Your Section 8 Defense begins with your Certification Visit.

Dr. Townsend is an acknowledged expert on the bonafide dr/pt relationship in Michigan. He has been consulted by attorneys, government officials, and various organizations to clarify and explain what constitutes a bonafide relationship and what does not, as well as the components and standards of a certification exam.  Here are some suggestions for a safe and legally defensible certification.

Be a real patient:

Michigan has a medical marijuana act, it does not have legal marijuana use.  We all agree that marijuana is pretty benign, that we are adults and should be able to use it if we wish, and the idea of actually prosecuting someone for a plant is absurd.  Yet the fact remains, we must request special permission to use it and there are requirements to meet.

The first and foremost requirement is that you have a qualifying condition- and a qualifying condition that is on the list.  There are named conditions, such as Cancer, Glaucoma, and Crohn’s Disease.  You either have them or you don’t, and if you have them and wish to have medical marijuana you should be able to document the diagnosis AND show that you are under treatment for it.  The second type of qualifying condition is a symptom- either directly caused by another condition or the treatment that condition requires. 

Here are some examples:

  • You have HIV and are taking treatment or are on Hospice.
  • You have cancer that is undergoing treatment
  • You have severe anxiety and require medication to function.  Both the anxiety and medication cause you to have severe nausea for which you have sought treatment

Things that are a little iffy-

  • You broke your leg playing high school football, and can’t document having sought medical care for it since (and you are 42 years old).
  • You had B-Cell skin cancer, it was removed, and hasn’t been a problem for the last 10 years.
  • You have a history of headaches but always just took a Tylenol and they went away.

Your condition must be ‘chronic and severe’:

At Denali Healthcare, chronic means it lasted longer than it should have- a good rule of thumb is more than 3 months if not years.  Chronic diseases that never go away are also covered under this definition. Severe means it is bad enough to have sought medical care, as proven by medical records (which also confirm the condition). If you can afford certification, a grow room, and cannabis, you can afford to document your medical condition by going to the doctor.

Have a Bonafide Relationship with your Doctor:

Bonafide has two meanings.  The first, broad meaning is that it is Latin for good faith.  The problem is what is evidence of ‘good faith’ differs based on your end goal.  What is ‘good faith’ to you and me may not be ‘good faith’ to a judge.  As a result, there is now a ‘legal’ definition of bonafide in the law. 

THE STANDARD:

There are certain things that set a ‘bonafide’ relationship apart from the hotel and dispensary doctors that the courts are looking for.

  1. The Physician has obtained and reviewed the patient’s records, reviewed their medical history and current medical condition.  Furthermore, a relevant in person exam is conducted.
  2. The Physician creates and maintains a medical record for the patient.
  3. The Physician has a REASONABLE EXPECTATION they will provide follow up care and reassess the patient’s use of marijuana.
  4. IF the patient permits, has notified the patient’s primary care physician.

There are several points of note in these four statutory requirements from PA 512 of 2012 (HB 4851). 

The doctor’s certification visit is like any other doctor’s visit and requires a medical record to be created and maintained.  This is common of all aspects of medicine, and the court has ruled the certification document (application) itself does not satisfy the requirement for a medical record.  There must be a separate note written and a file created. 

The doctor must take a history, review records and conduct an exam.  There are two cravats to this- another, independent, doctor should be able to review the file kept by the certification doctor and reasonably come to similar if not the same conclusion given the evidence at hand.  Second, the term ‘relevant’ is clearly used in the physical exam.  This indicates that the physical exam must elicit a finding that contributes to the diagnosis.  A finding of a scar from back surgery does not confirm or deny chronic pain- but a history of treatment for chronic pain does.  In this case, the physical exam is NOT relevant, it does not add anything to the diagnosis of chronic pain.

A reasonable expectation of follow up, rather than actual follow up, is required.  This is along the lines of ‘you can lead a horse to water, but can’t make it drink’.  If a physician is available, and recommends a follow up (especially if there are potential consequences if follow up is not carried out) – it is REASONABLE to EXPECT a patient to follow up with the doctor.  If the patient does not, they may be placed in a position in a Section 8 hearing to justify WHY they didn’t follow up as recommended.

Finally, all certification physicians are happy to notify the primary if the patient wishes, it is simply up to the patient to request.  Physicians REFERRING patients to specific certification clinics are generally automatically sent a report unless requested not to.  That is just how the referral system works.

In addition to your medical records, you will need your Michigan driver’s license or ID.

Know the Michigan Medical Marijuana Laws:

Public Act 512 of 2012 (HB 4851 ‘bonafide dr/pt relationship’)

Public Act 514 of 2012 (HB 4854 ‘transport’)

The Bonafide Relationship- Pitfalls to Avoid