Medical Establishment Abandons Patients and Ethics: Is there a doctor (or nurse) in the house?
Pubdate: Fri, 1 Mar 2002
Source: Alternatives for Cultural Creativity (Salem, OR)
Author: Ed Glick, RN
MEDICAL ESTABLISHMENT ABANDONS PATIENTS AND ETHICS: IS THERE A DOCTOR (OR
NURSE) IN THE HOUSE?
Nursing is Caring
Twenty years ago I began to learn what real suffering looks and feels like.
I watched helplessly while beautiful young men would, in three months time,
age 50 years, dying from a disease no one knew anything about at the time.
I have watched tobacco-cancer eat the lungs, livers and hearts out of
people. They had no idea, when they began using this legal herb, the
consequences in store for them.
I've cared for all of these people because they were suffering, and because
I am a nurse.
Today I sadly witness another widespread - and preventable - tragedy of
human suffering. It is the pain of ill and dying people, legally persecuted
for using an illegal herb, and simultaneously denied their appropriate
medicine by the medical establishment. This is the everyday experience of
cannabis patients, the "untouchables" of American medicine.
I've listened countless times as patients beg me to give them something I
can't - permission to use, grow, smoke, eat, and possess one simple herb.
They ask me to tell a narcotics "task-force" that they couldn't find their
registry card, or explain to a doctor that the drug keeps them from vomiting
up their protease inhibitors.
I've been watching this nightmare unfold in slow motion, while the medical
system that I thought supported patients consigns them to unnecessary
suffering and death.
My nursing education, which taught me all about mitering the corners of bed
sheets and the anatomy of disease, never prepared me for this.
Nursing school taught that the essence of nursing is compassion. Yet today,
I watch as Oregon's nursing and physician leaders cause pain and suffering
to the very people they are ethically committed to care for. Who forbids a
dying cancer patient a safe and natural herb that mitigates some of the
worst symptoms of their disease? What kind of society allows legalisms to
envelop and destroy an entire class of people, namely cannabis patients?
What can I say to these patients, other than "I'm sorry".
Oregonians To Medical Establishment: "Take Care Of 'Em"
Scientific, historical, and experiential research has described numerous
clinical indications for cannabis. The biochemical mechanisms underlying its
efficacy are only now being uncovered. Although its primary medical
indication is for pain, it is also indicated as an anti-emetic
(anti-nausea), anti-spasmotic, intraocular (eye) pressure reducer,
anti-anxiety agent, and appetite stimulant - among others. For many sick and
suffering people, Cannabis is a good medicine.
On November 3rd 1998, voters approved Ballot Measure 67, The Oregon Medical
Marijuana Act, 54% to 45%. Voters' intention was clear: cannabis patients
belong in the medical, not the criminal justice system.
The Oregon Medical Marijuana Act represented a watershed event in Oregon,
and nationally, by exempting patients from state criminal sanctions for
using cannabis, and by mandating the Department of Human Services (DHS),
Health Services (formerly the Oregon Health Division) to establish a
registration system on their behalf.
Upon passage, and with such unequivocal voter mandate, the legal protection
envisioned by OMMA's framer's was finally realized. We thought.
First results were encouraging. Through 1999 and 2000 the Medical Marijuana
Program grew rapidly under the leadership of Ms. Kelly Paige, an employee of
the Department. By May of 2001 it had grown to include 2800 registrants,
with some 550 physicians having registered one or more patients in the
Program. This remarkable number represents the highest physician compliance
rate in the US. It also reflects the large number of patients in Oregon who
use cannabis. And, in the three years that the Medical Marijuana Program has
existed, it has afforded some substantial protection to thousands of
Oregonians from unwanted contact with police.
But all is not well in this system. Structural flaws and interpretations
have left thousands more vulnerable to legal harassment. And, unfortunately,
even registrants in the Medical Marijuana Program face frequent police
searches because of inadequate possession limits and confusion in the law.
At the end of the day, thousands of ill Oregonians still suffer from double
exclusion (from both the Medical Marijuana Program, and the medical system),
and double inclusion (into the legal and criminal system). This is not what
Oregonian voters voted for.
The passage of the OMMA should have ended forever the abuse of cannabis
patients at the hands of police and District Attorneys. Unfortunately, it
didn't. In the intervening years, multiple unforeseen problems have
developed. These include 1. Patient inability to pay the application fee; 2.
Inadequate cannabis possession limits; 3. Uncooperative physicians, 4.
Obstruction of physicians by the Board of Medical Examiners, and 5. The
Oregon DHS's prohibitive new Administrative Rules. Each of these hurdles
effectively pushes patients back into the waiting arms of police and the
criminal justice system.
Prohibitive program registration fees have prevented many patients from
accessing the program. Chronically ill patients, bankrupted by America's
for-profit medical system, are forced to choose between sending $150 to the
Medical Marijuana Program, or paying rent. Some patients resort to selling
pharmaceuticals on the black market to raise the funds. As one patient
stated at recent Administrative Rules hearings: [The] "Oregon Health
Divisions Medical Marijuana Program is a Mafia Protection Racket."
Yet the Department is currently taking in excess of $350,000 per year in
patient money. This income should have allowed for a reduction in the
registry fee. It didn't.
Instead of a reduction in the registry fee, vast sums of patient moneys are
being spent by the bureaucrats of the Medical Marijuana Program on Attorney
General consultations, and Administrative Rules revisions. These activities
have prevented timely processing of applications. Legally, the OMMA requires
processing of applications within 30 days. The Department is chronically out
of compliance. This great waste of energy has come at the expense -
physically, and financially - of the patients whose well-being the program
is supposed to support.
Impossible plant and medicine possession limits also obstruct patients. The
OMMA allows only seven plants, up to three of which can be mature at any
time. "Usable" cannabis amounts are tied to the number of flowering plants.
Patients are often unable to maintain compliance with these small
allowances. If they harvest one plant then the allowable possession limit of
cannabis is reduced by one ounce! If they harvest all plants together, or
make cuttings, they exceed the limit again. If they grow their seven plants
outside, a sensible approach, they end up with seven large flowering plants,
and a pound or more of medicine. Most often the problem is simply an
inability to grow a quantity of medicine sufficient to meet the patient's
Unfortunately, Administrative Rules don't address these issues.
Doctors To Patients: "Don't Bug Me"
An even greater obstacle to patients became apparent in 1999, as large
numbers of physicians quietly decided not to participate in the Registry
Program. This left chronically ill people all over Oregon searching for a
physician who'd sign their form, allowing entry into the Medical Marijuana
Often, the doctor will privately admit to the patient that cannabis appears
to be an effective treatment. Still, many physicians refuse to sign the
form, citing fear of Drug Enforcement Administration (DEA), or disagreement
with cannabis therapy on ideological or medical grounds.
DEA fear is not entirely unjustified. US Attorney General John Ashcroft has
shown his disregard for patient suffering by actively arresting physicians
and patients, and closing Cannabis Resource Centers in California. There is
a possibility that the Attorney General may attack physicians in Oregon,
though this has yet to happen. (Amazingly, the Attorney General is fighting
Oregon patients on two opposing fronts. He simultaneously opposes terminally
ill patients who wish to use drugs to die, and severely ill patients who
wish to use drugs to live.)
Unfortunately physician non-participation inevitably pushes the problem back
on the patient. This constitutes gross patient abandonment. By protecting
themselves from the slight possibility of legal involvement, physicians
place their patients directly in the crosshairs of the criminal justice
system. Patients are easy prey to well-financed and trained narcotics
task-force paramilitaries. In 2001, cannabis patients in Oregon endured
numerous knock-and-talk searches and full-blown raids, including the
indignity of forced urine collections while handcuffed. In 2002, cannabis
patients are arrested and prosecuted because they lack legal and medical
Oregon's medical establishment has either ignored or exacerbated the
problem. The Board of Medical Examiners has initiated a witch-hunt against
one physician with the aim of removing his license to practice medicine in
Oregon. The Department of Human Services has introduced new rules resulting
in a decrease of the numbers of patients who can apply to the medical
Nursing organizations in Oregon have followed in the doctors' wake, much as
women (once) followed men: with silence and acquiescence. Neither the Oregon
Nurses Association nor the Oregon State Board of Nursing has addressed the
many problems cannabis patients and their nurses face in Oregon. Through
simple non-participation, nurses have mostly removed themselves from an
issue of great importance to thousands of Oregonians.
Government And Medical Board To Doctor Leveque: "Oh No You Don't!"
Into this vacuum of medical conscience stepped one physician: Doctor Philip
Leveque, a retired Osteopath from OHSU. Through 2000 and 2001, doctor
Leveque signed 800 Medical Marijuana Program applications. His effort
allowed virtually any patient suffering from a legally qualifying
"Debilitating Medical Condition" to access the safety net of the Medical
Marijuana Program. Through these actions, Doctor Leveque prevented a public
health emergency by simultaneously integrating large numbers of patients
into the medical system, and removing them from the illegal drug
Doctor Leveque was so successful, in fact, that in 2001 both the Oregon DHS
and the Board of Medical Examiners undertook investigations of him which
continue to this day. Citing concerns about documentation, the validity of
the "attending physician relationship", his "failing to uphold minimum
standards of practice", and now his psychological stability, they are
attempting to undo his good work and remove his license to practice. This
sends a signal to other physicians to not get involved in OMMA.
These actions are a clear example of a medical system that has distanced
itself from the needs of patients, even as it proclaims support for them.
The Medical Marijuana Program wasn't always this dysfunctional. When Kelly
Paige managed it there were big problems, including chronic understaffing,
but patient dissatisfaction was not one of them. Ms. Paige was, from the
beginning, a serious patient advocate who designed, organized, implemented
and operated the program almost single-handedly. She worked hard to educate
physicians and register patients. Ms. Paige was so successful that Oregon's
Medical Marijuana Program became the model program for other States with
similar laws. She helped implement programs in Hawaii, Maine and Colorado.
Unfortunately, Oregon's registry program was slowly swamped by lack of
administrative support and continual rapid growth.
In May of 2001, Willamette Week prepared a story describing a few cases in
which patients forged Dr. Leveque's signature on application forms. In a
colossal overreaction to the story, Department of Human Services Director
Bob Mink abruptly ordered Ms. Paige's reassignment. By stating: "I expect
more of my programs and managers", he in effect killed the messenger and
ignored the message. The one person who knew the program inside and out was
made responsible for problems she had identified, repeatedly communicated
and in some cases solved. Citing serious abuses of the program and poor
managerial oversight, new program staff were hired and asked to
simultaneously learn the program, operate it and rewrite the Administrative
Rules. From May, 2002 onwards, the Medical Marijuana Program floundered with
inexperienced staff, large backlogs of unprocessed applications and
spiraling patient dissatisfaction that continues to this day.
New, "Improved" & User-Unfriendly
The culmination of the new staff's efforts was a set of provisional rules
released in November, allowing the Department of Human Services to obtain
and review any patient's medical records to establish a "bona-fide"
physician/patient relationship. They also "clarified" the definition of
"attending physician" to exclude Dr. Leveque, (or any other physician) from
"rubberstamping" patient applications. Additionally, the Department applied
the rules retroactively, requiring all of Dr. Leveque's patients to submit
all their medical records for review and/or resubmit another application.
Failure to do so would disqualify them from the program. This action in
particular caused a collective anxiety attack amongst hundreds of patients
who had already gone to great personal effort to comply with the law. Many
subsequently gave up.
The Department of Human Services has continued to narrowly interpret the
OMMA, to the detriment of patients. In February 2002, Program Managers
announced that "designated primary caregivers" may only deliver cannabis to
a patient registered to that caregiver. This has the potential to destroy
the many advocacy and support organizations that assist patients by sharing
medicine with those who have no access.
Legal challenges to this "interpretation" are likely. Unfortunately, police
agencies will use this as an opportunity to intensify searches and arrest
patients and caregivers. The Department of Human Services bears direct
responsibility for the unnecessary suffering of patients and caregivers
caught in this legal crossfire.
Cannabis Patients To Medical Establishment: "Get Used To Us."
Today, there are many thousands of ill Oregonians using cannabis to relieve
their symptoms. They use it because cannabis affects "root" physiology of
pain, suffering and anxiety. Doctors and nurses know this to be true.
But most cannabis patients in Oregon use cannabis outside of the Medical
Marijuana Program, and will continue to do so. Why? For starters, the
misfortunes of many of the program's registrants are not lost on the many
disabled, but unregistered, people in this state. These folks have a
legitimate interest in registering for the program but, given current
conditions, would rather take their chances with the local cops.
Sadly, the current situation pulls patients in two opposite directions: one
of promised (but unobtainable) legal protection under the OMMA law; the
other of quiet disobedience. Either way, people will continue to use
cannabis as a proven effective medicine - and be arrested for it.
Patients in Oregon will receive the medicine they need and cease being the
targets of police harassment only when they are fully integrated into the
medical system. Until then, cannabis patients will continue to be uniquely
vulnerable. Their suffering is needlessly prolonged and exacerbated by the
Federal Government's War on Drugs (WOD) combined with physician and medical
system abandonment. We may not be able to do much about the WOD, but we can
influence physicians and the medical establishment of Oregon by holding them
to the highest medical ethics.
The Health Services's Mission Statement says it exists "To protect, preserve
and promote the health of all the people of Oregon. To prevent unnecessary
death and disability, improve the health status, and reduce the per-capita
cost of illness care for all Oregonians." The ethics of medicine and nursing
describe a philosophy of compassion that is at the "root" of medical
practice. Caring for others is a fundamental quality of civilized society.
Oregon voters clearly expressed themselves in November 1998. Their wishes
have only partly materialized.
Edward Glick, RN has been practicing nursing since 1983 in a variety of
clinical settings including AIDS, medical, cardiac, ayurvedic, and
currently, psychiatric at Good Samaritan Hospital in Corvallis, Oregon. He
participated in writing and campaigning for The Oregon Medical Marijuana
Act, (1998) and is a member of the DHS's Debilitating Medical Conditions
Advisory Panel (2000).
Ed is founder of "Contigo-Conmigo", an Oregon educational non-profit
corporation (1999), and a co-Chief Petitioner on OMMA-2.
Ed Glick is author of The Oregon Medical Marijuana Guide - A Resource for
Patients and Health Care Providers, (2001).
Ed can be reached at
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