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Marijuana enforcement audit, part two, reveals more messes -- and too much money

Categories: Marijuana

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Wax Jones
Monday meeting.
In March, state auditors gave the Medical Marijuana Enforcement Division a bad review for its ineffective tracking systems and delayed application processes. But that was only part one of a two-part report. The other half was released yesterday.

The second part of the audit had the same dismal view of medical marijuana enforcement, but this time focused on the shortcomings of the Colorado Department of Public Health and Environment (CDPHE) and Department of Revenue (DOR).

The department was shown to have few oversights when it came to monitoring physicians, caregivers and processing applications, has been collecting too much in fees and needs to update technology.

The report is almost ninety pages long, and gives recommendations to correct problems in three areas: regulation, program administration and fiscal management. Here are the audit's main points on each issue:

REGULATION

Physician Oversight

The auditors found several issues regarding physicians issuing red cards. For the 106,000 MMJ patients currently on file, only a small number of doctors issued their referrals.

Below is a graphic which shows the average number of patients per physician in the country (the red line), and compares that with the top fifty physicians giving MMJ referrals.

top.50.physicians.jpg

Auditors also looked at several web advertisements for physicians, and found twelve made claims that indicated their medical evaluations would be genuine or objective. They claimed convenience for easy access to marijuana, said medical records were not necessary, offered refunds and guarantees, and showed that some dispensaries had on-site doctors. Much of this alludes to financial ties between dispensaries and physicians, which are prohibited.

The audit also had issues with physicians authorizing high plant counts, with one patient being recommended 501 plants (the typical is 6). More patients are also being referred to MMJ for severe pain, which the auditors say may be a cover for using the drug illegally.

The CDPHE has the ability to refer doctors to the medical board for further investigation, which it has -- but not since 2011.


Caregivers

The report shows that caregivers are almost completely unregulated; they do not have to pass any sort of checks to become a caregiver, their names are almost impossible to gain by law enforcement officials, and they are not monitored to ensure that they are doing their job. Caregivers are also supposed to do more than just grow for patients; they are supposed to provide living assistance, which is something that is presumably not happening in most scenarios.

Continue reading for more CDPHE flaws.


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30 comments
Monkey
Monkey

I guess the CDPHE found a way to appease the auditors without doing much. Here is their "fix" to the problems that don't exist. Nothing will change for patients, caregivers or doctors, but we'll have updated forms. The old caregiver waiver for more than 5 made the patient list what services their caregiver offers, now it appears caregivers will list that information whether they serve more than 5 patients or not. And doctors must include etiology, which most already did anyway. I'm glad to see the CDPHE understands they have no enforcement authority and are simply re-wording some forms to appease the auditors and get on with the simple registry they're required to keep.

New Forms Released August 1, 2013

REVISIONS TO EXISTING FORMSPhysician Certification. Etiology is now required for any designation of cachexia, severe nausea, seizures, persistent muscle spasms or severe pain. If etiology is not included, the physician certification will be rejected.

NEW FORMSMMR1012 Caregiver Acknowledgment. Caregivers must complete this form to acknowledge they are assuming significant responsibility for managing the patient’s well-being. If a caregiver has five or more patients currently, the patient must also complete optional Section C: Patient Limit Waiver.

OBSOLETE FORMMMR1009 Caregiver’s Patient Limit Waiver. With the introduction of MMR1012 Caregiver Acknowledgement, the Registry will no longer be using this form to approve caregivers with more than five patients.

Information can be found, oddly enough, in the MMC newsletter, June 2013.

Monkey
Monkey

The CDPHE is responsible for maintaing a registry, not overseeing doctors, patients or caregivers. Their job is to record the information patients submit, and verify that the physician recommending marijuana is a MD or DO licensed in Colorado. That's the extent of their responsibilities, they have no authority to question someones plant numbers, how many patients a doctor sees or how caregivers preform their duties.

CoreyDonahue
CoreyDonahue

How is this news?  It's all shit I said 2 years ago.  Also where are the conversations between Nixonlooper and the Feds becasue in a year I don't want to see a fucking news artical on the story I broke last year. 

CHN420
CHN420

Of course, buried in the report is the biggest news.  The "confidential" Registry has been linked up officially with the CCIC/NCIC law enforcement database, for any police office to query your name at will, to see if you are now or ever were a medical marijuana patient. Even the Auditor realizes that the CDPHE and the cops do not have the authority to do this.

Read starting on Page 65 of the report:

Public Health established a mechanism to provide law enforcement 24-hour Registry access in April 2013.

Through an agreement with the Colorado Bureau of Investigation (CBI), Public Health implemented an automated interface between the Registry and the Colorado Crime Information Center (CCIC), a statewide computer system that delivers criminal justice information to law enforcement agencies. Using the interface, law enforcement officers can query a patient’s name, date of birth, and red card serial number to determine if a patient’s card is valid. If the patient has a record in the Registry, the interface generates a response that includes the patient’s red card issuance and expiration dates, as well as the number of marijuana plants and ounces of medical marijuana that a physician recommended for the patient’s medicinal use.

It is not clear that Public Health has constitutional authority to provide information about patient plant and ounce counts through the Registry-CCIC interface. The Colorado Constitution [art. XVIII, sec. 14(3)(a)]specifies that law enforcement shall be granted Registry access “only for the purpose of verifying that an individual who has presented a registry identification card to a state or local law enforcement official is lawfully in possession of such card.” In the 2000 Blue Book, Amendment 20 proponents reiterated that law enforcement could access the Registry “to verify that an individual who is arrested for the possession or use of marijuana is registered” with Public Health. Knowing the quantities of medical marijuana that patients and their caregivers can legally possess does not appear to be necessary to verify that an individual is lawfully in possession of a red card.

DonkeyHotay
DonkeyHotay topcommenter

 "The cash fund has seen significant growth, climbing from a year-end balance of $301,000 in 2009 to over $12 million last year. Which this over-abundance of cash may not seem like a problem, it violates state statutes: The cash fund is supposed to generate only enough money to support the services being provided."

REFUND the EXCESS unlawful FEES charged to THE PATIENTS who paid them !!

Send REBATE CHECKS to EVERY PATIENT that ever paid the obscenely inflated $110 fee.

If the State can register and produce PHOTO ID's and Driver Licenses for $12 (twelve dollars), there is no reason why they can produce a lame piece of red paper for FAR LESS than that.


DonkeyHotay
DonkeyHotay topcommenter

 "The agency was also shown to have fifteen confidentiality breaches from 2009 to 2012. The breaches included sending patient information and red cards to wrong addresses, having the incorrect caregiver listed on a red card, exposing information to a public health employee that did not do work related to marijuana, and sending a spreadsheet with the names of all caregivers active in December 2012."

Where are those ignorant habitually wrong shitsuckers, Robert Chase, et. al.  who repeatedly claimed the database was secure?

DonkeyHotay
DonkeyHotay topcommenter

 "The report shows that caregivers are almost completely unregulated; they do not have to pass any sort of checks to become a caregiver, their names are almost impossible to gain by law enforcement officials, and they are not monitored to ensure that they are doing their job."

Good thing that A20 did NOT require ANY of the above. There is no more authority to regulate or pass checks upon caregivers or expose their names than there is for PATIENTS themselves, BOTH being protected by Constitutional Amendment 20.

Of course the Greedy Big $$ Dispensary Cartels, and their paid McLawyer Lobbyists, and their parasitic partners at the insatiable DOR continue to strive to RESTRICT and ELIMINATE the ability of Patients and their Private Caregivers to GROW THEIR OWN sustainable untaxed, unregulated supply.

DonkeyHotay
DonkeyHotay topcommenter

 "Auditors also looked at several web advertisements for physicians, and found twelve made claims that indicated their medical evaluations would [sic] be genuine or objective."

You forgot the negation.

DonkeyHotay
DonkeyHotay topcommenter

@Monkey ... exactly, maintaining the REGISTRY ... NOT REGULATING Physicians/Patient relationships, NOT REGULATING Patient/Caregiver relationships, and NOT judging the content of the documents presented to them for registration -- being that registration is ENTIRELY OPTIONAL to any rights and privileges established by Amendment 20.

Just as the County Clerks do NOT judge the content or validity of the documents presented to them for registration/recording -- mortgages, deeds, trusts, promissory notes, marriage records, etc. -- the CDPHE MMJ Registry also was given NO AUTHORITY or POWER by A20 to meddle in the content of the documents provided to them for filing.

The new requirements on the new forms, such as mandatory Etiology under penalty of rejection exceed the purview and authority granted by A20. Furthermore, a "rejected" recommendation by CDPHE would still maintain the validity and power granted by A20 for such physician recommendations, being that registration with CDPHE is optional under A20.


DonkeyHotay
DonkeyHotay topcommenter

@CHN420 " “only for the purpose of verifying that an individual who has presented a registry identification card to a state or local law enforcement official is lawfully in possession of such card.”

NO OTHER PURPOSE!

RobertChase
RobertChase topcommenter

@DonkeyHotayThe Audit Committee creates confusion by using the phrase "Medical Marijuana Cash Fund" to refer to the patient register fund maintained by the CDPHE for the direct and indirect administrative costs of maintaining the patient-register -- that is the fund in which the CDPHE has illegally accumulated $12 million by charging patients far more than its costs.  The "Medical marijuana license cash fund" was established by HB10-1284 for the purpose of funding the DOR's regulation of medical cannabis.  The prohibitionists (and certainly Beth McCann) would like nothing better than to divert the $12 million in the patient-register fund to just about any other purpose than what the Constitution mandates.  HB13-1283 as introduced (by McCann) would have stolen $10 million from the patient-register fund to give to Dr. Thurstone & Co. for "marijuana abuse treatment" -- his specialty. 

DonkeyHotay
DonkeyHotay topcommenter

... and what of the many Fraudulent Physicians that currently offer increased plant counts in return for extra $$ paid to the physician, on a sliding scale, more $$ = more plants.

Imagine a normal physician offering to write you larger medical prescriptions if you paid him more $$ for the script.

This, by far, is the MOST EGREGIOUS Physician Fraud in the industry.


jondoenumber22000
jondoenumber22000

@DonkeyHotay lol, if you think the pigs aren't checking you when you get pulled over for running a yellow light or going 1mph over the speed limit then i got some cheap ocean front property in Arizona and a bridge for sale in San Francisco that you may be interested in.

CHN420
CHN420

@DonkeyHotayAnd here is the statute that the CDPHE claims gives them the authority to link up with the CCIC/NCIC national crime database. This was part of HB 10--1284.

2. 25-1.5-106 (7) (d) A PRIMARY CAREGIVER SHALL PROVIDE TO A LAW ENFORCEMENT AGENCY, UPON INQUIRY, THE REGISTRY IDENTIFICATION CARD NUMBER OF EACH OF HIS OR HER PATIENTS. THE STATE HEALTH AGENCY SHALL MAINTAIN A REGISTRY OF THIS INFORMATION AND MAKE IT AVAILABLE TWENTY-FOUR HOURS PER DAY AND SEVEN DAYS A WEEK TO LAW ENFORCEMENT FOR VERIFICATION PURPOSES. UPON INQUIRY BY A LAW ENFORCEMENT OFFICER AS TO AN INDIVIDUAL'S STATUS AS A PATIENT OR PRIMARY CAREGIVER, THE STATE HEALTH AGENCY SHALL CHECK THE REGISTRY. IF THE INDIVIDUAL IS NOT REGISTERED AS A PATIENT OR PRIMARY CAREGIVER, THE STATE HEALTH AGENCY MAY PROVIDE THAT RESPONSE TO LAW ENFORCEMENT. IF THE PERSON IS A REGISTERED PATIENT OR PRIMARY CAREGIVER, THE STATE HEALTH AGENCY MAY NOT RELEASE INFORMATION UNLESS CONSISTENT WITH SECTION 14 OF ARTICLE XVIII OF THE STATE CONSTITUTION. THE STATE HEALTH AGENCY MAY PROMULGATE RULES TO PROVIDE FOR THE EFFICIENT ADMINISTRATION OF THIS PARAGRAPH (d). 

The Auditor report claims that the phrase "make it available" to law enforcement gave CDPHE the right to give law enforcement the database and create the CCIC/NCIC link. However, in the next sentence, this provision in HB1284 clearly says the "state health agency shall check the registry." It does not say that law enforcement has the right to check the Registry directly. 

So the CDPHE has neither the Constitutional nor statutory authority to create this link-up with law enforcement.

The MAIN point of a confidential registry was to keep that information OUT of the hands of law enforcement, and now CDPHE has handed them the entire database to query it at will. Seems the CDPHE has failed miserably in the only task that the Constitution empowered them to complete – to protect the registry. 

jondoenumber22000
jondoenumber22000

@DonkeyHotay yeah you should be able to just walk into a pharmacy and buy whatever you want. a doctor should only be needed to write you a "recommendation" when you're sick and don't know which specific antibiotic etc you need. and most of that could be done by a pharmacist or nurse practitioner  at a fraction of the cost and time. that's the real fraud. it's a government sanctioned protection racket for statist authoritarian control freaks.

CHN420
CHN420

@DonkeyHotay The ACLU is funded by Soros, same person who supported MPP's restrictive A20 and A64 models. This is what they wanted from the beginning. Remember, a "registry" and limits on conditions and possession and cultivation were not in the original Prop. 215 Compassionate Use mmj model. When Soros took over the funding of mmj initiatives, every one of them after that included a Registry (which Dennis Peron would NEVER have adopted) and a long list of restrictions on conditions and amounts.

So we are unlikely to get any help from the ACLU, since this is the model one of their funders has wanted from the beginning. As Brian Vicente says, they feel it is their job to make law enforcement's job easier, even if it harms the patients.

DonkeyHotay
DonkeyHotay topcommenter

@CHN420 ... HIPAA surely applies to Caregivers, who are -- by requirement of Colorado HDPE rules -- health care providers to their patients.

HIPAA would likely govern as a "Business Associate" the CDPHE as they receive the private patient health information from Caregivers, Physicians and Patients themselves.

Business Associate Defined. In general, a business associate is a person or organization, other than a member of a covered entity's workforce, that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of individually identifiable health information. 

DonkeyHotay
DonkeyHotay topcommenter

@CHN420 ... unfortunately -- but predictibly -- most of the Marijuana McLawyers have been completely coopted by Greedy Big $$ Dispensary Cartel interests, which are diametrically opposed to the best interests of Private Patients and Individual Caregivers.

Most individual patients / caregivers don't have the big $$ to mount such principled challenges to the gross usurpation of their rights that MMED / CDPHE and the Legislature have wrought.

One could try David Lane who's been know to take a good case pro-bono, and isn't a corrupted Marijuana McLawyer, or try their luck at the ACLU.


CHN420
CHN420

@DonkeyHotay I don't think HIPAA applies, as CDPHE is not a "covered entity". Only a health plan, a health care clearinghouse, or a health care provider is covered.

CHN420
CHN420

@DonkeyHotay Yep, but which attorney in the state has the knowledge and ambition to sue? Even if anyone had money for a lawsuit, who would you pick to do it? They all seem pretty worthless.

DonkeyHotay
DonkeyHotay topcommenter

@CHN420 ... the statute created by HB1284 was a gross infringement upon Private Patients and Individual Caregivers as created by A20, lobbied and paid for by the Greedy Big $$ Dispensary Cartel and their McLawyer pimps.

It not only violates the privacy provisions of A20, it violates Federal HIPAA 

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/privacysummary.pdf

Perhaps it's time for some patient(s) to sue HDPHE / DOR for their violations of patient privacy.

Most pathetic part is that 1000s of clueless stoners/patients were duped into shilling for and and actually promoted HB1284, to their own detriment.


jondoenumber22000
jondoenumber22000

@DonkeyHotay  i get what you're saying now.....if you disagree with anything the government does then you hate america. is that right jackass?

DonkeyHotay
DonkeyHotay topcommenter

@jondoenumber22000 "a government sanctioned protection racket for statist authoritarian control freaks. "

Why do you hate America?

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