Experts Weigh In On Medical Marijuana ‘Hotel Certifications’

[jamieuke]

Experts weigh in on medical marijuana ‘hotel certifications’

 

31 Oct, 2013

 

by Jamie Lowell

 

Recommendations for the medical use of marijuana, when issued by physicians at marijuana trade shows, conferences and expos often leave patients vulnerable to prosecution if they become entangled in the legal system.

 

Changes to the Michigan Medical Marijuana Act (MMMA), passed by the state legislature in 2012, included a specific definition of the doctor/ patient relationship as it pertains to medical cannabis recommendations. The language is largely based on the Board of Medicine’s basic standard of care guidelines for medical marijuana evaluations.

 

 

 

This change has created a vehicle with which prosecutors have challenged the validity of some recommendations and negated the protections and defenses created by the MMMA. Those cases that involve recommendations received while attending an event, or other non-traditional venues for physician examinations, are the most easily and commonly exploited.

 

By codifying guidelines that are similar to the policy of the Michigan Board of Medicine into law, the legislature has altered the method through which the behavior of errant physicians is corrected. Normally the Board may choose to investigate complaints about a doctor’s practices and impose sanctions if deemed to be necessary; in medical marijuana cases a law now exists that can be used by law enforcement, prosecutors, and judges to assail both the physician and the patient.

 

Ben Horner is a Flint-based owner/operator of several marijuana related businesses, including a physician recommendation service that sometimes operates during conferences at hotels across the state. Mr. Horner discussed this component of his hotel events on the October 17 (episode #170) broadcast of the Internet radio program Planet Green Trees (PGT).

 

Mr. Horner pointed out that the expo/event certification “provides an opportunity to see a physician on the weekend,” and assured the listeners that his operation “lives up to the standards being discussed on the show.” Mr. Horner mentioned that it “brings a knowledgeable doctor to an area that may be in need.” He also noted that other medical practices operate outside of traditional settings, and suggested that the doctor handing out recommendations at the hotel conferences ought not to be considered differently.

 

The host of Planet Green Trees, criminal defense attorney Michael Komorn reminded all listeners that “you can go to Kroger to get a flu shot.” Even so, when Komorn was asked if the issue of the location of the examination where the patient received the recommendation can cause difficulty with the defense, he replied, “that is an understatement.”

 

Dr. Kumar Singh of the Greenlite Clinic and Dr. David Crocker of Michigan Holistic Health, physicians who perform medical marijuana evaluations as a part of their practice, weighed in on the issue as well. Both agreed that they follow the Board of Medicine guidelines and adhere to the necessary standards of care regardless of the changes in the MMMA.

 

When asked about offering evaluations in alternative locations and the currently preferred model, Dr. Crocker described his operation as being “run like a regular practice in a traditional clinic setting.”

 

Dr. Singh added, “I don’t feel it is an appropriate venue for a physician to be providing medical care out of one of these fairs. It deviates from the standard of care.”

 

The legal strategy of challenging the doctor patient relationship has played out in other medical marijuana states as well. Joe Grumbine is the founder of The Human Solution (THS), an organization offering court support for marijuana defendants. The THS motto is “No one should go to jail for a plant.” Grumbine discussed a case from Nevada involving the Ballard family. A family member “was recently convicted, however unfairly, because the jury didn’t buy the legitimacy of the doctor,” who Grumbine said was referred to as a “pot doctor.”

 

In Michigan the risk of incarceration in these cases is increased if the judge or prosecutor feels the bona fide relationship between the doctor and patient was compromised by the location of the examination, whether or not the recommendation actually meets accepted legal standards.

 

“Not to say that all such instances of MD’s writing recommendations in these circumstances might be viewed as unprofessional, but it is true that opponents of medical cannabis latch onto these examples to prove their point that mmj is a sham,” said Hunter Holliman, Field Coordinator for the national advocacy organization Americans for Safe Access. “What most consider to be an appropriate doctor/patient relationship takes place in a doctor’s office or medical facility, and occasionally at the patient’s residence.”

 

Read Holliman’s full response to the question, and the responses of some of the most experienced and knowledgeable defense attorneys in Michigan specializing in medical marijuana law, in the quoted statements below.

 

QUESTION: Is it more difficult to defend clients when the medical marihuana recommendation process, connected to the case, took place at a hotel conference, trade show,or expo?

 

Matthew Abel of Cannabis Counsel-

 

Yes. I feel that a recommendation issued in a doctor’s office should be the standard. There may be reasons for exceptions, and there are docs who do house calls.

 

Each case is different, but all else being equal…. A doc may need more equipment than is easy to carry around in order to do a complete medical evaluation.

 

Thomas Loeb, a Farmington Hills attorney-

 

Yes, it is much more difficult. There has to be a bona fide doctor-patient relationship. It can be very hard to show that when ‘Dr. Feel Good’ shows up at the No-Tell Motel and has office hours from 2 – 4 pm in room 338.

 

Paul Tylenda, Grosse Pointe criminal defense attorney-

 

The appearance of an insincere process is fodder for prosecutors to poke holes in the required doctor/patient relationship of section 8. The location of the certification and physical examination, if not in a traditional clinic setting, is one of the first attacks on the credibility of the doctor and the patient. Prosecutors will focus on that nontraditional setting to compromise the patient’s ability to succeed in a section 8 defense.

 

Michael Komorn of Komorn Law-

 

The doctor’s certification has become the most overly scrutinized aspect of the MMMA in many courts throughout the state.

 

I fundamentally disagree with this approach and suggest that the voter’s initiative never contemplated the judiciary having the authority to judge or evaluate a licensed physician’s recommendation that medical cannabis may benefit the patient’s debilitating condition. Unfortunately many courts have made decisions barring the patient or caregiver’s medical marihuana defense because of a certification that does not meet the new definitions of a bona fide doctor-patient relationship. With that being said, and knowing that prosecutors are still opposing the right to present a medical defense, a patient would be in a much better position to legally defend themselves if they have a certifying doctor who follows the protocol and guidelines set forth in the amendments of April 2013.

 

Despite the fact that the one time a year interaction with the doctor has become the norm, patients and caregivers need to be aware of how the courts are treating these certifications. Unfortunately the patients that get certified at a hotel or an event are at risk to lose the right to present their medical marihuana defense. Worse is that the doctors that perform these certifications usually will do all they can to avoid coming to court to defend the patient, despite the seriousness of the patient’s illness. Even worse is when they get to court, prosecutors make them look like idiots for failing to follow any of the requirements set forth in the amendments. From a lawyer’s perspective, these situations make defending the patient extremely difficult. My advice is, patients need to be more aware of how the courts are dealing with these issues, and take more responsibility in ensuring that their certifying doctor is equipped for following up with the patient and has a treatment plan for the medical use of cannabis. The goal of the certifying doctor should be to identify and be able to articulate the medical efficacy of use of cannabis in treating the patient’s condition. Patients who have this type of relationship with their certifying doctor will have a much greater chance of getting a dismissal of the charges or prevailing before a jury.

 

Neil Rockind of Rockind Law-

 

Sadly, a great many people still view medical marijuana skeptically. Having handled many medical marijuana cases, I blame part of this on physicians and doctors.

 

Unfortunately, some doctors refuse to participate in medical marijuana certifications. This results in patients (of these doctors) being relegated to seek certifications or recommendations from other doctors who are willing to consider marijuana as a suitable treatment option. Some of these doctors have treated marijuana certifications like other treatment options, developing relationships with patients, doing follow up treatment, performing examinations, reviewing records, etc. These doctors recommend medical marijuana to some patients but also refuse to recommend it to others. They improve the overall credibility and acceptability of medical marijuana. Other doctors do not: they see patients for medical marijuana certifications in totally unconventional and highly suspect places. Some visit them in hotel rooms, some at fairs, some at conventions. These certifications are undermining the Act. Plain and simple.

 

While I agree that the setting does not necessarily reveal whether the meeting is legitimate, it does prejudice whatever occurred at the meeting and causes others to prejudge all certifications. Medical marijuana certifications should not be about certifying any and everyone. They should be providing a group of people an alternative treatment option and as such should be respectable. When we get to that point, we’ll see more acceptance and less skepticism. I welcome that day for my clients.

 

John Targowski, The Law Office of John Targowski-

 

I represent a lot of people who are medical users or growers of cannabis but for whatever reason find themselves outside of Section 4 immunity (expired card, too much mj but still “reasonable” amount, patient to non-network patient transfer, busted within 20 day rule, etc). These individuals can be arrested and prosecuted for their marijuana activities and have Section 8 as a remedy, where there is a special hearing and the defendant patient has to “prove up the card” with a 3 factor test.

 

It is much more difficult to defend the patients of “low standards” doctors in Section 8 hearings when the defendant patient bears the burden of proving to the court that the relationship between the doctor and patient is a bona fide one. This is a huge hurdle in cases where the opinion that marijuana is therapeutic to the defendant was done in a “low standards” manner, which typically means with no patient medical records or at a questionable location (cannabis cup, cannabis expo, NORML meeting, hotel room, conference room, etc). Many people are confused by this, since the certifying opinion can lead to a card, even from a “low standards” doctor, but the Section 8 test of that relationship makes these “low standards” certifications one big surprise for the patient when he or she finds themselves in need of the Section 8 lifeline. That the Section 8 hearing is really about the thoroughness of the certification process used to get the doctor’s recommendation, and is not really about how deserving the defendant is of medical marijuana, doesn’t help the situation either.

 

David Rudoi of Rudoi Law-

 

It is much more difficult to represent medical marijuana patients and their connected caregivers when the physician certification resulted from a recommendation that took place at a business expo, festival or hotel. The reason for the added difficulty is due to Section 4′s strict limitations for immunity, causing my clients to seek the protection of the Section 8 affirmative defense.

 

In order to assert the Section 8 affirmative defense the defendant (AKA the lawyer) must present evidence of three separate elements. The first of these elements is that, in the course of a bona fide physician patient relationship, the physician has stated in their professional opinion and after having completed a full assessment of the patient’s medical history and current medical condition that the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s serious or debilitating medical condition or the symptoms thereof. In order for the physician patient relationship to be deemed bona fide, the state has set out a list of circumstances which must be present, most of which are impossible in the business expo, festival or hotel certification settings. If the circumstances required for the bona fide physician patient relationship are not present the Section 8 affirmative defense is no longer an option and the defendant is left without a valid defense under the Michigan Medical Marijuana Act.

 

Hunter Holliman, Americans for Safe Access-

 

Not to say that all such instances of MD’s writing recommendations in these circumstances might be viewed as unprofessional, but it is true that opponents of medical cannabis latch onto these examples to prove their point that mmj is a sham. What most consider to be an appropriate doctor/patient relationship takes place in a doctor’s office or medical facility, and occasionally at the patient’s residence.

 

Although many valid patients may be served by these festival/expo doctors, Courts have expressed doubts the perception is that there is no ongoing relationship and that the examination for the recommendation is extremely superficial. Many states have actually tried to prevent this by restricting the scope of the doctor/patient relationship.

 

By engaging in this practice, doctor’s may trivialize the medical benefits of cannabis as well as their state’s mmj programs by recommending to anyone they see. This results in a kind of de facto recreational legalization under the guise of medical where anyone regardless of their medical condition can obtain a recommendation.

[Natesilver]

I listened to the planet green trees episode about his and they were some good cases made about traveling clinics (not mmj related). Until more primary care physicians are willing to write certs, some people have to go to these events to get legal to use medicine. And I know, there are upstanding physicians like Dr. Bob who do this in an office setting, but until we have 100x Dr. Bob's statewide, some patients depend on these events or whatever you want to call them.

 

I mean, we want safe access right jamie?

Edited November 1, 2013 by Natesilver

[trichcycler]

I think many primary physicians are willing to write the certifications, however their associate hospitals, insurance companies and medical groups have pre-emptively struck mj down before this was an issue, quick like, to forbid their physician groups from participating. My family physician quoted me this. They know, but they mostly work for someone else he said....... "what doctor would discount the value of an age old remedy that is still in great demand, with no injury or deaths related, that is said to work wonders for those who use it regularly."  (except to save his mortgage, car, and job.)

[jamieuke]

We do want safe access.

 

As the experts quoted in the article mentioned, and as was discussed on Planet Green Trees, and what should have been gleaned as the point of the piece- the location of the examination alone can be the basis for leaving people in a legal lurch.

 

The logical arguments for why the 'hotel' doctor can be a valuable service for many and how the proper standards are adhered to, or how qualified a patient is, are not considerations for the courts in the circumstances, described by the experts.

[Chauncy Gardner]

The courts and the legal system are anti-marijuana - medical or recreational, they draw no distinction. Until their attitude, or the law, changes the persecution will continue

[Kingdiamond]

So for the doctor patient relationship how many office visits is the state looking for  the two year period ?

 

Is it just the renewal visit or multiple follow ups?

[t-pain]

the 'standard of care' is what they want.

so i'd hazard a guess that LARA wants the same amount of doctor visits that you would get for any other prescriptions like oxycontin.

for permanent issues , i think 6 month followups are the general timeframe.
which is what most cert docs have used. so every 6 months.
4 visits in 2 years. is my (non-legal-advice) guess.

[Dr. Bob]

I listened to the PGT episode, and witnessed first hand a 'certification circus' in Traverse City where some 600 patients were 'run through' the line with one  doctor over the weekend.  I've seen the results- patients are coming in to the clinic in TC with second thoughts.  One that comes to mind used her learner's permit and high school ID to get her cert.  Folks were wandering through the crowds encouraging folks to go stand in the line and get set up for $69.  No records were needed.  Then once they were there, a SECOND fee (apparently a pre-paid follow up visit in FLINT) was sold to them to make their certifications 'bona fide'.  Yes, seriously.

 

THAT kind of fiasco does nothing but promote the idea that these clinics and certifications in general are a sham.  It makes it difficult for legitimate clinics to get the respect in the medical profession and the courtroom, as they are lumped in with businesses that specialize in separating patients from $50-60K of their money over the course of a weekend.  Our policy on these certifications will be to require outside records, charge full price and not accept as a medical record what we view as a certification of questionable legitimacy when the patients come in with denials.  We are already starting to see them. 

 

The setting of a certification is one factor in the overall picture of legitimacy.  Are the relationships I had with my patients in the Army any different that those in my office simply because the former encounter occurred in a tent and the latter in a brick and mortar building?  Does the information in the chart, the way it is gathered and how it is stored come in to play?  Is it better to say 'come back in 6 months' or to actually schedule the patient an appointment in 6 months and send them a reminder?  Is there a reasonable expectation a patient in Traverse City will drive to Flint to have a follow up vs going back to the same place they got the certification?  Does requiring a patient to pre pay for a follow up visit rather than scheduling the visit somehow make it more legitimate or 'bonafide'?

 

What makes a visit bonafide is reputation of the physician/clinic, the procedures and qualifying documents required to make the medical decision, the follow up policy of the practice and the reasonableness of the follow up expectations, and the TRACK RECORD of certifications previously challenged under section 8 for the practice.  How the physician presents him/herself in court also comes into play.

 

What we do to meet these requirements are simple.

 

We require the records that confirm the claimed diagnosis.  These become part of the patient's chart.  We can bring them to court with us to support our diagnosis.

We make a note on each patient.  Not just a notation on the application, but a real note like a doctor would on any visit.

We meet with the patient.

We have fixed bases offices that are there, year in and year our.  We can be found for follow up, something many patients that used fly by night dispensary docs and no record clinics can't seem to do.

Our outreach clinics are clearly mobile but associated with a fixed base clinic.  They exist only because there is a need in an area, but not enough to support a full clinic.

We have an internet web page that helps patients find us, and we contact them to remind them of their follow up appointments and renewals.

We do other things besides medical marijuana and have a good reputation for doing them well (pain management and suboxone, counselling, acupuncture, etc).  We aren't a 'one trick pony'.

Our docs are licensed and free of blemishes on their DEA and Board licenses.  They are also court acknowledged experts in section 8, cannabis medicine, and their specialties.

We write and publish on the subject, speak to groups as experts, and have been called upon in Lansing as experts on the field.

Finally all our clinics are linked by an electronic medical record for continuity of care.

 

Many attorneys have chimed in on the difficulty with defending PATIENTS that were seen by 'hotel clinics' using the model of the no record, 200 patient a day, run them through the line clinics.  Other clinics are designed specifically to make the section 8 defense easier, despite the setting.  I would suspect that had the question been rephrased to the attorneys to emphasize the protocols and practices used by the clinics rather than the location that the clinic was held the responses would have been more informative to patients and potential patients.

 

Dr. Bob

[Dr. Bob]

the 'standard of care' is what they want.

 

so i'd hazard a guess that LARA wants the same amount of doctor visits that you would get for any other prescriptions like oxycontin.

 

for permanent issues , i think 6 month followups are the general timeframe.

which is what most cert docs have used. so every 6 months.

4 visits in 2 years. is my (non-legal-advice) guess.

There is no standard, beyond 'enough' to satisfy the court, in conjunction with the entire circumstances of the certification.  The key is documentation and re-evaluation of the effect of therapy.  Recall the law does not require follow up visits, only that the doctor have a reasonable expectation they will provide follow up.  We meet that by scheduling the appointment, by having fixed offices (even if the cert was done at an outreach clinic), doing reminders, and most importantly doing them FOR FREE simply to help protect the patient if they have to use a section 8 defense.

 

Dr. Bob

[jamieuke]

Bob- excellent info and responses. However, the question posed to the experts was specifically to see if the location alone creates problems for people when legal issues arise- which it clearly does.

 

The concept of meeting standards in non traditional venues was discussed, as well. It was established that even if acceptable standards of care are being used, the mere location of the examination remains a problem. That is precisely the reason that people need to be aware of this.

 

Of course , there is plenty of room to delve deeper into this issue and to be more specific about standards and the legal strategy of the prosecutors. Another angle that was discussed but could use further consideration, is the need for the recommending doctor to be willing to testify in court and support the relationship. The courts are demanding this testimony while the prosecutors intimidate and threaten the doctors.

 

This needs to be an ongoing discussion and it will continue. Your contribution in this discussion is valuable and we will keep it going here and PGT and wherever it can help people make informed decisions.

[bobandtorey]

Bob- excellent info and responses. However, the question posed to the experts was specifically to see if the location alone creates problems for people when legal issues arise- which it clearly does.

 

The concept of meeting standards in non traditional venues was discussed, as well. It was established that even if acceptable standards of care are being used, the mere location of the examination remains a problem. That is precisely the reason that people need to be aware of this.

 

Of course , there is plenty of room to delve deeper into this issue and to be more specific about standards and the legal strategy of the prosecutors. Another angle that was discussed but could use further consideration, is the need for the recommending doctor to be willing to testify in court and support the relationship. The courts are demanding this testimony while the prosecutors intimidate and threaten the doctors.

 

This needs to be an ongoing discussion and it will continue. Your contribution in this discussion is valuable and we will keep it going here and PGT and wherever it can help people make informed decisions.

Thanks

i agree 

This sounds like someone needs to challenge the courts about prosecutors threading these Doctor's 

[phaquetoo]

The only problem Im seeing at this time is Dr.'s who work thru hospitals, are being told they can not certify or renew pt's for the mm program, and than the ones not related to hospitals are being told not to do it by their ins company's!

 

I agree with the op and Dr. Bob but that doesnt get my familiy dr to renew me any longer, when I first started seeing my dr. they recomended and renewed me for 2 yrs, than the signs popped up that they would no longer be certing or renewing for the program, Becuase they moved their office into st.marys and were told they cant practice there and have anything to do with the mm program.

Mid mich has the same rules and they quit me when they found out I was an mm pt, after me being with them for 12 yrs!

 

Now for people like me I have to go to a dr. I dont know, give them my medical records to get renewed, now that isnt right, at least my primary physician knows I am a carded mm pt and we do discuss its effects on me good mostly, (although she did say she has 5 pts who are mm pts and they are all obese) lol no kidding, I laughed and said no that isnt why I am and it realy isnt, but I am having a harder time as I get older to lose the weight I gain every winter!

 

 

Ok one more thing, If some one was to use one of the so called dr's the op and attnys talk about and dont draw any attn to themselves and dont ever wind up in court for mm is it gonna matter what kind of certifications people use?  I mean people dont have many choices, Im not saying that it is right or wrong, but what is one to do?

 

I was seeing my dr once a month, than once every 90 days, now every 120 days, so I see my primary dr. 3 times a yr now after being with her for close to 4 yrs now!

 

Peace

[Dr. Bob]

Bob- excellent info and responses. However, the question posed to the experts was specifically to see if the location alone creates problems for people when legal issues arise- which it clearly does.

 

The concept of meeting standards in non traditional venues was discussed, as well. It was established that even if acceptable standards of care are being used, the mere location of the examination remains a problem. That is precisely the reason that people need to be aware of this.

 

Of course , there is plenty of room to delve deeper into this issue and to be more specific about standards and the legal strategy of the prosecutors. Another angle that was discussed but could use further consideration, is the need for the recommending doctor to be willing to testify in court and support the relationship. The courts are demanding this testimony while the prosecutors intimidate and threaten the doctors.

 

This needs to be an ongoing discussion and it will continue. Your contribution in this discussion is valuable and we will keep it going here and PGT and wherever it can help people make informed decisions.

The point being made is that there are many factors taken in to account to decide if a relationship was bonafide.  Can the setting help or hurt the argument, of course, but it is WHAT IS DONE that weighs far heavier.  As several have pointed out, there are few certification physicians (last time I checked only 1 in 15 Michigan doctors has ever written even one cert) so some mechanism needs to be created to meet the unanswered needs of those patients.  

 

Outreach clinics, like those used by social security, insurance companies, etc which travel to a patient's home or home town and CONDUCT THEMSELVES LIKE A MEDICAL CLINIC RATHER THAN THE DMV can answer that need.  BUT if we are going to have these outreach clinics, we must acknowledge that they will be looked at closer than a clinic in a medical office.  Therefore THEY MUST BE BETTER- with better procedures, follow up, medical record requirements etc because they are starting from a position of relative weakness.  A clinic doing the absolute minimum required by the law (having a medical license and pulse) does not protect you as one of my outreach clinics would simply due to the fact I have better procedures than what have been termed 'low standard' certification doctors.  But, as with all things, the proof is in the courtroom, and I've always been judged as having a bonafide relationship with my patients, which has resulted in many cases of dismissed charges or not guilty verdicts.  Heck sometimes they just throw in the towel when they see the witness list and the filing by the attorney as Michael has stated before.

 

The best certification is from your family doctor.  The second best is from a specialist with high standards in an office setting.  The third best is from a specialist with an office in an outreach clinic that is conducted like a medical clinic with high standards.  

 

Notice I didn't even list the circus events.  That is because those aren't even legitimate certifications in my considered opinion.  I don't accept them as medical records.  And I am pro cannabis.  I just rejected a young patient today because he got his initial cert from a hotel clinic in Gaylord.  Even the on the cert, the doctor noted that the patient '

described' back pain.  Further questioning showed the patient had never sought treatment for back pain.  Ever.  When asked for medical records, he gave me the cert from the hotel doctor.  That was money out of my pocket, but it protects the program and legitimate patients.  It also protected THAT patient because I don't want to go in to court and be force to justify my certification based only on 'the patient told me he had back pain'.  Now he is forced to get real records that WILL stand up in court, and I'll gladly certify him for free.  Or he can go back to the hotel, get his ticket punched, and take his chances.

 

If you have the money for the certification and medication, you have money to see a real doctor and get some real records.  I am encouraged by the fact I am starting to see more and more patients come in with brightly colored papers encouraging them to renew through the mail.  They to a person are saying they came to me because the 'through the mail' recertification seemed 'shady' to them.

 

And they are right.

 

Dr. Bob

Edited November 2, 2013 by Dr. Bob

[jamieuke]

Bob- again, good info, but you seem to disagree with the experts who are clearly saying that the mere location, regardless of how well the standard of care is carried out, creates major problems for those entangled in a related legal issue. This is the point and the reason that the message is so important.

 

Logic is not prevelant to the courts in these cases. The discussion will not lead to how well the patient was cared for at the hotel exam or how badly the patient may need the medicine. The "sketchy" image is all it takes for the prosecutor to damage the defense- as incredibly unreasonable as it is. This is the reality that the long list of experts are conveying- or that the piece is trying to convey, in part, through them.

 

Of course, the content of your responses is valuable as it comes from an experienced, participating medical professional. You also basically agree with the need for elevated standards. Hopefully, you will continue to offer your perspective here, on PGT and at large so that prospective and renewing patients will be better informed and more likely to choose a situation where the recommendation letter will actually have value in the event it is needed to.

[bobandtorey]

You may be prosecuted just because of the address of a building as to where you went to get certified  ?

[+Malamute]

Well, not specifically, but it may not look good when they look at the case in whole.

 

Such as,... if you tell the judge you got your certification at the expo center during the Cannabis Cup, it may not look so good. ;-)

 

 From there, it leaves a heavy burden that every single thing that happened and surrounding the legitimacy of that bona fide relationship is solid.  It Is like there is a list of 8 things they are checking off when deciding if a physician was acting properly.  Cannabis cup is like you are automaticly at 7 out of 8 and ya need a 7 to pass. ;-)

[Dr. Bob]

Bob- again, good info, but you seem to disagree with the experts who are clearly saying that the mere location, regardless of how well the standard of care is carried out, creates major problems for those entangled in a related legal issue. This is the point and the reason that the message is so important.

 

Logic is not prevelant to the courts in these cases. The discussion will not lead to how well the patient was cared for at the hotel exam or how badly the patient may need the medicine. The "sketchy" image is all it takes for the prosecutor to damage the defense- as incredibly unreasonable as it is. This is the reality that the long list of experts are conveying- or that the piece is trying to convey, in part, through them.

 

Of course, the content of your responses is valuable as it comes from an experienced, participating medical professional. You also basically agree with the need for elevated standards. Hopefully, you will continue to offer your perspective here, on PGT and at large so that prospective and renewing patients will be better informed and more likely to choose a situation where the recommendation letter will actually have value in the event it is needed to.

I do agree with them, but not fully.  As Mal says, it becomes part of the calculus in court, but it isn't the end all.  Most of the attorneys, and they are welcome to chime in, equate 'hotel clinic' with 'low standards doctor'.  That is not always a good assumption to make.  Mind you, most of my patients are seen in one of my eight fixed offices, but I still do outreach clinics based from those offices and have done literally hundreds of housecalls.  My old buds and I were thinking back to the good old days of the mid 80's and we figured out I ran abot 4000 calls as a paramedic.

 

Speaking of being a paramedic, I was in the second generation of them, what is referred to as the 'Hills Street Blues Era' (vs Johnny and Roy in the first generation).  There were many questions about the 'legitimacy' of trained paramedics running codes in houses or the back of an econoline 350 ambulance.  When I started in 1981 we had to call in for permission to start an IV.

 

I think that some of the push back about location is similar to the pushback the early medics got. 

 

Dr. Bob

[imiubu]

I remember a certain doc here doing 'hotel certs'.

Funny how times change. 

8 brick and mortar clinics now, wow.

I suppose there is something to be said about that.

Became quite a lucrative business it appears.

[Dr. Bob]

I remember a certain doc here doing 'hotel certs'.

Funny how times change. 

8 brick and mortar clinics now, wow.

I suppose there is something to be said about that.

Became quite a lucrative business it appears.

Thanks for your comment.  Perhaps you might look at the content of the posts and learn something.  I've ALWAYS done clinics with high standards and proper procedures and will continue to do so.

 

You are one of those people that are constantly negative, poorly informed, and have to have things explained several times and STILL don't understand what is being discussed.  It would be really nice if you could turn over a new leaf and start making positive contributions to discussions rather than all this constant whining and snipping.

 

Otherwise, we can continue to make you look foolish.

 

Dr. Bob

[imiubu]

Thanks for your comment.  Perhaps you might look at the content of the posts and learn something.  I've ALWAYS done clinics with high standards and proper procedures and will continue to do so.

 

You are one of those people that are constantly negative, poorly informed, and have to have things explained several times and STILL don't understand what is being discussed.  It would be really nice if you could turn over a new leaf and start making positive contributions to discussions rather than all this constant whining and snipping.

 

Otherwise, we can continue to make you look foolish.

 

Dr. Bob

 

 

I have read the entire thread bob.  I agree with much of what you said, and often do.

I do not whine & I only 'snip' at you.

As far as "we" making me look foolish, you have not done so, not even once (exept maybe in YOUR minds eye)

and are just the type of comments I have come to expect from you.

 

IMO the reason that you are now a 'certifying doctor' is not due to you being altruistic but rather because you

are a profiteer.

 

I will take the middle path w/ you now, as it seems many including you, just want to forget things in the past.

 

 

 

Jamie, I apologize for hijacking your thread.

[Dr. Bob]

I have read the entire thread bob.  I agree with much of what you said, and often do.

I do not whine & I only 'snip' at you.

As far as "we" making me look foolish, you have not done so, not even once (exept maybe in YOUR minds eye)

and are just the type of comments I have come to expect from you.

 

IMO the reason that you are now a 'certifying doctor' is not due to you being altruistic but rather because you

are a profiteer.

 

I will take the middle path w/ you now, as it seems many including you, just want to forget things in the past.

 

 

 

Jamie, I apologize for hijacking your thread.

Enjoy your little world.  Glad you read the thread, perhaps someone with patience can explain it to you.

 

Now back to serious things.

 

Dr. Bob

[imiubu]

We do want safe access.

 

As the experts quoted in the article mentioned, and as was discussed on Planet Green Trees, and what should have been gleaned as the point of the piece- the location of the examination alone can be the basis for leaving people in a legal lurch.

 

The logical arguments for why the 'hotel' doctor can be a valuable service for many and how the proper standards are adhered to, or how qualified a patient is,

 

are not considerations for the courts in the circumstances, described by the experts.

 

I listened and understood this point very well, thank you for yet another informative show.

[Dr. Bob]

I listened and understood this point very well, thank you for yet another informative show.

Ever actually BEEN IN COURT imiubu?  Ever see a successful section 8 defense?  I've been in quite a few and associated with others, so have many in here.  In mine, the setting of the clinics never even came up, just what was done and the records kept.  Very easy to cut a paste a single quote that suits your needs, yet leave the rest of his comments and discussion out.  Very shallow attempt to promote your point.

 

Come to think of it, what is your point, your opinion?  Do you actually have one?  Do you even know what you want and how you would recommend getting it?   Why don't you carefully and clearly explain what it is you hope to see.  Do you support hotel clinics?  What standards do you promote?  Do you think everyone should be certified ONLY by their primary care doctor in an office setting, or do you wish to see everyone get a card on a complaint of back pain?

 

You seem to have many comments about what OTHERS say or take a position on, let's see what YOU have to say and where YOU stand.  Stand up or shut up.

 

Dr. Bob

Edited November 2, 2013 by Dr. Bob

[+Malamute]

Eh,... profiteer comment.

 

 

Let me say, ol Bob there was offered a position at my local hospital where he would make as much and likely more for doing less work than he does with the certification/pain management business.

 

He does it because he prefers it and enjoys doing it I am assuming, and kinda know.

 

 

Saying he does it for the money over being a hospital physician is off though.

[jamieuke]

No prob- there is contribution to the discussion.

 

Many of us would have argued that the service of hotel certs is valuable and that it can be done with proper standards- until we see the reality of how it actually plays out in court. Certainly, those arguments won't make a difference when caught up in the legal system.

 

Malamute is right on as well- imagine that kind of fuel in the more hostile environments. You will not get past the issue of location- When one is arguing that the location ought not be a major consideration, one has been arrested and charged, and likely a more desirable target by prosecutors because of the facts of the case, which includes the doc visit taking place outside of a traditional clinic setting.