I write concerning a recent email I received about the N.E.D. Officer Keith Kamita is apparently giving public presentations in which he questions the motivations and integrity of patients who use medical cannabis and the physicians who certify their eligibility to do so. This news is consistent to my personal dealings with Mr. Kamita, who has expressed to me his suspicions that physicians are certifying patients that are not truly qualified by the law, at least as far as the law "originally intended". He implied that he would be scrutinizing the medical cannabis card applications we submit and stated that it would be a "good idea" for us physicians to elaborate on our patient's condition in the "comments" section of the "Physician's certification" (Page 3 of application). He actually stated that he hopes to avoid pursuing RICO charges against physicians. (Racketeer Influenced and Corrupt Organizations Act - Wikipedia, the free encyclopedia) Obviously, Mr. Kamita does not want to see the rising tide of medical marijuana tolerance that is sweeping the nation to spill over into Hawaii legal precedent any more than it already has. It is my opinion that his attitude and behavior can be used to exemplify why certain changes in Hawaii's current medical cannabis law need to be implemented. Mr. Kamita's presentation confirms that he is collecting data to build cases against physicians (and perhaps patients too.) No wonder he wants us cannabinoid friendly physicians to elaborate on our patient's conditions. He is looking for diagnostic patterns in our certifications to argue that we are breaking the law repeatedly. However, Mr. Kamita is neither professionally nor intellectually qualified to analyze our diagnoses or judge us or our patients based on any medical information submitted to the N.E.D. or otherwise. He's a police officer. While it could be countered that Mr. Kamita is "just doing his job" as an officer of the N.E.D., I find it disturbing that his presentation singles out physicians who certify medical cannabis patients. It would be telling to know whether he makes such presentations citing which physicians prescribe the most oxycodone or hydrocodone in the state, publicly questioning their professional integrity. The N.E.D. is certainly privy to such information along with the birth date information required with prescriptions for controlled substances. But state law (HRS 329: Uniform Controlled Substance Act) does not require diagnostic justification in such prescriptions. In fact, no where in HRS 329 does it state that physicians are required to provide diagnostic justification (i.e. "for pain" or "for AIDS", etc.) for providing written certification for the use of medical marijuana for qualifying patients. The law states that to be a qualifying patient, the patient must have a "debilitating medical condition", which it defines as: (1) Cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, or the treatment of these conditions; (2) A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: (A) Cachexia or wasting syndrome; (B) Severe pain; (C) Severe nausea; (D) Seizures, including those characteristic of epilepsy; or (E) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Crohn's disease; or (3) Any other medical condition approved by the department of health pursuant to administrative rules in response to a request from a physician or potentially qualifying patient... "Written certification" means the qualifying patient's medical records or a statement signed by a qualifying patient's physician, stating that in the physician's professional opinion, the qualifying patient has a debilitating medical condition and the potential benefits of the medical use of marijuana would likely outweigh the health risks for the qualifying patient. The department of public safety may require, through its rulemaking authority, that all written certifications comply with a designated form. "Written certifications" are valid for only one year from the time of signing. (HRS 329-121 "Definitions")
And so the law in itself does not require that physicians do more than notate in their patient records "that in the physician's professional opinion, the qualifying patient has a debilitating medical condition and the potential benefits of the medical use of marijuana would likely outweigh the health risks." The catch is that "the department of public safety may require, through its rulemaking authority, that all written certifications comply with a designated form." This "designated form" compels patients to consent to allow their physicians "to release any protected health information" pertaining to their "debilitating condition". It further compels the physician to furnish the patient's medical information that Mr. Kamita is citing in his presentations. It also requires physicians to certify that the patient was "seen and examined" at a permanent business location registered with the N.E.D., meaning that if your bed-ridden auntie needed a medical cannabis card, she'd have to travel to an N.E.D. approved medical office of one of us few physicians who provide written certifications in the state. House calls are not allowed - no matter how debilitated auntie is.
This "designated form" has got to go! It undermines doctor-patient confidentiality. It denies physicians their right and ability to go to their patients and serve them directly in their communities and homes as has been done since the dawn of time. Simply removing the phrase: "the department of public safety may require, through its rulemaking authority, that all written certifications comply with a designated form" would go a long way towards getting the N.E.D. out of the physician-patient relationship. "Written certification" could stay where it belongs — in the patient's medical records." But I don't believe that this is enough. Mr. Kamita's public attempts to discredit certifying physicians and their patients also hinges on this state's very narrow definition of "debilitating medical condition." Without a doubt, a host of other debilitating medical conditions, including psychiatric disorders, are safely and effectively treatable with cannabis. Hawaii patients would be much better served if, as in other states, their physicians merely had to offer their professional opinion that the benefits of medical cannabis outweigh the risks for their patients. No other medication is required such diagnostic cubby holing. And yet cannabis is safer than the majority of medications available by prescription and even over the counter. I am trying to organize my fellow physicians who provide cannabis written certification evaluations to draft a consensus standard of care professional opinion. My goal is not to dictate how physicians should practice medicine in Hawaii, but rather to form a united front amongst the few of us in the state who include such services in our practice. I'd be comforted to know that if the N.E.D. comes after one of us for practicing within the guidelines of our standard of care, they're coming after all of us. I invite all physicians to come on board with me on this. The sooner we do this the more protected we will be in our practices and the better served our patients will be. I am also investigating the Department of Health's administrative rules to request that the list of qualifying medical conditions be expanded to also include anxiety, insomnia, ADHD and PTSD. However, preliminary phone conversations indicate that this probably won't yield much owing to such conditions not being "intractable" nor conditions for which "no other treatment is available." I am so not naïve to think that my involvement with the medical cannabis movement is going to change state public policy much, but the tide is shifting in our favor, and agents of the N.E.D. know it. Since my name was listed in Mr. Kamita's presentation, I have attempted to contact him to ask for a copy of his slide show and a list of times/places where he'll be making future presentations. He has yet to return my call. Regardless, rather than being threatened by Mr. Kamita's drug war misinformation talks, I choose to look at them as ammunition that can be used in letters to our congress to change the law in positive directions — not to mention as free advertisement.
Wishing Well,
Kevin Baiko, M.D.
And so the law in itself does not require that physicians do more than notate in their patient records "that in the physician's professional opinion, the qualifying patient has a debilitating medical condition and the potential benefits of the medical use of marijuana would likely outweigh the health risks." The catch is that "the department of public safety may require, through its rulemaking authority, that all written certifications comply with a designated form." This "designated form" compels patients to consent to allow their physicians "to release any protected health information" pertaining to their "debilitating condition". It further compels the physician to furnish the patient's medical information that Mr. Kamita is citing in his presentations. It also requires physicians to certify that the patient was "seen and examined" at a permanent business location registered with the N.E.D., meaning that if your bed-ridden auntie needed a medical cannabis card, she'd have to travel to an N.E.D. approved medical office of one of us few physicians who provide written certifications in the state. House calls are not allowed - no matter how debilitated auntie is.
This "designated form" has got to go! It undermines doctor-patient confidentiality. It denies physicians their right and ability to go to their patients and serve them directly in their communities and homes as has been done since the dawn of time. Simply removing the phrase: "the department of public safety may require, through its rulemaking authority, that all written certifications comply with a designated form" would go a long way towards getting the N.E.D. out of the physician-patient relationship. "Written certification" could stay where it belongs — in the patient's medical records." But I don't believe that this is enough. Mr. Kamita's public attempts to discredit certifying physicians and their patients also hinges on this state's very narrow definition of "debilitating medical condition." Without a doubt, a host of other debilitating medical conditions, including psychiatric disorders, are safely and effectively treatable with cannabis. Hawaii patients would be much better served if, as in other states, their physicians merely had to offer their professional opinion that the benefits of medical cannabis outweigh the risks for their patients. No other medication is required such diagnostic cubby holing. And yet cannabis is safer than the majority of medications available by prescription and even over the counter. I am trying to organize my fellow physicians who provide cannabis written certification evaluations to draft a consensus standard of care professional opinion. My goal is not to dictate how physicians should practice medicine in Hawaii, but rather to form a united front amongst the few of us in the state who include such services in our practice. I'd be comforted to know that if the N.E.D. comes after one of us for practicing within the guidelines of our standard of care, they're coming after all of us. I invite all physicians to come on board with me on this. The sooner we do this the more protected we will be in our practices and the better served our patients will be. I am also investigating the Department of Health's administrative rules to request that the list of qualifying medical conditions be expanded to also include anxiety, insomnia, ADHD and PTSD. However, preliminary phone conversations indicate that this probably won't yield much owing to such conditions not being "intractable" nor conditions for which "no other treatment is available." I am so not naïve to think that my involvement with the medical cannabis movement is going to change state public policy much, but the tide is shifting in our favor, and agents of the N.E.D. know it. Since my name was listed in Mr. Kamita's presentation, I have attempted to contact him to ask for a copy of his slide show and a list of times/places where he'll be making future presentations. He has yet to return my call. Regardless, rather than being threatened by Mr. Kamita's drug war misinformation talks, I choose to look at them as ammunition that can be used in letters to our congress to change the law in positive directions — not to mention as free advertisement.
Wishing Well,
Kevin Baiko, M.D.
