The Rhode Island Medical Society has joined a legal fight against a state rule that prohibits nonphysicians from certifying patients for use of medical marijuana. The regulation, which took effect Aug. 22, overturned a policy that enabled physician assistants and nurse practitioners to recommend patients for medical cannabis. Physicians say the policy change burdens doctors with the task of certifying all medical marijuana patients — a duty they say other health professionals are qualified to perform.
“As we’re moving [further] to team-based care, this flies in the face of a physician being able to lead a team of nurses and physician assistants in providing care to their patients,” said Steven R. DeToy, director of public and government affairs for the Rhode Island Medical Society. The medical society is suing the state health department over the policy change. “By taking physician assistants out of the equation, it not only impacts patient access [to care] but also the normal work flow in a physician’s office. By state law, physicians are allowed to delegate to a physician assistant anything they want within their practice.”
The Rhode Island Dept. of Health defends the change, saying the revision was made after an analysis of the state’s medical marijuana law.
“In preparation for the opening of compassionate centers in Rhode Island, the department of health took a closer look at the newly amended medical marijuana statute,” health department spokeswoman Dara Chadwick said in an email. Compassion centers are nonprofit organizations that cultivate and dispense marijuana or related materials to state-approved patients. “Based on legal analysis of the statute, the decision was made to prohibit licensed nurse practitioners and licensed physician assistants from authorizing medical marijuana for their patients.”
Plaintiffs: State unfairly changed rule
Rhode Island’s medical marijuana law, enacted in 2006, allows patients with approved debilitating conditions to obtain medical cannabis. Patients originally were required to have a health professional’s certification before receiving a state medical marijuana card.
In August, Michael Fine, MD, director of the Rhode Island Dept. of Health, announced that the department no longer would accept medical marijuana applications signed by physician assistants or nurse practitioners. Only physician-signed forms would be approved.
16 states have medical marijuana laws. The Rhode Island Patient Advocacy Coalition and the Rhode Island Academy of Physician Assistants sued the health department in October. The Rhode Island Medical Society then joined the suit. The plaintiffs, represented by the Rhode Island American Civil Liberties Union, claim that the state did not go through the proper process to change the rule. The policy reversal took place without formal notice and without allowing health professionals and others to voice their concerns, said Steven Brown, executive director of the Rhode Island ACLU. The policy change also violates other state statutes, the lawsuit contends.
“There’s no authority for the department to deny these practitioners the ability to certify the forms,” Brown said. “We argue both the medical marijuana law itself and other statutes clearly give physician assistants and nurse practitioners the authority to sign these types of certifications.” If the policy stands, it would create a precedent undermining the foundation of PAs’ practice and negate the importance of physician delegation, the Rhode Island Academy of Physician Assistants said in a statement.
“It would also completely contradict the global signature provision of our practice act that specifically affirms the validity of a PA’s signature in lieu of that of the physician,” the statement said. “Whether to offer this option to patients is a decision that must be made by each PA/physician team.” Rhode Island is among 16 states that have legalized medical marijuana. Many of the statutes have been subject to legal challenges asserting that state prerequisites for obtaining medical marijuana are too strict.
The Rhode Island Medical Society has long supported its state’s medical marijuana law, DeToy said. “Most physicians don’t participate [in the program], but we have several hundred physicians who do participate, and it’s been working very well,” he said.
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