Doctors And One Year Recommendations.

[shishka]

I was informed recently that despite the state going to 2 year cards my doctor says his recommendation is only good for a year and I will have to see him every year and of course pay to see him.

 

The folks at the clinic blame the new laws for this but this is the first I've heard of this.

 

Does the state require a Dr. visit every year?

Edited November 17, 2013 by shishka

[Dr. Bob]

No it does not.  I recommend folks come in for a FREE one year follow up, but the only thing required is that the doctor have an expectation they can provide follow up.  It is up to the patient to come in.  I recommend they do because it improves their position if they have to do a section 8 defense.

 

Dr. Bob

[trichcycler]

keep it up !

[t-pain]

followup care is in the act, section 3a3

 

(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.

 

its also in the LARA admin rules for DO and MD:

http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_51869_60732---,00.html

 

 

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

Adhere to the established professional tenets of proper patient care
including: History and good faith examination of the patient

Development of a treatment plan with objectives

Provision of informed consent, including discussion of risks,
side effects and potential benefits

Periodic review of the treatment’s efficacy

Consultation, as necessary; and

Proper record keeping that supports the decision to
recommend the use of cannabis

Have a bona fide physician-patient relationship with the patient, i.e.,
should have a pre-existing and ongoing relationship with the patient as a
treating physician;

 

so yeah, try to see the doc once a year. apparently.

 

ehe dr bob it also says:

 

Ensure that the issuance of ‘recommendations’ is not a disproportionately
large (or even exclusive) aspect of their practice;

[bobandtorey]

At the GreenLite Clinic Dr. Kumar Singh has you to fill out a Patient Follow up Survey that you can mail inn or drop off every three months until renewal date it ask you things about your

 

response to treatment of Cannabis and if you are

 

experiencing  any side effects or complications from Marihuana/Cannabis

[bobandtorey]

followup care is in the act, section 3a3

 

 

its also in the LARA admin rules for DO and MD:

http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_51869_60732---,00.html

 

 

so yeah, try to see the doc once a year. apparently.

 

ehe dr bob it also says:

 cannabis-based products ? i fine this odd 

[trichcycler]

thank you for that very relevant point. I wonder what the definition of "follow up care " is ?

followup care is in the act, section 3a3

 

 

its also in the LARA admin rules for DO and MD:

http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_51869_60732---,00.html

 

 

so yeah, try to see the doc once a year. apparently.

 

ehe dr bob it also says:

[bobandtorey]

Imo the two year card may have been a set-up for the people that read it as shishka did most wouldn't go back until their card expires

[trichcycler]

very interesting !

Imo the two year card may have been a set-up for the people that read it as shishka did most wouldn't go back until their card expires

[Celliach]

Imo the two year card may have been a set-up for the people that read it as shishka did most wouldn't go back until their card expires

 

The two year card was a result of people on our side pushing for something that actually helps patients.  If anyone was responsible, it was CPU.

[+Malamute]

Think twice.... ;-)

 

 Although yes,... they didn't complain. :-)

[Dr. Bob]

followup care is in the act, section 3a3

 

 

its also in the LARA admin rules for DO and MD:

http://www.michigan.gov/lara/0,4601,7-154-35299_63294_63303_51869_60732---,00.html

 

 

so yeah, try to see the doc once a year. apparently.

 

ehe dr bob it also says:

 

 

Thank you for quoting the statements I've been following since they came out and used to formulate my answer back to me.

 

(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.

 

That is the law, exactly as I stated it.  You also quoted a memo that came out LONG before the law was changed to reflect this 'reasonable expectation' of follow up care.  The requirement is to recertify every 2 years, the follow up expectation is met in my practice by offering free follow up at my fixed offices or outreach clinic not only in one year, but any time the patient has questions.  Exactly as I previously stated.

 

Since you brought up the memo, that was sent to law enforcement over a year before it was released to physicians, and in fact I've never got one.  But even though it is not required under the law, I have a diverse practice that doesn't do a majority of certifications (most is pain management and suboxone, but we also offer acupuncture, counselling, massage, etc).  The memo was designed to attack dedicated certification clinics, especially the traveling ones.

 

My practice meets all the guidelines and always has.  

 

Examples of activity that is VERY questionable include:

 

Offers to renew certifications 'through the mail' with no physician contact or an offer of a 'complimentary doctor visit' at some hotel to 'stamp' the paperwork (you pay for the paperwork not the doctor, which should clue you in to the shady nature of the offer).

 

Hotel certifications NOT based in a LOCAL fixed office.  Doing a cert it a hotel in Marquette, with the nearest office 5 hours away down state is rather questionable.  Make sure the fixed office is at least in the same area code.  Another example of a sham 'hotel clinic' is getting a cert at hotel and having to 'prepay' for an office visit 'many hours' away.  Recently we saw this based out of a clinic which required pre-payment and a 10 hour round trip to the office for 'follow up'.  Both are NOT reasonable expectations of follow up and are designed to give the clinic 'deniability' if the patient gets in trouble and didn't follow up.  It does NOTHING to protect the patient on a section 8.

 

There are enough clinics within a reasonable distance throughout the state now.  Go see the doctor in person, like a real medical office visit, and do it right.  Saving $25 or doing something by mail that should be done in person will come back to haunt you.

 

I am aware of one case of a patient in the Niles area that did just that.  They went to a mill in a hotel.  The police claimed to find an unlocked door to the house when they came, and despite having a card on them, being well within the limits of section 4 for quantity, they charged and forced a section 8 due to the unlocked door.  He secured EXCELLENT legal counsel well known on this board.

 

The 'marketer' that ran the 'clinic' came to court and was, according to the patient, eaten alive by the prosecutor on the stand ('she couldn't shut her mouth' is what the patient told me, and dug herself a major hole from which she couldn't recover).  It all came down to the doctor needing to prove a very questionable bona fide relationship.  Unfortunately it came to light the doctor had an issue with narcotics and was under an agreement with the DEA NOT TO DO CERTS.  It was right there, and was NEVER disclosed to the patients by the marketer.  Even though he was well represented, and had an excellent case, he plead as the clinic cut his defense to shreds.  He is awaiting sentencing on a potential 2 year charge.  Wonder if the $25 bucks he saved going to this 'clinic' was really worth it?  Bad part, had he gone to someone that followed the rules and had a clean doc he would have been fine per the attorney.  

 

Don't be another horror story.  Don't renew by mail or deal with something shady when it really is just as easy to do it right with a local clinic.

 

Dr. Bob

[t-pain]

Thank you for quoting the statements I've been following since they came out and used to formulate my answer back to me.

 

sorry dr bob, didnt mean to direct it at you. was directing it at the OP.

i must have misread one of your posts talking about your clinics about specializing in mmj. i misread it to mean specializing in mmj recs, but having time to rethink, your post was obviously talking about specializing in mmj with prescription pain management.

 

 

 

dang bobandtorey, two good questions from you in this thread.

it does say cannabis based products... hmm indeed

[Dr. Bob]

sorry dr bob, didnt mean to direct it at you. was directing it at the OP.

i must have misread one of your posts talking about your clinics about specializing in mmj. i misread it to mean specializing in mmj recs, but having time to rethink, your post was obviously talking about specializing in mmj with prescription pain management.

 

 

 

dang bobandtorey, two good questions from you in this thread.

it does say cannabis based products... hmm indeed

No worries man.  And this is a good informative thread.  I don't fault doctors for charging for visits (although currently I don't).  But the card is a two year card, there is no way to restrict it.  

 

With my practice, I spend a lot of time keeping current.  The result is that I am rarely surprised by changes in the law and most of them were pretty common sense (and some actually helped patients such as the 2 year card, outdoor grows, a few clarifications that have brought some patients to grief, etc.).  In fact, it is rare I need to make any changes to what I am already doing.

 

Dr. Bob

[shishka]

Thank you for all the input everyone.

 

I've been with the same Dr. since the program started so this not enough to make me look elsewhere. Just thought it was a bit odd they way it was stated, like if I were to find myself in court after the first year I would have no support from the Dr.

 

To be fair though, these are solid "records manditory" Dr's and provide me with my high blood pressure scripts so I do feel it is worth it to pay a little additional money. I watch them turn people away left and right that come in with no records.

 

I do not want a Dr. with a reputation of being "easy".

 

Was just wondering about others experience with the 2 year cards.

[Dr. Bob]

Thank you for all the input everyone.

 

I've been with the same Dr. since the program started so this not enough to make me look elsewhere. Just thought it was a bit odd they way it was stated, like if I were to find myself in court after the first year I would have no support from the Dr.

 

To be fair though, these are solid "records manditory" Dr's and provide me with my high blood pressure scripts so I do feel it is worth it to pay a little additional money. I watch them turn people away left and right that come in with no records.

 

I do not want a Dr. with a reputation of being "easy".

 

Was just wondering about others experience with the 2 year cards.

Very good for you.  Guess it just falls under the category of 'that's what the doctor wants.'  Sounds like they do a good job.

 

Dr. Bob

[Ms Chocolate]

Just as your doctor has the power to grant you the ability to use, she/he has the power to un-grant your ability (Rule 19 (4)). If the doc feels more assured with certifications thought follow-ups, go with it.