Rare Disciplinary Case Against Pa. Doctor Offers Glimpse Into The Big Business Of Medical Marijuana Cards

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HARRISBURG - When Bette Gray considered using marijuana to ease her chronic pain last year, she turned to Veriheal, a national medical marijuana company.

The company contacted Theodore Colterelli, a Pennsylvania doctor who has the power to decide whether patients qualify for the state's medical marijuana program.

After the virtual meeting, Colterelli agreed. But the assessment got him thinking about the process. Gray told Spotlight PA that he barely saw Colterelli during the meeting and found the conversation brief. He also said he didn't know where to upload his medical records to Veriheal.

- Did he give official permission? he recalls

Gray filed a complaint against Colterelli with the Department of Health, which oversees the state's medical marijuana program. The department later accused it of violating state law by approving Gray's certification without reviewing his medical records. But more than a year after the department began disciplinary proceedings against Colterelli in April 2021, proceedings were still pending in early November.

Colterelli's attorney, Richard Hark, told Spotlight PA that doctors follow all aspects of medical marijuana laws for all patients they see, and noted that the department did not allege Colterelli violated state regulations for other patients. In legal documents, Hark said Gray's complaint was "motivated by a false sense of public duty," that the doctor had correctly issued the certificate, and called the department's action against Colterell a "gross abuse" of its power.

Indeed, Colterell's case is special. He is the first doctor to face formal disciplinary action from the Pennsylvania Department of Health for violating the rules of the state's medical marijuana program since it began in 2016, public records show. There are over 417,000 active patients and over 1,800 licensed cannabis therapists.

Although some medical professionals fear that almost anyone can obtain a license to use medical marijuana, the Department of Health rarely takes disciplinary action against doctors for potential violations of the program. Although public records show the department has warned several doctors for alleged violations of program rules, no other disciplinary cases like the one against Colterelli had occurred as of early July. Additionally, state regulators have inconsistently enforced other program rules, such as advertising restrictions, according to a previous investigation by Spotlight PA.

In Pennsylvania, medical marijuana cards are a multi-billion dollar business. Each year, hundreds of thousands of patients must obtain a prescription if they want to legally use marijuana in the state. Certification often costs between $100 and $200, and to be awarded, a doctor must have a valid medical license, complete a four-hour training course and be approved by the health department.

Some medical marijuana advocates, such as Pennsylvania pharmacist Lauren Vrabel, have raised concerns about the health department's oversight of the certification process.

"Certified physicians must be verified to maintain patient medical records, including proof that a provisional diagnosis occurred prior to certification," Vrabel said in a written statement to lawmakers. "According to the rules and regulations, they must also present evidence that they have received the appropriate advice."

Other medical marijuana advocates have publicly questioned the practices of third-party medical marijuana companies, including Veriheal. The company helps patients make appointments with doctors who can perform evaluations, a key step in obtaining a medical marijuana card in Pennsylvania. Their profits are often based on approval: Veriheal's Pennsylvania website instructs patients to "get approved or get your money back."

Veriheal is accused of paying doctors only if they give permission to the patient.

The Pennsylvania Department of Health has repeatedly stated that it does not control this activity. Press officer Maggie Barton told Spotlight PA that "patient health and safety is a top priority." He declined to comment on Colterelli's case and provided few details in response to general questions about the department's compliance with medical standards.

Veriheal spokesman Anthony Dutcher told Spotlight PA that the company "has no control over the professional conduct of physicians," does not provide medical services and does not maintain complete medical records.

"Veriheal takes compliance very seriously and believes that compliance is an ongoing effort to stay vigilant and continually improve," Dutcher said in an email.

Under Pennsylvania law, doctors who practice medical marijuana must complete a comprehensive evaluation of the patient's medical history and current health status in order to issue a certificate.

"I'm kind of aware because I said it last time and I'll say it again because I want to make this point," former Health Secretary Rachel Levine said at a November 2019 board meeting. medical marijuana. "Careful medical history, physical examination, review of records ... we expect adequate and thorough advice from our doctors when examining patients."

Before the coronavirus pandemic, laws required doctors to see patients in person, but regulators and lawmakers relaxed the rules to allow remote visits. But while states have streamlined the certification process, the Health Department has also struggled to make the public aware of how many patients each doctor sees, data that can reveal irregularities that may or may not violate the program's rules.

The department sued the journalist after the State Public Records Office ordered all the doctor's details to be made public. The department argued that state medical marijuana laws contained broad privacy rules that prevented the release of information, and, as of early November, the case was pending in Commonwealth Court.

It's unclear how many people Colterelli accepted under the Pennsylvania program. The department's attorney raised the issue at a disciplinary hearing, but the expert overseeing the trial decided there was no need to respond.

Gray, 62, has more experience in health care than most people. He is a licensed respiratory therapist, founder of a free medical clinic in the District of Columbia and a member of the State Board of Osteopathic Medicine. He told Spotlight PA that when he made an appointment for medical marijuana through Veriheal last year while seeking help, it wasn't a problem. But his professional experience pushes him to finish to the end.

"I am committed to protecting the citizens of the Commonwealth as patients," Gray said. "And here, as a patient, I don't really like or understand how this medical cannabis process is going to work."

While Gray told Spotlight PA that he has some concerns about his meeting with Colterelli, the department's official claims are based on access to Gray's medical records.

The department said Colterelli violated program rules that require doctors to review "previous medical history documented in a patient's medical record" if the records are visible.

At trial, attorneys for Colterelli and Gray disputed whether the process for uploading medical records was clear to patients. Colterelli noted that uploading documents is easy and he was "confused because he couldn't do it."

Colterelli insisted on conducting a thorough background check and determined that Gray was an ideal patient for medical marijuana. Often, he says, patients come to one-on-one appointments without their records, and he has to diagnose them, too. The process involves looking for symptoms, problems, what causes them and what tests they are doing.

You work with them very carefully. You also judge their character, their honesty, how they answer you, you know," Colterelli testified." This is not a frivolous process."

According to her testimony, she was able to do this during her time with Grey.

It is not clear from the file how long his confession lasted. Colterelli describes the visit as about 10-15 minutes.

Gray's concern that he could barely see Colterell was not part of the department's argument for sentencing the doctor. State law does not require video for remote consultation; some experts say it may just be audio.

After the trial, the Health Department's attorney recommended that Colterell be removed from the program. According to the lawyer, the alleged "serious breach" directly affected the safety of every patient he met.

Colterelli's lawyers argued that the case should be dismissed. He claimed that Gray's medical records were not available and that the doctor issued the certificate incorrectly. He wrote that Colterelli interviewed him carefully and provided a "complex, coherent, compelling and complete case history." He noted that Gray had been candid in his meeting with Colterelli.

In March, expert Debra Sue Rand ruled that Colterelli violated state regulations and recommended a three-month suspension of her right to certify medical marijuana. Rand wrote that when Gray offered to share her computer screen to show her medical records during the video interview, she refused.

Doctors should review medical records to make sure patients aren't taking other medications or have other medical conditions that would make marijuana use inappropriate, Rand wrote.

Rand noted, however, that the department doesn't claim it doesn't regularly review patients' medical records or dispute that certification is appropriate for someone with Gray's disease.

A top Health Department official accepted the hearsay expert's recommendation in a final decision on Oct. 21, but Colterelli still has the chance to appeal. His lawyers declined to comment on the decision. A spokesperson for Veriheal said the company has had no contact with Colterelli since February 2022.

In Colterelli's case, the Health Department did not charge Veriheal with wrongdoing.

The company's website says the goal is "to make it as easy as possible to get a medical marijuana card." List the standard price for an annual certificate at $199.

Earlier this year, a Florida doctor and his attorney raised a public question about the company's practice.

Jack Rothman told the Florida Board of Medicine that Veriheal offered him this deal: The company would refer patients to him and pay him $55 per hospitalization. But if Rothman decides a patient is ineligible, he will receive no compensation.

In a statement to Spotlight PA, Veriheal did not respond to Rothman's claims. A spokesman said the company "does not participate in the doctor's professional fees," but did not elaborate.

Rothman is an independent contractor for another medical marijuana company, DocMJ, according to company CEO Aaron Bloom, an attorney who represented Rothman at the Florida Board of Medicine. The company is headquartered in Florida and also offers telemedicine services in Ohio and Texas.

Bloom told Spotlight PA that paying doctors' fees only if they give the patient permission creates a financial incentive to do so.

Both Veriheal and Bloom offer a money back guarantee to patients if they are not approved. But Bloom says he pays his doctors an hourly rate, regardless of the number of patients they see or the evaluation results.

"We're wasting doctors' time," Bloom told Spotlight PA. "We don't punish doctors for practicing proper medicine."

Pennsylvania physician Mary Frances Kester expressed similar concerns to the Department of Health last year when she described the pressure doctors face when third-party certifying companies pay them only if they accept patients. Kester mentioned Veriheal in her public comments and later told Spotlight PA that she worked with the company and left after having problems with its practice.

"I don't blame Veriheal for what they did," Kester told Spotlight PA. "I blame the state for not fixing this.

In June, the department responded to concerns that doctors are only paid if they admit patients to the hospital. But he denied responsibility, saying commenters "should report it to the appropriate authorities". The department's response, part of a formal process to implement the medical marijuana program's rules, did not say who it should be.

In Colterelli's case, experts warn that there is no evidence that the doctors "received an economic advantage, other than the opportunity to receive a regular salary."

Colterelli's attorney Har told Spotlight PA that financial compensation was not an issue for the doctors. He said it "never influenced the nature and manner of medical reports, diagnoses and prescriptions."

Gray told Spotlight PA in July that he didn't think doctors should work with third-party certifications. A few months later, his vision softened a bit. But he still thinks the company deserves more attention.

"The state must also take responsibility for this," he said. "... How does the state verify these companies?

This is not the case at the moment.

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