New Unpublished Coa Ruling On Mmma From Oakland County

[Greg Rx]

BuuuWaahhHaaa

 

lol@ "farmacology"

That was my serious example

[GregS]

What might happen if a physician were to indicate that it should be used PRN (pro re nata, i.e., as needed)?

...or q.s. (quantum sufficicat, a sufficient quantity), or A.T.C (around the clock), or ad lib. (ad libitum, as one desires, freely), or s.a. (secundum artum, use your judgment)? All are prescription abbreviations. Can you help us out with this GregRx?

[GregS]

OK, I'm with you, I misread the tone of your post. I'd say, however, that some patients can use their trusted family physicians, though you are right, few patients can rely on that route, and it can cause substantial issues if the family physician is not knowledgeable about medical marijuana.

 

As far as differentiating bona fide from not, I'd say it is to some degree easier than what you've stated for patients to discern. It is now defined in the act:

 

 

 

If you are not bringing records or signing a HIPAA release for your treating physician, item 1 is not met. If the physician is not keeping a chart for you at every visit, number 2 is not met. If you don't know when or where you are supposed to come back, number three is not met. Most patients don't really care about number 4, but if the physician for some reason refuses to notify your primary physician on your request, that should be a red flag.

 

I don't think patients should have to do this; in my opinion patients should be able to rely upon the physician's professional credentials to presume that these criteria are being met as mandated by law. Section 4(f) mandates that a physician have a bona fide physician-patient relationship before providing a written certification. A patient should be able to rely upon the physician's MD or DO state-licensing and regulation for 100% of the decision-making process of whether or not their relationship with the physician is bona fide.

 

Said another way, the patient should be able to rely on the licensing process that has taken place and the regulatory efforts of LARA to ensure that physicians are not providing meaningless certifications. That being said, a great number of the charts I have received from HIPAA requests to the "medical marijuana doctors" reflect each of the elements in section 3(a).

Much like the ruling in tut/wik, which concludes that a patient's illegal activity does not taint that of a compliant caregiver, should the physician's activity, when sworn to in a document as being bona fide, that does not stand up to scrutiny affect an otherwise compliant patient's, and subsequently a caregiver's, compliant activity? I think not.

[GregS]

another unpublished, this one out of kent county.

 

20150922_C321585_46_321585.OPN

 

(321585 is the case number, if you want to look it up on coa website)

 

this one is a dispensary case

 

Accordingly, although on the basis of different reasoning, both this Court’s opinion in McQueen,

issued before defendant engaged in the charged conduct, and our Supreme Court’s opinion in

McQueen, issued after defendant engaged in the charged conduct, interpreted the MMMA in a

manner that simply did not afford immunity to defendant relative to the operation of his

marijuana dispensary.

 

oops. coa took a misstep. sec8 is available for all defendants no matter whut.

 

Second, we see

nothing in the language of § 8 that would permit the operation of a marijuana dispensary. Third,

and finally, defendant does not even attempt to analyze § 8 and explain how it would allow for

the operation of a dispensary.

 

nice one coa.

 

The answer is that a primary caregiver cannot

receive compensation under § 4(e) for costs associated with the impermissible act of assisting

unconnected registered qualifying patients.

 

whuh new argument.

Sec. 8 does not prohibit a caregiver from charging a price or covering their costs. The COA fukd up again.

Edited September 28, 2015 by GregS

[Greg Rx]

...or q.s. (quantum sufficicat, a sufficient quantity), or A.T.C (around the clock), or ad lib. (ad libitum, as one desires, freely), or s.a. (secundum artum, use your judgment)? All are prescription abbreviations. Can you help us out with this GregRx?

You are doing great, I forgot the latin terms 30 years ago. QS usually is used for compounding to top off a final volume. Sig: 1-2gm q2-4hrs prn pain. refill ad lib

[GregS]

You are doing great, I forgot the latin terms 30 years ago. QS usually is used for compounding to top off a final volume. Sig: 1-2gm q2-4hrs prn pain. refill ad lib

Perhaps any designation of dosage should be a part of the physician's certification for purposes of sec. 8, and added to the supporting documents. It is not a matter for a caregiver to know, as was clearly ruled in tut/wick, but only to provide what a patient asks for. The defendant is correct that s/he is best able to determine dosage. The stuff is not toxic, and effective titration should be achieved at will. There is no pharmacological reason to limit it. The COA judges are out of their depth, but that has never stopped them before.

[GregS]

Hey tpain. Was this decision pre or post tut/wick?

[t-pain]

they quoted tut/wick a lot, so its after. sept 22nd.

[GregS]

You are doing great, I forgot the latin terms 30 years ago. QS usually is used for compounding to top off a final volume. Sig: 1-2gm q2-4hrs prn pain. refill ad lib

I was a seminarian.

 

Would writing certifications in this fashion in any way affect the status from a mere certification to a prescription? It is the fact now that physicians do not write these as Rx's, but as a more informal certification, because it would be seen as a violation of federal law.

[trichcycler]

I was a seminarian.

 

Would writing certifications in this fashion in any way affect the status from a mere certification to a prescription? It is the fact now that physicians do not write these as Rx's, but as a more informal certification, because it would be seen as a violation of federal law.

 

Just excellent Gregs !

 

a most relevant question posed to the right person! Top of the morning to you all!

Edited September 27, 2015 by grassmatch

[t-pain]

there might be some problem with a dr writing a prescription for marijuana.

 

first, because it is possible for a dr to write a schedule 1 prescription, but it requires a super special DEA license , only a few drs have this prescription power, mostly for clinical research studies, or the 4 federal mmj patients as well.

 

second, because it may be a federal crime to aid and abet or conspire to do marijuana / controlled substances without a license.

 

thats why the recommendation model exists, because its basically just free speech between you and your dr. the dr says you may benefit from mmj. thats all a certification/recommendation says.

 

thats why i think the bona-fied bill the legislature added to the law is unconstitional.

 

how can a dr followup with mmj patient's self-treatment?

 

mmj is not a prescribed treatment for any disease, its only a recommendation.

 

a treatment requires a plan, a dosage, etc.

 

treatmenmt: 3. management in the application of medicines, surgery, etc.

 

which are all things a dr cannot currently do without special dea license.

a doctor cannot manage a marijuana treatment in any way, legally, imo.

 

this is the reason why hospitals bar doctors from having patients with mmj.

this is why the doctors drug test patients and if they test positive for mj then the dr says he cannot prescribe controlled substances to that patient.

because legally, the dr would be knowing of illegal activity (mj use) and would be breaking a dea rule/law.

 

the drug’s federal classification restricts licensed physicians from discussing marijuana treatment options with patients

here we go, all the way back to the original decision which allowed a reccomendation to take place.

 

[2] Although a DEA registrant cannot prescribe marijuana due to its Schedule I classification, authority exists that a registrant may make a medical marijuana “recommendation” to a patient in compliance with state law. Conant v. Walters, 3009 F.3d 629 (9th Cir. 2002) (holding that under the First Amendment, the federal government was enjoined from investigating a physician or revoking the physician’s DEA registration based solely upon the physician’s professional recommendation for medical use of marijuana made without specific intent to aid the patient in acquiring marijuana). Washington law, for example, allows a physician to sign and date an authorization on tamper-resistant paper stating that in the physician’s opinion, the patient may benefit from the medical use of marijuana. RCW 69.51A.010, -.030.

[GregS]

Sec. 8 does not prohibit anyone from charging a price or covering their costs. The COA fukd up again.

The SC ruled that sales are permitted, based on sec. 3 definitions, and nothing in sec. 4. If that is the case it would also apply to sec. 8. Can anyone help out with that case. Which was it?

[+Malamute]

Sec 4(e) A registered primary caregiver may receive compensation for costs associated with assisting a registered qualifying patient in the medical use of marihuana. Any such compensation shall not constitute the sale of controlled substances.

 

 

 

 

Definiton of "costs" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Cost" n 1. The amount paid or charged for something; price or expenditure. Cf. EXPENSE

 

 Types of costs:

 

 aboriginal cost

 after cost

 applied cost

 average cost

 avoidable cost

 carrying cost

 common cost

 cost of completion

 direct cost

 distribution cost

 fixed cost

 flotation cost

 historical cost

 implicit cost

 indirect cost

 manufacturing cost

 marginal cost

 mitigation cost

 mixed cost

 net book cost

 opportunity cost

 original cost

 prime cost

 prophylactic cost

 replacement cost

 social cost

 sunk cost

 tangible cost

 transaction cost

 unit cost

 variable cost

 

It goes on for 2 more pages with full definitions... ;-)

 

 

 

Definition of "Compensate" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensate" vb. 1. To pay (another) for services rendered <the lawyer was fairly compensated for their time and effort> 2. To make an amendatory payment to; to recompensate.

 

 

Definition of "Compensation" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensation" n. Remuneration and other benefits recieved in return for services rendered; esp. salary or wages.

   "Compensation consists of wages and benefits in return for services. It is payment for work, If the work contracted for is not done, there is no obligation to pay. [Compensation] includes wages, stock options plans, profit-sharing, commissions, bonuses, golden parachutes, vacation, sick pay, medical benefits, disability, leaves of absence, and expense reimbursement." Kurt H. Decker & H. Thomas Felix II, Drafting and Revising Employment Contracts S 3.17, at 68(1991).

 

 

 Definition of "Expense" as listed and defined in Blacks Law Dictionary 8th edition:

 

 "Expense" n.  An expenditure of money, time, labor, or resources to accomplish a result;

[GregS]

Sec 6(e) A registered primary caregiver may receive compensation for costs associated with assisting a registered qualifying patient in the medical use of marihuana. Any such compensation shall not constitute the sale of controlled substances.

 

 

 

 

Definiton of "costs" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Cost" n 1. The amount paid or charged for something; price or expenditure. Cf. EXPENSE

 

 Types of costs:

 

 aboriginal cost

 after cost

 applied cost

 average cost

 avoidable cost

 carrying cost

 common cost

 cost of completion

 direct cost

 distribution cost

 fixed cost

 flotation cost

 historical cost

 implicit cost

 indirect cost

 manufacturing cost

 marginal cost

 mitigation cost

 mixed cost

 net book cost

 opportunity cost

 original cost

 prime cost

 prophylactic cost

 replacement cost

 social cost

 sunk cost

 tangible cost

 transaction cost

 unit cost

 variable cost

 

It goes on for 2 more pages with full definitions... ;-)

 

 

 

Definition of "Compensate" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensate" vb. 1. To pay (another) for services rendered <the lawyer was fairly compensated for their time and effort> 2. To make an amendatory payment to; to recompensate.

 

 

Definition of "Compensation" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensation" n. Remuneration and other benefits recieved in return for services rendered; esp. salary or wages.

   "Compensation consists of wages and benefits in return for services. It is payment for work, If the work contracted for is not done, there is no obligation to pay. [Compensation] includes wages, stock options plans, profit-sharing, commissions, bonuses, golden parachutes, vacation, sick pay, medical benefits, disability, leaves of absence, and expense reimbursement." Kurt H. Decker & H. Thomas Felix II, Drafting and Revising Employment Contracts S 3.17, at 68(1991).

 

 

 Definition of "Expense" as listed and defined in Blacks Law Dictionary 8th edition:

 

 "Expense" n.  An expenditure of money, time, labor, or resources to accomplish a result;

Thanks, but I am asking about the SC ruling that states that a sale between a patient and caregiver is a permitted activity. What case was that?

Edited September 27, 2015 by GregS

[GregS]

Found it in McQueen, p 14.

 

"...we hold that the definition of “medical use” in § 3(e) of the MMMA

includes the sale of marijuana. The Court of Appeals erred by concluding otherwise, and

we reverse that portion of the Court of Appeals’ judgment defining “medical use.”

 

http://medicalmarijuana.procon.org/sourcefiles/state-of-michigan-vs-mcqueen.pdf

Edited September 28, 2015 by GregS

[GregS]

Sec 6(e) A registered primary caregiver may receive compensation for costs associated with assisting a registered qualifying patient in the medical use of marihuana. Any such compensation shall not constitute the sale of controlled substances.

 

 

 

 

Definiton of "costs" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Cost" n 1. The amount paid or charged for something; price or expenditure. Cf. EXPENSE

 

 Types of costs:

 

 aboriginal cost

 after cost

 applied cost

 average cost

 avoidable cost

 carrying cost

 common cost

 cost of completion

 direct cost

 distribution cost

 fixed cost

 flotation cost

 historical cost

 implicit cost

 indirect cost

 manufacturing cost

 marginal cost

 mitigation cost

 mixed cost

 net book cost

 opportunity cost

 original cost

 prime cost

 prophylactic cost

 replacement cost

 social cost

 sunk cost

 tangible cost

 transaction cost

 unit cost

 variable cost

 

It goes on for 2 more pages with full definitions... ;-)

 

 

 

Definition of "Compensate" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensate" vb. 1. To pay (another) for services rendered <the lawyer was fairly compensated for their time and effort> 2. To make an amendatory payment to; to recompensate.

 

 

Definition of "Compensation" as listed and defined in Blacks Law Dictionary 8th edition:

 

"Compensation" n. Remuneration and other benefits recieved in return for services rendered; esp. salary or wages.

   "Compensation consists of wages and benefits in return for services. It is payment for work, If the work contracted for is not done, there is no obligation to pay. [Compensation] includes wages, stock options plans, profit-sharing, commissions, bonuses, golden parachutes, vacation, sick pay, medical benefits, disability, leaves of absence, and expense reimbursement." Kurt H. Decker & H. Thomas Felix II, Drafting and Revising Employment Contracts S 3.17, at 68(1991).

 

 

 Definition of "Expense" as listed and defined in Blacks Law Dictionary 8th edition:

 

 "Expense" n.  An expenditure of money, time, labor, or resources to accomplish a result;

Please note that the language regarding compensation and that you cite in the Act is in sec. 4(e), rather than 6(e). It is because the determination by the Supreme Court that sales are permitted under the activity of "transfer", found in the sec. 3 definition, that sales are also defensible under sec. 8.

Edited September 28, 2015 by GregS

[GregS]

forget it.

 

Edited September 28, 2015 by GregS

[GregS]

McQueen is probably what you are thinking of, page 13:

Right. It begins on p. 11.

[+Malamute]

 you cite in the Act is in sec. 4(e), rather than 6(e).

 

 

Thanks.  Not sure how that happened -)

[+Malamute]

I should probably add the sale under transfer from McQueen to that little definition stuff.  I just paste it anymore.

[Greg Rx]

Perhaps any designation of dosage should be a part of the physician's certification for purposes of sec. 8, and added to the supporting documents. It is not a matter for a caregiver to know, as was clearly ruled in tut/wick, but only to provide what a patient asks for. The defendant is correct that s/he is best able to determine dosage. The stuff is not toxic, and effective titration should be achieved at will. There is no pharmacological reason to limit it. The COA judges are out of their depth, but that has never stopped them before.

This is a good place for me to state that I think we should resist any and all attempts to treat cannabis like a prescription. There is no way to dose it other than trial and error. Then you change strains, batches, or dosage form and you have to start over.

[trichcycler]

smart, for many reasons^

[t-pain]

is a recommendation only. nothing to do with dosages or prescriptions.

 

anyone who says otherwise is a lying prosecutor

[Greg Rx]

smart, for many reasons^

Yes, I could have written mush more but work called.

[GregS]

Who in hell was this guy's lawyer? Had he brought the sec. 8 defense and proved that he was an unregistered caregiver to his "patients" with whom he is not connected through the registry, that may have worked, and the case been dismissed in the required pre-trial hearing. If he had had notarized agreements with all of them that attest to a bona fide certification, and designating him as their caregiver, even without connection, and If he could show an amount not more than necessary, the case, by law, would have to be dismissed.