For nearly two years, a group of B.C. chiropractors say they rang alarm bells about "outlandish claims regarding vaccination and treatment of children" made by three board members at the College of Chiropractors.
They say they tried to file a complaint against Avtar Jassal, Parm Rai and Gil Desaulniers, but the college would not accept their evidence, according to a letter to Health Minister Adrian Dix from Jay Robinson, who was then president of the B.C. Chiropractic Association (BCCA).
The BCCA, a voluntary professional organization, also repeatedly raised its concerns with officials at the health ministry, but saw no evidence of action, the letter says.
"In fact, it has taken … until the CBC brought forward the entirely unacceptable actions of Dr. Avtar Jassal, just one of the three chiropractors involved, to the public and subsequently your attention, for any action," Robinson writes in the May 25, 2018 letter, obtained as part of a Freedom of Information request to the health ministry.
The college says it has no record of a written complaint from the BCCA about the three former board members. Robinson says that's because the regulator refused to accept it.
Jassal resigned from his post as vice-chair of the college's board last May, after CBC reported on an anti-vaccination video he'd created and posted on Facebook in violation of college rules.
In the video, Jassal suggested that fruit smoothies are more effective than the flu shot at preventing influenza.
Jassal's activities had been the subject of previous complaints from members of the public.
Options for dealing with 'dysfunctional' college
In a written statement, Dix told CBC the messages spread by the three board members were intolerable.
"It is simply unacceptable when people spread information that is inaccurate and beyond the scope of their practice, professional codes of conduct, while having the credibility of being part of a regulated health college," Dix said.
A trove of ministry emails released last week details the government's response after CBC's first story on Jassal was published on May 2, 2018.
The emails suggest the story set off a scramble at the health ministry to come up with a plan for dealing with a professional college that wasn't operating as it should, though Robinson's letter, from the chiropractic association, contends the province had plenty of prior warning.
The day after the CBC's story about Jassal, the ministry's director of regulatory initiatives, Brian Westgate, writes that he was asked to outline "what options we have when a college is not meeting its legal obligation as set out under the HPA [Health Professions Act]."
He titled his first draft "Options to Act when College dysfunctional." The contents of that document and subsequent drafts have been redacted.
But Robinson argues the ministry shouldn't have been caught off guard by CBC's reporting.
According to his letter, the BCCA first contacted the health ministry in November 2016 about Jassal, Rai and Desaulniers, alleging they were "pursuing a private non-evidence based agenda that we believed could negatively impact the profession and public safety."
Not only were all three men members of the college board, but Jassal was the board's vice-chair and sat on the college's inquiry committee, which investigates complaints against chiropractors.
According to Robinson, the BCCA attempted to file a complaint against the three men over their anti-vaccination posts in April 2017 and then again in May.
College policy explicitly prohibits chiropractors from providing any advice on immunization.
"We were advised the college would not accept our complaint and that nothing would be done," Robinson writes.
Robinson says ministry officials promised him someone was working on the problem, but he saw no change.
That November, a member of the public complained to the ministry about Jassal, Rai and Desaulniers' anti-vaccination posts. Most of the materials were removed from the chiropractors' websites in response, but Jassal's video remained on his Facebook page.
Jassal resigned as vice-chair in May, but Rai and Desaulniers remained on the college board until a new election was held in the fall, when they were disqualified from running because they were under investigation.
Relationship on the mend
In the time since Robinson's letter, the college has improved its process for handling complaints about marketing and communication issues, according to interim registrar Richard Simpson.
"Both the college and the BCCA have worked hard to improve their collaborative relationship, so that issues identified and brought to the attention of the college are addressed in a timely and fully-responsive manner," Simpson wrote.
Jassal and seven other chiropractors received fines and reprimands last year for spreading anti-vaccination misinformation.
The college has also developed a new efficacy claims policy, which makes it clear that chiropractors can't make false claims about being able to treat conditions like Alzheimer's, cancer, autism and ADHD. It's developed a web-scraping tool to identify potential violations, and as of early March, 67 chiropractors were under investigation over alleged violations.
And the college has also promised a thorough review of the scientific evidence about chiropractic treatments for children.
There have been changes at the provincial level, too. Dix says the government has amended the Health Professions Act, giving the health minister more power to intervene in regulatory matters to protect the public.
The province has also commissioned an expert to review regulation of B.C.'s health professions and recommend changes to the current system.