News (Media Awareness Project) - US MT: Medical Marijuana Card Ok'D After 8 Minutes, 6 Questions |
| Title: | US MT: Medical Marijuana Card Ok'D After 8 Minutes, 6 Questions |
| Published On: | 2010-08-21 |
| Source: | Billings Gazette, The (MT) |
| Fetched On: | 2010-08-24 03:02:06 |
MEDICAL MARIJUANA CARD OK'D AFTER 8 MINUTES, 6 QUESTIONS
It took me eight minutes to get a doctor?s recommendation for medical
marijuana.
Jason Christ thinks I waited too long.
The less time physicians spend with medicinal-pot seekers the better,
according to Christ, executive director of Montana Caregivers Network.
The controversial group has helped thousands of Montanans sign up for
medical marijuana cards at traveling clinics and via Internet
consultations.
My eight-minute conversation with a doctor over Skype, an Internet
video-communication program, was unnecessarily long, Christ said.
?It sounds like it was pretty thorough,? he said after I described it
to him. ?It?s not really necessary to have a doctor who does an
in-depth evaluation, like an hour-long evaluation.?
That?s not how the voter-approved Montana Medical Marijuana Act reads
or what the Montana Board of Medical Examiners requires. But Christ is
confident that his organization is on the right side of history.
?I don?t think we should be making it harder for people? to get
medical marijuana, he said. ?We should be making it easier.?
It was easy for me.
I did it as The Billings Gazette?s health reporter after MCN invited
me to witness and report on interactions between its doctors and
patients and then refused to let me into the clinic when I arrived at
the agreed-upon time. With no other way to assess the validity of
those doctor-patient interactions, I decided to sign myself up for a
consultation.
I called MCN in July to schedule a web appointment with a doctor. Two
days later, I logged on to Skype from a laptop computer equipped with
a web camera and waited for the doctor to ?call? me.
Once we were connected, he asked me why I needed medical
marijuana.
I told him the truth: I have back pain. It started 15 years ago after
I fell onto a concrete floor, and it has gotten progressively worse.
Shortly after my fall, I saw an orthopedic doctor, who recommended
stretches, and I occasionally go to a chiropractor.
The doctor I did the recent web interview with has been licensed to
practice medicine in Montana since 2001 and was at one time a surgeon
in Great Falls.
The doctor asked six questions: Is the pain localized to your back or
does it radiate into your legs? Do you have any other medical
conditions? Do you take any medications? Do you drink alcohol? Do you
smoke tobacco? Have you ever smoked marijuana before?
He did not ask me for my medical records or proof that what I told him
was true. He did not ask me what kind of pain it was or to rate it on
a pain scale.
He did not ask me if I had any questions about marijuana as a
medicine.
I did have questions, but he did not seem to have time to answer them.
A caregiver could talk to me about the form of marijuana that I should
use and what to expect from the drug, he said.
The doctor did tell me not to smoke marijuana ? smoking is, after all,
unhealthy ? and to select a ?stable? caregiver.
What does that mean? I asked.
?They would have a storefront and different products,? he said. ?A lot
of people have been growing marijuana illegally for years and have a
lot of knowledge about it medically. You want one of those people.?
I paid $150 to MCN for the Internet consultation. When I mailed the
doctor?s signature to the state Department of Health and Human
Services, which issues medical marijuana cards, I parted with another
$25.
Now I am one of about 23,500 Montanans who have been authorized to use
medical marijuana. Like me, almost 70 percent of cardholders were
approved to treat severe or chronic pain.
The Montana Medical Marijuana Act does not define severe or chronic
pain, one of eight medical conditions that the law says may be treated
with pot. But the act does outline what must take place before a
doctor can certify a patient to use marijuana.
A physician must use his or her professional opinion ?after having
completed a full assessment of the qualifying patient?s medical
history and current medical condition made in the course of a bona
fide physician-patient relationship.?
In a meeting earlier this year, the Montana Board of Medical Examiners
voted to ask lawmakers to replace ?bona fide physician-patient
relationship? with a phrase about ?generally accepted standards of
care.? Doctors who recommend medical marijuana should be held to the
same standards as other practicing physicians, the board said.
In May, the medical board fined a doctor who failed to meet the
expected standards of care by spending an average of six minutes with
patients before signing marijuana recommendation forms.
Members of the board declined to comment on my experience. But Pat
Bollinger, a registered dietician on the board, said the board has
been clear about what is expected from doctors.
?It?s pretty clear from our position paper what standard care is, and
it?s pretty evident when the standard of care is being met,? Bollinger
said.
At their May meeting, board members defined ?generally accepted
standards of care? with a list of eight bullet points.
My online visit failed to meet at least three of the requirements:
taking a medical history, discussing advantages and disadvantages of a
treatment and monitoring a patient?s response to a treatment.
?This is exactly the kind of medical encounter we hope ends,? said
Rep. Diane Sands, D-Missoula, a member of a legislative subcommittee
looking at ways to revise the state?s medical marijuana law.
?It is total medical incompetence.?
The subcommittee will report to the Children, Families, Health and
Human Services interim committee, which will draft a bill for the 2011
Legislature based on the subcommittee?s recommendations.
If legislators approve a bill that tightens medical marijuana
regulations, Montanans who got cards under questionable circumstances
might not be able to renew them, Sands said.
I?m not the only one who has sought a medical marijuana card without
planning to use it.
Law enforcement agencies across the state have sent undercover
officers complaining of a variety of medical conditions to traveling
clinics. They almost always get approved, and it often takes even less
time than it did for me.
?The ones I?ve gone to, it?s been a minute,? said Mark Long, narcotics
bureau chief for the state Division of Criminal Investigation. ?The
guys who try to ask questions or go into detail get hurried up because
there?s a line behind them.?
?Yours is one anecdote of what we hear all the time,? Long told me. ?I
think it?s a joke.?
[sidebar]
A standard of care The Montana Board of Medical Examiners declared in
May that physicians who recommend marijuana to patients must follow
the same ?generally accepted standards of care? that are required of
all doctors.
Anyone who has information about a doctor who is not following the
guidelines may make a report to the board by calling 406-841-2333 or
clicking here.
Medical marijuana criteria The Montana Medical Marijuana Act
authorizes the use of marijuana to treat specific conditions. They
are:
?Cancer.
?Glaucoma.
?HIV or AIDS.
?Cachexia or wasting syndrome.
?Severe or chronic pain.
?Severe nausea.
?Seizures, including but not limited to seizures caused by
epilepsy.
?Severe or persistent muscle spasms, including but not limited to
spasms caused by multiple sclerosis or Crohn?s disease.
Meeting the standards The medical board defined ?generally accepted
standards? of care as:
?Taking a medical history.
?Performing a relevant physical examination.
?Reviewing prior treatment and treatment response.
?Obtaining and reviewing relevant diagnostic test results.
?Discussing advantages, disadvantages, alternatives, potential
adverse effects and expected response to the treatment recommended and
ensuring that the patient understands them.
Monitoring the response to treatment and possible adverse effects.
?Creating and maintaining patient records.
?Notifying the patient?s primary-care physician when appropriate.
Related Links
Related: Children, Families, Health, & Human Services Interim Committee
2009-2010:
http://leg.mt.gov/css/committees/interim/2009_2010/Children_Family/defaul
t.asp
Related: Medical Marijuana: Physician?s Written Certification for
Medical Marijuana and the Bona Fide Physician-Patient Relationship:
http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/Medical%20Marijuan
a%205_25_2010.pdf
Related: Medical Marijuana Act:
http://www.dphhs.mt.gov/medicalmarijuana/title50chapter46mma.pdf
It took me eight minutes to get a doctor?s recommendation for medical
marijuana.
Jason Christ thinks I waited too long.
The less time physicians spend with medicinal-pot seekers the better,
according to Christ, executive director of Montana Caregivers Network.
The controversial group has helped thousands of Montanans sign up for
medical marijuana cards at traveling clinics and via Internet
consultations.
My eight-minute conversation with a doctor over Skype, an Internet
video-communication program, was unnecessarily long, Christ said.
?It sounds like it was pretty thorough,? he said after I described it
to him. ?It?s not really necessary to have a doctor who does an
in-depth evaluation, like an hour-long evaluation.?
That?s not how the voter-approved Montana Medical Marijuana Act reads
or what the Montana Board of Medical Examiners requires. But Christ is
confident that his organization is on the right side of history.
?I don?t think we should be making it harder for people? to get
medical marijuana, he said. ?We should be making it easier.?
It was easy for me.
I did it as The Billings Gazette?s health reporter after MCN invited
me to witness and report on interactions between its doctors and
patients and then refused to let me into the clinic when I arrived at
the agreed-upon time. With no other way to assess the validity of
those doctor-patient interactions, I decided to sign myself up for a
consultation.
I called MCN in July to schedule a web appointment with a doctor. Two
days later, I logged on to Skype from a laptop computer equipped with
a web camera and waited for the doctor to ?call? me.
Once we were connected, he asked me why I needed medical
marijuana.
I told him the truth: I have back pain. It started 15 years ago after
I fell onto a concrete floor, and it has gotten progressively worse.
Shortly after my fall, I saw an orthopedic doctor, who recommended
stretches, and I occasionally go to a chiropractor.
The doctor I did the recent web interview with has been licensed to
practice medicine in Montana since 2001 and was at one time a surgeon
in Great Falls.
The doctor asked six questions: Is the pain localized to your back or
does it radiate into your legs? Do you have any other medical
conditions? Do you take any medications? Do you drink alcohol? Do you
smoke tobacco? Have you ever smoked marijuana before?
He did not ask me for my medical records or proof that what I told him
was true. He did not ask me what kind of pain it was or to rate it on
a pain scale.
He did not ask me if I had any questions about marijuana as a
medicine.
I did have questions, but he did not seem to have time to answer them.
A caregiver could talk to me about the form of marijuana that I should
use and what to expect from the drug, he said.
The doctor did tell me not to smoke marijuana ? smoking is, after all,
unhealthy ? and to select a ?stable? caregiver.
What does that mean? I asked.
?They would have a storefront and different products,? he said. ?A lot
of people have been growing marijuana illegally for years and have a
lot of knowledge about it medically. You want one of those people.?
I paid $150 to MCN for the Internet consultation. When I mailed the
doctor?s signature to the state Department of Health and Human
Services, which issues medical marijuana cards, I parted with another
$25.
Now I am one of about 23,500 Montanans who have been authorized to use
medical marijuana. Like me, almost 70 percent of cardholders were
approved to treat severe or chronic pain.
The Montana Medical Marijuana Act does not define severe or chronic
pain, one of eight medical conditions that the law says may be treated
with pot. But the act does outline what must take place before a
doctor can certify a patient to use marijuana.
A physician must use his or her professional opinion ?after having
completed a full assessment of the qualifying patient?s medical
history and current medical condition made in the course of a bona
fide physician-patient relationship.?
In a meeting earlier this year, the Montana Board of Medical Examiners
voted to ask lawmakers to replace ?bona fide physician-patient
relationship? with a phrase about ?generally accepted standards of
care.? Doctors who recommend medical marijuana should be held to the
same standards as other practicing physicians, the board said.
In May, the medical board fined a doctor who failed to meet the
expected standards of care by spending an average of six minutes with
patients before signing marijuana recommendation forms.
Members of the board declined to comment on my experience. But Pat
Bollinger, a registered dietician on the board, said the board has
been clear about what is expected from doctors.
?It?s pretty clear from our position paper what standard care is, and
it?s pretty evident when the standard of care is being met,? Bollinger
said.
At their May meeting, board members defined ?generally accepted
standards of care? with a list of eight bullet points.
My online visit failed to meet at least three of the requirements:
taking a medical history, discussing advantages and disadvantages of a
treatment and monitoring a patient?s response to a treatment.
?This is exactly the kind of medical encounter we hope ends,? said
Rep. Diane Sands, D-Missoula, a member of a legislative subcommittee
looking at ways to revise the state?s medical marijuana law.
?It is total medical incompetence.?
The subcommittee will report to the Children, Families, Health and
Human Services interim committee, which will draft a bill for the 2011
Legislature based on the subcommittee?s recommendations.
If legislators approve a bill that tightens medical marijuana
regulations, Montanans who got cards under questionable circumstances
might not be able to renew them, Sands said.
I?m not the only one who has sought a medical marijuana card without
planning to use it.
Law enforcement agencies across the state have sent undercover
officers complaining of a variety of medical conditions to traveling
clinics. They almost always get approved, and it often takes even less
time than it did for me.
?The ones I?ve gone to, it?s been a minute,? said Mark Long, narcotics
bureau chief for the state Division of Criminal Investigation. ?The
guys who try to ask questions or go into detail get hurried up because
there?s a line behind them.?
?Yours is one anecdote of what we hear all the time,? Long told me. ?I
think it?s a joke.?
[sidebar]
A standard of care The Montana Board of Medical Examiners declared in
May that physicians who recommend marijuana to patients must follow
the same ?generally accepted standards of care? that are required of
all doctors.
Anyone who has information about a doctor who is not following the
guidelines may make a report to the board by calling 406-841-2333 or
clicking here.
Medical marijuana criteria The Montana Medical Marijuana Act
authorizes the use of marijuana to treat specific conditions. They
are:
?Cancer.
?Glaucoma.
?HIV or AIDS.
?Cachexia or wasting syndrome.
?Severe or chronic pain.
?Severe nausea.
?Seizures, including but not limited to seizures caused by
epilepsy.
?Severe or persistent muscle spasms, including but not limited to
spasms caused by multiple sclerosis or Crohn?s disease.
Meeting the standards The medical board defined ?generally accepted
standards? of care as:
?Taking a medical history.
?Performing a relevant physical examination.
?Reviewing prior treatment and treatment response.
?Obtaining and reviewing relevant diagnostic test results.
?Discussing advantages, disadvantages, alternatives, potential
adverse effects and expected response to the treatment recommended and
ensuring that the patient understands them.
Monitoring the response to treatment and possible adverse effects.
?Creating and maintaining patient records.
?Notifying the patient?s primary-care physician when appropriate.
Related Links
Related: Children, Families, Health, & Human Services Interim Committee
2009-2010:
http://leg.mt.gov/css/committees/interim/2009_2010/Children_Family/defaul
t.asp
Related: Medical Marijuana: Physician?s Written Certification for
Medical Marijuana and the Bona Fide Physician-Patient Relationship:
http://bsd.dli.mt.gov/license/bsd_boards/med_board/pdf/Medical%20Marijuan
a%205_25_2010.pdf
Related: Medical Marijuana Act:
http://www.dphhs.mt.gov/medicalmarijuana/title50chapter46mma.pdf
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