We were in clinic in Vanderbilt and a patient came in with a worried look.  He had just gotten a colored piece of paper in the mail, asking him to do his renewal through the mail in exchange for a check.  Once he paid for the paperwork, he could stop at a hotel room and get a 'complimentary visit'  with a doctor and pick up his filled out paperwork for the state.  He thought it was shady- paying for the paperwork and getting a free visit with a doctor to make it 'legal'.

The law changed April 1st, with the goal of shutting down the signature mills and making medical marijuana certifications just like any other visit with the doctor.  But, as the old story goes, good doctors don't need to be forced to be good doctors with a change in the law, and those that found the loopholes before the law change would continue to find them afterward.  Pay for the paperwork, get a free visit with the doctor to make it legal.

At Denali Healthcare, our physicians and medical staff evaluate patients.  We make decisions and recommendation based on training and experience.  We stand behind our patients and can justify our decisions and recommendations in court if need be.  THAT is what we charge for.  The paperwork is 'complimentary'.

Are you paying for a doctor visit, or are you buying paperwork and the doctor is an afterthought to make it 'legal'?  What did the voters intend?  What does the law require?  What protects you in court?  We as a community have to decide what we are comfortable with- do we do things right or do we see what loopholes we can find?  It isn't hard to do things right.

It has been brought to my attention that many patients have received denials from another certification clinic, MMMCC, due to the physician continuing to sign certifications months after his license to practice medicine in Michigan expired.  This clinic is active in Gaylord and Grand Rapids and is based out of the Detroit area.  

Many of these patients are coming to me to have their certifications done again, correctly.  While I charge for certifications, I don't feel it is right to charge these patients again after they already paid the internet clinic for an invalid certification.  I've contacted that clinic and they refuse to cover the cost of the repeat certification.  Accordingly, I will see these pateints free of charge to correct their certifications in my Muskegon Office (for the GR patients) on May 11th, and in my Gaylord office on May 17th.  See my clinical calendar for locations, times, and contact numbers for these clinics.

Due to changes in the certification rules, this kind of activity will no longer protect patients in court.  Accordingly, I've decided to step forward for the community and take corrective action to protect the patients that got invalid certifications from this clinic.  We DO require medical records, so bring them with you when you come to our clinics, along with your old certification documents.  You will see me personally for your recertification, a valid one.  You must bring the certification paperwork from this clinic and Dr. Gonte (signed between 1-1-13 and now) to receive the free 're do' of the certification.

The new certification forms are out and can be downloaded from the state website here.  The state will continue to accept the old forms for the month of April, BUT they will only qualify you for a ONE YEAR card.  It has come to our attention that some patients are still being issued the old forms with their certification due to the failure of their doctors/clinics to update to the new forms.  Make sure your certification is with a clinic that follows the current guidelines (you meet with the doctor, you are required to have medical records, there is a follow up, and the new forms are used).

The price of the registration with the state is still $100 for the new two year certification, and samples of the documents needed for the $25 reduced fee can be found here.  Our prices for the certification visit, which include free follow up and free expert witness services from the doctor, have not changed.  

Stay tuned to the website for our new on line application process, which will streamline your forms and allow you to qualify for a reduced price for your certification.  You will still have to meet in person with the physician at one of our clinics, but the on line paperwork and prepayment will reduce errors and make filling out the state forms a breeze.  They will also create a secured, on line medical record for you to obtain copies of your certification documents, do on line follow ups, and replace your paper records in our office (in the unlikely event law enforcement ever tries to seize our records, once you renew on line your records are no longer there).

Remember to check your expiration dates and refer to our clinic schedule to renew your certifications.

Dr. Bob

Well the dreaded change in the law is here, no more no record mills, telemedicine, and the world is ending.  Or is it?

Yes there will be some changes, and my hand has been forced to some extent.  We shut down this first week to get the dust a chance to settle, I took a well earned vacation (but ended up having to replace the transmission in the Yukon down in Pensacola) and we are working on some exciting things.

First off the bat, I am going to pull back a little to my main offices to try and reduce the 6000 plus miles I drive every month.  Dr. Harwell is no longer in practice so I am taking over his offices in Muskegon, Grand Rapids, and Ann Arbor and his charts.  I didn't buy them or ask for them, but he wanted me to have them so his patients were well cared for.  That will give me about a dozen fixed base offices, and 15-20 travel clinics.  We are looking at adding additional physicians to cover the expanding practice.

Second, the new forms are a blessing really.  Yes they are longer and somewhat complexed, but they lend themselves very well to automation.  Yes, we are entering the 21st century.  ALL clinic actions, from the new and renewal applications, to release of information, to caregiver change forms will be available on line.  Not in the form from the state, but in a SIMPLE and EASY to read form which will be used to populate the state forms for you, and correctly every time.  No rejections because a birthdate was wrong or a box not checked.  Most denials are due to paperwork not being filled out correctly, these on line operation will eliminate that.  

Sometimes we do great then hang ourselves!  Just wanted to give everyone a laugh and something they could remember in this situation.

Dr. Bob

As many of you have heard, Dr. Harwell of Triple M Clinics was arrested in Cadillac last week.  This is going to be an important case for medical marijuana in Michigan.  Dr. Harwell is a competitor of mine, the only significant clinic other than mine in N. Michigan.  The issue is not so much how he did certifications, which is different than my approach, but the nature of the charges.

The doc is accused of taking a patient complaint of headache and transforming that into 'severe and chronic pain'. He is accused of conspiring with the patient by asking something along the line of 'these headaches, are they chronic?'.

Whether he is a good doctor, or has good interview skills, or asks leading questions to a false diagnosis is a matter for the medical board, not a criminal court. Pre-signed certifications, certifications issued with no medical records and no doctor/patient contact, and the like are fraud. That is a criminal act. That is 'selling signatures' for a schedule 1 controlled substance. That is not what happened.

This is the new dispensary.  $300-400 will get you this entire set up.

The Michigan Supreme Court has issued the long awaited McQueen Ruling.  There are no surprises, P2P, Farmers Markets, and Dispensaries have never been defined in the act as clearly as the self growing patient and the caregiver/registry desginated patient system.  What is very unfortunate is that the court voided a very favorable opinion from the CoA- The Green opinion which allowed patients to help each other in times of need with free transfers as part of medical use.

Now is not the time to vent about how the SC got it wrong, or try and figure out ways to 'game' the system.  1 patient, 12 plants, 1 caregiver, 5 patients.  That is the rule of law now.  Go outside of it privately if you must, just don't get caught doing it.  It is my hope for my patients that the legislature will look into addressing the problems of supply, crop failures and folks that can't grow for themselves and can't find caregivers.

Bills as Passed

HB 4834   HB 4851   HB 4853   HB 4856

This is a nice summary forwarded from Brad Forrester in Cheboygan...
CHANGES TO THE MMMACT AS A RESULT OF LEGISLATION PASSED ON 12/13/2012

HB 4834 amends Section 6 of the MMMAct (MCL 333.26426)

1)  There is now a requirement that patients and caregivers be Michigan residents.

PROOF OF MICHIGAN RESIDENCY
For the purposes of this subdivision, a person shall be considered to have proved legal residency in this state if any of the following apply:

(i) The person provides a copy of a valid, lawfully obtained Michigan Driver License issued under
          the Michigan Vehicle Code, 1949 PA 300, MCL 257.1 to 257.923, or an official State Personal\
          Identification Card issued under 1972 PA 222, MCL 28.291 to 28.300.

(ii) The person provides a copy of a valid Michigan voter registration.

2)  The MMMAct states the department shall verify an application within 15 days from the day it is received by the department. This was changed to 15 BUSINESS days (M-F), weekends no longer
     count toward the 15 day verification process.

3)  The MMMAct states the department has 5 days to mail out card to qualifying patients and caregivers. This was changed to 5 BUSINESS days (M-F), weekends no longer count toward the
5 days the department has to mail out your card.

4)  The MMMAct states that MMP Registry I.D. cards are good for one year. This was extended to
two (2) years.