Hello michigan
- Thread starter GSTATUS
- Start date
I understood this thread to be about :
How I understand this is that seeing an mmj recommending doctor over a period of time will establish
both a pt's medical records and the bona fide Dr/pt relationship, correct?
Also, I heard that @ least 3 chart notes in 2 years documenting a patients qualifying condition/s is the
minimal requirement for a recommending doctor if patient does have some med records, is this the standard?
Did you advocate at one time for telemed to be accepted for mmj recommendations?
Thank you.
Dr. Bob;
How I understand this is that seeing an mmj recommending doctor over a period of time will establish
both a pt's medical records and the bona fide Dr/pt relationship, correct?
Also, I heard that @ least 3 chart notes in 2 years documenting a patients qualifying condition/s is the
minimal requirement for a recommending doctor if patient does have some med records, is this the standard?
Did you advocate at one time for telemed to be accepted for mmj recommendations?
Thank you.
Dr. Bob
Well-Known Member
Great question Leigh!
We certify people under two broad circumstances. The first is that they are a regular pain or suboxone patient of ours. The second is if they have medical records confirming their condition(s). Here are some guidelines we use when evaluating medical records...
Qualifying Conditions and the medical records they require.
To determine if you qualify, you will need to show us that you have one of the following conditions:
- Cancer (A medical record confirming cancer listing type and current therapy)
- Glaucoma (A medical record showing glaucoma and treatment)
- Crohn’s Disease (Recent medical records confirming the diagnosis)
- HIV (Confirmatory blood testing and medication)
- Hepatitis C (Blood work and proof of treatment)
- Nail Patella Syndrome (Confirmation of diagnosis from your doctor)
- ALS (Confirmation of diagnosis from doctor)
- Alzheimer’s disease (Confirmation of diagnosis)
- Wasting Syndrome (Diagnosis of wasting syndrome from primary care physician)
- Chronic Pain (Confirmation of 3 months of symptoms requiring treatment from a physician/chiropractor)
- Severe Nausea (Confirmation of 3 months of symptoms and treatment for nausea)
- Seizures (Diagnosis of seizures and current anti-seizure medications)
- Muscle Spasms (Confirmation of 3 months of symptoms and current treatment)
- Post Traumatic Stress Disorder (Confirmation of Diagnosis by Mental Health Professional)
It is designed to make the bona fide relationship portion of the section 8 defense a slam dunk- to the point if that is what they (the prosecution) is hanging their hat on, they generally end up dismissing when they see what we are bringing in. This most recently happened in Muskegon, but we had pre-trial dismissals elsewhere (in Paw Paw with Mike Komorn recently as well) and those that actually go to trial do not turn out well for the prosecution (Antrim Co as noted in the article).
As for telemedicine, I am a strong advocate of it and used it, especially in the rural UP and NE Michigan in the past. I testify for the need for telemedicine at the hearings for the bona fide dr/pt relationship bill. I am DEEPLY disappointed they did not allow it in PA 512. It is inherently unfair they do allow it for a wide range of medical visits (as noted by the laws Adam cited) yet it is SPECIFICALLY not allowed for something as simple as a medical marijuana certification. However, just because it is unfair we can't ignore the law not allowing it for certifications. This is especially true because the patient is the one that goes to jail if it turns out the certification is ruled invalid because of the Skype visit, and if the prosecutor discovers the certification was done via skype, it will be without question.
Those advocating skype are doing so to obtain the money for the certification at the expense of the safety of the patient. It is as simple as that and the law is that clear. I don't like the loss of skype, it increased my travel to 6000 miles a month to personally meet with EVERY medical marijuana certification patient, but it is a minor inconvenience to me and some wear and tear on my car and worth it because it protects the patients.
If a physician is going to do certifications, it is important they understand the law which requires them to get in their car and go see the patient in person. The patients have to drive to the office, there is no reason to expect the doctor not to do the same in exchange for the certification fee.
Dr. Bob
Dr. Bob
Well-Known Member
One more thing- There are some doctors that will certify patients without prior records. While we do not do this (except for patients that are seeing us for other reasons like pain or narcotic addiction), it is perfectly ok.
The proper way to do this is to see the patient over an extended period of time and establish records similar to those that we would require from the patient's primary. For chronic pain for example, if we had 3-4 monthly visits, with diagnostic studies (xrays, mri, etc) and medication it would be a solid certification. For crohns, there would have to be a colonoscopy ordered with biopsies to confirm the diagnosis. These are very solid.
Some will use pain logs, these are much weaker because LARA and the courts have a problem with 'self reported' symptoms. There are also concerns that the patient could have filled out all three months of the pain log the morning of the visit, and we would be hard pressed in court to refute that if the prosecution claimed it. We considered a couple of ways to overcome this:
1/ Require the patient to enter the symptoms and pain log on our website, where their responses could be time stamped.
2/ Require they take the pain log to another doctor and have it noted in the visit record. While this doesn't prove anything, it does allow us to say we felt it was reasonable and another doctor felt the same way.
Prior to PA 512 and the medical board guidance that came out the year before the law was passed, these were considerations, though we didn't do any under those conditions. Afterwards, they are weaker.
Our current standard (for my practice) is that we want solid certification only. For chronic pain we require at least 3 months of symptoms documented (chronic) that are 'severe' enough to go to the doctor for treatment. We realize there are reasons people do not go to doctors, but that is our standard.
Dr. Bob
The proper way to do this is to see the patient over an extended period of time and establish records similar to those that we would require from the patient's primary. For chronic pain for example, if we had 3-4 monthly visits, with diagnostic studies (xrays, mri, etc) and medication it would be a solid certification. For crohns, there would have to be a colonoscopy ordered with biopsies to confirm the diagnosis. These are very solid.
Some will use pain logs, these are much weaker because LARA and the courts have a problem with 'self reported' symptoms. There are also concerns that the patient could have filled out all three months of the pain log the morning of the visit, and we would be hard pressed in court to refute that if the prosecution claimed it. We considered a couple of ways to overcome this:
1/ Require the patient to enter the symptoms and pain log on our website, where their responses could be time stamped.
2/ Require they take the pain log to another doctor and have it noted in the visit record. While this doesn't prove anything, it does allow us to say we felt it was reasonable and another doctor felt the same way.
Prior to PA 512 and the medical board guidance that came out the year before the law was passed, these were considerations, though we didn't do any under those conditions. Afterwards, they are weaker.
Our current standard (for my practice) is that we want solid certification only. For chronic pain we require at least 3 months of symptoms documented (chronic) that are 'severe' enough to go to the doctor for treatment. We realize there are reasons people do not go to doctors, but that is our standard.
Dr. Bob