Patient of fertility doctor feels 'a lot of anger, anxiety, betrayal'
EDMONTON -- A former patient of an Edmonton fertility doctor feels betrayed after learning he profited off the prescriptions he wrote her.
Anna Fike and her husband spent four years and thousands of dollars to have their son through in vitro fertilization (IVF).
The couple began seeing Dr. Tarek Motan in 2015 and only stopped in 2017 when the clinic stopped providing IVF services.
"Now looking back after this letter, a part of me feels like maybe we dodged a bullet."
She opened the letter on Saturday. Signed by Motan, it informed her – and an unknown number of his other patients during those years – that he and a pharmacist had accepted rebates from three drug companies to sell their products.
"My heart dropped. It was just a flood of emotion. A lot of anger. Anxiety. Betrayal. Guilt," Fike told CTV News Edmonton. "The hardest thing was the betrayal because both my husband and I actually really liked Dr. Motan."
"He wasn't somebody who seemed to be in it for the money to make the quick buck. I think maybe if that's how he had come off, this would be easier to understand. But he didn't. He really came across as a champion for couples struggling with these issues. And now that voice is lost because he's lost all credibility."
Motan would pay for fertility drugs such as Gonal-f, Puregon, and Menopur that were then dispensed and sold to patients at Glengarry Pharmacy. Patients were instructed by Motan to specifically go to this pharmacy.
In some cases, Motan wrote in the letter, he received higher rebates when he prescribed higher doses, which may have increased patients' risks and costs but which he prescribed because he "had more successes with this technique decreasing the number of IVF cycles needed."
Fike says she was put on the highest recommended dose of Gonal-F at 450 units, more than twice the recommended starting dose.
She wasn't aware at the time that meant she was at higher risk for developing ovarian hyperstimulation syndrome (OHSS).
"The way the risks were presented was: 'These are the risks for taking this medication.' It wasn't: 'Because you are on such a high dose, your chances for X, Y or Z is exponentially higher.'"
Fike feels lucky she never experienced any severe side effects and grateful for her son Jake, who was born in 2019 with the help of an egg donor and a Vancouver fertility clinic. But Motan's deceit has dredged up worst parts of her journey to getting pregnant: the miscarriages, the failed IVF cycles.
"It's this cycle of regret, guilt, anger – and not regret of the decisions we made, but regret of not having all of the information. Of making decisions seeing half the picture," Fike said.
The mother wonders if – prescribed differently – she would have been able to have a baby with an egg of her own, or if Motan would have prescribed the family's egg donor with high doses, too, had they stayed at the Edmonton clinic.
"There's a part of me that wonders: is there another shoe that's going to drop down the line? … Is he only telling us a piece of information because this is what he was caught doing?"
Motan wrote in the letter, "I wish to apologize to my patients that attended at the RAH Fertility Clinic for my lack of transparency."
Fike said, "There's no apology for what I did. Just that I got caught."
LACK OF TRUST
She says her trust in the system has taken a hit.
When her son was born, she sent Motan a birth announcement.
"Until I read that letter, if somebody would've asked me, I would've sung his praises," she commented.
"I, right now, don't trust a doctor."
It's unclear how many patients who were treated by Motan received the letter, or how much money he was paid by pharmaceutical companies.
Neither he nor the Glengarry Pharmacy have responded to CTV News Edmonton's requests for comment. Motan is listed as an associate professor in the University of Alberta's obstetrics and gynaecology department.
The Alberta College of Pharmacy, which opened an investigation in 2019 and ended it in 2020, says it did not report the case to the public because it didn't land in front of the body's hearing tribunal. "The pharmacist took responsibility for their conduct and agreed with ACP’s determination that it was necessary that they make changes to their practice and the operation of the pharmacy to ensure the public is protected," an ACP statement read.
Motan's permit to practice remains active. The CPSA says overprescribing and profiting from doing so contravenes its code, but wouldn't confirm there are complaints it is investigating involving Motan.
A public health professor at the University of Calgary says the situation is not unheard of, but presents two issues which the professional colleges may have to examine: one of conflict of interest, and one of quality of care.
The standards of practice which rule each area of medicine legally binding, but have teeth in that they are equipped with disciplinary routes from reprimands and retraining, to license suspension or revocation, Lorian Hardcastle explained.
What the colleges' processes don't address is financial compensation if patients are injured during their care.
"The college process is about deterring doctors from behaving in certain ways and, where possible, ensuring that they can be effectively retrained or punished such that they can practice safely."
It is possible that – as was seen after the ACP's investigation – few details will be made public if the file doesn't make it to a hearing tribunal.
Of a possible investigation by CPSA she said, "It's not clear whether there are additional facts that will come to light when the physician is investigated that may cause them to reopen this issue, but it sounds like they (the ACP) considered it through."
Fike wishes there was legislation governing health care professionals across Canada.
"I foolishly never even thought my doctor could be getting kickbacks from drug manufactures because I made the assumption that something like that would be illegal – not just unethical, but actually illegal," she said.
"As soon as money comes in, it becomes a conflict of interest."
With files from CTV News Edmonton's Touria Izri