Pubdate: Sat, 07 May 2005
Source: Helena Independent Record (MT)
Copyright: 2005 Helena Independent Record
Contact:  http://helenair.com/
Details: http://www.mapinc.org/media/1187
Author: Linda Halstead-Acharya, The Billings Gazette
Cited: Marijuana Policy Project http://www.mpp.org
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)

AIDS PATIENT RUNS INTO MEDICAL MARIJUANA GRIDLOCK

Jim Hartford knows how marijuana eases his AIDS symptoms. What he doesn't 
know is how to get a physician's approval so he can register to use it.

Hartford, of Billings, was diagnosed with HIV nearly 11 years ago. He takes 
a cocktail of drugs to manage what has developed into AIDS. He knows that 
AIDS is one of the conditions for which medical marijuana can be approved, 
and he believes that cannabis can relieve some symptoms -- nausea, lack of 
appetite, a feeling of restlessness in the legs -- in ways that other drugs 
cannot.

"There are four drugs, essentially, that I can cut out by using marijuana," 
he said.

Hartford was born in Lewistown and grew up between Missoula and Billings. 
He later moved to Oregon where he was a registered user of medical 
marijuana and then last year -- after Montana voters passed the state's 
Medical Marijuana Initiative -- he decided to move back home.

"I wanted to be close to my family," he said. "It was time. The fact that 
Montana had backed me on this issue, I thought it was great. I could come 
back and maintain my health."

But Hartford ran into a roadblock. His physician at Deering Clinic told him 
he cannot sign the paperwork required for Hartford to register with the 
state to be a medical marijuana user.

Hartford understands the doctor's reluctance, given that the physician is 
following a directive. He also understands that the process takes time. In 
Oregon, it took Hartford six months to get his registry card. But he's 
irritated at the options he was given.

He was told to write a letter.

"But to where? Nobody said," he said.

He was told he could go to another doctor.

"That doesn't work because you have to have the doctor treating the illness 
sign the papers."

Finally, he said, he was told to wait until the federal and state 
governments agree on the matter. To date, Montana has approved the use of 
medical marijuana, but the federal government has not.

"I just don't have time to wait," he said. "I've dealt with this too long."

Above all, Hartford is frustrated that he doesn't know what to do next. 
Ideally, he said, he would like to go before a judge to present his case.

Hartford believes most of the confusion over medical marijuana stems from a 
lack of information and education. When a physician signs an application, 
he or she is merely attesting to the fact that the patient has one of the 
conditions listed in the statute and that the benefits of using medical 
marijuana would likely outweigh the risks, he said.

"It's the state of Montana giving the permission, not the doctor," he said.

But the state-versus-federal question continues to plague some patients, 
physicians and clinics. Answers are not easy to come by.

At Montana's Veterans Administration facilities, the question has already 
been decided. Because the physicians there are federal employees, they 
abide by federal law and will not sign, explained Ruth Linfield, assistant 
to the chief of staff at the VA in Helena.

"It's pretty cut and dried for us," she said.

As for physician liability -- some physicians fear losing their licenses -- 
Bruce Mirken, director of communications for the Marijuana Policy Project, 
said that matter was resolved in October 2003. That's when the Supreme 
Court let stand a decision preventing the federal government from revoking 
a physician's license for "recommending" the use of medical marijuana.

Still, physicians at Deering Clinic, which receives federal funding, feel 
some gray areas remain.

Uncertain whether they would jeopardize their federal dollars, they decided 
to err on the side of caution. With advice from legal counsel, officials 
there decided not to sign applications until the matter is definitively 
resolved.

"It's hard to risk the support for 14,000 patients" for a few who request 
approval for medical marijuana, said Dr. Jim Guyer, the clinic's director. 
"We're just kind of waiting for the issue to clear."

As it stands, Deering advises anyone wanting authorization to look outside 
the clinic for a physician willing to sign. However, the clinic does not 
have a list of providers willing to do so. Patients are also informed of 
prescription alternatives that can treat their symptoms.

Hartford, who would rather take fewer medications than more, doesn't see 
that as a viable option. He is also surprised by Deering Clinic's stand 
because his first authorization came from a physician at a county health 
clinic in Oregon.

The Marijuana Project's Mirken said he knows of no court case directly 
related to federally funded clinics.

Officials at two federal agencies, one that deals with Medicaid and another 
that deals with community health clinics, said the question has not come up 
before. But they do not foresee any threat to federal funding.

"Because there is no illegal drug being dispensed, because a prescription 
is not even being written and because there is no state cost involved and 
no federal costs involved, there are no violations of conditions of 
participation we could figure out," said Mary Kahn, a spokesperson for 
Medicaid.

A call to the Montana Attorney General's office for clarification on 
state-federal issues is directed to Roy Kemp, bureau chief of the licensure 
bureau of the Montana Department of Public Health and Human Services. Kemp 
is charged with establishing the state's medical marijuana registry, 
protecting the anonymity of the individuals listed on that registry and 
providing information related to the state's program. He declined to speak 
on federal issues or interpret legal matters.

Whether statute allows Hartford to seek the signature of another physician, 
Kemp says that's a question for an attorney. Mirken says he is unaware of 
anything in Montana law that would prevent Hartford from doing so.

"In some states, it's a relatively common practice," he said. "Of course 
the second doctor would be expected to follow appropriate standards of 
medical care."

And, as Kemp points out, there are 72 physicians from 20 Montana counties 
who have done so to date. There are currently 100 Montanans listed on the 
registry.

Kemp also offers that, under Montana's statute, Hartford's Oregon card 
would qualify him to use medical marijuana in Montana, provided the card is 
current -- which it is not.

Meanwhile, Hartford wonders where to turn.

"I never wanted to be the one to take this up," he said. "I just wanted to 
live my life. The people of Montana were very brave to vote this in, but 
now nobody's letting me know what's going on. And I don't know where to go 
with it." 
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MAP posted-by: Richard Lake