My Patient Was Told Some Nutty Stuff

[Ezrah]

I was speaking to a patient of mine, and the clinic he went to before told him he needs to come back quarterly to see there doctor to keep in compliance with the new law. They also had some other interesting things to say that seem to not be correct. Did I somehow miss a change in the law or are these guys just pulling some shady business? Has anyone heard of this?

[Timmahh]

They are using Dr Bobs proposal that as a Pt you ll have to pay 3 or 4 times a year to maintain your credibility....

 

 

its BS. Put the name and number up for this Piece of Work center, we can start a call campaign for truth and honesty from this less than honest place of business.

[solabeirtan]

I have to look at the law again but I thought I read that you really only need to recertify with the Doc every three years. Like a rec should be good for up to three years ? Anyone else see that ?

[Ezrah]

They are using Dr Bobs proposal that as a Pt you ll have to pay 3 or 4 times a year to maintain your credibility....

 

 

its BS. Put the name and number up for this Piece of Work center, we can start a call campaign for truth and honesty from this less than honest place of business.

 

I am going to get all the details, these folks also told him he had to sign with a caregiver right there at his appointment when he went a year ago for his first certification. Oh you don't have one well that's ok we will put you with one of our guys. Really shady

[Croppled1]

They are using Dr Bobs proposal that as a Pt you ll have to pay 3 or 4 times a year to maintain your credibility....

 

 

its BS. Put the name and number up for this Piece of Work center, we can start a call campaign for truth and honesty from this less than honest place of business.

 

Until it I saw how it was written in this post in terms of use i thought everytime you said BS it stood for Bill Schuette :-) One of the things that has concerned me is the evolution of the MMMA is it is no longer all inclusive of everyones veiws . I would rather know what Dr Bob is doing because I don't agree with many of his positions . He has some good ideas but is restrictive on dosing and other issues like adjunctive care . I had never heard of this I agree it puts a excessive burden on people of whom many suffer terribley . You will hear me say often people get to sick to go to the Doctor because transport is so hard on them and hospitalization is no longer done just for suffering for the poor Sort of the same situation for our Veteran this week who can't get into a Farmers Market . I think in some cases skype is a viable option and yes it has been used in patient care in this State and others long before cannabis was legal for medical use or pre 2008 . The Arenesons out of Montana created opposition to change in that regard based in Xenophibic discrimination . The U of M uses it as do many hospitals .

 

My surgeon only saw me a few times before fusion surgery ( was considered one of the best in the world for brain and spine . I was just lucky to have my case accepted by him ) Frankly . I am suprised a cannabis review isn't lifelong for those whom are disabled without a change in disabillity status . I was suprised they created a annual renewal and felt it was excessive .

 

I know the MMMA decided they did not want to be a forum for publishing ideas they saw as dangerous with a negative impact for caregivers and patients . However its scary for everyone because we all throw ideas out there to learn from the feedback positive or negative . Is there anywhere MMMA members can see what Dr Bob is proposing so they can prepare arguements against poor ideas like dosing requirements under 1 oz a week or 3-4 mandatory cannabis Doctor visits That could increase costs up to 1/20th of persons pre tax per annum income for those living at the level of poverty at $150 per visit . I am having issues now that medicare requires a primary care Doctor but I can find nobody that accepts medicare and is open to cannabis therapy . No problem if I use cash but thats not a option when I pay for medicare A B C and D . Every community clinic is tied to zero tolerance policy under Federal funds which usually drives policy . However where does one find Dr Bobs proposals we can't deal with a threat if were not aware of it . Thank you in advance .

[Timmahh]

Cropped, if you have read the Proposed bill before the Committee, you have read Dr Bobs work...

 

 

bs can be Bull Schuitte or Bill Schuette. Basically they equate to the same thing in my eyes.

 

 

But at this point, their is NO New Law. There is ONLY the clarification of what a Bona Fide Dr Patient relationship is as outlined by the Michigan Board of Physicians.

 

there is a proposed bill, as worked by Dr. BOB, that MAY be up for review starting this Thursday. This Vile piece of paperwork Submitted by Dr Bob is a way for you to have to be forced to make 3 drs visits per year to maintain your credibility as a Cannabis Patient. Nothing more. Sure it protects you per Dr Bobs submission, as you have to jump through hoops and dance on your tippy toes to comply. Oh lets not forget your being forced to pay for 2 additional Drs visits as well.

 

 

With the Submission of what a Bona-Fide, Dr/Patient relationship is by the Michigan Board of Physicians (the ruling body of all Medical Practice in Michigan) the proposed bill by Dr Bob, has no traction, thus no need for further review. That doesnt mean it wont get looked at, but I presume it will be dropped once the letter from the MI BoP outlining a Bona Fide relationship is submitted via public records when we are there on the 1st of March.

 

It didnt appear neither Canvenaugh nor Walsh were aware of the recent letter by the Mi BoP addressing the Bona Fide relationship rule, Which basically states, you go to a Dr, he says you can benefit from the use of medical cannabis, you get your recommendation. same as before. the one added caveat is notification to the Primary Dr, WHERE APPROPRIATE! that where appropriate means if you and your certifying Dr feel your Primary Physician (if you even have one) needs to know about the Cannabis Recommendation.

 

at least as i understand it, unless you are talking about something i am not aware of currently, or im just way off base.

[Croppled1]

Cropped, if you have read the Proposed bill before the Committee, you have read Dr Bobs work...

 

 

bs can be Bull Schuitte or Bill Schuette. Basically they equate to the same thing in my eyes.

 

 

But at this point, their is NO New Law. There is ONLY the clarification of what a Bona Fide Dr Patient relationship is as outlined by the Michigan Board of Physicians.

 

there is a proposed bill, as worked by Dr. BOB, that MAY be up for review starting this Thursday. This Vile piece of paperwork Submitted by Dr Bob is a way for you to have to be forced to make 3 drs visits per year to maintain your credibility as a Cannabis Patient. Nothing more. Sure it protects you per Dr Bobs submission, as you have to jump through hoops and dance on your tippy toes to comply. Oh lets not forget your being forced to pay for 2 additional Drs visits as well.

 

 

With the Submission of what a Bona-Fide, Dr/Patient relationship is by the Michigan Board of Physicians (the ruling body of all Medical Practice in Michigan) the proposed bill by Dr Bob, has no traction, thus no need for further review. That doesnt mean it wont get looked at, but I presume it will be dropped once the letter from the MI BoP outlining a Bona Fide relationship is submitted via public records when we are there on the 1st of March.

 

It didnt appear neither Canvenaugh nor Walsh were aware of the recent letter by the Mi BoP addressing the Bona Fide relationship rule, Which basically states, you go to a Dr, he says you can benefit from the use of medical cannabis, you get your recommendation. same as before. the one added caveat is notification to the Primary Dr, WHERE APPROPRIATE! that where appropriate means if you and your certifying Dr feel your Primary Physician (if you even have one) needs to know about the Cannabis Recommendation.

 

at least as i understand it, unless you are talking about something i am not aware of currently, or im just way off base.

 

Thank you for your polite response . we all do the best we can and just try to be helpful to one another . I agree 101% with you on how Dr Bobs proposal would be bad for patients . Especially for many whom suffer being transported and have hardships to leave home as well as financial limitations . Plain and simple sick people more often then not have less resources . In a tough market any cannabis patient is having extra difficulty finding employment . We need less restriction or reasons to jail patients and more protections from abuse through grey area claims resulting in arrest and or prosecution that injures and can even stress to the point of killing some patients in weakened conditions . Most problems with police can be eliminated if weight only applies to transport and inert ingrediants are not counted in medables but we see nothing addressing these issues causing patients to smoke instead of ingest what they can of their requirements of cannabis . Bottom line is smoking or vaporizing still is the best way for many patients as described by Dr Grinspoon in many references . I have rarely had quality medables like are avialable from select caregivers and patients need no barriers to trying them or aquiring them . Everybody still thinks in terms of punishments not harm reduction . Have a great night .

[Michael Komorn]

It sounds like the friiend was may have been talking about the impact of the New Lara memo. Despite its restrictions, this is a far better suggested solution instead of the proposed amendments being offered by the judiciary committee. While they may be more restrictive, they do give some guidance to the medical community to follow, and while I agree in principal the need for Skype certifications, and yes they are accepted as a standard of care, too many where not for the reasons of lak of transportation. Without debating the Skype issue, and assuming the Legislature tables the Dr. bill, in light of this new Lara memo, I would like to believe more doctors will come forward and provide certification services as part of their regular practice. The preference of the Lara guideline over the legislative amendment is that it makes the issue one of Public Health and not Public Safety. Meaning the guidelines of the Lara memo would be monitored by those that are set up to monitor the health care industry instead of LEO. Please note i do not think any change is necessary, but between the two, Lara is preferred. Also I believe the days of one stop certifications will be over. Nonetheless with a little bit of effort from the mm community, and some moderate changes in the way the Dr Patient relationship is viewed, the patient community should not be effected.

[purklize]

It sounds like the friiend was may have been talking about the impact of the New Lara memo. Despite its restrictions, this is a far better suggested solution instead of the proposed amendments being offered by the judiciary committee. While they may be more restrictive, they do give some guidance to the medical community to follow, and while I agree in principal the need for Skype certifications, and yes they are accepted as a standard of care, too many where not for the reasons of lak of transportation. Without debating the Skype issue, and assuming the Legislature tables the Dr. bill, in light of this new Lara memo, I would like to believe more doctors will come forward and provide certification services as part of their regular practice. The preference of the Lara guideline over the legislative amendment is that it makes the issue one of Public Health and not Public Safety. Meaning the guidelines of the Lara memo would be monitored by those that are set up to monitor the health care industry instead of LEO. Please note i do not think any change is necessary, but between the two, Lara is preferred. Also I believe the days of one stop certifications will be over. Nonetheless with a little bit of effort from the mm community, and some moderate changes in the way the Dr Patient relationship is viewed, the patient community should not be effected.

 

Is the "Lara memo" you refer to the same thing as that from the Michigan Board of Health (or whatever it's called) that just defined a bona fide relationship? If so why do you think the days of one stop certifications will be over? Do you mean that you think this rule will shut down certification clinics? This would be a disaster for us... hardly anyone would be able to get certified anymore, especially those with conditions like mine (severe migraines, which is "phantom" pain and unprovable unless they happen to be in your house when you're projectile vomiting).

 

Thanks!

 

PS I deeply appreciate what you do for the community, you're a A+ guy.

[mibrains]

link to document

 

RICKSIIYDER

GOVERNOR

STATE oF MICHIGAN

DEPARTMENT OF LICENSING AND REGUI.ATORY AFFAIRS

BUREAU OF HEALTH PROFESSIONS

RAEMMSDELL

OIRECTOR

Licensed Medical Doctors and Osteopathic Physicians

Rae Ramsdell, Director PR

Bureau of Health Professions

January 13,2012

ST6/EN I{. HILFINGER

OIRECTOR

MEMORANDUM

TO:

FROM:

DATE:

SUBJECT: Certification for the Medical Use of Marthuana by Michigan

Physicians - A Statement by the Michigan Board of Medicine

and the Michigan Board of Osteopathic Medicine and Surgery

The Bureau of Health Professions in the Michigan Department of Licensing and Regulatory

Affairs is responsible for the Michigan Medical Marihuana Program (MMMP) as a result of the

Michigan Medical Marihuana ballot proposal that was passed by voters in November 2008.

Since the inception of the MMMP, there has been uncertainty among physicians and patients

alike regarding what constitutes an established physician-patient relationship. ln an effort to

provide clarification, the Bureau of Health Professions formally requested that the Michigan

Boards of Medicine and Osteopathic Medicine and Surgery provide written expectations

defining what constitutes a bona fide physician-patient relationship.

Attached for your information i,

"

do"urent titled "Statement of the Board of Medicine and

Board of Osteopathic Medicine and Surgery Regarding Ceffication for Medical Use of

Marihuana by Michigan Physicians." While the standards of conduct contained in this document

alglhe rAnq$andards that would be anticipated iqany_p_ltySt_cjan:pglieqtlelatlqn€bi9-the_-

Boards of Medicine and Osteopathic Medicine and Surgery felt that their expectations needed to

be clarified since Medical Marihuana physician certifications are quite different from other types

of medical certifications a physician may routinely complete.

ln addition to mailing this stiatement to all medicaldoctors and osteopathic physicians who hold

Michigan licensure, it will also be posted on the Bureau of Health Professions'website at

www michiqan.qovlhealth license.

Please feel fiee to contact me at (5171373-8068 with any concems or questions you may have.

Attachment

LAFIA b an equal opportunity emptoyer.

Auiliary aids, services and other raasonable accommodalions are amilable upon tequest to indMduab with disebilities. -

611 W. OTTAWAST- o P.O. BOX30670 o IANSING' MICHIGAN 48909

mvrr-mictrigan.gov/healthlkxnse' (517) 3354918

Statement of the Board of Medicine and Board of Osteopathic Medicine

and surgery Regarding Gertification for Medicar use of Marihuana

by Michigan physicians

The Bureau of Health Professions (BHP) located in the Department of Licensing and

Regglatory Affairs is cfrarged with protecting the of health, safety ano welrare of the 6"pi; Michigan. The BHP administers boaids for each licensed health profession in Michigan. The board! are charged by statute with establishing standards for education and training, issuing licenses and identrfying the standard oicare that is expected of those regulated by the law.

ln November 2008-thgmajority of the voters in Michigan Apprgv€d the Michigan Medt-qal Marihuana Act (MMA) by ballot initiative to protict persons with specific medical

conditions from penalties under state law so thit they may use marihuana for medical purposes without fear of prosecution. Marihuana remains a Schedule I controlled

substance under federal law. The Department and the Boards of Medicine and

Osteopathic Medicine and Surgery in Michigan have taken no position on the suitability

of marihuana in the treatment of medical disorders.

The MMA is intende! !o apply to patients with complex, chronic, serious and debilitating

medical conditions. lt is expected that such patients would require careful and compbtE

evaluation and regular follow-up. The Boards believe that they have an obligation to

ensure that members of the public receive proper medical evaluation anJ advice

meeting ge-nerally accepted standards of care when seeking certification for use of

marihuana for medical purposes.

Both the Department and the Boards are troubled by repofis and advertisements of

physicians scheduling patient evaluations in clinicaily inappropriate or inadequate

settings and/or within timeframes that do not enable a fdi and adequate medical

assessment to be done. ln some jnstances physicians have conducted certifying

evaluations solely through lntemet interactions, wtrign are clearly _inadequate lni inappropriate for the examination of patients for certification for marifrubna use. The

Boards are concemed that in such instances the public may not be receiving an

adequate level of evaluation and treafinent as specified by the puOtic Health Code.

The MMA states:

A physician shall not be subject to anest, prosecution, or penalty in any

manner, or denied any right or privilege, inctuding but not limited to ciit

q?lalty or disciplinary action by the Michigan board of medicine, the

Michigan board of osteopathic medicine and iurgery, or any other business or occupational or professionat licensing board or bureau, solely for

providing written certifications, in the course of a bona fide physlcianpatient

relationship and after the physician ias completed' a futl

assessment of the qualifying patient's medicat history, or for otherwise

8t1512011

stating th,at, in the physicianb professio nal opinion, a patient receive therapeutic is likety to or patliative'beneftt from the medicat use of marihuana to treat or alleviate the patient's senbus or aebitnating psryomvpidtoemd.st haast sociafed with the senbus or debititating^ ii"iiiiJiJ -"ioinndditiitoionn o,r nothing shall

-pr.event a profession"t ii"iniing''biard trom sanctioning a physician tor.f.aiting to properly evaluate

"

condition p,"ii"il" medical or otherwise viotating tie sianitara or ciiiir;;;tr;;;; medicat conditions. MCL 339.26424 (4)(0

The standard of care that applies wlgn certifoing individuals as candidates for use of medical marihuana is the same as.that

"rp6.tia

in any other situation in which an individual is being evaluated for medical services. A special standard, higher or lower, is not called for in certifling patients for use of marihuana.

Experts-in-the field agree with this-opinion, -Affiong -the -advisory-r€corrffierd"tiofls

isgued by the American Society of Addiction f,AeOi"ine in S"pt"irO" r 2010 are the following statements:

Physicians... in the gatekeeping role have an obligation to help licensing authorities assure that physiciani who choose to discuss the medical use of cannabis and cannabis-based products with patients:

Adhere to the estabrished professionar tenets of proper patient care including:

" Histou and good faith examination of the patient

" Deveropment of a treatment pran with objectives

" Provision of informed consent, including discussion of risks,

side effects and potential benefits o Periodic review of the treatment's efficacy . Consultation, as necessaU; and . Proper record keeping that supports the decision to

recommend the use of cannabis

shou.ld have a pre-existing and ongoing relationship with the patient

treating physician; "s "

Ensure that the issuance of 'recommendations' is not a disproportionately

large (or even exclusive) aspect of their practice;

Have adequate training in identifying substance abuse and addiction.

8115t2011

The Board of Medicine and the Board of Osteopathic Medicine and Surgery has

adopted the following statement to clarify the standard of care applicable to the

evaluation of an individual for the purpose of certification to use marihuana for any

medical condition:

Generally accepted components of a full medical evaluation to determine

suitabitity and appropriateness for recommending treatment of any kind, including

certification for medical marihuana, include:

- a hands-on physician patient encounter

- full assessment and recording of patient's medical history

- relevant physical examination

- review of prior records of relevant examinations, treatments and treatment

response including substance abuse history

- receipt and review of relevant diagnostic test results

- discussion of advantages, disadvantages, alternatives, potential adverse

effects and expected response to treatment

- development of plan of care with state goals of therapy

monitoring of the response to treatment and possible adverse effects

- creation and maintenance of patient records documenting the information

above - communication with patient's primary care physician when applicable

The Boards expect that these medical encounters would be completed at permanent

locations that enable the patient to retum for follow-up, consultation or assistance as

needed.

A physician failing to meet generally accepted standards of practice when certifying a

paiieirt to use marihuana for a medical condition may be found to be practicing below

ihe acceptable standard of card and therefore may be subject to disciplinary action.

8l't512011

[cristinew]

more bull. patients that have chronic conditions for years do not need this,

 

cannot blame just one dr for this,

[TomJ]

My doctor wants me to tell him the results of the strains I have used and how they helped me. I just think it's for his own documentation purposes. There is no charge for this he just wants to know.

[Ezrah]

It sounds like the friiend was may have been talking about the impact of the New Lara memo. Despite its restrictions, this is a far better suggested solution instead of the proposed amendments being offered by the judiciary committee. While they may be more restrictive, they do give some guidance to the medical community to follow, and while I agree in principal the need for Skype certifications, and yes they are accepted as a standard of care, too many where not for the reasons of lak of transportation. Without debating the Skype issue, and assuming the Legislature tables the Dr. bill, in light of this new Lara memo, I would like to believe more doctors will come forward and provide certification services as part of their regular practice. The preference of the Lara guideline over the legislative amendment is that it makes the issue one of Public Health and not Public Safety. Meaning the guidelines of the Lara memo would be monitored by those that are set up to monitor the health care industry instead of LEO. Please note i do not think any change is necessary, but between the two, Lara is preferred. Also I believe the days of one stop certifications will be over. Nonetheless with a little bit of effort from the mm community, and some moderate changes in the way the Dr Patient relationship is viewed, the patient community should not be effected.

 

Hello Michael,

 

Can you clarify if laws amending the current law which was from an ballot initiative, would they need a super majority or 2/3rds support. This has always been a point of confusion for me

[cristinew]

shou.ld have a pre-existing and ongoing relationship with the patient

treating physician; "s "

Ensure that the issuance of 'recommendations' is not a disproportionately

large (or even exclusive) aspect of their practice;

 

if they take this and put it into law , it would shut down all of the MM Clinics

[Croppled1]

shou.ld have a pre-existing and ongoing relationship with the patient

treating physician; "s "

Ensure that the issuance of 'recommendations' is not a disproportionately

large (or even exclusive) aspect of their practice;

 

if they take this and put it into law , it would shut down all of the MM Clinics

 

You go to a specialist for everything else why not cannabis ? Once a year is invasive and expensive enough . Will the State , Medicare or insurance companies pay for more visits ? Just feels discriminatory . All my other Doctors are tied to Federal programs preventing participation or recommendations . Doctors express fear but say if it helps they are ok with it they just don't want to be on record .

[Hempcheff]

I only had to meet one time with the doc that is going to slice my hand open to perform surgery , and the visit was about 10 minutes. I had to bring my records to him, and im all set to go into surgery. all through beaumont hospital.

 

 

makes the cert for cannabis seem unusually difficult.

[missyjay99]

It sounds like the friiend was may have been talking about the impact of the New Lara memo. Despite its restrictions, this is a far better suggested solution instead of the proposed amendments being offered by the judiciary committee. While they may be more restrictive, they do give some guidance to the medical community to follow, and while I agree in principal the need for Skype certifications, and yes they are accepted as a standard of care, too many where not for the reasons of lak of transportation. Without debating the Skype issue, and assuming the Legislature tables the Dr. bill, in light of this new Lara memo, I would like to believe more doctors will come forward and provide certification services as part of their regular practice. The preference of the Lara guideline over the legislative amendment is that it makes the issue one of Public Health and not Public Safety. Meaning the guidelines of the Lara memo would be monitored by those that are set up to monitor the health care industry instead of LEO. Please note i do not think any change is necessary, but between the two, Lara is preferred. Also I believe the days of one stop certifications will be over. Nonetheless with a little bit of effort from the mm community, and some moderate changes in the way the Dr Patient relationship is viewed, the patient community should not be effected.

 

Before I joined I read everything every where, I read some of this dr. bobs writings and supposed amendments, but that is all they are for now, I also believe I read that the follow up visits can be done via skype (it is acceptable practice according the the ama) I also read that this dr. bobs follow up visits would be part of the price you pay to get your cert in person! Please dont quote me on that though! sounds like the friend went to one of them traveling clinics that have been assigning their own c.g's to any one that didnt have one when they got certed! A friend of mine wanted to keep his own grow rites, and they realy gave him a hard time, They also wanted to mail out his rec and other paper work for him, If you run into that run, Kidding,, Make sure you leave with all the copys and originals and do all of the mailing your self, dont let anyone mail in your rec for you, you may wind up with a c.g and the box checked no grow rites on it!

 

I have to agree with Mr. Komorn on this one!

[+Dizledot]

Thank you for your polite response . we all do the best we can and just try to be helpful to one another . I agree 101% with you on how Dr Bobs proposal would be bad for patients . Especially for many whom suffer being transported and have hardships to leave home as well as financial limitations . Plain and simple sick people more often then not have less resources . In a tough market any cannabis patient is having extra difficulty finding employment . We need less restriction or reasons to jail patients and more protections from abuse through grey area claims resulting in arrest and or prosecution that injures and can even stress to the point of killing some patients in weakened conditions . Most problems with police can be eliminated if weight only applies to transport and inert ingrediants are not counted in medables but we see nothing addressing these issues causing patients to smoke instead of ingest what they can of their requirements of cannabis . Bottom line is smoking or vaporizing still is the best way for many patients as described by Dr Grinspoon in many references . I have rarely had quality medables like are avialable from select caregivers and patients need no barriers to trying them or aquiring them . Everybody still thinks in terms of punishments not harm reduction . Have a great night .

 

 

Just my thoughts on this revolving around Doc B. There was some alleged mis doings in a news article about him which may have put quite a crimp in his bottom line even after the charges were dismissed after a witness died. I don't know how this guy can be out there making changes that will directly benefit his wallet after these accusations. I'm sorry, but credibility goes a long way in my book and I would think that it would in this case dealing with law makers as well.

[Kevin]

That problem is easily remedied. Educate yourself as a patient or caregiver and you won't fall for the nutty stuff.

[LITLJON]

I had try-ed to contact the good Dr. Bob, few times here and on his site, and by phone looking for help. Didn't like the concept of skype, no clinic close enough. Blown off every time. IMO If it doesn't benefit him it doesn't matter. Regardless of my experience. I didn't vote for him to represent anyone.

 

While I against forced unions maybe we should unionize?..?

 

My edit: it's the almighty $$ that needs to benefit

[Budz-4-U]

I had back surgery in '09. Once a year is more than enough, I think, for re-certification. Arthritis and degeneration tend to make the situation worse over time. So, it's not like it's going to fix itself. I don't have insurance. Paying the doctor $70 a year, and Lansing $100 a year, is enough cash out of me. $170 a year for the "privilege" to medicate with something that should have little or no regulation to begin with.

[cristinew]

(e) The department shall- issue registry identification cards

withi-n 5 days of approving an application or renewal, which shall

expire +--year--2 Years after the date of issuance

 

2 years on the updated house bill,