It could be called the Leveque Rule, after Dr. Phillip Leveque, a 78-year-old Molalla osteopath who has signed for more than 40 percent of the state's 2,200 medical marijuana patients.

But the rule raises some troubling issues for Oregon doctors, who question how the rule will be enforced and whether it will conflict with a new federal law protecting patient privacy.

And a patient advocacy group said the rule amounts to unnecessary red tape that will make life harder for patients.

The temporary rule went into effect Friday and applies to pending and future applications. It will be in force for up to 180 days. In the meantime, a public hearing to establish a permanent rule will take place this fall.

While not identifying Leveque by name, state officials referred to a doctor who signed for "a disproportionately large number of applicants" to justify the need for the new rule.

"The large number of cases makes us question whether this person could truly qualify as the attending physician for all these patients," Dr. Grant Higginson, state health officer with the Department of Human Services, said in a statement.

"We need to make sure a physician-patient relationship actually exists in these cases before we process them, and the new rule allows us to do so."

Leveque could not be reached for comment Friday.

He said in earlier interviews that he did not examine in person each of the more than 900 patients he has signed for. In some cases, patients would mail him copies of their medical charts and he would consult with them over the phone.

Leveque said he feels "a moral obligation" to sign for patients who legitimately qualify for medical marijuana under the law. He said the reason he's signed so many applications is that patients often have trouble getting their regular doctors to sign.

The state Board of Medical Examiners has notified Leveque that he is under investigation, alleging that he signed a medical marijuana form for a patient without examining her, diagnosing her condition, conferring with her primary physician or documenting his care in her medical charts.

Under the new rule, a physician who signs a written statement for a medical marijuana applicant must at minimum maintain an active, up-to-date medical file for the patient. The rule gives medical marijuana program staff authority to examine the original patient file or require a copy of the file from the physician, solely to examine the patient-physician relationship.

Paul Frisch, legal counsel to the Oregon Medical Association, said the state was making a good faith effort to address a problem, but "the solution creates more problems than it resolves."

"If you're looking for doctors who shouldn't be doing this, this is an odd way of doing it," he said.

Frisch said if the Health Division believes a doctor is not acting in good faith, officials should refer their concerns to the Board of Medical Examiners, which has authority to yank a doctor's license.

Mac Prichard, spokesman for the Department of Human Services, which oversees the Health Division, said the program staff will not attempt to verify that an ongoing patient-doctor relationship exists for every application.

The rule states that in determining whether to examine a patient's medical records, staff members may consider factors such as complaints from patients, family members or health care providers, or the number of applications a single doctor has signed for.

But it doesn't say what that number is.

It might be an easy call to request those records if a single doctor has signed for hundreds of patients, but less so if the doctor has signed five or 10 or 20, Frisch said. He urged the state to set up a specific threshold.

"If you're doing more than 25 of these, perhaps you're inviting scrutiny, and you need patient authorization," he said. "It's not clear what is required at this point."

Of the 538 doctors who have signed for medical marijuana patients, 63 percent had signed for a single patient, according to state records obtained by The Register-Guard under public records laws.

Only 13 doctors have signed for more than 10 patients.

Frisch also is concerned that the new rule will conflict with a new federal law, the Health Insurance Portability and Accountability Act, or HIPA.

The federal law, which is in effect but won't be enforced until April 2003, makes it clear when and under what circumstances patient information can be shared with third parties, Frisch said. He said HIPA likely will require doctors to get specific authorization from patients before sharing their medical charts with the state.

Prichard said the state is not ignoring HIPA.

"We're saying it is the responsibility of the doctor to secure a release from the patient if in fact a release like that is necessary," he said. "If the doctor can't get the OK from the patient, then we can't look at the record and we'll have to deny the application."

Voter Power, a Portland-based medical marijuana patient advocacy group, has referred hundreds of patients to Leveque. The group's director, John Sajo, criticized state officials for adopting a rule for which Sajo contends there is no compelling need.

"We think they're piling more rules onto the patients and doctors, which is going to make life harder for patients," he said.

"We think they're being overly bureaucratic."

The rule won't necessarily stop Leveque from signing for patients, but it will make it more difficult, he said.

Sajo also was critical of the Health Division for promulgating a new rule when they're breaking an existing rule that requires them to process applications for medical marijuana cards within 35 days.

Some patients have been waiting 100 to 120 days to get their cards, he said. The delay could be harming a patient's health, he said.

That's why Voter Power is contemplating legal action to compel the state to follow its own rules, he said.

Marijuana Law:

Oregon's medical marijuana law permits each cardholder to have a total of seven plants: three mature, or budding, plants, and four immature plants. Those with a permit can possess three dried ounces - one for each mature plant.

Source: Register-Guard, The (OR)
Author: Tim Christie, The Register-Guard
Published: August 11, 2001
Copyright: 2001 The Register-Guard
Contact: rgletters@guardnet.com
Website: http://www.registerguard.com/

Related Articles & Web Site:

Stormy Ray Foundation
http://www.stormyray.org/

Oregon Stiffens Medical-Marijuana Rules
http://cannabisnews.com/news/thread10587.shtml

Doctor Defends His Use of Medical Marijuana Law
http://cannabisnews.com/news/thread10292.shtml

Doctor OKs Almost 900 Medical Marijuana Cards
http://cannabisnews.com/news/thread10232.shtml

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..Just wait until the day comes when they finally are forced to accept
Marijuana at the federal level...they will try to continue
regulating every aspect of legalized pot,and confuse things
with thousands of new laws....dddd


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