where pharmacists can see all the records.

"It would be so easy to limit access to those narcotics at the pharmacy level that maybe that's the place that it should happen" he said.

Oxycodone, a potent painkiller, is recognized by the government as posing a high risk of abuse. (Graeme Roy/CP)

As a result of Go Public's inquiries, Shoppers Drug Mart says it is investigating how this could have happened in its stores.

"We are conducting an internal review…and we will be reinforcing the professional standards of practice and ensuring that ID is presented when first setting up a profile," said Shoppers spokesperson Tammy Smitham.

"Our initial review of the records has shown that in many cases our pharmacists reached out to the physicians who prescribed the medications to verify that they were legitimate and they were given the go-ahead in those cases."

The College of Pharmacists said it is very concerned about this case.

"We will absolutely do the full investigation. We are even conducting part of the investigation now based on the information that you have provided to us," said deputy registrar Suzanne Solven.

Not isolated

"It's actually quite scary how frequent it is. It's not just isolated in B.C. and it's not just this one woman," said Neil Calder, an ex-addict from rural Nova Scotia.

Calder, who helps the Canadian Centre on Substance Abuse with research, said addicts have told him about various schemes to steal identities and get prescription narcotics.

"There's so many ways that people actually steal people's identities and people's health cards," said Calder. "People are dying from this. People are dying from doctors being duped or conned. People are dying from abusing these drugs and there has to be a solution."

B.C. recently brought in photo ID cards, as Ontario has. Sandra Adamson points out, they will only work if pharmacists and doctors insist on seeing them.

"Who would think that somebody would access your care card to go to the doctors and get prescriptions?"

Submit your story ideas to Kathy Tomlinson at Go Public

Follow @CBCGoPublic on Twitter

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Prostate tests should start in 40s, advocacy group says

While more research is needed on an accurate test for detecting early-stage prostate cancer, Prostate Cancer Canada says the PSA is the best available. Parliamentarians seen here raise money for prostate cancer research during the group's Movember fundraiser. (Chris Wattie/Reuters)

Men in their 40s should get a baseline prostate-specific antigen (PSA) blood test to "know their numbers," Prostate Cancer Canada says.

The patient advocacy and research foundation released new recommendations today after reviewing the evidence.

Too much PSA in the blood only sometimes signals prostate cancer. It also can mean a benign enlarged prostate or an infection.

Prostate cancer screening aims to identify men with an aggressive form of the disease compared to those who can be safely watched because the tumour is unlikely to cause harm during the patient's lifetime.

"It is important to separate treatment from testing," according to the recommendations.

"Establishing a baseline PSA value will allow men to make informed decisions regarding further testing once they know their number and have determined, with their primary care provider, a schedule for future PSA testing. While a single test may not indicate the presence of cancer, a baseline test provides a benchmark for knowing how future PSA values change over time."

Previously, the group recommended that men in their 40s talk to their doctor about a baseline PSA test.

In 2011, a U.S. government panel called the Preventive Services Task Force recommended that healthy men should not receive the PSA test as part of routine cancer screening because there is little if any mortality benefit.

Prostate Cancer Canada does not recommend the use of the PSA test as a population-based screening tool, saying the evidence currently doesn't support its use for that purpose.

The Canadian group noted some men are at increased risk because of:

• Ethnicity (Black African or Black Caribbean descent).
• A family history of prostate cancer in a father, brother or son.
• Age.

"Men in the high-risk category should have a discussion with their primary care provider about their risk for prostate cancer and when to begin PSA testing," the group said.

At age 70 or older, Prostate Cancer Canada said the decision to end PSA screening should be based on individual factors.

The Canadian Cancer Society says the five-year relative survival rate for prostate cancer is 96 per cent, meaning that, on average, men diagnosed with prostate cancer are 96 per cent as likely to live five years after diagnosis as people in the general population.

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Average European man 11 cm taller since 1870s

The average height of a European man increased by 11 cm between the 1870s and 1980, a study by a U.K. economist has found.

Timothy J. Hatton, who teaches economics at the University of Essex and at the Research School of Economics at Australian National University in Canberra, examined height data for males around age 21 from 15 European countries using a series of population surveys and military records.

He found that as infant mortality rates decreased, the height of the average male increased.

Infant mortality rates fell from an average of 178 per 1,000 in 1871-75 to 14 for the 1976-80 period.

"The evidence suggests that the improving disease environment, as reflected in the fall in infant mortality, is the single most important factor driving the increase in height," Hatton said in a press release.

Other factors that account for increases in height include higher income per capita; more sanitary housing and living conditions; better general education about health and nutrition; and better social and health services.

Increases in height are a good indicator of improvements in the average health of populations, which is why Hatton was surprised to find that the pace of increases in height actually picked up in the period of the two world wars and the Great depression — that is, before many key medical breakthroughs and the advent of national health services.

Hutton's study, published online Monday in the journal Oxford Economic Papers, found a "distinct quickening" in the pace at which height of the average male in northern and central Europe increased during this time. A decrease in infant mortality definitely played a part in this but smaller family size could also have had a role, the study said, since this factor has been linked to increases in height.

The study did not include women as the historical data on women's height is limited.

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School lunch would curb impact of poor diet: researcher

The Conference Board of Canada says P.E.I.'s Breakfast for Learning program should be expanded to include lunch. (iStock)

P.E.I.'s Breakfast for Learning program should be expanded to include lunch, says the Conference Board of Canada.

Currently, about 6,000 students are fed a healthy breakfast at 49 schools across the province. A handful of schools also serve snacks.

But lunch should be served as well, said board researcher Alison Howard, who co-authored Enough for All: Household Food Security in Canada, a study that was released last week.

Children can face negative impacts if they don't get enough healthy food, she said.

"For example, teenagers are particularly at risk from suffering from depression, social anxiety, suicide. Also nutritionally deprived children tend to experience more health problems, such as anemia, weight loss, colds and infections. They tend to be absent from school more often, and have more learning difficulties," said Howard.

"And, moreover, diet-deprived children are just less able to concentrate and perform well at school, thus threatening their opportunity to gain an education and to gain those vital skills that they're going to need for the rest of their lives."

Investing in more extensive school meal programs now will mean spending less money for social assistance, healthcare and policing later, said Howard.

For mobile device users: Should the Breakfast for Learning program expand to include lunch?

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Pharmacies, doctors fail to stop narcotic shopping spree

Two sisters in B.C. are going public to expose what they see as a big hole in the health system after a drug addict was able use their identities to get thousands of taxpayer-funded prescription narcotic pills.

Sandra Adamson, a cook from Surrey who works for the RCMP, contacted CBC's Go Public because she believes the systems meant to detect and stop prescription abuse aren't working.

"I want the doctors held accountable and I want the pharmacists held accountable — and I want them to start red flagging stuff like this when it comes up," Adamson said. "Don't you have a clue when somebody is addicted?"

Lisa and Sandra Adamson's medical and pharmacy billing records show hundreds of prescriptions from numerous doctors over a five year period — and most of the drugs were dispensed to someone else. (CBC)

Records show the huge drug-shopping spree under the Adamson sisters' names spanned five years, while no doctor or pharmacist put a stop to it.

"They just kept feeding the habit," said Sandra.

The prescriptions were written by several physicians and the pills dispensed at small and large pharmacies around B.C.'s Lower Mainland, including a London Drugs, a Wal-Mart and several Shoppers Drug Mart outlets.

"Now we know how easy it is to use somebody else's identity to get any kind of prescription drugs they want," said her sister Lisa Adamson, who works as a road construction flag person and lives in Burnaby.

High doses for years

The sisters' records show 260 individual prescriptions were dispensed — an average of 90 pills per time — most for 20 mg (per pill) of the highly addictive narcotic Oxycodone.

Pharmacists saw the long list of narcotics in the records when they filled prescriptions, but filled the prescriptions anyway. (CBC)

In all, 23,000 narcotic pills were handed out — more than 200 mg per day — between January 2007 and January 2013.

Medical experts suggest anyone who consumes 100 mg a day or more of Oxycodone is likely addicted. 200 mg per day is considered an upper limit dose, except for very ill cancer patients.

In this case, the drugs were prescribed for numerous vague ailments, including back pain, neck pain, sprains and muscle pain.

"You can tell just by looking at the paperwork here that she's an addict. And why would they keep supplying her with it?" said Sandra.

The sisters both have drug coverage through BC Pharmacare, which means the drugs and doctor visits cost taxpayers an estimated $30,000.

It didn't stop until the alleged impersonator was charged with stealing a bottle of 208 Oxycodone pills last fall at the counter of a Shoppers Drug Mart in Port Moody, B.C., after the prescription had been filled.

"If there hadn't been the theft involved, she would still be using my name and still doing it," said Sandra.

Discovered by chance

That prescription was under Sandra's name, but Port Moody police said they quickly determined she was not the woman on the Shoppers surveillance video. When police showed her the tape, Sandra recognized the woman right away — her old friend Audrey Gettings, whom she had not spoken to in years.

Audrey Gettings, seen here in a photo from several years ago, is accused of impersonating her old friend Sandra Adamson. (CBC)

Gettings has since been charged with theft and personation, the Criminal Code's term for impersonation. There is a warrant out for her arrest.

Police said that even though Gettings had not been to that Shoppers location before, she was not made to show ID or a medical card — and the pharmacist filled the prescription anyway. The pharmacist later told police the woman claimed she'd lost her wallet.

"Especially at a large chain, you would think that they would be more on the ball…and actually say…'Do you have some form of ID?'" said Sandra.

"We've seen the video surveillance. They didn't even ask her. She just walked up. Handed the prescription. They punched it up in the computer."

Professional standards require all pharmacists to ask for ID when they don't know someone.

After the theft, the sisters said they put two and two together, because Lisa had been questioned by police about a theft of a doctor's bag and prescription pad a year earlier. She had no idea what police were talking about.

The sisters realized their old friend knew their information — enough to get their personal health numbers (PHN) from any pharmacist willing to look it up.

"All she had to do was use my full name, my date of birth and my address and say, 'Oh I misplaced my care card'. Because you are already in the system, they just type it in and OK, yup, no problem," said Lisa.

The imposter could then give that PHN at any doctor's office or pharmacy to access services, claiming she lost her ID.

"How many other victims are out there whose names have been used so other people can get prescription drugs to feed their habit?" said Lisa.

System failures laid bare

"There might be a lot of people out there that are actually getting these prescriptions in other people's names so that they can sell [the pills] on the street at 20 bucks a pop."

The pharmacy at this Shoppers Drug Mart dispensed the narcotics, even though the customer couldn't produce any ID. Several Shoppers Drug Mart pharmacies are listed in the records. (CBC)

When Port Moody police realized the scope of what was happening, they asked the College of Physicians and Surgeons of B.C. to send a bulletin, warning all doctors about Gettings. The college refused, citing privacy restrictions.

The sisters requested their government doctor and pharmacist billing records.

They reveal how several pharmacists — many at Shoppers locations — viewed the history of the drug shopping repeatedly, yet failed to red flag the sisters' accounts to put a stop to it.

In B.C., pharmacists or doctors can report someone to Pharmacare, to flag them as a "restricted user", which limits them to one doctor and/or pharmacy.

"But none of them did that. They just kept filling them," said Sandra.

The records also show several prescriptions were filled when there was no corresponding doctor visit, which suggests those prescriptions were forged, likely on stolen prescription pads.

Walk-in clinics prominent

Dr. Helen Karimirad and Dr. Peter McDermick were among the top prescribers. Karimirad works at a walk-in clinic in North Vancouver, and McDermick is now retired.

This North Vancouver walk-in clinic was one where doctors wrote dozens of prescriptions. (CBC)

Between the two doctors, records show they prescribed almost 4,500 pills in two one-year periods. They both declined to comment.

Dr. Michael Davidson from North Vancouver is also prominent. He wrote prescriptions for 2,400 pills in all for the patient he thought was Lisa between April 2010 and August 2011 at a walk-in clinic. He is also the doctor who had his bag stolen.

"[Drug addicts] can fool us so easily just by their techniques," he said.

Davidson said he sees 30 to 40 patients per day when he works at the walk-in clinic, so he doesn't have time to deal with addicts properly.

Dr. Michael Davidson wrote several of the prescriptions and said walk-in clinic doctors are too busy to deal with addicts properly. (CBC)

"That's the way the system is these days — and the volume at walk-in clinics is horrendous. The doctors want to be busy — they get paid for the number they see," he said.

"We probably should just say, 'No' — and just not deal with those people."

Records show, at one point, Davidson prescribed 80 Oxycodone pills to the woman posing as Lisa, then another 60 two days later.

"Each time we see a patient we have a page to complete the history and say what we have done but there is no previous visit history. We have no file," he said.

'Don't know who anybody is'

"All we need is a Medicare number, their date of birth and a name and an active [personal health] number…we don't know who anybody is."

Susan Prins, spokesperson for B.C.'s College of Physicians and Surgeons, indicated practices at walk-in clinics are a concern.

"The College expects physicians who work in walk-in clinics to provide the same standard and quality of care to patients as physicians who work in traditional office settings, including conducting a review of a patient's Pharmanet profile (when appropriate) prior to issuing any prescription," she said.

"This type of criminal activity is widespread."

Davidson thinks the root of the problem is at the drug stores, where pharmacists can see all the records.

"It would be so easy to limit access to those narcotics at the pharmacy level that maybe that's the place that it should happen" he said.

Oxycodone, a potent painkiller, is recognized by the government as posing a high risk of abuse. (Graeme Roy/CP)

As a result of Go Public's inquiries, Shoppers Drug Mart says it is investigating how this could have happened in its stores.

"We are conducting an internal review…and we will be reinforcing the professional standards of practice and ensuring that ID is presented when first setting up a profile," said Shoppers spokesperson Tammy Smitham.

"Our initial review of the records has shown that in many cases our pharmacists reached out to the physicians who prescribed the medications to verify that they were legitimate and they were given the go-ahead in those cases."

The College of Pharmacists said it is very concerned about this case.

"We will absolutely do the full investigation. We are even conducting part of the investigation now based on the information that you have provided to us," said deputy registrar Suzanne Solven.

Not isolated

"It's actually quite scary how frequent it is. It's not just isolated in B.C. and it's not just this one woman," said Neil Calder, an ex-addict from rural Nova Scotia.

Calder, who helps the Canadian Centre on Substance Abuse with research, said addicts have told him about various schemes to steal identities and get prescription narcotics.

"There's so many ways that people actually steal people's identities and people's health cards," said Calder. "People are dying from this. People are dying from doctors being duped or conned. People are dying from abusing these drugs and there has to be a solution."

B.C. recently brought in photo ID cards, as Ontario has. Sandra Adamson points out, they will only work if pharmacists and doctors insist on seeing them.

"Who would think that somebody would access your care card to go to the doctors and get prescriptions?"

Submit your story ideas to Kathy Tomlinson at Go Public

Follow @CBCGoPublic on Twitter

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Fredericton hospital's quality 'compromised' by cuts

A former nurse and nursing professor says Fredericton's Dr. Everett Chalmers Hospital has a number of problems when it comes to patient care and she blames recent government cuts.

Penny Ericson spent a significant amount of time in the Fredericton hospital while her husband Carl was being treated before his death earlier this year.

Penny Ericson, a former nursing professor at the University of New Brunswick, said the Dr. Everett Chalmers Hospital in Fredericton has a number of problems when it comes to patient care. (CBC)

She outlined her concerns and observations in a lengthy document that she sent to officials at the Horizon Health Network, the Department of Health and the New Brunswick Nurses Union.

Ericson said she was shocked at the lack of proper cleaning in the hospital's hallways, washrooms and cafeterias. She said the problem goes beyond the staff assigned to the work.

"People are doing jobs for which they are not properly supervised. They come to work to do a good job. But they don't have systems in place to let them do that," Ericson told the CBC's Information Morning Fredericton.

"The housekeeping staff were friendly, they would attend to my requests, however, they don't have the ability to properly clean the environment because they haven't been told what needs to be cleaned and they don't have the equipment to clean it properly."

'So they have saved money but they've saved money, as far as I'm concerned, in the wrong places because they've compromised quality.'— Penny Ericson

Ericson said she blames the health authority's board for not providing experienced supervisors to ensure the work is done properly.

"I put everything squarely on the shoulders of the board. The hospital has focused on saving money because the government has put them in that position," she said.

"The government has said, 'You must live within your means, you must live within a tight budget.' So they have saved money but they've saved money, as far as I'm concerned, in the wrong places because they've compromised quality."

The Horizon Health Network announced earlier this year plans to cut 131 jobs as a part of a broader plan to reduce spending by almost $22 million in 2013-14.

In April, John McGarry, the president and chief executive officer of the Horizon Health Network, said the organization's financial challenge is "substantial" but that "less money does not have to mean a reduction in the quality of the services we provide."

The provincial government's health-care budget in 2013-14 is $2.5 billion, representing zero growth over last year.

Document meant as a 'teaching tool'

Ericson is a former nurse and a nursing professor at the University of New Brunswick. She also ran unsuccessfully for the NDP in the 2003 provincial election.

Ericson outlined a number of concerns about the cleanliness of the Dr. Everett Chalmers Hospital. (CBC)

Ericson's 27-page document was sent to John McGarry, the president and chief executive officer of the Horizon Health Network, and was called, "Carl Ericson's Last Class."

"The following report has been written as a teaching tool as well as a report to highlight the need for changes. Carl was a teacher. It is a hope that this 'last class' will teach those in administrative positions to make changes that will be consistent with the goals of Horizon Health," Ericson's document said.

"There were many examples of good care during Carl's hospitalization, but this report's focus is on the shortcomings observed by those involved. The report has been written in the best interest of providing constructive criticism that may lead to enhanced patient care."

Ericson's document also stressed it has been created "as a learning/teach tool, not as evidence for litigation."

Penny Ericson document (PDF)
Penny Ericson document (Text)

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Tylenol to get health warnings on cap in U.S.

Johnson & Johnson says its U.S. bottles of Extra Strength Tylenol will bear a new warning label on the cap to alert users to potentially fatal risks of taking too much of the pain reliever. (Johnson & Johnson/Associated Press)

Bottles of Tylenol sold in the U.S. will come with warning labels on the cap to alert people that the popular painkiller contains acetaminophen that can damage the liver when taken in excess.

Acetaminophen is a medicinal ingredient in more than 470 products, according to Health Canada's online database.

It's also found in more than 600 common over-the-counter and prescription products in the U.S., including brands like Nyquil cold formula, Excedrin pain tablets and Sudafed sinus pills.

The label change is prompted by the concern that people may not realize the risk of overdosing if they take more than one of these products at the same time, or even same day.

The new cap message will read: "Contains acetaminophen" and "Always read the label."

"At this time, the cap text messaging is being introduced on Tylenol bottles sold in the US market based upon a number of factors that are specific to the U.S. market, including the prevalence of simultaneous usage of multiple acetaminophen products by a significant portion of the U.S. adult population," Shelley Kohut, director of communications and public relations at Johnson & Johnson said in an email to CBC News.

"Our commitment is to continue to assess and evaluate the needs of Canadian consumers and to provide information and educate, as appropriate, to support the continued safe and effective use of our products."

Kohut said Tylenol meets Health Canada's 2009 labelling standard for acetaminophen.

The U.S. move comes as Johnson & Johnson faces more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is also planning to curtail the use of some acetaminophen products.

Dr. David Juurlink, a drug safety researcher at Sunnybrook Health Sciences Centre in Toronto, said the U.S. change is sensible.

"Almost everyone has this in their medicine cabinet," Juurlink said in an interview. "It's a drug that if taken to excess can cause severe and sometimes fatal liver injury and I'm not sure how widely known that is."

In 2012, Dr. Rod Lim and his team at London Health Sciences Centre reported a case of the 22-day-old boy that they successfully treated in the emergency department at a community hospital after an accidental overdose of acetaminophen.

Identifying all products that contain acetaminophen is useful so parents don't mistakenly give more than one product containing the drug to their child at the same time, Lim said.

"People remember what they take for a single dose. They say, 'I take two tablets,'" Lim said. "The problem is they're used to taking it every four hours but they'll exceed the maximum daily dose within 16 hours. So it's confusing for consumers to think of what they can take and how often and not realize that they can't take it continuously for that day."

For example, taking two, 500-milligram tablets or capsules of acetaminophen every four hours from 8 a.m. to midnight for example adds up to five grams. The maximum dose for a day is 4 grams.

Acetaminophen overdoses occur when the liver is unable to detoxify high doses of the drug and liver failure results. If an overdose occurs, people can do well if they get to a hospital early, Juurlink said.

But Juurlink also fears that the warning changes might also spur deliberate overdoses, which he speculates make up the majority of severe liver injuries from Tylenol that come to medical attention.

In Canada, Tylenol's manufacturer, McNeil Consumer Healthcare, a division of Johnson & Johnson, recently introduced a website to give consumers information on the safe and responsible use of over-the-counter medicines, including products containing acetaminophen.

Gerry Harrington is director of public affairs for Consumer Health Products Canada, which represents manufacturers, marketers, and distributors of consumer health products including over-the-counter medications.

"There are significant differences between the Canadian and American experience with acetaminophen overdose, including a higher fatality rate and a greater incidence of narcotic combination products in the U.S.," Harrington said in an email. "For these reasons, I think it's too early to say whether such an initiative would be appropriate in Canada."

A spokeswoman for Health Canada said the department is aware of the labelling changes in the U.S. and is evaluating them as part of its continual surveillance of acetaminophen products.

Bottles of Extra Strength Tylenol in the U.S. will have the new label starting in October.

With files from The Associated Press, CBC's Amina Zafar and Jill English

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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