Experts Weigh In On Medical Marijuana ‘Hotel Certifications’

[Dr. Bob]

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.

Apparently you are not in the same courts I am.  I go because a patient went outside of section 4 and got arrested.  I present my records.  The patient is determined to have a bonafide relationship, and that is that.  I've never been asked where I saw the patient, only if I was able to provide follow up and followed the standard.  We all have our own experiences.  Perhaps many of these attorneys are used to dealing with doctors that don't show up for their patients, or don't require or keep records, or whatever.  I've never had that problem.  And in many cases where THEY do, they call me to recertify their patient and review the initial one so they can use me on the stand.  BTW, those visits take place in my office, a confrence room or THEIR office. 

 

So where does a visit in a lawyer's office fall in the great scheme of things?  Does it have to be a DOCTOR's office?

 

See what I mean, not really all that important where, but how.

 

Dr. Bob

[Dr. Bob]

So bottom line, if you are my patient, I have you covered.  If you went to a 'low standards' clinic, you can still have me.  For $300 an hour from and back to Clare.  Does that $69 buck cert still seem that good of a deal?

 

Dr. Bob

[imiubu]

So bottom line, if you are my patient, I have you covered.  If you went to a 'low standards' clinic, you can still have me.  For $300 an hour from and back to Clare.  Does that $69 buck cert still seem that good of a deal?

 

Dr. Bob

 

Dam it bob, I said I would lay off you but it grinds me that you assume sooo much... you have made comments to me getting my cert at

a 'kegger' at one point.  I will say again as I said to you then.... "...just because I don't have you as my certifying doctor does not mean

I got my cert at a kegger." Possibly you should pay attention doc ?

 

If you remember a convo we had some time ago... then you should remember also where I get my cert and you approved...

geesh man.

 

Oh... and 'I have you'... believe me I do

[jamieuke]

Bob- Although, it gets away from the point if the previous post- I believe the issue of the reliability of the doc to show up in support of his or her patient if necessary, is an important one and should be discussed further.

[Dr. Bob]

Dam it bob, I said I would lay off you but it grinds me that you assume sooo much... you have made comments to me getting my cert at

a 'kegger' at one point.  I will say again as I said to you then.... "...just because I don't have you as my certifying doctor does not mean

I got my cert at a kegger." Possibly you should pay attention doc ?

 

If you remember a convo we had some time ago... then you should remember also where I get my cert and you approved...

geesh man.

 

Oh... and 'I have you'... believe me I do

all about you and getting your knickers in a twist.  And you hijack a good discussion about standards to do it. 

 

feel better?  feel like you made a contribution to the discussion?

Edited November 2, 2013 by Dr. Bob

[Dr. Bob]

Bob- Although, it gets away from the point if the previous post- I believe the issue of the reliability of the doc to show up in support of his or her patient if necessary, is an important one and should be discussed further.

My experience with prosecutors trying to question the relationship (it happened in Gaylord once) was that the judge said he knew who I was and had the paperwork on the patient and that was enough.  What are they going to say when asked 'So- you are somehow saying it is different because the patient was certified in Grayling vs the Mp office, though the doctor, the electronic medical record, the documentation and the procedures were the same in both locations.  Does it have to do with what pictures are hung on the wall counsellor?  Move on with you questions.'

 

Dr. Bob

[imiubu]

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.

[Dr. Bob]

Thanks for making my point by cutting and pasting the orginal article.  Would you like the key points highlighted?  Still waiting for your contribution to the discussion, your plan.

 

Dr. Bob

Edited November 2, 2013 by Dr. Bob

[Dr. Bob]

You know, it is always good to be ahead of the curve....

 

The 'Signature Mill Triad'

 

21 December 2011

Dr. Robert Townsend

 

How does a ‘signature mill’ develop? Why are they in the News? Why are they still renting hotel rooms and doing no record/no doctor clinics designed to squeeze out as much cash as they can before they are shut down? There are three components to the ‘signature mill triad’:

First you have the businessmen/women that prey on human weakness and lack ethics. These are relatively smart people that know a good cash cow when they see one. The term ‘bona fide dr/pt relationship’ is not defined in the law, so they feel free to define it as whatever makes them the most money. Records are not specifically required by law, so they don’t requiring them to maximize the number of warm bodies they can pass through, collecting up to $200 apiece for a legal high. They have no risk, all the risk is assumed by their doctor and his license (we just collect the money the doctor makes the medical decisions…), and the patient risks jail. By doing the minimum required by the law they maximize their profits, and the patients are just ATM’s to these ‘marketers’. There is no sense of obligation or duty, no ethics, no greater good or ‘big picture’. You don’t see these folks writing articles or taking a stance, unless there is profit to be made from it.

Quality doctors cost money, because they are professional, have standards, and a reputation to fall back on to support their judgment and protect their patients. Damaged physicians (malpractice, board action against them, loss of DEA registration, etc) are cheaper and can sign their name just as easy. Years of education and lack of prospects make these physicians desperate enough to pre-sign certifications. Professionals don’t sell their integrity, but there are those that will. These doctors are the second leg of the ‘signature mill’ triad.

The final leg of the ‘signature mill’ triad is none other than some of the patient themselves. I defy any reader to tell me that patients are so stupid as to think that dropping off an application one day, and picking up a signed recommendation the next, without ever having presented any records or seeing a physician, could possibly not realize what they were doing was wrong. Marijuana is a schedule 1 narcotic that has been illegal for generations. It took a voter initiative to even allow it for compassionate use to the sick, under limited circumstances, and it is being fought tooth and nail by the authorities. How could a no record, no physician clinic possibly make the determination a patient was ill enough to need medical marijuana?

The answer is they know they can’t, and they are going to the clinic because it is cheap, easy, and they are gaming the system to get a legal high. In the process, they are making a mockery of the entire Act and hurting all the legitimate patients and clinics that are trying to do things right and build respectability for marijuana as medicine. Even when they are told what, specifically, to look for: how to check a physician’s credentials, why they have to have records to protect themselves, and a doctor that will stand with them if they end up in court, or are even told specifically about a known mill, they continue to support those mills financially.

The pity of it is that those same patients cry out the loudest when a mill is shut down, while the rest of us struggle to do damage control. We have to because we are trying to protect the Act. We are trying to protect the integrity of the system. We are the legitimate certification doctors, the legitimate patients, the legitimate caregivers that remain when the marketers move on to the next ‘cash cow’.

In aviation we refer to the ‘accident chain’- a series of steps that lead to tragedy. Break any step and the accident doesn’t occur. Clinics are run by DOCTORS, and managed by business people according to ethics and standards- you can still make a decent profit AND serve a community. There is ethical marketing- providing a superior product at a competitive price and getting the word out. There is no need to cut corners, plant stories under false names in newspapers, or violate basic principles of privacy, patient safety, and in some cases stoop to illegal activity and fraud. Doctors need to remember they swore an oath, they don’t pre-sign certifications, and they don’t let profit cloud their professional judgment.

Finally it comes down to the patients- Find out about the clinic and the doctor you are going to see, look up licenses and ask questions. Is that guy signing your certification a doctor or a real estate agent? Is the staff more interested in your money or your records? Is the doctor in charge or is the receptionist? Do you know who the doctor is, what his/her qualifications are, and are they the ones that you want standing between you and a cell? You have a choice of what kind of clinic you want to support.

Saying ‘I told you so’ only goes so far. The mills will not go away until three questions are answered:

From the marketers ‘who do I make this check out to your Honor?’

From the medical board ‘where were you, doctor, on July 25^th when those patients were being certified?’

From the patients ‘what do you mean my certification is revoked?’

- See more at: http://www.drbobmmj.com/about-dr-bob/dr-bob-s-blog/129-triad.html#sthash.unuQlseT.dpuf

[phaquetoo]

wow I know some one who is a great study lmao, I figured id comment here so I dont have to read a whole bunch when or if I come back, you never know when a thread is gonna get locked when things start getting out of hand! 

 

I know how to lock threads and get banned better than most

 

It realy is time for us all to pretty much get along, at least in open threads, As I see it we have a few peeps in here who have to have the last word, why not let it be

 

Peace  

 

 

edit= back to your regular programing already in progress!

Edited November 3, 2013 by phaquetoo

[trichcycler]

I think that the fairground certifications may have been out of line IF.........we didn't see the same type of medical fair ops giving out shots, heart monitoring, ct scans, blood tests, etc all the time. I've seen portable offices conducting real medical exams and nobody in line questioned their position, qualifications or anything else for that matter. It was a super convenience to these patients to be able to go to one of them for their tests/exams. Now that those are popular and well accepted I think so should a physical examination and recommendation be.

 

I once got sent to a blood draw ordered by the company for all employees for dna screening, supposedly anon, with fancy cancer/diabetes bar graphs, the fattest to the skinniest results, and more. I quit at that moment. They said that their insurance carrier mandated it.  the scene was a partially used storage room, with old cubicles and file cabinets pushed aside, lunch tables brought in, and everyone lined up getting their vein milked, in a storage room. they thought it was acceptable. just sayin.

[Dr. Bob]

I think that the fairground certifications may have been out of line IF.........we didn't see the same type of medical fair ops giving out shots, heart monitoring, ct scans, blood tests, etc all the time. I've seen portable offices conducting real medical exams and nobody in line questioned their position, qualifications or anything else for that matter. It was a super convenience to these patients to be able to go to one of them for their tests/exams. Now that those are popular and well accepted I think so should a physical examination and recommendation be.

 

I once got sent to a blood draw ordered by the company for all employees for dna screening, supposedly anon, with fancy cancer/diabetes bar graphs, the fattest to the skinniest results, and more. I quit at that moment. They said that their insurance carrier mandated it.  the scene was a partially used storage room, with old cubicles and file cabinets pushed aside, lunch tables brought in, and everyone lined up getting their vein milked, in a storage room. they thought it was acceptable. just sayin.

 

This is marijuana, like it or not it is special permission to use a schedule 1 controlled substance.  It isn't a drug store flu shot or held to the same standards.  People don't get arrested, tried or imprisoned because they got their cholesterol screened at a county fair.

 

This is a special thing to be able to use this wonderful substance.  A gift from the voters of Michigan.  If the rules say wear a purple tee shirt and hop on your left foot, or for me to do it for that matter, then do it with a smile.  You are asking for something others don't get.  I am asking for permission to allow you to do it.  Keep it in perspective.  It isn't a right.

 

We both have hoops to jump through.

Dr. Bob

Edited November 3, 2013 by Dr. Bob

[trichcycler]

I respectively agree with you. With such a strong scheduling you have to wonder why we're allowed to produce it in our homes for sale to the public nearly unchecked(look at craigslist,budtender, etc)  with no standards of growing, servicing, monitoring, or health dept screening. A convicted felon is allowed to grow posess, and even manufacture this schedule 1 drug, and  I see no provisions to produce any other scheduled drug on the list, except this one that the government believes is the most dangerous, and least useful.  

 

Seems to make a small matter of "location of the doctor office" in my mind, but I am keeping up with this info.

[GregS]

333.26423 Definitions.

 

 

3. Definitions.

 

Sec. 3. As used in this act:

(a) "Bona fide physician-patient relationship" means a treatment or counseling relationship between a physician and patient in which all of the following are present:

 

(1) The physician has reviewed the patient's relevant medical records and completed a full assessment of the patient's medical history and current medical condition, including a relevant, in-person, medical evaluation of the patient.

 

(2) The physician has created and maintained records of the patient's condition in accord with medically accepted standards.

 

(3) The physician has a reasonable expectation that he or she will provide follow-up care to the patient to monitor the efficacy of the use of medical marihuana as a treatment of the patient's debilitating medical condition.

 

(4) If the patient has given permission, the physician has notified the patient's primary care physician of the patient's debilitating medical condition and certification for the use of medical marihuana to treat that condition.

 

Anything more or anything less is not required. This IS the standard of care, Singh's comments notwithstanding. Your quote Townsend: "The term ‘bona fide dr/pt relationship’ is not defined in the law, so they feel free to define it as whatever makes them the most money. Records are not specifically required by law". I realize it is a little dated, and it is only fair to restate the law in light of that.

 

This bug is fixed.

Edited November 4, 2013 by GregS

[trichcycler]

Dr Bob,

 

I understand that a fully functional doctors office provides a more respectable base, in a court explanation, and may even calm patients with sense of security, and the knowledge that their doc will be there again the next visit. I also understand that if a doctors boss isn't bent on denying cannabis use, I bet the physician would rather just see another patient in their home office, and examine them there, instead of driving across town to a cheesy hotel, fair, or someones home.  It would seem that the medical establishment itself is driving these physicians  underground, which may lead us to the real culprits in the scheme of things.

 

If it wasn't for the courts ripping a location, do you personally think it makes a difference in real life if a physician comes to my home, meets me at the ski resort, or sits in rented front office for the purpose of rec'ng marijuana use for patients, or treating an illness for that matter, as long as the patient is ok with house calls or hotel meets ?

 

thank you

[Dr. Bob]

Dr Bob,

 

I understand that a fully functional doctors office provides a more respectable base, in a court explanation, and may even calm patients with sense of security, and the knowledge that their doc will be there again the next visit. I also understand that if a doctors boss isn't bent on denying cannabis use, I bet the physician would rather just see another patient in their home office, and examine them there, instead of driving across town to a cheesy hotel, fair, or someones home.  It would seem that the medical establishment itself is driving these physicians  underground, which may lead us to the real culprits in the scheme of things.

 

If it wasn't for the courts ripping a location, do you personally think it makes a difference in real life if a physician comes to my home, meets me at the ski resort, or sits in rented front office for the purpose of rec'ng marijuana use for patients, or treating an illness for that matter, as long as the patient is ok with house calls or hotel meets ?

 

thank you

Yep, obviously depends on what kind of visit it is, but many were handled by 'house calls' before offices came about.  My grandfather had his appendix out on the dinning room table.  But CLEARLY something as simple as a mmj evaluation can be done via telemed or in a non-traditional setting.  The REASON it cannot is that it is cannabis, it is politically charged, and it can produce problems for both the patient and the doctor as we have been discussing before the interruption.  The main issue is the content of the visit, but the location can make the content need to be better to pass muster.  Simple as that.

 

Dr. Bob

[trichcycler]

Get  patients to follow the current laws and these issues would be moot.  ignorance and lawlessness go hand in hand it seems. time and time again I hear patients spouting off at the mouth in court, at the police, giving them all the info they need to continue enacting their zealous plot.

Edited November 4, 2013 by grassmatch

[trichcycler]

does anyone know of pain clinics operating similarly out of vehicles, hotel rooms, or rented offices ?    

[trichcycler]

has this form ever been reviewed by an attorney like Kormon ?  do they offer comment ?

[+Malamute]

There has been successful defense of Sec 4 in court.  As BobR tries to say, no Sec 4 defense ever before a jury, but definitely in front of  a judge.  Bench trial with Sec 4 defense; no jury trials with Sec 4 defense.

 

 I believe there tends to be confusion on that sometimes.

 

 Trying to figure out a way to skirt the edges of the law is never recommended and no Attorney I know of has ever supported these silly documents GregS has created.  As a matter of fact, they have said it is a waste of time.  *shrug*

[trichcycler]

good points...

 

but when I walk into the lawyer office with detailed plans of committing a felony, making money for it...., they will not take my money to defend me, before I commit the crime.

*nods*

 

 There is a caveat to most attorneys in those cases. They tell their clients that their activity is "defensible". They do not say "legal".  Defensible simply means, "Sure, I will defend you in court and make a case for you". ;-)

 

 And.... the very few that have and do say it is "legal",  that should tell you everything you need to know about that particular attorney.

 

 

Edit: I xcan also add that attorneys defend everyone who is in court. Murderers, rapists, forgers etc.  Acceptance of a case doesn't mean support for said actions.

[trichcycler]

house calls, any opinions?

[Dr. Bob]

house calls, any opinions?

Done hundreds if not thousands of them as a doctor, ran codes in living rooms as a paramedic. 

 

Again, back to my original point.  Are they valid, of course, but this is cannabis a schedule 1 controlled substance, and it is under the microscope.  We must over come attitudes to defend our certifications.  Venue location is another hurdle that will need to either be justified, overcome or both.  The way we do this is by using procedures that very clearly represent the upper limits of the medical standard.  'Getting by' with the minimum- affidavits, on the spot 'exams', or anything that gives the impression, justified or not, that rules are being skirted.

 

That is why these mass 'stand in line will will sign' clinics are viewed poorly, and reflect poorly on the entire medical marijuana community.

 

As far as your question grass.  If I had a homebound patient, I would and be able to justify it in a heartbeat.  But a 'tupperware party' certification clinic I would not do because even if my procedures were good, it is at the lower end of the standard of care.  I sure as heck would not show up at hempfest with my pen.

 

Dr. Bob

[Wild Bill]

State Required Bona-fide Doctor / Patient Relationship for MI Medical Marijuana Certification

 

Rae-Ramsdell-Letter 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…

 

Click here to read the Rae Ramsdell Letter clarifying what constitutes a bona-fide physician-patient relationship ie. should have a pre-existing and ongoing relationship with the the patient as a treating physician and periodic review of the treatment’s efficacy.

 

 

http://amma-usa.com/wp-content/uploads/2012/06/Rae-Ramsdell-Letter.pdf

[trichcycler]

never saw that, thank you much !

that is clear enough for me to understand, and I have complied !  those who don't, and then choose to break more laws, well, hope that license plate job works out well.

State Required Bona-fide Doctor / Patient Relationship for MI Medical Marijuana Certification

 

Rae-Ramsdell-Letter 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…

 

Click here to read the Rae Ramsdell Letter clarifying what constitutes a bona-fide physician-patient relationship ie. should have a pre-existing and ongoing relationship with the the patient as a treating physician and periodic review of the treatment’s efficacy.

 

 

http://amma-usa.com/wp-content/uploads/2012/06/Rae-Ramsdell-Letter.pdf