High Number of Medical-Pot Certifications by Naturopaths No Big Deal, Says Board Director

The head of the Arizona Naturopathic Physicians Medical Board isn't concerned with a new report that shows naturopaths make most of the states medical-marijuana recommendations.

"Yes, our doctors are the top prescribers," says Gail Anthony, the board's executive director. "I don't think it would be a big deal."

Anthony does, however, recommend that licensed naturopaths follow state rules concerning written medical-marijuana certifications -- even if a recent court ruling states they can't be prosecuted for flouting those rules.

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Naturopathic physicians make up a small fraction of physicians overall in Arizona. But a state report released this month shows they write about 75 percent of the medical-marijuana certifications.

Anthony points out that previous reports by the state showed similarly high numbers by naturopaths, a situation that simply "is what it is."

"Our doctors don't get a lot of insurance reimbursement -- they work on a cash basis," Anthony says. "They are manning these marijuana-certification clinics."

The board regulated 760 physicians as of March 2014, says a September 2014 state Auditor General report that complained of lax oversight. By comparison, Arizona reportedly had more than 16,000 M.D.s and D.O.s. as of September.

According to the Third Annual Medical Marijuana Report by the Arizona Department of Health Services released this month, naturopaths wrote three-quarters of roughly 52,000 certifications from July 2013 to June 2014.

Fewer than one-in-five naturopaths -- 130, to be precise -- wrote any certifications in that time-frame. But a few of them are very prolific: Twenty-one of those doctors wrote more than 28,000 certifications.

The state's numbers also reveal that the naturopaths are filling a key niche for the state's program.

Just 408 M.D.s and 70 D.O.s wrote certifications overall, for just 3 percent of their total number. While those doctors together wrote nearly 12,000 certifications, something's causing the vast majority of M.D.s and D.O.s to stay away from the program. If it wasn't for the naturopaths, most patients would likely be unable to find a recommending physician.

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Naturopaths typically go through a rigorous schooling and internship, but add various traditional or holistic practices that distinguish them from allopathic and osteopathic doctors.

A week after the DHS report was released, spurring the Arizona Daily Star to warn of "pot mills," the state Court of Appeals ruled that doctors could not be prosecuted in connection with providing medical-marijuana certifications -- even when doctors lie on the form.

The unanimous ruling, based on the broad protections in the voter-approved 2010 Medical Marijuana Act, indicates no urgent need for the naturopaths to slow down their certification-writing.

The ruling stemmed from a 2012 prosecution of Dr. Robert Gear, a licensed Arizona naturopath who was indicted by a grand jury in Navajo County on charges of forgery and fraud for a signed attestation he made on a certification.

The evidence that something went wrong seems clear enough: Gear had signed off on the part of the form attesting he'd reviewed a year's-worth of a patient's medical records, as required under state DHS rules. But the "patient" he'd seen had really been an undercover police informant who had submitted no medical records.

Navajo County Brad Carlyon appealed the case after the Superior Court threw it out.

In upholding the lower court's decision, the appellate judges noted that the 2010 AMMA provides protection from prosecution for physicians in recommending medical marijuana, whether for writing certifications "or for otherwise stating that" a patient's symptoms would be helped by marijuana. Carlyon's office forgot about that part, to paraphrase the Appeals Court, and focused on the state health department's rule concerning written certifications.

Trouble is, those rules aren't part of the law, which says nothing about a mandatory review of medical records. The most-stringent requirement in the law is that the physician, "sign and date the written certification only in the course of a physician-patient relationship after the physician has completed a full assessment of the qualifying patient's medical history."

The DHS didn't overstep its bounds by creating the rule about reviewing 12 months of medical records, but physicians can't be prosecuted criminally for breaking that rule, the 3-0 appeals court ruling affirms.

DHS Director Will Humble notes that the ruling doesn't address the potential discipline by a professional board for the unprofessional conduct of one its members.

"So, as long as a physician licensing board takes false attestations seriously... then there would still be professional (as opposed to criminal) consequences," Humble tells New Times.

The Arizona Naturopathic Board is still reviewing the November 20 court ruling and its possible ramifications, Anthony says. She had no comment on whether the board was investigating Gear.

Complaints against physicians will be investigated, and discipline handed out has needed, she says.

"We don't like our doctors lying," she says. "If a complaint comes across my desk, we look at that, and investigate it. The board makes the final determination of whether it reaches a level of unprofessional conduct."

A review of the board's disciplinary cases shows that five naturopaths have received various punishments since 2012 for alleged violations of the state's certification-writing rules, including 30-day suspensions, $1,000 fines and mandatory training classes.

Though Humble has griped publicly in recent years about naturopaths writing excessive numbers of certifications, Anthony says she has a "pretty good working relationship with DHS. I don't know if there's tension, so to speak."

Got a tip? Send it to: Ray Stern.

Follow Valley Fever on Twitter at @ValleyFeverPHX. Follow Ray Stern on Twitter at @RayStern.

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