Medical marijuana: CDPHE's Dr. Chris Urbina on physician assistants, patient denials
By mid-January, as many as 4,200 potential medical marijuana patients will be told they are as much to blame for a "fraudulent" MMJ application as the doctor who signed off on a physician assistant's evaluation of that patient. The punishment? Waiting six months before they can apply again for the medication they needed a few months ago when they actually started the process.
In a press release on Friday, the Colorado Department of Public Health and Environment finally addressed growing concern among patients about medical marijuana applications being denied because of issues with physician assistants allegedly performing evaluations.
According to the CDPHE, a denial letter will be sent out to those patients who visited with physician assistants and not doctors, according to the department's interpretation of state law that says patients must have a working relationship with an actual physician.
Keep in mind that while this law currently prevents physician assistants from doing medical marijuana evaluations now, they still can do everything from sewing up a wound to prescribing Oxycontin. As a constant emergency room patient myself, I've been attended to more by PAs than actual doctors. I can completely understand why patients who have spent any time dealing with the health-care system for their debilitating condition wouldn't think twice about seeing a PA for an MMJ evaluation. But apparently the CDPHE doesn't and essentially is saying patients who trusted their doctor and health-care provider to do the right thing should be punished by not getting the meds they need.
I spoke with CDPHE director Dr. Chris Urbina yesterday. He explained the department's reasoning:
"We took this seriously," he says. "We contacted the physicians to find out, first of all, if they had actually seen the patients. That was the important piece, because by constitution, by law, the physician has to have a working relationship with the patient to make a determination of 1) Do they have a debilitating condition that they can apply for a medical marijuana card, and 2) Does the physician then have a long term relationship so that he or she can monitor the patient to make sure their condition is either not getting better, etc. just like a physician-patient relationship you would expect. And finally, do they have some documentation of that. So, in those cases we are reviewing this with the physicians. And those cases where they didn't have a relationship, those cases will be denied."
Again, that sounds like punishing patients for someone else's mistake -- especially considering the CDPHE has the ability to simply reject the applications and allow patients to visit another doctor immediately. As the CDPHE also mentioned in the press release: "Denied applicants must wait six months from the date of denial before reapplying for the registry. Rejected applicants can resubmit a new application without delay and without the additional application processing fee."
But not Urbina, who says the CDPHE is merely following the letter of the law outlined by the constitution and recent legislation.
Page down for more of our interview with Dr. Ubrina. "The issue is, if the physician said they did not see the patient, that is clearly a denial. If it is unclear whether or not they saw the patient or not, it's a rejection. We are being very careful about not trying to penalize patients in any way."
How does this interpretation not punish patients?
"I understand what your question is leading to," he responds. "I think the medical marijuana rules are written very clearly. I think you know what they are. They have to have a treatment relationship that includes a personal physical examination and they have to consult with a physician. In this case, the constitution regarding medical marijuana and the law is more specific than other debilitating conditions.... I understand where you're saying. I do."
He might. But denying patients medicine for six months when they thought they were doing the right thing shows little understanding from the CDPHE. To me, it also says that the CDPHE doesn't take marijuana as seriously as other medicine, as I doubt such a policy would be used for any other legal substance -- especially if the patient was acting in good faith when they trusted their healthcare provider. However, Urbina, an active physician himself, denied my assertion.
"All medications and medical marijuana are under tight scrutiny. As a physician, I managed lots of patients with chronic, debilitating conditions and I had to follow the law and I had to develop a very close working relationship with patients. I think the same conditions exist for medical marijuana. The rules are very similar in terms of the physician-patient relationship, so we are taking this very seriously."
One thing that the CDPHE release didn't mention was that patients have the right to appeal the denial. Appeals and requests for hearings have to be filed in writing within thirty days of the denial with the CDPHE. That said, if the board you are up against interprets the law the same way that Urbina has, it seems there's little chance of having the decision reversed right now.
As for patients just applying, Urbina has the following bit of advice:
"Going forward, as we continue to investigate these cases, we urge patients to seek confirmation from the health care providers and physicians that the provider is indeed a physician with no impediments to their ability to recommend medical marijuana. We don't want anyone else to be caught in this situation going forward.... They want to check to make sure that they are following the law."
I can understand that going forward. The department has made its stance clear. But for the 4,200 sitting in limbo now, denying them outright seems more like a political jab at medical marijuana while completely ignoring people in pain. I think Colorado voters expected more than that when we voted for Amendment 20 over a decade ago as a way to provide compassionate care.
William Breathes is the pot pen name for our medical marijuana dispensary critic. His dispensary reviews run weekly in our marijuana blog Mile Highs and Lows. Keep up with all your marijuana news, entertainment and occasional opinions like this at The Latest Word.
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