Pubdate: Tue, 16 Jul 2013
Source: Denver Post (CO)
Copyright: 2013 The Denver Post Corp
Contact:  http://www.denverpost.com/
Details: http://www.mapinc.org/media/122
Author: Eric Gorski
Page: 1A

AUDIT HITS HEALTH AGENCY OVER FEES, LAX REGULATION

State auditors examining the Colorado Department of Public Health and
Environment's role as gatekeeper to medical marijuana use found lax
regulation of physicians, unnecessarily high patient fees and a
failure to oversee caregivers.

An audit released Monday is the second rebuke in recent months of
Colorado's efforts to oversee medical marijuana.

In March, auditors came down even harder on the Department of Revenue
division charged with regulating medical pot businesses, finding
wasteful spending and incomplete enforcement.

Oversight of medical marijuana in Colorado falls to two state
agencies. The Marijuana Enforcement Division, part of the Department
of Revenue, regulates dispensaries, grow locations and
infused-products manufacturers. The health department is responsible
for maintaining the patient registry, among other roles.

The registry is expected to shrink considerably once recreational pot
shops open early next year, a consequence of voter-approved Amendment
64 last November. The numbers have begun to dwindle in recent months,
with 105,886 patients as of May 31, downfrom108,656 in January.

The audit Monday found evidence the health department does not
sufficiently oversee doctors who give patients recommendations needed
to get medical marijuana.

One doctor provided recommendations for more than 8,400 patients. Some
doctors showed a penchant for recommending plant counts far above the
standard of six plants per patient, which can be exceeded if medically
justified. One physician recommended 501 plants for a single patient.

The audit found the department did not take full advantage of
enforcement steps, including referring doctors to the Colorado Medical
Board or holding hearings if doctors are suspected of improper
financial ties to medical marijuana businesses.

The department referred concerns about five doctors to the medical
board for investigation in 2011- the last year it has done so. Karin
McGowan, interim director of the health department, suggested at a
legislative committee hearing it was a challenging issue.

"I think it is difficult to determine whether people who have high
patient counts have just specialized in that area or are doing
something inappropriate," she said. "It is hard to tell."

The medical board has taken final agency action against two doctors
who were referred by the health department, a spokeswoman said. Both
were put on five-year probation for violations including failing to
properly evaluate patients.

The audit also found little departmental oversight of caregivers, a
little-tracked component to the medical marijuana system. Caregivers
are supposed to take significant responsibility for managing patients'
well-being, not just supply them with marijuana.

Of 5,400 registered caregivers, auditors identified 52 who exceeded a
five-patient limit and some operating substantial grow operations,
raising the question of whether they are operating as marijuana
businesses. Waivers to the patient limit are available but auditors
raised concerns about them.

Auditors also flagged the department for charging patients too much
for application fees. By the end of fiscal year 2012, it had built up
excess reserves of more than $11.3 million with the fees. The large
reserves have put the department out of compliance with a statutory
limit on such funds since 2004.

McGowan said the state Board of Health discussed eliminating the fee
altogether but was concerned about lower barriers inviting fraud. Fees
have been reduced over the years, most recently to $35.

The department agreed to numerous steps as a result of the audit,
including seeking more patient information from doctors, asking
caregivers to more fully account for their services and revisiting its
fees.
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MAP posted-by: Matt