Chemotherapy outsourcing done by hospitals across Canada

Hospitals in at least threeprovinces besides Ontario and New Brunswick outsource their chemotherapy preparation.

After about 1,200 people in New Brunswick and Ontario received lower-than-intended doses of the chemotherapy drugs cyclophosphamide and gemcitabine supplied by Mississauga, Ont.-basedMarchese Health Solutions, the Ontario Hospital Association (OHA) surveyed its members about their reliance on external providers of pre-compounded intravenousmedications, including those used for chemotherapy.

Newfoundland and Labrador, Saskatchewan and British Columbia contract out bulk preparation of chemotherapy drugs like cyclophosphamide to Baxter Canada. Manitoba and Nova Scotia saidthey prepare all chemotherapy in-house.

There is no suggestion that Baxteris involved in any overdilution of drugs.

The OHA found nine of 88 hospitals who responded said they bought pre-compounded IV medicationsfrom Baxter.

Hospitals in British Columbia buy cyclophosphamide and gemcitabinefrom Baxter, as does Saskatchewan's Cancer Agency. Eastern Health in Newfoundland and Labrador said it outsourcesbulk preparation of cyclophosphamide to Baxter Canada.

Health Canada says Baxter Canada is federally licensed forsix drug activities:

• Fabrication.
• Packaging/labelling.
• Testing.
• Importing.
• Distribution.
• Wholesaling.

Regulatory oversight of admixingthe bulk mixing of drugsfor multiple patients in different locations without individual prescriptions needs to be tightened, federal and provincial health officials say.

"In terms of the activities themselves, admixing is not listed [in Baxter's licence]. That'ssomething that was deemed to be under provincial jurisdiction," said Steve Outhouse, director of communications for federal Health Minister Leona Aglukkaq.

Health Canada has inspected Baxter for the areas that clearly fall under federal jurisdiction, Outhouse said.

"In terms of admixing, that's something that under the federal government's view had been a provincial responsibility so there was no inspections that would have happened for those activities."

Alison Drinkwater, director of public affairs forBaxter, did not immediately respond to requests for comment from CBC News.

"In 1986, Baxter opened Canada's first out-of-hospital admixture facility," the company's website reads."Featuring state-of-the-art quality control processes and clean room technology, Baxter's Central Intravenous Admixture (CIVA) pharmacy service provides Canadian hospital pharmacists and healthcare professionals with sterile parenteral therapies in a wide array of compounded formulations with extended shelf-life.Baxter's CIVA Pharmacy Services provides a range of IV therapies."

"It's important to note that Baxter is an established Canadian drug manufacturer which has been and continues to be regulated by Health Canada, serving patients across the country," said Zita Astravas, press secretary to Ontario Health Minister Deb Matthews.

A survey released this week by theOntario Hospital Associationsuggested that hospitals in the province also buy precompounded IV medications such as epidurals, narcotics and antibiotics fromBaxter CIVA, Marchese, Galenova, Gentes & Bolduc and others.

During question period in Ontario's legislature on Wednesday, NDP health critic France Glinas asked Matthewsabout howlong the oversight gap has existed and how it"extends to some of the biggest players in the health-care system."

Matthews called it a problem that requires a national solution, adding the federal minister has acknowledged that.

Matthews said she's posted regulationsdirecting hospitals to purchase only from accredited suppliers.

Ontario's College of Pharmacistsis also developing a regulation to give them access to inspect premises where pharmacists and pharmacy technicians practice, including where drugs are prepared.