The Society of Cannabis Clinicians (SCC)is a project of the California Cannabis Research Medical Group (CCRMG)
SCC was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).
As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.
Following are the practices of one physician that could serve as a model for others contemplating recommending and approving cannabis to their patients.
Practitioner’s Perspective
Medical-Legal Consulting
Protecting Patients and Doctors
Due to cannabis’s excellent safety profile, and the wide variety of illness for which cannabis can alleviate symptom distress, making cannabis recommendations safely and effectively is a skill that can be achieved quite readily. However, due to law enforcement’s institutional bias against cannabis, knowledge of the medical-legal aspect of cannabis consultations is at least as important as the medical knowledge, both to protect the patient, and to protect the doctor.
Caution Against Doctor/Dispensary Cross-Referrals
The extent to which physicians offices or free-standing cannabis clinics may work with and cross-refer to and from dispensaries is very unclear, and an issue that threatens to lose for recommending physicians, (and any employee physicians or practitioners), the full protection of the Conant decision.
I consider this to be very thoughtless and short-sighted, and perhaps unethical.
My 2 concerns are:
1. How does this close association between dispensaries and recommending physicians impact the quality of the legal protection that is at the heart of a pure medical-legal consultation? Will patients have a harder time defending their medical use in court, and/or be brought to court more often when a prosecutor can rely on his or her ability to discredit sloppy medical consultation work?
2. What should be the reaction of the hard-working pioneers of medical cannabis consultation, who have taken the biggest initial risks with the Medical Board and law enforcement, when patients seek out the “convenience” of dispensary-associated clinics and/or providers whose practice standards are so lax as to be open to criticism about the bona fide medical relationship between themselves and their patients? I don’t understand it well but WordPress tutorial really helped me with online field.
The executive MBA degree requires the student to have a higher level of job experience and education, at least five years of post-baccalaureate experience, states U.S. News. Because of this higher level of experience, the executive MBA is seen as the highest type of MBA program that a person can acquire. Yet, despite this prestigious degree, the graduate still has to enter a job market that is experiencing a recessional period. Companies are cutting workers jobs to save money. Having an executive MBA degree won’t shield you from losing your job. Consider carefully if getting one is right for you.
Have you observed the dentist salt lake city lately? It can be fundamental to preserve standard visits using the dentist to make certain the correct wellness of the mouth. At the very least as soon as every single six months a dentist need to carry out a cleaning of the teeth in addition to check for any cavities, gingivitis, and so on. Your oral wellness is as fundamental as your physical well being creating it just as fundamental to determine the dentist as it truly is to determine your physician once you turn out to be ill. Dental wellness issues can in fact trigger physical complications, for instance heart illness, blood infections as well as depression if they may be not taken care of on a timely basis.
When these questions were discussed at a meeting of medical cannabis activists, most could understand the reasons for my concern.
One good friend, and one of the heroes of the movement, absolutely supported these practices as a sign of healthy marketplace competition. He expressed the general feeling of many that doctors charge too much for their services, and patients would benefit if physicians were to have a price war.
I pointed out that there are two important purposes for a medical cannabis consultation: to give the patient competent evaluation and advice, and to provide the patient with the legal protection of the California Compassionate Use Act. If either of these is not accomplished, the price of the visit is no longer the important factor. A $50.00 visit is no bargain if the recommendation is indefensible, If a patient with deficient documentation gets arrested, the cost of attorney’s fees and court appearances will more than cancel out this kind of savings.
My standards for recommending medical cannabis, requiring documentation that the patent is seeing their primary doctor for the serious illness or symptoms that they medicate with cannabis, are geared to making the recommendation as “bullet-proof” as possible and avoiding this kind of expense and inconvenience.
It has been my experience that, on the occasions when law enforcement calls to verify a recommendation and I am able to say: ‘Not only did the patient consult me about his/her illness, but he/she sees his/her primary doctor regularly for this serious problem,” I almost always receive a polite reply along the lines of “Thank you, we just wanted to make sure it was a valid recommendation”. The big saving for patients is in not having to hire an attorney or go to court.
One activist pointed out that some doctors or clinic chains do not make anyone available to testify for patients anyway!
Since there seem to be varied expectations of what a medical cannabis recommendation should include, perhaps it would be useful to present the services I provide to my medical cannabis patients at this time:
Included in my fee are the following:
Consultation (45 minute first appointment; 30 minute yearly follow-up re-evaluation)
Recommendation for up to one year (if the patient’s use of medical cannabis is appropriate under the California law and the patient has met all my other requirements, which are described at the time of scheduling the appointment).
Brief telephone conferences with law enforcement, attorneys, employee health officers, etc, as needed, to verify validity of the recommendation. (While this is not my favorite thing, those of us who are experienced are good at it).
Adequate knowledge of the medical and legal aspects of cannabis so as to be able to testify in support of my patient in a court of law, and the willingness to do so.
NOT included in my fee:
Travel to and testifying in court or any other legal proceedings.
Written reports, disability evaluations.
This listing is not meant to be exhaustive, nor the “right way”. This is just the way my practice has evolved at this time, and I welcome your comments.
Protecting Doctors
I have now reviewed three cases of doctors under investigation by the Medical Board (MBC).
Most recently, I was asked by Americans for Safe Access to review a case of a doctor who was investigated for having recommended medical cannabis to a young adult, whose mother complained to the Board that she found this inappropriate. The doctor was ultimately charged with five “simple departures” and one
“ extreme departure” from the standard of care, and was scheduled for a settlement conference prior to a full hearing before an administrative law judge (ALJ).
I reviewed all of the patient’s records, and the MBC expert’s report and accusations. As usual, the expert appeared to be a reasonably competent doctor, but completely inexperienced in the actual standard of care appropriate for a limited medical-legal consultation.
I refuted the expert’s charges in a six-page declaration, which was presented to the Board’s prosecutor and the ALJ. The issues raised in my declaration, and excellent counsel by ASA attorney Joe Elford, resulted in acceptance by the doctor of one “simple departure” (with no license restriction), so as to avoid further legal costs.
Two factors make it more difficult to defend doctors investigated for recommending cannabis:
1. Inadequate documentation of diagnosis.
2. Providing cannabis recommendations in connection with dispensaries or clinics associated with dispensaries, as discussed above.
Although I am willing and able to try to defend doctors in both of these situations. it will be much less expensive for the doctor to avoid these two pitfalls.
Choosing a Consultant
How does one choose a doctor for a medical cannabis consultation?
Here are some qualities that I would suggest patients look for:
1. A good track record: physicians with substantial experience and a high level of comfort with medical cannabis.
2. Ability and willingness to testify in court for you should the patient’s medical use of cannabis be questioned.
3. Willingness to confirm the legitimacy of the cannabis recommendation if contacted by law enforcement (this may save the patient considerable expense for fees for providing court testimony)
4. Adequate and accessible medical record keeping, including supporting documentation from other providers. The physician who requires documentation of ongoing care of the patient’s illness by his or her treating physician, has the easiest time defending that patient to law enforcement.
Receiving a Masters of Education degree is a tremendous accomplishment. There is an enormous amount of work that goes into this type of degree and it is very important that the people that bother to do so be acknowledged. When they receive a Masters of Education degree they have earned an honor that most other people can’t or won’t do.
Using their Master of Education degree in the workforce will prove to be an asset for them. They will find that they are a much better choice than other workers, because they have demonstrated a higher level of discipline. They are more competitive and will receive the better paying jobs than people that did not receive this higher degree.
What patients can do to help their doctors (as well as themselves):
1. Have a primary care provider with whom you consult at least once a year regarding the serious illness or symptoms for which you use medical cannabis.
2. Bring records covering the last 12 months to your medical cannabis re-evaluation each year.
Know what auto insurance can do for you and your financial problem at the moment.