HELENA – A Montana physician who saw about 150 patients over 14½ hours during a medical marijuana clinic last year will be fined $2,000 for providing substandard care, the first time a doctor in the state has been disciplined in a marijuana case.
The state Board of Medical Examiners’ action follows a stern warning issued by the board to doctors who participate in the “cannabis caravans” that travel around the state registering medical marijuana patients. The board cautioned those doctors not to let their standards of care slip, saying the mass screenings “inherently tend towards inadequate standards of care.”
The physician, Dr. Patricia Cole, of Whitefish, said she never breached the doctor-patient relationship and believes she is being made an example of by the board. Cole said she is afraid other doctors may be discouraged from prescribing medical marijuana in their own offices because of this.
“Ideally, the recommendations would be done by the patients’ primary care physician. Unfortunately, there are very few physicians who are willing to prescribe (medical marijuana),” she said Tuesday.
A person must have a debilitating medical condition certified by a doctor in order to register as a medical marijuana patient with the state. Montana now has about 15,000 registered patients, according to state health officials, up from 2,923 a year ago.
A major factor in that boom has been the clinics sponsored by the Montana Caregivers Network that travel around the state, signing up hundreds of new patients at a time.
The board determined Friday that Cole spent an average of six minutes with each patient during an October 2009 clinic in Great Falls. The board said she did not document whether she took medical histories or physical examinations of patients, did not discuss proper dosing and failed to document a risk analysis of medical marijuana for them.
“Dr. Cole’s practice of seeing scores of new patients in one day is below the standard of care, particularly given that physicians commonly afford new patients greater time than that allotted for established patients,” according to the settlement released Tuesday between the board and Cole.
Under the agreement, Cole will be allowed to continue recommending medical marijuana to patients in her practice, but she will be banned from participating in any more medical marijuana conferences. The $2,000 fine will rise to $4,000 if she commits any other violations in the next year.
An order was signed by the board on Tuesday but a clerical error will likely keep it from being filed for a day or two, said board attorney Michael Fanning.
Cole’s attorney, Mark Frisbie, said Cole agreed to the board decision because she did not want to risk a greater punishment by pursuing litigation. But Frisbie said that in his opinion, Cole did not breach the bona fide doctor-patient relationship defined by state law.
“There’s no time limit listed in the definition of a doctor-patient relationship,” he said.
The state medical board said Cole saw 151 patients during the Great Falls conference hosted by the Montana Caregivers Network; Cole and Frisbie said the actual number was 148. Cole said she does not recall the exact number of people who received medical marijuana cards but estimated only five or so did not.
A complaint against Cole was filed in November from within the medical board, Fanning said. A peer reviewer examined 20 charts from patients she saw at the clinic.
In 17 of those cases, “documentation fell below the standard of care with significant omissions,” the reviewer found. In five cases, the reviewer cited “a significant or potentially significant impact on patient morbidity.”
The reviewer concluded that the omissions in record keeping constituted a breach of the board’s standards of cares and her obligations under the state’s medical marijuana law.
Cole said she reviewed many of the records of her patients that day before the actual clinic, time that was not accounted for in the board’s review.”I understand the board wants records to look the way they look in a family practice office,” she said. “We saw a lot of people. We did a very shorthand version of office records.”
Cole participated in other clinics from July until November but said she is no longer an advocate of them.
“I think the degree of infrastructure that’s really needed was beyond the scope of the organization,” she said. “There needs to be enormous attention to the care and the filing (of records), as rapidly as all this has been growing.”
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