3/24/2017 MIRS Capitol Capsule, Friday, March 10, 2017

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QUOTEOFTHEDAY

"Thestatutedoeshavesome
blindspots."
ShellyEDGERTON,directorofthe
DepartmentofLicensingandRegulatory
InsideToday'sMIRS Friday,March10,2017 Affairs,ontheMichiganMedicalMarihuana
Act(MMMA).

Michigan'sMedicalMarijuanaCertificationLoophole
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Publisher'sNote:ThefollowingarticlewaswrittenbyMIRSCourtsCorrespondentSimonSCHUSTER. BoostUSIsraelCooperationon
ThepieceexploresissuespertainingtotheMichiganMedicalMarijuanaAct(MMMA).Inthecourseofhis Cybersecurity
work,Schusterdetailsonedoctorwho'sissued15percentofthestate'smedicalmarijuanacardsin2015.
Schuitmakerlegislationcontinues
thefightagainstprescriptiondrug
TheaddressinacrypticFacebookpostadvertising"MMMPCARDS"leadsme,lateoneSundaynight,to abuse
thedarkenedstorefrontofanappliancewholesalerinNorthLansing.Thestoreislockedandshuttered,
KnollenbergNewsRelease:Senate

BILLHOUND+
butaroundtheside,there'salightonaboveawindowlessdoor.Asignistapedtoit"medicalmarijuana billswouldhelpcurbopioidabuse
doctor." epidemic

MackinacCenterTemporarily
Insideisabareroomwithaplywoodcounteratoneendandadoorlessofficeinthecorner.Ipay$150 RemovesSomeSalariesfrom
cashonly$100ifIhadbroughtanymedicalrecords.Mydriver'slicenseisscanned,bloodpressure DatabaseAfterQuestioningState
recordedonablanksheetandI'mhandedapacketofpaperwork,whichIsettofillingout. Data

ReadMore
Ahusbandandwiferuntheoperation,butthedoctor,VernonPROCTOR,isnotthere.He'sabusyman,
theytellme,anddayslaterIlearnwhattheymean. STATEWIDEHEADLINES

NodoctorcertifiesmorepatientsforMichigan'sMedicalMarihuanaProgram(MMMP).Outofthe136,097 MichiganDemocratspushfor
federalinvestigationintoTrump
medicalmarijuanaapplicationsthestateprocessedin2015,Proctor'ssignaturewason21,226ofthem.
Russiaties
That'smorethan15percent.Fiftyeightcertificationsaday,ifheworkedeverydayoftheyear.
Michiganretailerscomeoutagainst
borderadjustmenttax
Thenextmostprolificdoctorcertified5,797duringthesameperiod,accordingtoasignedaffidavitfrom
KarenKRZANOWSKI,thethenmanageroftheMMMPoffice. Governor,lawmakersfocuson
changingculture,targetingopioid
addiction
https://mirsnews.com/capsule.php?gid=5039#49497 1/7
3/24/2017 MIRS Capitol Capsule, Friday, March 10, 2017
Proctor'soperationisnotillegal.Insteaditleaveshispatientsvulnerabletoprosecutioninanincreasingly InFlint,tenantssufferwithshutoffof
regulatedmarket,ashehasskirtedstatelawforyearswithlittlerecourseavailabletothestateagency water
taskedwithoversightofMichigan'smedicalmarijuanaindustry,theDepartmentofLicensingand Databaserevealsstateemployees'
RegulatoryAffairs(LARA). salariesbutnumbersmaybe
wrong
"Thestatutedoeshavesomeblindspots,"ShellyEDGERTON,thedepartment'sdirector,toldme. DNCleadersheadedtoMichiganto
tryandreverseGOPvote
Backattheclinicit'saslownight,thewifetellsme.Only19peoplestoppedin.Theweekbefore,she Mich.Senatevotestorepeallaw
said,therewere45. requiringgunrecords
MichiganSenateapprovesbad
Proctorpresumablyoperatesoutofmakeshiftclinicsacrossthestate.HetoldmeheworksinFlint, applecopbill
GrandsRapidsandLansingandperhapsothercities,too.Courtrecordsshowthestatereceived
HealthvotedelayedafterAmash
paperwork,withinthespaceofaweek,forapplicantsthatlivefromDetroittoTraverseCity.Documents meetingwithTrump
alsoclaimedhehasclinicsinPetoskeyandBaldwin,wherehisbusinessisregistered.Hedeclinedtobe
interviewedforthisstory,leavingthefullextentofhisbusinessunknown. Michiganretailers:GOPbordertax
willhikeprices

Previously,hewouldcertifypeoplefromLansing'sdispensariesthemselves,appearingfourdaysstraight ReadMore
inDecemberatadifferentpurveyoreachnight.

That'schangedwiththepassageoftheMedicalMarihuanaFacilitiesLicensingAct,thehusbandsaid. HouseJournalSummaries
Onedoctornowcertifiespatientsfromabarcounter.ForProctorit'sthebackofthisappliancestore,and
SenateJournalSummaries
onlyonceaweek,butthedrilldoesn'tseemtohavechanged.

"Iguesstheythoughtitwasgoingtostopusfromdoingcertificationsorsomething,"hesaid."Thatwent
overlikeafartinchurch."

Prospectivepatientswalkinbetween6and8p.m.,fillouttheirformsandleave,returningat9p.m.when
thedoctorarrives.Iopttostickaroundandwait,watchingthemtricklein.

It'sadiversecrowd,representingabroadrangeofages,race,genderandeconomicstatus.Amongthem
isanolder,barrelchestedmanwithalongbeard,afewmillennialsthatlooklikecollegestudents,an
obeseHispanicmaninsweatpantsandaseeminglywelltodo,middleagedwhitecoupleinhighend
athleticwear.

Michigan'smedicalmarijuanalawsmandatethatapplicantsmustbediagnosedwitha"debilitating
medicalcondition,"whichisoutlinesasaspecificlistofailments.

Here,noonebringsrecords,andnooneisturnedaway.

Shortlybefore9p.m.theyreassembleintheshabbylobby.Proctorarrivesshortlyafterandstridesbriskly
intotheoffice,carryingalargestackofpaper.Hespendsafewminutesriflingthroughthestackof
paperworkbeforehim,thenbeginstocalleachofusintothedoorlessoffice.

Hespendsnomorethan90secondsoneachpatient,andI'moneofthelast.Ourconversationconsists
offourquestionsandinlessthan30secondsI'vebeencertified.

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ThenextdayImailinmypaperworktoLARA,certifiedmail,witha$60moneyorderfortheprocessing
fee.TheMMMPofficereceivesmyapplicationFeb.23,andI'mapprovedMarch1.
WithDr.Proctor,itseemsanyone
cangetamedicalmarijuanacard.

Thediagnosisofaqualifying
conditionisrequiredtoestablish
whatthelawreferstoasa"bonafide
physicianpatientrelationship."Either
medicalrecordshavetoestablishthe
condition,orthecertifyingphysician
hastoconductaphysicalexam.

Thethingis,thestatehasnowayto
verifypatientsactuallyhavethis
relationshiporaproperdiagnosis.

https://mirsnews.com/capsule.php?gid=5039#49497 2/7
3/24/2017 MIRS Capitol Capsule, Friday, March 10, 2017
ShellyEDGERTON,LARA'sdirector,explainedtheextentofthestate'sverificationprocesstoaHouse
appropriationssubcommittee.

"Whatwecurrentlyhaveispatientsaregoingtodoctors,thedoctorsaresaying`Irecommendyoufor
medicalmarijuana,'"shetestified."Thatperson'sjustgettingacertificate,payingafee,andifeverything
checksoutwe'reissuingthemacard."

UntilrecentlyProctor'ssystemhasworkedoutwithfewsnags.Courtrecordsindicatehe'sbeendoing
thesetypesofcertificationssinceatleast2010,whenanundercoverdetectivegotacertificationunder
similarprocedures.(Mypaperworkincludedaliabilitywaiver,certifyingunderpenaltyofperjurythatIwas
notajournalistorlawenforcementagent.Ididnotsignit.)

Afterall,he'simmunefromcriminalprosecutionordisciplinaryactionfromMichigan'sBoardofMedicine,
"solelyforprovidingwrittencertifications,inthecourseofabonafidephysicianpatientrelationship,"
withinthestatute,providinghe'sadministeringtheproperstandardofcare.

Untilthe2012changestotheMMMP,thebonafiderelationshipwasalargelyundefinedterm,saidDoug
MAINS,aformerlegislativeattorneywhohelpedcraftthereforms.

"Wewerehearingthatdoctorswereflyinginfortheweekendfromoutofstateandissuingathousand
certifications,orweresettingupshopinthebackofaclothingstoreorsomethingandissuinghundreds
ofcertificationsaday,"Mainssaid."Wetriedtomakeitsoitresembledthetypeofphysicianpatient
relationshipyou'dhavewithyourdoctorinakindoftraditionalsetting."

Itincludedaddingarequirementforfollowupappointments,andcheckinginwiththepatient'spatient
primarycarephysicianifgivenpermission.ThoughLARAstillhasnowaytoverifythat.

"Ifthephysicianislicensedandfillsoutthepaperworkcorrectly,thatwouldqualifysomeonetoreceivea
card,"saidAndrewBRISBO,thedirectorofthelicensingdivisioninLARA'sBureauofProfessional
Licensing."There'sreallynothingelseinthestatutethatauthorizesLARAtodoanyfurtherauditingof
that,orfurtherenforcementorvalidation."

That'slefthowcloselydoctorsadheretothestatute'srequirementsuptothephysicians.

DanielGROW,acriminaldefenseattorneywhospecializesmedicalmarijuanacases,saidthat"even
thoughthestatutenowincludesdefinitionofwhatneedstobedone,there'sstillsomevariancefrom
doctortodoctor."

Henotesthatwhile"somedoctorsareextraordinarilythorough,"byreviewingmedicalrecordsand
makingfollowupappointments,"itrangesallthewaytotheotherextreme,wheremaybeyougotoa
musicfestivalandsomeone'stherewritingcertifications."

ThemorepubliclyvisibleclinicsMIRScontactedeitherrequirerecordsorprovideanonsitediagnosis.

"TheonesthatarelesslikewhatyouandIareusedtowhenyouandIgotoadoctortendtobemore
problematicinthecourtroom,"Growsaid."That'snottosaythatthepatientswon'tbeprotected,butthe

BILLHOUND+
outcomesmayvary."

Thelawallowseachmedicalmarijuanapatienttopossessupto2.5ouncesofthedrugandgrowupto
12plants.WithavalidcardandphotoID,apatientisgenerallyexemptfromarrestorprosecutioninrun
inswiththelawwhat'sknownassection4immunity.

ForProctor'spatientswhodon'tviolatethestatute,they'lllikelyneverhavetheintegrityoftheircard
questioned.Patientswhogetcaughtwithtoomuchmarijuana,oraregrowing13plantsinsteadof12
that'swhenproblemsarise,accordingtoMatthewABEL,marijuanacentricattorneyandadvocate.

"That'swhenthephysicianpatientrelationshipoftencomesup,"hesaid."Wheresomeoneisnotinstrict
compliance,wheretheremightbeatechnicalviolation,deliberateornot."

Thesetechnicalviolationscanstillbedefendedincourt,buttheyrequirewhat'sknownasasection8
defense.Thepatientstillhastoprovideagoodreasonfordeviatingfromthelimits,buttheircertifying
physicianmustprovetheyneededthemarijuana.

https://mirsnews.com/capsule.php?gid=5039#49497 3/7
3/24/2017 MIRS Capitol Capsule, Friday, March 10, 2017
ApreviouspatientofProctor's,ShawnGOODWIN,hadtriedtoassertthisdefensewhenhegotcaught
withmorethanthelegallyallowedamountofmarijuana.InDecember2014theCourtofAppealsruled
thatwhilethatdefensewouldn'thaveheldupanyway,hisrelationshipwithProctorfailedthreeofthefour
prongsofthetestforabonafidephysicianpatientrelationship.

"Dr.Proctoralsotestifiedthathedoesnotalwayskeepthepatients'medicalrecords.Hestatedthatifhe
neededthem,hecouldusethepatientsignedauthorizationtoobtainthemfromtheprimarycare
physician,"therulingsaid."Further,testimonyofDr.Proctorandthefourpatientsrevealsthatheonly
sawthosepatientsforcertificationandrenewalofcertificationanddidnotscheduleanyfollowup
appointmentstocheckonthepatients,theircondition,andtheefficacyofthemedicalmarijuana."

Abelsaidmuchofitisuptothejudge,whetherthelegitimacyofapatient'scardisinvestigated.With
that,Abelsaid,"there'snotalotofconsistency."

"That'salsoadanger,"Abelsaid."Justbecauseaphysicianhaswrittenyouarecommendationnow,a
judgeisgoingtosecondguessthat,apparently."

Growhasalsoseenthatinconsistencyinhispractice.

"CertainjudgesareveryadversarialtowarddoctorsthatarenotwhatyouandIareusedtowhenyougo
togoseeadoctor,"Growsaid.

That'stherubinProctor'sapproach.Manypatientswillneverhaveaproblemwiththeircards,butifthey
endupincourt,theywillhavetofacetherepercussionsofitsshortcomings.

Abeltakesissuewiththatreality.

"Ithinkthat'sinappropriateandifthere'sanissueaboutadoctorcertifyingapatient,itshouldn'tbethe
patientwho'spunished,itshouldbethephysicianwho'ssubjecttoprofessionaldisciplineifinfactthe
physicianisnotcomplyingwiththelaw,"hesaid.

Proctormaybefacingprofessionaldiscipline.HehastwoformalcomplaintsagainsthimwiththeBoardof
MedicineandBoardofPharmacy.TheyhavebeenpendingsinceNovember2015.Thehearingonthe
caseswasheldlastfall,andifheisfoundtohavecommittedprofessionalmisconducthismedicallicense
couldberevoked.

Theyaccusehim,predictably,ofnotprovidingadequatecaretothemedicalmarijuanapatientshe
certifies,thoughthat'snotthemaincomplaint.ItallegeshedispensedSuboxone,awatereddownopioid,
alongwithahostofothernarcotics,fornearlyayear"withoutproperlicensureandrecordkeeping."

Hisattorney,NicholasBOSTIC,flatoutdeniedtheallegations.

"Hedoesn'tprescribeopioids.That'swhat'ssoridiculousaboutit,"hesaid."Theyfoundonepatient
whereheprescribedanopioidfora10or14dayperiodandtheyclaimedhedidn'taskenough
questions,theyclaimedhedidn'tgetenoughbackground...theyfoundoneexampleoutofhundredsand
hundredsofpatientfiles,whereheprescribedanopioidandthentheyhadaconniptionfitoverit."

ItappearsBosticandProctorhavegonetolengthstoslowthemovementofthecomplaintsthroughthe BILLHOUND+
MichiganAdministrativeHearingSystem.

"Posthearingbriefsandexhibitskeptbeingsubmitteddelayingtheproposalfordecision,"saidKevin
RAY,aspokespersonforLARA.AdecisionisexpectedbymidApril.

They'vefiledseverallawsuits,twoinfederaldistrictcourtandanotherintheCourtofClaims,against
LARAandtheBoardofMedicine.Theyallegethatthestateagenciesillegallyprocuredsubstanceabuse
treatmentrecordsforhispatients,whichareprotectedunderfederallaw.

BosticcalledLARA'shandlingofthecomplaints,whichhavebeenamendedmultipletimes,"disgusting,"
andcastdoubtonthemotivesforthecomplaint.

"Oneofthemoreinterestingthingsthatwefoundwasthattheadministrativelicensingcomplaintswere
generatedinternally,from(LARA),"hesaid."Theyweren'tfromthirdparties,likecitizens."

https://mirsnews.com/capsule.php?gid=5039#49497 4/7
3/24/2017 MIRS Capitol Capsule, Friday, March 10, 2017
Itisn'tclearwhetherthesheervolumeofcertificationstheMMMPofficewasprocessingfromProctorwas
anyredflag,thoughtheKrzanowskiaffidavitnoted""MMMPstaffrecognizehissignature."

ThatrecognitionofhissignatureledtothesuitintheCourtofClaims.Documentsclaimthatwhenthe
MMMPstaffwouldreceiveacertificationfromProctorthatappearedforged,they'dcallhimtoverifythe
datethecertificationwasmade.Afteratime,hebegantorefusetoverifythedates,andtheMMMPoffice
stoppedapprovinghiscertificationsuntilhebeganverifyingthemagain.Proctorallegesinanaffidavitthis
was"retaliationforthevigorousdefensethatheispresentingtothedisciplinaryaction."

MIRS'requesttointerviewthecurrentdirectoroftheMMMPoffice,DesmondMITCHELL,wasdeniedby
aLARAspokesperson.

Brisbo,thelicensingdivisiondirector,said"we'reawareofthoseconcerns(regardingdoctorslike
Proctor),andwe'veheardaboutthat,andwe'reexaminingwhatthelawwouldallowustodoto
potentiallydomoreintermsofauditingthoserecordsandvalidatingthem."

AlltheattorneysIcontactedinthecourseofreportingthisstorysaidoperationslikeProctor'sspeaktoa
largerissuemost"normal"doctorsareunwillingtowritemedicalmarijuanacertifications.

"Especiallybigcompanies,biggeroperationsandmorevisibleentitiesareaskedtoparticipatein
marijuanarelatedactivities,theypuckerupandgetnervousbecauseit'sagainstthelawunderfederal
law,"saidBobHENDRICKS,anattorneywhospecializesinmedicalmarijuanabusinesslaw."That's
what'sgoingonwiththesephysiciansbyandlarge.Theyworkforlargehealthcareproviderswho
receivemillions,maybemultipleofmillionsofdollars,inMedicareandfederalrelatedfeesandtheysign
allkindsofagreementswiththefederalgovernment...lotsofthosedocumentsprobablyhavelanguage
inthemthatsays`youagreethatyouwon'tengageinactivitythat'sunlawfulunderfederallaw.'"

There'salsonexttonoinformationreadilyavailablefromLARAaddressinghowtogetcertifiedproperly.
GrowsaidthatforlowerincomeMichigandersitcouldmakegettingcertifiedariskierendeavor.

"Itwouldhaveadisparateimpactonfolkswhodon'thavegoodaccesstotraditionalhealthcare,"he
said."Eitherfolksthathavechosentonotgotherouteofconventionalmedicine,orfolkswhobecauseof
economicproblemsdonotregularlyseeadoctor."

Abelthinksthere'sanelementofinjusticeinit.

"Thedoctorwhodidn'tdoasthoroughanexam,theirrecommendationisunlikelytoholdupaswellas
onewhowasmorethorough,"Abelsaid."Isthatfairtothepatient?Doesthatmeanyourconditionisany
lessserious?Maybeyouhavemultiplesclerosis,butthedoconlytookoneminute.Doesthatmeanthat
recommendationisnotasgoodasadocwhotakesahalfhourwithyou?...Thedoctorsarethe
gatekeepersandtheyshouldbeheldtosomekindofstandard."

AsforProctor'sphilosophybehindmarijuana,Bostichasasimpleanswer.

"He'sabelieverintheabilityofmedicalmarijuanatohelppeople."

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