Massachusetts’ nascent medical marijuana law has sparked a recent flurry of new Internet companies promising to match patients with doctors who will certify they need the weed for health reasons, a phenomenon that has dismayed the state’s medical society and raised concerns with the board that regulates physicians.
A number of the companies are run by entrepreneurs with no medical background, which the Massachusetts Medical Society said raises questions about the quality and safety of the care.
Some of the sites, the society said, appear to be tiptoeing just inside state rules, which require a “bona fide physician-patient relationship” be in place before marijuana can be prescribed.
“The fact that you have people with no medical pedigree [launching these companies] is testament that this is purely a money-making operation,” said Dr. Ronald Dunlap, a cardiologist and president of the medical society. “These people are working around the edges.”
Voters last November approved a ballot referendum that legalized marijuana for medical use, but left it to the health department to issue regulations that would implement the law.
With those rules released in May, the department is whittling a list of 158 applications for registered marijuana dispensaries to 35, the maximum number of facilities allowed in the first year under the ballot initiative.
In the interim, patients are allowed to legally grow a small amount of marijuana for their own use, as long as a Massachusetts physician certifies they have a medical need.
Once the dispensaries open, which is expected in the spring, the state will begin tracking patients and doctors in a computerized system. A doctor’s certification will still be required then.
Among the newly launched Massachusetts doctor-finder websites is Commonwealth M.D., founded by Jai Chawla, a 28-year-old Cornell University graduate with a degree in history who founded an Internet security company, which he still runs.
Chawla, who is temporarily running his new business from a friend’s basement in Cambridge, said he charges $250 to cover the patient referral and the physician consultation.
“I understand that’s a large fee for a patient to be paying out of pocket,” said Chawla in a phone interview, noting that patients’ health insurance probably will not cover the service because marijuana is not federally sanctioned.
Most of the fee goes directly to the physicians so his company can remain “competitive” in attracting physicians, Chawla said. He said he has “fewer than five” physicians in his referral service, which opened a few weeks ago.
Matt Allen, executive director of the Massachusetts Patient Advocacy Alliance, which lobbied for the medical marijuana law, said the fees charged by the companies will probably be too high for many patients with chronic medical conditions who are on fixed incomes.
“We do hope some of these places will offer discounts for these patients,” Allen said.
But he also said the companies offer a needed service to some patients, such as veterans, who may be unable to get a certification where they typically receive medical care, through the Department of Veterans Affairs, because of federal rules prohibiting marijuana use.
Massachusetts would not be the first state to encounter growing pains with its medical marijuana law. A June report by Colorado’s state auditor found that 13 years after voters there approved the use of medical marijuana, a number of physicians appeared to be flouting the state’s bona fide patient-physician relationship requirement. It concluded that half of the 108,000 patients who had obtained state cards to possess medical marijuana received their certification from one of just 12 physicians.
One of those physicians had certified more than 8,400 patients, it said.
Massachusetts Public Health Department spokesman Dave Kibbe said in a brief statement that state rules require physicians to have a “bona fide relationship” with patients they certify for medical marijuana. He declined to comment further on the services.
New state regulations define a bona fide relationship as one in which the physician has “conducted a clinical visit, completed and documented a full assessment of the patient’s medical history and current medical condition, has explained the potential benefits and risks of marijuana use, and has a role in the ongoing care and treatment of the patient.”
Dunlap said his organization has expressed its concern about physicians potentially skirting the bona fide relationship rule in these websites to the state Board of Registration in Medicine, which regulates physicians.
Barbara Piselli, the board’s interim executive director, said her agency is monitoring the situation.
“We want to ensure all physicians are complying with the regulations concerning certification for medical marijuana, and that patients are receiving quality and safe medical care,” she said.
At least one of the new companies in Massachusetts, Delta 9 Medical Consulting, is run by a state-licensed anesthesiologist, Dr. Harold Altvater, who bluntly explains on his website what patients must do to fulfill the bona fide relationship requirements.
“You schedule follow up visits at least every six months helping to full fill the ‘bona fide’ physician-patient relationship desired by the overlords,” it states. “Yes, this will cost you about $17 dollars a month to remain compliant with the regulations.”
Altvater charges $250 for an initial certification, and $100 for renewals.
In a phone interview, Altvater said he has certified about 275 patients for medical marijuana since February, and that each exam is at least a half-hour, which includes a review of the patient’s medical record and education about medical marijuana.
According to Altvater’s site, the business is based in Malden and Methuen.