Alberta Health is funding a primary care clinic that offers high doses of vitamin D —an alternative treatment Health Minister Sarah Hoffman insisted the clinic could not offer under its funding agreement, and one her ministry has previously rejected as unproven and potentially unsafe.

A CBC News investigation has revealed Precision Health, the clinic operated by controversial Calgary-based private health foundation Pure North, has prescribed vitamin D in single doses of up to 50,000 international units (IU) — more than 12 times the tolerable upper intake level set by Health Canada.

In response to the CBC News investigation, Pure North admitted Precision Health prescribes vitamin D and says it has conducted vitamin-D blood-level tests on "many" of its patients, which Pure North pays for. Pure North has repeatedly said vitamin D at high doses is safe and is not an alternative treatment.

In October 2016, Pure North was one of four community groups that received pilot-project funding from Alberta Health to operate nurse-practitioner-led clinics designed to treat high-needs patients such as inner-city residents and low-income seniors.

Pure North is a private, non-profit health foundation created in 2007 by Canadian Natural Resources Limited (CNRL) co-founder and multimillionaire philanthropist Allan Markin. The foundation offers unproven alternative-health treatments, including high doses of supplements like vitamin D, chelation therapy, and the removal of mercury-amalgam dental fillings.

Earlier this year, CBC News revealed that in December 2013, then-health minister Fred Horne gave Pure North $10 million in funding to expand its seniors program. Horne did so against the advice of ministry staff who had concluded the program was not adequately supported by science, could not prove the health and economic outcomes it claimed, and, in the case of high-dose supplements, could cause adverse effects in participants.

Hoffman told CBC News in March that she declined to extend funding for Pure North's seniors program in 2015 based on advice from her officials. She repeatedly stressed her ministry's new $4.2 million grant with Pure North, establishing the Precision Health clinic, was only for primary-care services and it was not offering any of its alternative treatments, including high-dose supplements.

Wildrose accountability critic Nathan Cooper says Hoffman must answer questions after assuring the legislature a publicly funded clinic was being closely monitored. (Legislative Assembly of Alberta) But when told by CBC News that Pure North itself has admitted to offering high-dose supplements, Hoffman and the ministry have refused to answer questions.

Wildrose accountability critic Nathan Cooper said Hoffman needs to be accountable.

"She provided reassurances to the assembly on numerous occasions that this wouldn't happen, that (the clinic) would be closely monitored, and clearly it has not been," Cooper said.

Hoffman's claims contradicted

Hoffman, and the ministry, have refused to respond to repeated interview requests from CBC News over the past several weeks. Specifically, Hoffman and the ministry were asked to explain several public statements they made, including that:

The Precision Health clinic was not offering patients any supplements, including any vitamin supplements.

Hoffman's press secretary, Tim Wilson, said in March that the grant was to establish a primary-care clinic that "will not involve delivering vitamin supplements." That same month, Hoffman said if there was any evidence that the Precision Health clinic offered any alternative treatments, such as high-dose supplements, its funding would be "at risk."

CBC News was contacted by a 74-year-old Precision Health patient who filed a complaint to Alberta Health Services (AHS) in April after she was twice prescribed vitamin D in single doses of 50,000 IU at the Precision Health clinic during appointments in January and March. AHS told her it had no authority over a private clinic.

In an interview in mid-June, Pure North spokesperson Stephen Carter denied - three times - that the Precision Health clinic offers any supplements.

But moments later when told CBC News had proof a patient had been prescribed vitamin D, Carter said providing supplements like high-dose vitamin D is within the scope of the clinic's nurse practitioners. He also said Pure North doesn't provide any instructions to Precision Health nurse practitioners about the services they choose to provide to their patients.

In a follow-up email sent last week, Carter claimed Pure North is unaware of Hoffman's earlier threats to defund the Precision Health clinic if it offered any alternative treatments, including any vitamin supplements.

"The only statements by the Minister (that) Pure North is aware of indicate that supplementation will not be paid for by provincial health dollars," he said. Carter also said the Precision Health clinic discusses the risk of all treatments with its patients.

2. Precision Health could not be offering any alternative treatments because Alberta Health and an independent third-party organization were carefully monitoring the clinic to ensure compliance with the grant agreement.​

"The nurse-practitioner project has very rigorous oversight," Hoffman told the legislature in May, in response to questions from Liberal MLA Dr. David Swann.

But spokespersons for Hoffman and the ministry could not explain why the ministry apparently didn't know Precision Health had been prescribing vitamin D and testing for vitamin D levels, despite a formal complaint having been filed with AHS.

Alberta Health spokesperson Cameron Traynor said the ministry is now "reviewing the concerns brought to us that services provided at the Precision Health clinic were outside of the scope of the grant agreement.

"As part of this review, we would encourage anyone with these concerns to contact us to discuss the services they received," Traynor said.

CBC News provided a copy of the funding agreement between Alberta Health and Pure North to a University of Alberta law professor who specializes in health-care law. Erin Nelson said there is nothing in the agreement that explicitly restricts Precision Health from offering alternative treatments.

Pure North spokesperson Stephen Carter initially denied the Precision Health clinic offered supplements to patients but later admitted it. (CBC News) "The agreement itself doesn't appear to limit what kinds of services nurse practitioners could offer," Nelson said.

Alberta Health however, insists the agreement does bar the clinic from offering alternative treatments.

Hoffman's press secretary told CBC News in a March 28 email that the Institute for Health Economics at the University of Alberta was monitoring Precision Health and the other three clinics in the pilot project.

"We have set up clear evaluation processes led by an expert advisory group headed by the Institute for Health Economics to confirm that the parameters of the project are being met (including site visits and interviews with staff and clients)," Tim Wilson wrote.

But institute spokesperson Jasmine Brown said it is not monitoring any of the pilot-project clinics, including Precision Health.

"Our involvement is limited to the evaluation of the Nurse Practitioner Demonstration Project only," Brown said. "We are not monitoring for compliance with the grant agreement."

3. Precision Health is completely separate from Pure North's regular operations.

This oft-repeated ministry claim was echoed by Alberta Health associate deputy minister Andre Tremblay in a May meeting of the legislature's public accounts committee.

"There is no relationship in terms of the nurse-practitioner program and the (Pure North) supplements program," Tremblay said in response to questions from Swann. Tremblay insisted Pure North and Precision Health are completely separate.

Alberta associate deputy health minister Andre Tremblay told a legislative committee the Precision Health clinic operated separately from Pure North. (Legislative Assembly of Alberta) But Pure North spokesperson Carter said Precision Health treats Pure North clients and, in fact, the foundation used its client list to recruit patients for Precision Health. Pure North has also paid for "many" vitamin D blood tests for Precision Health patients, he said.

Although Pure North and Precision Health operate from the same office, and serve many of the same patients, Carter stressed they have separate staff and finances, as well as separate electronic medical records systems.

Precision Health was scheduled to receive up to a $1.65 million instalment of the total $4.2 million grant around June 30. Traynor said that money has not been paid out.

If you have any information for this story, or information for another story, please contact us in confidence at cbcinvestigates@cbc.ca

@charlesrusnell

@jennierussell_