While supporters of the state’s medical marijuana pilot program cheered the extension and changes signed into law on June 30, Southern Illinois patients still face more hurdles than people with qualifying conditions living elsewhere in the state.
That’s because the region’s major health systems — Southern Illinois Healthcare, Heartland Regional Medical Center, and the Southern Illinois University School of Medicine — as well as some other smaller providers, have directed the physicians they employ not to participate.
“The continued concerns from hospitals, particularly in the Southern Illinois area, is very unfortunate as thousands of patients that are eligible are being held at bay because of physician or health system concerns,” said Bob Morgan, a health care regulatory and policy attorney with the Chicago firm Much Shelist, P.C. “It puts patients in a horrible situation when none of the physicians available to them are able to certify their conditions.”
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Morgan, who also formerly served as the state’s first coordinator of the program, said he has heard that it is “much more difficult” for patients with qualifying conditions in Southern Illinois to gain access compared to other parts of the state. That's because the policies of the major health systems, as well as the fact that there are fewer providers and specialists generally from which to choose.
Further complicating matters, he said, many patients in Southern Illinois are sent to specialists in bordering states — Missouri, Kentucky or Indiana — but the law only allows physicians practicing in Illinois to certify patients.
Legal vulnerability a concern
In explaining their policies, hospital system administrators in Southern Illinois have cited concerns about legal vulnerability should they allow their physicians to participate, given that marijuana — including medical marijuana — is still illegal under federal law. Changes to the law were intended to help ease those concerns, but didn't go far enough to make SIH comfortable with it, said SIH communications coordinator Rosslind Rice.
Under the new law, physicians will no longer be asked to sign off that it is their “professional opinion” that the patient was likely to receive from the medical marijuana a “therapeutic or palliative benefit.”
Instead, physicians only will be required to attest to the patient having one of the qualifying conditions recognized by the state. Medical marijuana is not prescribed by doctors in the traditional sense. Patients make an application to the Department of Public Health, which includes the physician certification, a background check, and other requirements.
Upon approval, they are given a patient registry ID card, which allows them to purchase marijuana from an approved dispensary. The law allows these individuals to possess 2.5 ounces over a 14-day period, and slightly more via a waiver process.
Morgan, who also is president of the Illinois Cannabis Bar Association, said this change was made specifically to address the concerns of physicians and hospital groups.
The SIU School of Medicine, which sees patients in Carbondale and elsewhere in the region, also is sticking with its decision not to allow physicians to participate — at least for now. Lauren Murphy, a spokeswoman for the school, said faculty are reviewing changes that are part of the new law.
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“So until that review is complete, our position remains unchanged,” she said. “SIU does not support the physicians in activities that result in the prescribing or dispensing of any drugs classified as Schedule I by the U.S. Drug Enforcement Agency.”
In the fall, a spokesman for Heartland Regional Medical Center also said its physicians were instructed not to participate in the certification process. A spokesperson for the hospital could not be reached for comment this week to find out if the hospital planned to reconsider its position in light of changes made in the new law.
A slow start, especially here
Illinois’ medical marijuana law — a four-year pilot program — was signed into existence by former Gov. Pat Quinn in 2013, though it was rolled out in fits and starts. The first sales didn’t happen until November 2015. Without the extension Rauner signed on June 30, the program would have expired at the end of 2017.
At the program's infancy, health systems across the state expressed many of the same concerns noted by those in Southern Illinois, Morgan said. But in other areas, administrators have since taken steps to relax their policies and give physicians the discretion to determine whether it is appropriate for patients on a case-by-case basis, he said.
The new law also added post-traumatic stress disorder and terminal illness, defined as one where the life expectancy is six months or less, to the list of roughly 40 qualifying conditions that can make a person eligible.
Marion doc in hot seat
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Meanwhile, because some physicians are declining to or are not allowed to participate in the certification process, a Marion doctor that will has become rather popular.
Pied Pfeifer Compassionate Care, where Dr. Bodo Schneider is the medical director, advertises on its Facebook page that the clinic is sympathetic toward medical cannabis.
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The clinic opened in Marion in September 2013, four months before the effective date of the state’s Compassionate Use of Medical Cannabis Pilot Program Act. Schneider, who also operates a clinic in upstate Orland Park, said in a previous interview with the newspaper that he believes in traditional medicine and often prescribes it.
But he also believes that medical marijuana can have benefits for some patients, such as those living with chronic pain, cancer, late-stage HIV or AIDS and other debilitating conditions. Marijuana has been shown to revive an appetite and can also bring pain relief without some of the harsh side effects associated with opioids, he said.
But the dilemma with the number of patients flooding the clinic is the law specifies that only doctors with a “bona-fide physician-patient relationship” can certify a patient seeking a medical marijuana ID card.
The Department of Public Health defines that as one where the physician has an “ongoing responsibility for the assessment, care and treatment of a patient’s debilitating medical condition.” Though the rules do not define a specific time it takes to establish this relationship, Schneider has told the newspaper he was directed by the department that 90 days was a good rule of thumb.
But now he's in the hot seat of another state agency over whether he truly has established that relationship with the clients he's certifying for the medical marijuana program.
The Illinois Department of Financial and Professional Regulation, which oversees doctors, filed a complaint against Schneider in June 2015 alleging that he inappropriately charged patients a fee for pre-certification for medical marijuana without establishing a legitimate physician-patient relationship, and for visits where he did not conduct a physical examination.
For three examinations over 90 days, patients seeking certification were asked to pay the clinic about $300 cash between an intake, evaluation and third meeting to finalize the certification process, according to the regulatory agency's complaint, which states that Schneider’s actions are grounds for suspension or revocation of his license.
While the complaints against Schneider are still pending, he said recently that he remains hopeful it will be dismissed. A hearing in Chicago is scheduled for July 25.
“We’re not getting rich here,” Schneider said. Schneider said he believes he is providing a needed service that levels the playing field for people in Southern Illinois. He said some area physicians employed by the large hospital systems tell him they would participate if they could.
“I’m getting referrals from SIH physicians for patients wanting to participate, and because they feel like they cannot (certify the patients), I’m seeing them,” he said. “The response has been overwhelmingly positive.”
Praise for governor's actions
As to the extension of the law that Rauner signed, Schneider said he was pleasantly surprised that the governor acted more than a year in advance of the program’s scheduled expiration, as this provides some stability. “I’ve been very pleased and I have to send out a 'congrats' and a 'thank you' to the governor,” he said.
Others involved in the medical marijuana industry in Southern Illinois expressed similar sentiments.
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“It’s a great day for the patients of Illinois,” Paul Montes, managing director of Wellness Group Pharms, a cultivation facility in Anna, said earlier this month. “We’re excited that the administration is doing what’s best for the state and we’re very happy.”
Though the roll out was slow, Montes said he has no complaints. He said the program is poised to “absorb many, many patients.” “All the cultivators are prepared for the expansion,” he said. “The administration has been great. This will just help things along.”
Rosie Naumovski, a co-owner of Thrive Harrisburg and Thrive Anna, marijuana dispensaries, said she was “extremely excited” the governor “listened to the public outcry as far as recognizing PTSD, and for it to be an approved condition.”
That helps the program along, she said. Though she also noted the difficulty people with qualifying conditions are having in jumping through that first hoop — finding a physician that will certify them for the program. She remains hopeful that may change in the future.
“It’s been a big struggle in this region for people to find participating doctors, and it shouldn’t be that way,” she said. “The program was not designed that way.”
On Twitter: @MollyParkerSI