Hello michigan

st0wandgrow said:

So, what is the consensus here? This is kind of important for patients to know.

Seems pretty clear that an in-person exam is now codified in to law based on what Dr Bob posted. If his info is correct, I'd say it's kind of irresponsible for CCC to continue doing telemedicine certs. Adam, you talked a great deal about being advocates for your patients, but your actions don't seem to back up your words IMO.[/QUOTE

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st0wandgrow said:

So, what is the consensus here? This is kind of important for patients to know.

Seems pretty clear that an in-person exam is now codified in to law based on what Dr Bob posted. If his info is correct, I'd say it's kind of irresponsible for CCC to continue doing telemedicine certs. Adam, you talked a great deal about being advocates for your patients, but your actions don't seem to back up your words IMO.

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Patients who engage in telemed put themselves at risk. Their protection is only assured in the event of a bona fide relationship within the law. That requires "...a relevant, in-person, medical evaluation of the patient." If they are telecertified they do not meet that requirement, and they can be prohibited from using the protections of the MMMA and subsequently convicted and jailed, as can be their careigivers.

GregS said:

Patients who engage in telemed put themselves at risk. Their protection is only assured in the event of a bona fide relationship within the law. That requires "...a relevant, in-person, medical evaluation of the patient." If they are telecertified they do not meet that requirement, and they can be prohibited from using the protections of the MMMA and subsequently convicted and jailed, as can be their careigivers.

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It seems tragic that a patients protections under the law can stripped by another's (pot doc's) legal transgressions. At some point ignorance of the law is just going to have to be a defense under the law, as a majority of American's cannot simply afford an attorney ...

I know I have said that I do not want to participate in this thread, but when people call out my integrity, I have to respond. Nobody, and I mean NOBODY, has done more than the staff of our medical center to stand up for the rights of patients. We are there full time for our patients for whatever they need. Patients come in and tell us almost daily about how they could get no assistance on denials or for questions from most certification centers. Just because we are not down in Lansing working on legislation or doing other "high profile" activism, does not mean that we are not living this movement. It does not mean that we are willing in any way to put patients at risk. If anyone on this thread had ever met us or come into our medical center they would know that the very mention of this is simply ludicrous and obviously part of an agenda.

Here is a challenge for all the people who believe the nonsense being spread by one person (yes, just one person who has others hoodwinked by a hidden agenda) about telemed: Please site ONE CASE where the prosecution has ever raised the issue of telemed either successfully or not. It is not enough to quote the doctor on this thread as an authority. Quote one case. Any case. No? Because there has never been one, folks. The new telemed laws state:

As used in this section, “telemedicine” means the use of an electronic media to link patients with health care
professionals in different locations. To be considered telemedicine under this section, the health care professional must
be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the
patient must be able to interact with the off-site health care professional at the time the services are provided.

Who do people think does almost all of the physical examinations in doctor's offices? When you get weighed, it is the nurse who does this. When you get your blood pressure taken, who does it? It is the staff of the medical center that does it. We have an on-staff social worker and a medical assistant.

Telemed includes in person in its definition. The MMMA did not change medical law and policy in Michigan. It falls under Uniformity and as such is included if not specifically excluded. Internet medicine means never seeing the doctor. It refers to using email to send records, consult with the doctor (if that actually happens) and getting a cert (in the case of medical marijuana) mailed to your address. This does not include telemed. Period. It has nothing to do with it.

Read the bills I posted earlier in this thread. They are very clear, and none of the changes to the MMMA did away with this law in Michigan.

Here is another question I would like answered by anyone: How would you feel about a doctor delegating authority to their nurse to certify you? What if you went to a certification center, saw a nurse when you thought you were seeing a doctor and received your certification that way? What do you think would happen if the prosecutor was able to find this out? Do you think a nurse certifying you would hold up in court? Does this even pass the sniff test of informed consent?

The MMMA clearly states that a person must be certified by an MD or DO. The law never said that a nurse could certify you. How would you feel if you found out this had happened to you? What kind of defense could you mount with a certification that was done this way.

People who live in glass houses should not throw stones.

who cares.this is a forum to grow and smoke not listen to some buthurt bullshit looking more like advertising with motive imoa lol what if.what if my grandma had wheels she would be a car

Perhaps there are other threads that you would enjoy more, Freebloody.

freebloody said:

who cares.this is a forum to grow and smoke not listen to some buthurt bullshit looking more like advertising with motive imoa lol what if.what if my grandma had wheels she would be a car

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This is a patients forum.

GSTATUS said:

Hi everyone. I have the oppurtunity to move to traverse city Michigan at the end of next month. One of the perks is I've been told I can very easily obtain a medical marijuana card and grow legally. I feel overwhelmed with happiness just thinking about this!

If someone can answer a few questions I would greatly appreciate it. I do not exactly have any serious illnesses but I was told that I could get the card with no problem and no medical records. Could this be true? I would hate to move there and it end up being heresay. Are there any experienced michiganers out there that I can talk with?

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Adam from TC said:

I know I have said that I do not want to participate in this thread, but when people call out my integrity, I have to respond. Nobody, and I mean NOBODY, has done more than the staff of our medical center to stand up for the rights of patients. We are there full time for our patients for whatever they need. Patients come in and tell us almost daily about how they could get no assistance on denials or for questions from most certification centers. Just because we are not down in Lansing working on legislation or doing other "high profile" activism, does not mean that we are not living this movement. It does not mean that we are willing in any way to put patients at risk. If anyone on this thread had ever met us or come into our medical center they would know that the very mention of this is simply ludicrous and obviously part of an agenda.

Here is a challenge for all the people who believe the nonsense being spread by one person (yes, just one person who has others hoodwinked by a hidden agenda) about telemed: Please site ONE CASE where the prosecution has ever raised the issue of telemed either successfully or not. It is not enough to quote the doctor on this thread as an authority. Quote one case. Any case. No? Because there has never been one, folks. The new telemed laws state:

As used in this section, “telemedicine” means the use of an electronic media to link patients with health care
professionals in different locations. To be considered telemedicine under this section, the health care professional must
be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the
patient must be able to interact with the off-site health care professional at the time the services are provided.

Who do people think does almost all of the physical examinations in doctor's offices? When you get weighed, it is the nurse who does this. When you get your blood pressure taken, who does it? It is the staff of the medical center that does it. We have an on-staff social worker and a medical assistant.

Telemed includes in person in its definition. The MMMA did not change medical law and policy in Michigan. It falls under Uniformity and as such is included if not specifically excluded. Internet medicine means never seeing the doctor. It refers to using email to send records, consult with the doctor (if that actually happens) and getting a cert (in the case of medical marijuana) mailed to your address. This does not include telemed. Period. It has nothing to do with it.

Read the bills I posted earlier in this thread. They are very clear, and none of the changes to the MMMA did away with this law in Michigan.

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But in the law according to LARA it says "in person". Common sense would tell you that means live and in the flesh not on tv or on the phone. And yes it's the nurse who does the menial things like bp and weight but when it comes to the actual exam and me telling my doc that my arthritic knee has been very bothersome as of late it's the doc that feels my knee and checks for range of motion and the hands on stuff not the nurse.

Adam from TC said:

Here is another question I would like answered by anyone: How would you feel about a doctor delegating authority to their nurse to certify you? What if you went to a certification center, saw a nurse when you thought you were seeing a doctor and received your certification that way? What do you think would happen if the prosecutor was able to find this out? Do you think a nurse certifying you would hold up in court? Does this even pass the sniff test of informed consent?

The MMMA clearly states that a person must be certified by an MD or DO. The law never said that a nurse could certify you. How would you feel if you found out this had happened to you? What kind of defense could you mount with a certification that was done this way.

People who live in glass houses should not throw stones.

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This is very simple. Just as telemed does not pass muster as a bona fide requirement, neither do a nurse or nurse practitioner's involvement as the certifying health professional. IF it were to be demonstrated as a fact in a case, it would be entirely indefensible. There is no latitude given in the law to permit that. I cannot agree that your statement that a telemed exam is in any way equivalent to an in person exam. I expect that the section of law you cite is somewhere in the public health code. Because it conflicts with the MMMA it is null and void and without effect per sec. 7(e): All other acts and parts of acts inconsistent with this act do not apply to the medical use of marihuana as provided for by this act. While I do not disagree that cannabis certification is something that would benefit from permission to use telemed, it is forbidden by statute. I am unaware of any case that has been brought to court in which it is part of the prosecution case. That, however, does not mean that it has not come up.

Are you suggesting that you use telemed and'/or delegate certification responsibility to nurses, nurse practitioners, or physician assistants?

And by the by, slander and libel are not recoverable torts if they are the truth or a parody.

Adam from TC said:

I know I have said that I do not want to participate in this thread, but when people call out my integrity, I have to respond. Nobody, and I mean NOBODY, has done more than the staff of our medical center to stand up for the rights of patients. We are there full time for our patients for whatever they need. Patients come in and tell us almost daily about how they could get no assistance on denials or for questions from most certification centers. Just because we are not down in Lansing working on legislation or doing other "high profile" activism, does not mean that we are not living this movement. It does not mean that we are willing in any way to put patients at risk. If anyone on this thread had ever met us or come into our medical center they would know that the very mention of this is simply ludicrous and obviously part of an agenda.

Here is a challenge for all the people who believe the nonsense being spread by one person (yes, just one person who has others hoodwinked by a hidden agenda) about telemed: Please site ONE CASE where the prosecution has ever raised the issue of telemed either successfully or not. It is not enough to quote the doctor on this thread as an authority. Quote one case. Any case. No? Because there has never been one, folks. The new telemed laws state:

As used in this section, “telemedicine” means the use of an electronic media to link patients with health care
professionals in different locations. To be considered telemedicine under this section, the health care professional must
be able to examine the patient via a real-time, interactive audio or video, or both, telecommunications system and the
patient must be able to interact with the off-site health care professional at the time the services are provided.

Who do people think does almost all of the physical examinations in doctor's offices? When you get weighed, it is the nurse who does this. When you get your blood pressure taken, who does it? It is the staff of the medical center that does it. We have an on-staff social worker and a medical assistant.

Telemed includes in person in its definition. The MMMA did not change medical law and policy in Michigan. It falls under Uniformity and as such is included if not specifically excluded. Internet medicine means never seeing the doctor. It refers to using email to send records, consult with the doctor (if that actually happens) and getting a cert (in the case of medical marijuana) mailed to your address. This does not include telemed. Period. It has nothing to do with it.

Read the bills I posted earlier in this thread. They are very clear, and none of the changes to the MMMA did away with this law in Michigan.

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I don't doubt that you guys care about your patients. BUT, in light of the very clear language in PA512, wouldn't you, and more specifically your patients be best served to err on the side of caution and change your practice to in-person certifications?

You said yourself that this hasn't YET been challenged in court..... so do you want one of your patients being a guinea pig for this? What's the big deal to have your doctor be there in person? Does he have better things to do?

Well this thread was about telemedicine certification and the fact they don't qualify under the bona fide dr/pt relationship as defined for medical marijuana under PA 512 of 2012. The fact that Stow AND GREGS both agree with the position I stated should say something. As for the delegation of nurses to do certifications, we initially looked into to that when the law first changed, under the medical practice act it would seem it was allowed, but on advice of our lawyer, we felt it was simply too much of a risk to our patients given the clear intent of the law for an in person meeting between doctor and patient. We at Denali do not believe it would protect patients, so we don't allow it for certifications, though we do for med refills of established patients alternating with the physician and under written protocol. All prescriptions are written by the physician after individual review of the patient's chart and in person meetings by the nurse and doctor on an alternating month basis. It is clearly an appropriate way to manage long term patients.

I really think the issue of telemedicine certs is settled. Attempts to apply other laws when the rules for medical marijuana are clearly written simply is an attempt to increase revenue at the expense of patient risk and should not be accepted, either by certification centers or patients. Chronic certification center has good people, and as long as they are indeed doing IN PERSON meetings between doctors and patients there should be no problem going there. As for those clinics that advocate some questionable legal basis for telemedicine or through the mail certifications or renewals, again the question is 'Who gets the money for the cert, and who goes to jail if it is overturned?'. That clarifies any motivations.

Dr. Bob

GregS, I am suggesting that another practice uses a nurse to certify patients. We would NEVER do that. This telemed question is loaded on one side. Perhaps I am expecting a different level of sophistication here. It is not forbidden. I can't believe that I have to explain this again. If it is not specifically forbidden it is allowed under Uniformity. Telemed was NOT mentioned in the MMMA. There is no conflict with the new language and the 2012 telemed law. NONE. The conflict only arises on forums like this where people have an agenda. The new language would have had to have mentioned telemed as specifically not allowed. Instead it used the term "internet medicine" which is an entirely different definition. They are not even related in any legal way. Telemed is the law of the land in Michigan medical policy and law. The system I referencing was set up by one of the top lawyers in Michigan and had the backing not only of this lawyer but the backing of the law in Michigan as well. This is not in dispute. If anyone would read the telemed laws they would see that there is a clear definition of what telemed is, and it covers the "in person" aspect of the MMMA. That was why they used that language-because it already existed in Michigan law. It was already covered in another law, and they did this so there would be no debate like this. The very fact that this has never come up in court is PROOF that it is a red herring. This is just a way for people within the movement to create schisms and divisions between competing businesses. Nothing else. It is being used as a tool to beat people over the head who are working hard every day to help patients with the resources they have at their disposal. When people buy into this argument they are participating in a civil war of sorts that is going on within the movement. They are taking sides in it when they may not have even realized the civil war was even going on. Unfortunately, the fact that an industry has spawned before the movement was complete has inserted corruption into the movement. I will be so happy when legalization is complete and we can all go back to our lives and avoid BS like this stupid civil war.

We need to be in the business of assisting people in getting certified according to the standards outlined in the laws. We should not be participating in restricting patient access. As long as certain standards are met, such as meeting with an actual MD or DO, a reasonable expectation of follow-up, standard record keeping and a real and genuine relationship with your doctor or certifying medical center, then aside from that the methods used can vary as much as the law allows. Since the use of telemed is standard in rural medicine in Michigan, there is absolutely no reason to project an image that this is somehow not available for people who are getting certified for medical marijuana. The only reason that a person would project this idea out of nowhere is to further an agenda.

What Adam is alluding to is that point I made earlier about delegation of authority and our initial thoughts on using it for rural certifications. We realized quickly it was a bad idea and for patient protection, we put a stop to it in short order. During that time I was caught in a blizzard in SC (yes, they do have bad weather) and I was unable to return to TC to see patients on one clinic day due to the travel delay. We considered doing the patients by Skype with my nurse present in the office meeting personally with the patient, but ended up cancelling as I recall. That is the basis of his 'glass houses' comment, and a bit of dirty pool to try and divert attention from Skype certifications. We are transparent at Denali and admit our mistakes, we make changes with every law and ruling to protect our patients, and don't risk them for a certification fee.

Dr. Bob

Given Adam's response, posted at the same time my last one came up, it appears to be obvious they use telemedicine, which is why they are hanging on another law while ignoring PA 512. I would encourage folks to simply think on this and decide if it meets their comfort level for their cards. It does not meet ours at Denali.

Please review my postings, I have given them EVERY OPPORTUNITY to come out and say they do in person meetings between doctors and patients. I have said they are good people and as long as they do IN PERSON MEETINGS they are fine. Telemedicine is not fine. They can either stop it and bring the doctor into the office, or stop doing certs that put people at risk. Their choice, and the choice of the patients.

Dr. Bob

I would ask again, what do people think of a doctor delegating authority to a nurse to certify their patients? Would you feel comfortable with this? Is there proper informed consent for a patient who thinks that they are seeing an actual doctor but instead are seeing a nurse? Would this hold up in court? NO. NEVER. This is now a standard practice going on, but everyone wants to talk about telemed (and apparently our medical center in particular--doesn't that sound a bit suspect?) because some people needs to divert attention away from other issues. This is a bait and switch. It is not the first time and it won't be the last. Don't buy into the hype.

Talk to your doctor, follow up with them and do your due diligence. Your relationship with your doctor is the foundation of the entire set of protections in the act. Oh, and make sure that it is an actual doctor that you are meeting with--whether or not you were able to shake their hand.

Well it is what it is, this is a conversation about telemed and certifications, not delegation of authority to nurses. Nor was the delegation of authority related to certifications. Who is doing the bait and switch? In certifications, you MUST be able to shake their hand, because you MUST have an in person meeting with them.

Dr. Bob

Adam from TC said:

I would ask again, what do people think of a doctor delegating authority to a nurse to certify their patients? Would you feel comfortable with this? Is there proper informed consent for a patient who thinks that they are seeing an actual doctor but instead are seeing a nurse? Would this hold up in court? NO. NEVER. This is now a standard practice going on, but everyone wants to talk about telemed (and apparently our medical center in particular--doesn't that sound a bit suspect?) because some people needs to divert attention away from other issues. This is a bait and switch. It is not the first time and it won't be the last. Don't buy into the hype.

Talk to your doctor, follow up with them and do your due diligence. Your relationship with your doctor is the foundation of the entire set of protections in the act. Oh, and make sure that it is an actual doctor that you are meeting with--whether or not you were able to shake their hand.

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We will apparently agree to disagree regarding the telemed issue. The members here have been generous in stating their respect for my contributions, and I thank them. You? Yes we will perform our due diligence and be engaged in bona fide relationships, to include a head to head consult. Otherwise we run the risk of losing our protections. You are obviously comfortable with that risk. We are not. Options to enter into said relationship are many and not difficult to navigate.

TheMan13 said:

It seems tragic that a patients protections under the law can stripped by another's (pot doc's) legal transgressions. At some point ignorance of the law is just going to have to be a defense under the law, as a majority of American's cannot simply afford an attorney ...

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Which is the more reason to thoroughly vette a potential certifying physician well before problems arise.

Seriously Adam, is there a reason you will not require an in person meeting? Is it that hard to take that step? Why won't your doctors just come to the office to meet with the patient? We'll all stand in line to tell you that you are doing the right thing! What is your motivation to use telemedicine vs an in person exam? There are many doing in person exams in TC, why is it so hard for you to?

Dr. Bob