Medical marijuana doctor loses license to practice

Medical marijuana buds.JR Delia/The New York Times

For the second time in a week, state regulators have stripped the medical license of a physician who works with medical marijuana patients, declaring that the doctor presents an immediate and serious threat.

The two physicians whose licenses have been yanked are accused of improperly certifying that thousands of patients were eligible to receive medical marijuana. In the second case, regulators suggest the doctor — described as the state’s third-highest provider of medical marijuana certificates — may have imperiled the health of pregnant women.

The actions by the Board of Registration in Medicine shine a spotlight on a type of medical practice that has long been controversial: Both suspended doctors worked in offices whose sole purpose is to sign certificates allowing people to possess marijuana for medical purposes.

The suspensions come after prosecutors said last month that a man who drove into a State Police cruiser, killing a trooper, had a medical marijuana certificate and was under the influence of the drug at the time. Authorities have not revealed who provided the certificate to the driver.

Asked whether the disciplinary actions against the two doctors are coincidental or represent the start of a crackdown, Dr. Candace Lapidus Sloane, medical board chair, said only that
the board receives many complaints and investigates them all “to protect patient safety.”

Governor Charlie Baker’s office declined to answer the Globe’s questions about the cases, instead providing a brief statement. “We are dedicated to maintaining strong protections for patients, and to ensuring proper behavior of medical professionals who are certifying patients,” said the statement from the governor’s spokeswoman.

On Thursday, the state pulled the license of Dr. Tyrone S. Cushing, accusing him of recommending medical marijuana in 2013 for a visibly pregnant woman with a history of substance abuse.

Cushing worked at CannaMed, which the board described as “a medical marijuana consultation center.” CannaMed has an office in Framingham and three in California.

The other doctor whose license was suspended — Dr. John C. Nadolny — was medical director of Canna Care Docs, a similar operation with offices in seven states, including eight in Massachusetts.

Both actions were summary suspensions, in which the board suspends a license without a hearing after finding that the doctor poses an immediate and serious threat to the public health, safety, and welfare. Suspended doctors must stop practicing but may request a hearing.

Only 149 physicians were registered with the state to sign medical marijuana certificates at the end of April. But the majority of nearly 30,000 certified patients get their certificates from just a small portion of those doctors.

In its order, the medical board described Cushing as the state’s third-highest provider of medical marijuana certificates, having issued 4,649 certificates as of May 20 while working only two days a week. Cushing acknowledged he did not conduct physical examinations or obtain vital signs from any patients, and may have certified many pregnant women, according to the order.

In suspending Nadolny’s license last week, the board said he had signed 5,792 certificates without having a physician-patient relationship with the patients, as required by state law, and that he often delegated the work to nurse practitioners.

Certification allows patients to buy up to 10 ounces of marijuana every two months.

Kevin Kafka, managing director of Canna Care Docs, said in a statement the practice believes that nurse practitioners are allowed to sign certificates with a physician’s supervision, but has suspended the practice pending clarification from the Department of Public Health.

“We stand by the certifications of patients that we have issued for medical marijuana in Massachusetts,” Kafka said, adding he was not aware of any investigation into other physicians in his practice. Ten physicians work under contract with Canna Care, he said.

The board’s action against Cushing resulted from a complaint made by a Department of Children and Families caseworker in August 2013. Asked why the board did not act sooner, Sloane, the board chairwoman, said she could not comment because it is an active investigation.

According to the order, Cushing signed a one-year certificate for a patient who was seven months pregnant and who had received treatment for opioid addiction. The order stated that he failed to discuss treatment alternatives, the risks associated with using marijuana along with other drugs, and her use of opioids and Prozac. Regulators also said the doctor did not discuss the patient’s “admitted prior use of recreational marijuana,” or the risks of marijuana use during or after pregnancy.

Cushing did not follow up with the patient’s obstetrician, her primary care doctor, her mental health provider, or her substance abuse treatment provider, according to the order.

Cushing did not reply to a voicemail message left at his home Friday. A man who answered the phone at CannaMed but who would not identify himself said, “Nobody’s commenting right now.”

Dr. James S. Gessner, an anesthesiologist who is president of the Massachusetts Medical Society, said in an e-mail that doctors are reluctant to certify patients for medical marijuana because its effectiveness has not been scientifically proven, it poses health risks, and the drug remains illegal under federal law.

Gessner said the high number of certifications issued by certain physicians “raises deep concerns about certifiers adhering to the Department of Public Health’s regulations, which states that a ‘bona fide’ physician-patient relationship must exist between the patient and the certifier.”

But with few doctors willing to provide certification, patients say it’s a challenge to obtain a drug they believe relieves pain and other conditions. Jeanne Ficcardi-Sauro, a 57-year-old from Mansfield who has stage four breast cancer, said she could not get her oncologist to recommend her for the state’s medical marijuana program.

“She just made a face at me,” Ficcardi-Sauro said. “I am not a stoner.”

She ended up securing a certification from a Natick physician, Dr. Uma Dhanabalan.

Dhanabalan, a family physician, said she has written certifications for roughly 600 patients in the past two years.

Unlike other physicians who typically issue certifications that are good for one year, Dhanabalan said she insists on writing certifications for a maximum of six months for new patients, because, she said, “I want to know what’s happening to my patients.”

Dhanabalan said she learned about marijuana for medical use when her mother was dying five years ago. She said few physicians receive adequate training in the field, and patients suffer for it.

“We need guidelines and to be trained in it,” Dhanabalan said. “There needs to be a specialty in this field.”