Doctor fined for role in marijuana clinic

The Montana Board of Medical Examiners says a Whitefish physician's past work with medical marijuana patients "amounts to unprofessional conduct" and has ordered her to pay a $2,000 fine.

The board also ordered Dr. Patricia Cole to abide by a number of conditions for 12 months. She 'specifically is prohibited from serving as the consulting physician for third parties or caregivers in mass conference-like settings akin to that which gave rise to this action."

According to the board's May 21 order, Cole saw 151 patients seeking state medical marijuana cards over a 14 1/2-hour period during an October 2009 medical marijuana conference in Great Falls.

The board collected charts for 20 of these patients from their medical marijuana provider and submitted them to a peer review.

The peer reviewer concluded that Cole breached her statutory obligations to comply with "generally accepted standards of practice" and the state's Medical Marijuana Act, including:

¥ Documentation was lacking whether she personally took comprehensive past or present medical histories, performed physical examinations, or performed medical marijuana risk-benefit analysis.

¥ Seeing scores of new patients in one day is considered below the standard of care, "particularly given that physicians commonly afford new patients greater time."

¥ Cole failed to document if she advised patients about proper dosages and the potential dangerous side-effects and interactions of medical marijuana, including the dangers of operating machinery and motor vehicles.

¥ Cole failed to recommend timely follow-up evaluations to assess the effectiveness of the medical marijuana treatment.

¥ Questions were raised about whether Cole had enough time to preview patients' records-release consent forms and whether she allowed the Montana Caregivers Network, which organized the conference, to manage the patients' records.

The board concluded that Cole had "committed a sanctionable breach" of state law. She was ordered to pay a $4,000 fine, with $2,000 stayed for 12 months so long as she commits no further violations. She also "must scrupulously adhere to all then applying medical standards of care, statutes and regulations governing medical marijuana."

Cole must pay the cost of subsequent peer review, up to $1,500. At the end of 12 months, a peer reviewer will take a look at a log she is required to keep of each patient who she issues a medical marijuana-use certificate.

"I understand the guidelines and agree with them," Cole told the Pilot, "but they didn't exist last year."

She said the intent is to have the medical marijuana recommendation process look like a family practice office, which Cole says she intends to maintain here in Whitefish. But at the time of the clinics last year, very few doctors were willing to recommend medical marijuana, so patients with debilitating illnesses had to seek them out.

Cole says the medical board focused on her record-keeping, but she feels she looked carefully at each patient. She said she reviewed the records of about half the 151 patients as last October's clinic in Great Falls ahead of time. Another large group came in with records in hand, and while others didn't have records, their scars or burns clearly demonstrated their debilitating condition.

"I approve of the board wanting it to look more like a family practice, but there's a large demand and they'll need a lot more doctors willing to recommend medical marijuana," she said.

The board also unanimously adopted a position paper on mass screenings by medical marijuana providers, where large groups of people are charged $100 to $150 for a doctor's recommendation to smoke marijuana.

The board pointed out on May 21 that it "takes no position on the general suitability of marijuana in the treatment of medical disorders," but that it "does have an obligation to protect the public by ensuring that physicians provide medical services via a bona fide physician-patient relationship that meet the generally accepted standards of care."

The board said it was concerned about reports that physicians were certifying patients for medical marijuana "in a mass screening format" and through online consultations. Whether for student athletes or medical marijuana, mass screenings and group evaluations "inherently tend towards inadequate standards of care," the board said.

Physicians found to be practicing below the acceptable standard of care would be subject to disciplinary action for unprofessional conduct, the board warned.