Medical marijuana: Physician assistants the cause of delayed applications?

Thumbnail image for BREATHES.CARDsquare.jpg
The Colorado Department of Public Health and Environment announced last week that as many as 4,000 medical marijuana patient applications and renewals were being held up in order "to ensure patients and physicians are within guidelines." Despite the CDPHE's vagueness, we've learned that many the applications are being scrutinized because they were apparently completed by a physician's assistant and only signed off on by a doctor.

According to Carol Goddard, executive director of the Colorado Academy of Physician Assistants, physician assistants cannot recommend Schedule 1 drugs such as medical mariuana or even evaluate a patient for a recommendation for a Schedule 1 drug. Interestingly, however, they can prescribe Schedule 2 drugs like Oxycontin and even cocaine with DEA approval or the co-sign of a doctor,.

Vincent Palazzotto, director of the Medical Marijuana Assistance Program of America, says one of the docs associated with the MMAPA affiliate organization Mobile Doctors of America (MDARX) used physician assistants to perform the evaluations on about 800 patients for whom he subsequently signed recommendations -- a practice that was permitted at the time by the CDPHE, he maintains. But since then, the CDPHE has reversed that decision. "It's important to remember that this is a CDPHE thing," Palazzotto says, noting that the MDARX has letters from several professional medical groups that encourage the use of physician assistants on these evaluations.

Palazzotto says that MDARX has begun contacting patients who were evaluated by physician assistants and are experiencing delays in their application. But there's no need to wait for a call; patients can also phone MDARX at 1-855-632-7987 and set up a time to see a doctor again for free.

Unfortunately, not all doctors' groups are being as open about what is going on.

We've received numerous e-mails from patients who went to Well Docs, where they were evaluated by physician assistants before a doctor signed the recommendation. One patient who has been waiting over sixty days for his medical marijuana card says he was told by Well Docs that he would have an answer by December 15; the Well Docs rep advised him to call around that time to make sure.

The patient says he moved to Colorado a few months ago specifically to get a medical marijuana card for neurological pain issues. Because he's new to the area and didn't know any compassionate caregivers, he says he's stuck in a pretty rough spot. "For right now, no dispensaries will serve me because my papers are expired... Colorado is currently testing my will to go on. I am stuck at home and in pain constantly."

In answer to the complaints, Benjamin Einhorn sent a message to me from the Well Docs Facebook account last week: It read: "yes some of our liscences [sic] are on hold and any that are denied because of our doctor we are fixing for free when this whole thing comes down." But since then, the Facebook page for Well Docs has been shut down and I have been unable to reach Einhorn or any other representative at the numbers listed for their Denver and Boulder locations.

No word from the CDPHE when the issues may be resolved.

Editor's note: After the publication of this post, we received a note from MMAPA board member Betty Aldworth, who writes:

MMAPA does not conduct physician evaluations for MMJ, and does not facilitate those evaluations. MDARX (Mobile Doctors of America) is the company referred to in your piece. While MMAPA and MDARX do partner on a number of projects, they are separate entities with separate missions. MMAPA has a distinct board of directors with no control over MDARX, and as a member of that board it's important to me that the distinction between the organizations is clear.

The references have been altered in the text above to reflect Aldworth's information. We regret the error.

More from our Marijuana archive: "Med. marijuana patients pulled over by cops talking their way into jail?" and "Warren Edson on High Times Cannabis Cup in Amsterdam, 2012 Denver cup (VIDEO)."

My Voice Nation Help
25 comments
Sort: Newest | Oldest
well behaved
well behaved

Let’s getthe record straight………….The Registry first tried to eliminate providers to doMMJ certifications by the conditions and restrictions on a physician's license lastyear. This year the MMJ registry send vague messages that they were going tovoid applications that were completed and signed by a PA or NP because the SB10-109 states "(I) A PHYSICIAN AND A PATIENT HAVE A TREATMENT ORCOUNSELING RELATIONSHIP, IN THE COURSE OF WHICH THE PHYSICIAN HAS COMPLETED AFULL ASSESSMENT OF THE PATIENT’S MEDICAL HISTORY AND CURRENT MEDICAL CONDITION,INCLUDING AN APPROPRIATE PERSONAL PHYSICAL EXAMINATION; Do you really think aphysician would be fraudulent working professionally with PA/NPs?? No one isbreaking the law by delegating medical functions. Look at the legislation andrules that regulate physicians and NP/PAs…….

The factsare VITAL: Delegation of medical functions

From theDORA Board of Nursing site: Nurse Practice Act

In Colorado,the practice of professional nursing (including those listed on theadvanced practice registry) includes the performance of both independentnursing functions and delegated medical functions. The Board of Nursing (BON)considers RNs to be independent practitioners. http://www.dora.state.co.us/nu...

Dependentnursing function falls under delegated medical. CRS 12-38-103 (4) definesdelegated medical function to include the RN implementation of a medical plan.".a written plan, verbal order, standing order, or protocol - whetherpatient specific or not, that authorizes specific or discretionary medicalaction, which may include but is not limited to the selection ofmedication." The amount of physician oversight would be determined by thephysician and nurse involved in this process. http://www.dora.state.co.us/nu...

MedicalPractice Act:Rule 400 regarding PAs

4. Delegationof Medical Services. Delegated services must be consistent with thedelegating physician’s education, training, experience and active practice.Delegated services must be of the type that a reasonable and prudent physicianwould find within the scope of sound medical judgment to delegate. A physicianmay only delegate services that the physician is qualified and insured toperform and services that the physician has not been legally restricted fromperforming. Any services rendered by the physician assistant will be held tothe same standard that is applied to the delegating physician. http://www.dora.state.co.us/me...

And Policy:40-24 Title: Clarifying the scope of practice of Physician Assistants2-2010

PAs maylegally sign other documents and forms typically requiring a physiciansignature as authorized by the PA’s supervising physician and consistent withBoard of Medical Examiners Rule 400. http://www.dora.state.co.us/me...

Soas I see it, the MMJ Registry couldn't go after 1. the professionalrelationship between the physician and a PA or NP who accepts a delegatedmedical function 2. they sent in law enforcement to at least 2 NPs/PAs who weredoing evaluations and trying to frame them and scare the physicians who workwith them...but recently Dr. Aquino-Villman and Dr. Mestas were acquitted forthe same undercover police approach  3. TheyFINALLY decide to void applications over a second signature!!!! A frickingsecond signature!!!!!!!!!!!!!

Check thetimeline….FACTS speak. Thisis what has been happening. It is all making sense. No providers to docertifications...no patients to buy MMJ....industry in crisis....make the Fedshappy. Call yourlegislators, the Governor’s Office and the MMJ Registry COMPLAIN!   Support your physicians and physician’sassistants and nurse practitioners.

sadhu
sadhu

I received my rejection on Friday, two signatures again from Well Docs with Dr Sujdak and his Jerk NP.

There are gonna be a lot of angry people .. 

 Lawsuits are coming

Kagen Darlene Dismang
Kagen Darlene Dismang

I went to Well Docs as well with Dr. Sujdak and I got my rejection letter today. I had to go pay for a new evaluation and to send it off again. If theres a lawsuit I would like to hear about it

Blackwolf303
Blackwolf303

I attended a MDARX event in Northglenn about a month ago. My recommendation was signed by a PA. I was ensured that this was ok and normal practice. I was contacted by CPDHE and was told my app is being kicked back due to the two signatures. The signing doctors name was Frank. J. Wright MS out of Ft. Collins ..he has flew the coop and i can't find him. Has anyone used this doc? If so, what were your results in solving this issue? I will continue to search for Mr. Wright and hold him accountable when he is found.

Michael Roberts
Michael Roberts

Thank you for sharing your experiences, Blackwolf. Look for more on this subject in a future Latest Word post.

gianna
gianna

I want to stress that hundreds of people who had legitimate doctor's exams have been held up too.  My clinic did some exams with PA's, so all of the clinic's patients have been held up.  My app was received 9/26, and I just got a call saying that my app has been verified and will be processed in the next two weeks.  However, MMR admits that they did not screen these apps for other errors, which might cause them to be rejected.  So some of us are likely to wait three months to get rejected.  Mine included an indigency waiver, but the rules for that keep changing.  So I fear that for some technicality about the waiver may still keep me from getting my renewal, after 3 months already.

MMJ Timmy Top Thompson
MMJ Timmy Top Thompson

This is just such a shame for the MMJ community. I think that Colorado is leading the way in doing things right, and I, while sympathetic for the bystanders of this ordeal, agree with the caution being exercised. We need to continue doing things in the proper fashion, with MMJ regulations and continue to create order from the chaos, until it is plain as day that the Colorado MMJ community is completely legitimate, and following the laws that we've passed.

Guest
Guest

Well Docs Changed their name to Rocky Mountain Patient Services. Same locations new name.

Charnollett
Charnollett

Well Docs Doctor and offices are being used under Rocky Mountain Patient Services!

MMJGal
MMJGal

Does anyone know if WellDocs re-name themselves Rocky Mountain Patient Services? 

Rsji2004
Rsji2004

Rocky Mountain Patients Services purchased well docs office leases we are NOT associated with well docs. All of our docs are in good standing. We have been in business since 2009 and have a 5 * rating.

Rsji2004
Rsji2004

We started as dispensary and as of 2010 are no longer. We moved forward with helping patients obtain their mmj evals with docs and provide an excellent service, great attitude. All of our patients send referrals because we do provide good honest business.

Troy
Troy

So who is to blame? From what I understand rules were changed recently to prohibit physicians assistants from recommending marijuana. So, were the clinics with PAs signing unaware of the rule change and if so, did the cdphe adequately notify docs of the change? Or is the cdphe nitpicking over applications signed by PAs and dated prior to the rule effective date but weren't processed until after the new rule was implemented?

BOH hates MJ patients
BOH hates MJ patients

the rule change went into effect 10/25 - but the ARE INDEED holding apps from the beginning of October.

Troy
Troy

Damn.  Wish the westword would make this clear in the articles if it is the case.  The board of health seems to have a history of changing the medical marijuana rules and then enforcing them on applications dated prior to the rule change.  If the applications are notarized before 10/25 I don't see how the cdphe can legally hold them to rules that take effect on 10/25.

Nate505
Nate505

They started enforcing part of the Amendment a mere month (and a week or so) ago when the Amendment has been on the books for over a year?  I know bureaucracy is slow, but that doesn't seem like they are just merely enforcing something...unless they are that amazingly stupid and inefficient, which is starting to become not hard to believe.

Waiting
Waiting

I maintain that CDPHE did NOT change the rules, they merely started enforcing what is written in the State Constitutional Amendment.  It clearly states that only a doctor of medicine can write the referrals.  This has been the case since the beginning, they merely caught on to it happening and started enforcing it. 

Troy
Troy

Thanks william

William Breathes
William Breathes

 Troy, we would love to make this more clear. Unfortunately, we have yet to get clarification from the CDPHE. When we do, we'll be sure to update everyone on the situation.

Troy
Troy

And what does this mean in regards to other patients that got approved earlier in the year for licenses by seeing a PA that had a doc co-sign, are these licenses still legal?

Leave Behind
Leave Behind

For the record, the Medical Marijuana Assistance Program of America (MMAPA) is an alternative treatment assistance program that connects hospice patients, disabled veterans, and the indigent community to a network of alternative treatment service providers who provide low cost medicine and evaluations on our behalf.  

MMAPA works alongside Mobile Doctors of America to bring referring physicians (and previously PA's) to areas of the state where there have been few physicians willing to accept patients at low-to-no cost.  Due to the recent changes the CDPHE has implemented, Mobile Doctors of America is currently interviewing physicians who are interested in fulfilling our organization's mission of providing affordable and accessible evaluations throughout the state. 

For more information or to get involved, please contact us at 855-632-7987 or visit www.MMAPA.us  

Sincerely,The MMAPA Team

Zan Dimmer
Zan Dimmer

Someone help that poor patient out. People need to be more compassionate. MMED is just following the rules. Places like MMAPA and WellDocs are exactly what this industry is being based on. Green rushers trying to make a quick million and bail. Go to your primary physician and ask him if he will recommend Medical Marijuana for you, if he refused you may want to look for another primary your doctor should always listen to your problems and help where they can.

Side note: PA are allowed to prescribe oxy? Well that ones easy to explain... Big Pharma has made there way into their offices already and these doctors andddddddd PA's get paid to prescribe Oxy and such..

Colorado Mmj Patient
Colorado Mmj Patient

This bullshit is a complete MESS. I know of several patients that are truly suffering because of this. CDPHE has enough money to hire more people, why can't they get this figured out?

Now Trending

From the Vault

 

Loading...