Since Rhode Island made medical marijuana legal in 2006, there has, some say, been one roadblock after another in getting patients served and, more recently, in facilitating the three approved dispensaries, or compassion centers.
Delays, limitations, and legal revisions have frustrated caregivers, patients and the owners of the would-be dispensaries, which still have not opened.
But when the R.I. Department of Health last August barred registered nurse practitioners and physician assistants from signing medical-marijuana certification forms, which they have been authorized to do since the law was passed six years ago, a line was crossed, says the Rhode Island chapter of the American Civil Liberties Union.
“[The move] is a further indication of the general hostility the state has shown toward promotion of the medical-marijuana program,” said Steven Brown, executive director of the Rhode Island ACLU. “This isn’t just some isolated back-tracking.”
The Rhode Island ACLU in October filed a lawsuit in R.I. Superior Court against the DOH on the grounds that the department changed its policy in violation of the state’s Administrative Procedure Act, because it did not allow for public comment or give notice of the decision.
Named as original plaintiffs in the lawsuit, in addition the ACLU, are the Rhode Island Academy of Physician Assistants, the Rhode Island Patient Advocacy Coalition and Peter Nunes.
Nunes, according to court documents, is a 50-year-old Bristol resident who was denied participation in the medical-marijuana program because he obtained his medical approval from a physician assistant before the new DOH rules, but attempted to obtain his certification after they went into effect.
Nunes could not be immediately reached for comment.
A DOH spokesperson said the department would not comment on a pending lawsuit. The department previously has said it made the changes after reviewing the amended law that Gov. Lincoln Chafee requested and that the General Assembly approved in May 2012.
The issuing of compassion-center licenses was put on hold, the ACLU said, beginning when the three centers were approved in March 2011 because Chafee then requested the state law be revised after U.S. Attorney Peter Neronha said he intended to prosecute the centers under federal law.
Neronha last April said he would prosecute property owners if they leased space to compassion centers.
In a bill passed by the House on May 16, new dispensary limits were imposed to shrink the centers below a size that would attract federal law enforcement attention.
“I’m not sure [the new DOH changes] are going to be problematic for the dispensaries, but I think it will be problematic for people who receive primary care from nurse practitioners,” said Seth Bock, founder of the Greenleaf Compassion Center that he plans to open in Portsmouth.
Bock said he has been working to get a new Portsmouth location approved by the DOH after a selected one “was not working out.” The other two approved compassion centers are in Providence and Warwick.
But Bock is concerned about patients who have been working with nurse practitioners or physician assistants as their primary care givers who now will have to develop a new medical relationship with a doctor in order to obtain a medical-marijuana certification.
James Carney, the president of the Rhode Island Academy of Physician Assistants, who has been a practicing physician assistant for 31 years, shares that fear.
“This maneuver on the part of the DOH really throws a roadblock up to access to care. We see this as the DOH stepping in and undermining the basic foundation of how we practice,” he said. “In Rhode Island law, it is stated that physician assistants are working as an agent of a physician and that physicians can delegate tasks to physician assistants.
The legal issue, the ACLU said, is that in addition to the DOH not allowing for public comment, the August decision “summarily reverses” a six-year policy.
“Physician assistants and nurse practitioners are hired to do just this sort of work and there’s no reason why they should not be doing it,” Brown said.