GNWT responds to coroner’s report

The Government of the Northwest Territories responded Friday to the coroner’s report into the 2009 death of a Yellowknife man on the anti-depressant Venlafaxine.
Minister of Health and Social Services Sandy Lee said the department took the recommendations in the March 2 report seriously and waited until the end of the month to respond since two of the recommendations were clinical in nature and needed to be addressed by medical professionals.

“We are committed to a timely response,” she said Thursday. “We will not rush to judgments on matters as serious as this. We take all recommendations seriously.”
The March 2 report into the death of Steven Harry concluded the 20-year-old man committed suicide on Feb. 1, 2009 by consuming a lethal amount of Venlafaxine, which is more commonly known as Effexor. Harry, who attempted to commit suicide at least three times in the months before his death, was given a three-month prescription for Venlafaxine on Jan. 4, 2009. Three days later, he was taken to Stanton Territorial Hospital by members of the RCMP after consuming a handful of the pills. The officers had been called to the home after Harry allegedly assaulted his mother.
Less than a month later, Harry appeared at Stanton Territorial Hospital with an empty bottle of Venlafaxine, and suffered a seizure while in the ER. The decision was then made to medivac Harry to Calgary. After he went into cardiac arrest while en route, the medivac landed in Edmonton so Harry could be transported to Royal Alexandria Hospital. Despite resuscitative efforts, Harry was pronounced dead shortly after arrival. The report by deputy chief coroner Cathy Menard concluded that at the time of his death, Harry had 59 times the therapeutic level of Venlafaxine in his bloodstream.
Menard’s report made three recommendations: that the Department distribute a warning notice calling attention to the potential dangers of prescribing Venlafaxine to patients whose depression may be of concern; that the Department educate physicians to only prescribe a partial fill of the medication in the case of high-risk patients; and that the Department develop a plan for a properly-equipped drug detoxification centre in the NWT.
The first two recommendations were already in place before Menard released her report, Dr. Jim Corkal, Stanton’s medical director, said.
“Physicians are aware of the side effects of Effexor,” Corkal told reporters. “This case has once again highlighted them.”
Following Harry’s death, Stanton undertook an internal review that included an education process on the drug, including the recommendation that physicians should order a pharmacy to dispense only a partial prescription in the case of a high-risk patient.
“We had already acted on that particular recommendation prior to receiving the coroner’s report,” Corkal explained.
Dr. David King, the Department’s medical director, said his role was to review the process that was in place and to ensure patient safety.
“I’m pleased to report the process is in place,” he said.
When Health Canada has issued warnings on Effexor, they were distributed to physicians, pharmacy directorates, and medical directors across the country, King said.
“That particular process had already been in place and had been developed and distributed,” he said of Menard’s first recommendation.
The Department has not considered placing a limitation on the amount of anti-depressants a physician in the NWT can prescribe, King said. King said pharmacists will contact a physician if they need clarification or have concerns about a prescription, which adds an additional safety measure.
“I don’t regulate pharmacists, pharmacists don’t regulate physicians,” he said. “In the spirit of cooperation (and) looking for the best possible outcomes for our patients, I think collaboration is the way to go, and there is a means to do that.”
Lee said that NWT medical professionals are on top of any warning and practice due diligence when prescribing medication. The Department’s current procedures meet the recommendations made by Menard.
“Our message today is that the residents of the NWT should be assured that the proper procedures are being followed,” she said.
Corkal said those who are currently using Venlafaxine have no reasons for concern.
“It’s okay,” he said. “It’s not like everyone has to stop their Effexor use out there.”