A Brockville doctor who increased his patient's dose of potent painkillers by a factor of 10 over the 13-month period before her overdose death will continue to practice.
Dr. Alan Redekopp got a formal reprimand from Ontario's College of Physicians and Surgeons Monday. He is restricted from prescribing narcotics, controlled drugs and benzodiazepines, and must post a sign in his Brockville office advertising as much.
"Dr. Redekopp is relieved to have the CPSO matter concluded and he looks forward to continuing his medical practice," his lawyer, Laura Stewart, said Monday.
The College's order comes exactly three years to the day after 19-year-old Dustin King was found dead on a couch in Donna Bertrand's downtown Brockville apartment, overdosed on OxyContin.
Ms. Bertrand, a 41-year-old patient of Mr. Redekopp's, died of an overdose days later in the same apartment.
Friends of Mr. King and Ms. Bertrand said afterward she'd been giving the teenager drugs.
The pair of deaths rocked the Brockville community and culminated in a coroner's inquest this summer. The 48 sweeping recommendations that came out of that inquest ranged from limits on the size of prescriptions to changes in the way physicians, police officers and the public are educated about the potential dangers of painkillers.
Prescription opioids have become the fastest-growing cause of addiction Canada-wide. The problem is especially pronounced in Ontario, where the number of people killed annually by opioids equals the number of drivers killed each year in motor vehicle accidents.
The province is beginning to roll out an online registry that would track, in real time, who is prescribing what to whom. Since Nov. 1, the province has begun to collect the personal information of everyone filling for narcotics and controlled substances. But the database itself won't be functional until spring.
The College's order states Dr. Redekopp "failed to maintain the standard of practice of the profession … in prescribing narcotics and/or benzodiazepines."
An expert report obtained by the College found his records rife with "unintelligible notation, deficient recording of drugs prescribed, and notes in non-chronological order."
Of even more concern to the expert evaluating his records, however, were Dr. Redekopp's prescribing practices. He "exhibits a lack of knowledge, skill and judgment" when it comes to prescribing opioids, benzodiazepines and psychostimulants; he prescribed "bizarre combinations of drugs."
All that said, the report notes Dr. Redekopp "appeared to be a compassionate physician motivated by a desire to serve the needs of a large and undoubtedly demanding patient population."
He will have to submit to unannounced inspections by the College to ensure he's following the order. He is also expected to take a course in medical record-keeping for physicians.
During his testimony at the inquest in Brockville this past summer, Dr. Redekopp repeatedly contradicted his own notes in reference to Ms. Bertrand's care. He said he trusted her when she repeatedly requested higher doses of OxyContin despite warnings from police and concerns from pharmacists and his own staff that she was diverting her pills to the street. On occasion he acquiesced to dosage increases without seeing Ms. Bertrand in person.
Dr. Redekopp's office was closed Monday, according to a voice mail message.
Mel Kahan, an addictions expert who testified at the Brockville inquest, said the College's decision to let Dr. Redekopp continue to practise is "reasonable" but far more needs to be done from a public-health perspective.
"It's not the issue of one occasional bad doctor: About 20 per cent of doctors are high prescribers of opiates. … These are doctors that were trained in a certain time … and they have learned an unsafe way of opiate prescribing," Dr. Kahan said. "There needs to be a public-health response. Identifying one or two doctors is not going to do it."
Dr. Kahan called for mandatory opiate-prescribing education for doctors in residence, and the possibility of new regulations on what drugs are prescribed.
Joanne Bertrand, Donna Bertrand's older sister, has become a vocal advocate for better education and enforcement around prescription opioids.
She isn't surprised by the College's decision, but she is a bit disappointed.
"I'm still just trying to take it all in," she said Monday from her home in Ottawa. "In order for them to take away his licence, that would open up a big can of worms. That would put every doctor that prescribes opiates right out there in the wind. And no one is going to prescribe anything.
"Do I think he should have lost his licence? As a family member, sure."
Ms. Bertrand said her family is considering further legal action.
"The fact remains that he was an enabler. And now he's lost his licence to be an enabler any more, going forward. But it's a big, big world out there. And there's still a lot of doctors that don't know the effects and the harm of it."