Pubdate: Mon, 30 Sep 2013
Source: Boston Globe (MA)
Copyright: 2013 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Kay Lazar

MEDICAL MARIJUANA WEB SERVICES RAISING CONCERNS

State Medical Leaders Concerned About Untrained Entrepreneurs

Massachusetts' nascent medical marijuana law has sparked a recent 
flurry of new Internet companies promising to match patients with 
doctors who will certify they need the weed for health reasons, a 
phenomenon that has dismayed the state's medical society and raised 
concerns with the board that regulates physicians.

A number of the companies are run by entrepreneurs with no medical 
background, which the Massachusetts Medical Society said raises 
questions about the quality and safety of the care.

Some of the sites, the society said, appear to be tiptoeing just 
inside state rules, which require a "bona fide physician-patient 
relationship" be in place before marijuana can be prescribed.

"The fact that you have people with no medical pedigree [launching 
these companies] is testament that this is purely a money-making 
operation," said Dr. Ronald Dunlap, a cardiologist and president of 
the medical society. "These people are working around the edges."

Voters last November approved a ballot referendum that legalized 
marijuana for medical use, but left it to the health department to 
issue regulations that would implement the law.

With those rules released in May, the department is whittling a list 
of 158 applications for registered marijuana dispensaries to 35, the 
maximum number of facilities allowed in the first year under the 
ballot initiative.

In the interim, patients are allowed to legally grow a small amount 
of marijuana for their own use, as long as a Massachusetts physician 
certifies they have a medical need.

Once the dispensaries open, which is expected in the spring, the 
state will begin tracking patients and doctors in a computerized 
system. A doctor's certification will still be required then.

Among the newly launched Massachusetts doctor-finder websites is 
Commonwealth M.D., founded by Jai Chawla, a 28-year-old Cornell 
University graduate with a degree in history who founded an Internet 
security company, which he still runs.

Chawla, who is temporarily running his new business from a friend's 
basement in Cambridge, said he charges $250 to cover the patient 
referral and the physician consultation.

"I understand that's a large fee for a patient to be paying out of 
pocket," said Chawla in a phone interview, noting that patients' 
health insurance probably will not cover the service because 
marijuana is not federally sanctioned.

Most of the fee goes directly to the physicians so his company can 
remain "competitive" in attracting physicians, Chawla said. He said 
he has "fewer than five" physicians in his referral service, which 
opened a few weeks ago.

Matt Allen, executive director of the Massachusetts Patient Advocacy 
Alliance, which lobbied for the medical marijuana law, said the fees 
charged by the companies will probably be too high for many patients 
with chronic medical conditions who are on fixed incomes.

"We do hope some of these places will offer discounts for these 
patients," Allen said.

But he also said the companies offer a needed service to some 
patients, such as veterans, who may be unable to get a certification 
where they typically receive medical care, through the Department of 
Veterans Affairs, because of federal rules prohibiting marijuana use.

Massachusetts would not be the first state to encounter growing pains 
with its medical marijuana law. A June report by Colorado's state 
auditor found that 13 years after voters there approved the use of 
medical marijuana, a number of physicians appeared to be flouting the 
state's bona fide patient-physician relationship requirement. It 
concluded that half of the 108,000 patients who had obtained state 
cards to possess medical marijuana received their certification from 
one of just 12 physicians.

One of those physicians had certified more than 8,400 patients, it said.

Massachusetts Public Health Department spokesman Dave Kibbe said in a 
brief statement that state rules require physicians to have a "bona 
fide relationship" with patients they certify for medical marijuana. 
He declined to comment further on the services.

New state regulations define a bona fide relationship as one in which 
the physician has "conducted a clinical visit, completed and 
documented a full assessment of the patient's medical history and 
current medical condition, has explained the potential benefits and 
risks of marijuana use, and has a role in the ongoing care and 
treatment of the patient."

Dunlap said his organization has expressed its concern about 
physicians potentially skirting the bona fide relationship rule in 
these websites to the state Board of Registration in Medicine, which 
regulates physicians.

Barbara Piselli, the board's interim executive director, said her 
agency is monitoring the situation.

"We want to ensure all physicians are complying with the regulations 
concerning certification for medical marijuana, and that patients are 
receiving quality and safe medical care," she said.

At least one of the new companies in Massachusetts, Delta 9 Medical 
Consulting, is run by a state-licensed anesthesiologist, Dr. Harold 
Altvater, who bluntly explains on his website what patients must do 
to fulfill the bona fide relationship requirements.

"You schedule follow up visits at least every six months helping to 
full fill the 'bona fide' physician-patient relationship desired by 
the overlords," it states. "Yes, this will cost you about $17 dollars 
a month to remain compliant with the regulations."

Altvater charges $250 for an initial certification, and $100 for renewals.

In a phone interview, Altvater said he has certified about 275 
patients for medical marijuana since February, and that each exam is 
at least a half-hour, which includes a review of the patient's 
medical record and education about medical marijuana.

According to Altvater's site, the business is based in Malden and Methuen.
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MAP posted-by: Jay Bergstrom