Pubdate: Wed, 03 Jun 2015
Source: Prince George Citizen (CN BC)
Copyright: 2015 Prince George Citizen
Contact:  http://www.princegeorgecitizen.com/
Details: http://www.mapinc.org/media/350
Author: Sheryl Ubelacker
Page: 8

SOME MEDICAL POT PRODUCERS PAYING FEES TO MDS FOR PATIENT REFERRALS: COMPANY

TORONTO - A major producer of medical marijuana says doctors and 
specialized clinics are receiving kickbacks from some licensed pot 
producers in exchange for sending them patients, a practice the 
company calls unethical and a violation of professional medical standards.

Greg Engel, CEO of Nanaimobased Tilray, said his company recently 
resigned from the Canadian Medical Cannabis Industry Association 
(CMCIA) after unsuccessfully pushing for the organization to adopt a 
code of ethics that would outlaw the practice.

The dozen members of the CMCIA were unwilling to sanction such a code 
because "many were currently participating" in such kickback schemes, 
he said. Tilray is starting a new industry group, the Canadian 
Medical Cannabis Council, which will insist on strict adherence to 
ethical conduct.

In a statement from the CMCIA, executive director Neil Belot said the 
organization agrees on the need for a high level of ethical conduct 
among producers, but more agreement had not been reached on the 
wording of such a code.

The CMCIA said Tilray's proposal was not accepted by its board 
because it could "have had the inadvertent effect of prohibiting 
members from conducting meaningful research and data collection 
initiatives," for which they receive specific compensation from 
doctors and clinics.

The group's lawyers also advised the board to exercise caution in 
developing guidelines, due to potential risks associated with 
Canadian competition law.

"Tilray resigned from the association before the matter was fully 
discussed or resolved," Belot said. "Instead of continuing to work 
together on an important issue, Tilray chose to exit the association."

Engel said his company has never and will never compensate a 
physician for a referral or for writing a prescription for medical cannabis.

Yet the company provided copies of invoices it had received from two 
doctors, three clinics and two patient aggregator groups that work 
with health practitioners. The unsolicited bills seek direct payment, 
most for $50 each, or a percentage of cannabis sales.

"Even though we don't have agreements in place with any physicians, 
they've actually submitted invoices to us for payment," Engel said 
from Nanaimo.

"Some of these clinics are also asking for fees, anywhere from $150 
to $400, for a patient referral to the licensed producer," he said of 
the practice that's begun permeating the fledgling industry.

"And then there are a number of patient aggregator groups that are 
looking to either payments or a percentage of sales for referring 
patients to them."

The Canadian Medical Association has strict guidelines prohibiting 
its 80,000-plus members from accepting any type of fee related to 
prescribing a medical device, pharmaceutical or medicinal marijuana.

"The rationale is really fairly straightforward that you shouldn't be 
recommending products or services and then have a financial 
incentive," said Dr. Jeff Blackmer, the CMA's vice-president of 
medical professionalism.

Patients should have the assurance that their health-care provider is 
acting in their best interest - not in the provider's best 
"financial" interest, he said.

"The fundamental principle is that a patient wants to feel like their 
doctor's prescribing pad is not for sale."

A number of provincial colleges of physicians and surgeons that 
regulate doctors' conduct - including those in Ontario and B.C. - 
also ban acceptance of any fee from pharmaceutical companies or 
licensed cannabis producers linked to prescriptions.

Kathryn Clarke, a spokeswoman for the Ontario college, said the 
regulatory body has a policy that's specific to medical marijuana, 
which was recently updated to reflect changes made in April 2014 to 
federal regulations governing medicinal cannabis.

Under the new rules, a doctor provides a document - in effect, a 
prescription - which allows a patient to purchase a certain amount of 
cannabis from a licensed producer of their choice.

"The policy sets out the expectations of physicians when they're 
contemplating prescribing medical marijuana, and the college has 
taken the position that completing the medical document is akin to 
writing a prescription, and as such physicians are not permitted to 
charge a fee for doing so," Clarke said Tuesday.

As well, under the Ontario Medicine Act's conflict of interest rules, 
doctors are prohibited from receiving any benefit for referring patients.
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MAP posted-by: Jay Bergstrom