A Colorado Physician Responds to SB 109
Submitted by lebowski on Tue, 02/02/2010 - 09:07
Publish Date:
02/02/2010
To whom it may concern,
Regarding Senate Bill 109, I think this is a case of legislators trying to regulate something that they do not fully understand. I am not sure if any of the legislators have been physicians or have any knowledge of the medical profession.
I am a physician here in private practice in Denver and I also do medical marijuana evaluations. I think that this particular law is misguided in several ways. For instance, currently for my evaluations, I do keep records on every patient seen just as I do in my regular practice. In addition, I also inform the patients of their HIPPA rights and keep their files private as I would any other patient. Each patient is seen and their physical findings are documented such as scars, limps, amputions or other physical findings. The patients do not all have a full physical examination, however, I do document any physical findings that are pertinent. In addition, when I see patients at my regular practice, they do not receive a full examination at every visit. If a patient is coming to the doctor for a sore throat, I do not do a Pap Smear or neurological exam on them for instance. I do check their throat, ears and lungs and heart as well as for a rash. This is consistent with the standards of medical practice.
In addition, many conditions do not have any physical findings. If I have a patient suffering from migraines, they do not have any physical findings unless they are actually having a migraine the day they visit my office and usually if they are having a migraine, they do not come to the primary care doctors office or the medical marijuana evaluation either. From that perspective, a patient suffering from AIDS, breast or lung cancer, or glaucoma may not have any findings on physical exam. AIDS patients are diagnosed by blood work which is not done in the doctor’s office. Glaucoma patients can be diagnosed but only with specialized equipment found in opthomologists’ offices. Breast or lung cancer may not be apparent unless the patient has already had a mastectomy or a lung removed.
If I have a patient that suffers from migraines, I do not require them to come into my office in tears, vomiting from the nausea before I would prescribe them migraine medications. I think this would be cruel. I also have many patients that have old back injuries that periodically use pain killers or muscle relaxers for their backs. I do not require them to get an MRI every year or come to the office if they are so bad they cannot even get out of bed that day. If they are not having a flare-up, there are not going to be any physical findings on that particular visit.
I do believe that sometimes patients are fraudulent both in my regular primary care office as well as the marijuana evaluations but I think it is a doctor’s responsibility to believe his patients for the most part. For instance, I have several obese patients who swear to me that they exercise every day and follow a low calorie, low fat diet. I do find this incredulous, but I do not deny these patients their cholesterol or blood pressure medications because perhaps they are not completely truthful. For that matter, I do not deny them their pain medications for the arthritis that obesity contributes to.
I find that medical marijuana has helped some patients that other therapies have not been very helpful or have been toxic. Several patients are using this in conjunction with their regular medications as well as chiropractic manipulation, acupuncture, chemotherapy and other modalities. Since many pain conditions are chronic , I am supportive of patients using different modalities to treat their pain. Many patients also have intermittent conditions such as gout for which they only need medication a few times a year. In addition there are double blinded placebo controlled studies supporting the use of marijuana for various conditions.
I find that many of my patients are already frustrated by having their insurance companies tell the doctors what medications they can and cannot use and now the government is doing the same thing. I do think there are physicians that are unethical, but this is not limited to the medical marijuana physicians and if a patient goes to a pain clinic for vicodin refills, the doctor does not even see the patients every time and gives them refills and I can guarantee you that they take a less comprehensive history than I do. I wonder if any of the congressmen sponsoring this law have ever actually visited a physician.
I believe that by regulating the medical marijuana in the proposed way, the legislators are going to punish some of the doctors that are perhaps less ethical in their approach to patient care, but I believe that many more patients are going to suffer than the few “bad” doctors out there. These same doctors are also probably not the best physicians out in private practice and perhaps the provision that doctors that have been previously sanctioned should not be allowed to prescribe is not a bad idea, but that would really depend on what the doctor was sanctioned for and should probably be evaluated on a case by case basis.
I became a physician to alleviate suffering and disease and really try to help my patients. I believe in upholding the Hippocratic Oath. I wonder if the legislators are upholding their obligations to their constituents when trying to cut down on medicinal marijuana which was obviously favored by the majority of their constituents when passed as a constitutional amendment.
Thank you for your time and please feel free to contact me with any questions or concerns,
Dr. S
An addendum:
In addition, to those that have reported that they feel that when dispensaries owners or caregivers pay the physicians there is a conflict of interest, I would like to point out that there are clinics in Walmarts and Walgreen's all over town. Just like in the dispensaries, the physicians and providers there will see a patient and write a prescription. The patient is then allowed to go anywhere in the state of Colorado to fill their prescription. The patients are most likely to fill their prescriptions at the walmart or walgreens because they are already there, but they are not required to do so. I do not see how this differs from the patients getting the recommendation at a dispensary. They are welcome to purchase their medication then at a dispensary, but they can also go to any dispensary in town with the appropriate documentation. For that matter, if conflicts of interest are really a concern, how about going after the insurance companies who have no interest at all in the health of patients and try to limit their care at every opportunity in order to make a profit. It should also be noted that the insurance companies are actually paying the physicians and some physicians in HMO's are bonused on how much money the doctor "saves" the HMO, not on how many lives the doctor saves. Talk about a conflict of interest. Not only that, but most of the visits for the medical marijuana evaluations are paid by the patients and not by a dispensary or caregiver.
I also would like to note that there is no requirement for a minimum number of visits, age, physical or other restrictions for physicians with any other medications from antibiotics to blood pressure medications to narcotics. There is no restriction for a physician recommending vitamins or other supplements or chinese herbs if the physician feels like it is in the best interest of the patient.
I would also like to comment that I have never been sued for malpractice and have not been sanctioned by the board or had any disciplinary actions by the board in the past and am in good standing in the professional community. I also do not use medicinal marijuana as I do not have any conditions for which I need it and have not been a user in the past, but I do support it's use for patients that need it.
Once again, thank you for your consideration.
Dr. S
It states pretty clearly that patients will not even be allowed to grow their own medicine. It will shut down the dispensaries as well. The cost for a patients to obtain a card will also go up to about $1000.
in downtown denver).