Open letter to Hawaii State Senator Josh Green, MD

James Berg, MD
Hawi, HI

February 26, 2014

Open letter to Dr. Joshua Green,

From James Berg, MD

RE: SB no. 2574 S.D.1

Dr. Green,

Medical marijuana patients and the public should be aware of your current bill amending the medical marijuana law that would add to the suffering of qualified patients and embitter the medical marijuana community. You have been promoting a bill entitled SB no. 2574 S.D.1, which demands that patients obtain their medical marijuana certificate from their primary care physician that is defined as “designated by the patient as a primary care physician to the patient’s insurance provider.”

I have a double board certification in both family medicine and integrative-holistic medicine, and I am an expert in herbal medicine and natural approaches to healing. I do not work with any insurance companies, yet I am a primary care physician to many patients on the Big Island of Hawaii. Many of these people have been my patients for over a decade and they consider me their “real” primary care doctor, but many also use their insurance doctors to get tests and see specialists if needed. I also help the qualified patients to get legally certified to grow and use marijuana as their medicine.

I would like to know how many of my patients have complained to you or the state about their concerns about my care as a family doctor. As far as I know, I have never had any complaints levied against me, nor any formal investigation into the way I practice. The bill you are promoting that defines a primary care physician as the one designated by the patient to their insurance is an arbitrary restraint of trade for fully qualified doctors like myself; More importantly, this is a truly malicious attempt to make it harder for patients to get the effective medicine of their preference. Your efforts is not about helping people, it is about hurting them!

Most of the insurance-based primary care doctors in Hawaii refuse to do the medical marijuana certification for their patients. Most patients are hesitant to bring up the matter with their insurance-paid physicians under the fear that they would be prejudiced against in their care. Kaiser Permanente does not allow their primary care doctors to do it, nor the VA, nor any Federally funded clinic in the state of Hawaii. That is at least half the people in Hawaii. Too often, if a patient acknowledges that they have a medical marijuana certificate, they might loose access to their other pain medicines prescribed through their insurance. And they could loose the respect of their physician.

What about the seizure patient who goes to the VA – their primary care physician and neurologist is excluded from the program, therefore a seizure patient with the VA would not be allowed to fulfill the medical marijuana law? What about the severely nauseated patient with Kaiser or a local federally funded clinic, these patients will not be allowed to fulfill the law as proposed, even from a board certified gastroenterologist? What about the AIDS/HIV patients in the same situation, their primary care physician from the VA and their infectious disease specialist would not be allowed to help, and thus the patients would be excluded from the new amendments. How does this arbitrary law change serve these patients in need? What happens to the patient who has insurance from another state? Are they automatically excluded, even if they are a legal resident of Hawaii? Clearly, this amendment is directly contrary to the spirit of the law to allow patients access to this medicine! Many fully medically qualified patients would be automatically excluded from the mm program because of their insurance. Qualified patients need access to this medicine and by law, are entitled to it. Your bill will frustrate many patients and truly cause them harm! Tell us please, how does it help them?

t should also be pointed out that the current medical marijuana law of the state of Hawaii specifically states:

“HRS 329-124 Insurance not applicable.   This part shall not be construed to require insurance coverage for the medical use of marijuana.”

Under your amendment, insurance coverage would be required for a patient to obtain the certificate for the medical use of marijuana. How can you require patients to go through their insurance companies that are not allowed to help patients in this regard? If a patient has to go through their insured primary care doctor, that is requiring patient’s use their insurance to get their card. That is directly contrary to the mm law as it is written in HRS 329-124.

How does your new bill help patients? I would argue that not one patient is actually helped, but many, many will be harmed by your bill. As a fellow doctor, I would like to make this explicitly clear, you are hurting many patients by your demanding that they go through their insurance to get their medical marijuana card because these doctors have already shown their unwillingness to help their patients in this way!

In 2012, you introduced a bill that would have excluded patients with pain, muscle spasms, nausea and wasting. The reasoning, you claimed was that most of these patients were in the young 20’s and coming in for trivial pain conditions. Over 90% of the patients in the state would have been disqualified based on your false information. Luckily, the bill did not pass. I calculated that the average age in my practice of a mm patient was 47 years old – twice the age you claimed. You proved to everyone with a mm certificate that you are willing to speak untruths about the evidence behind medical marijuana certification for political, not medical reasons. Many people have already lost faith in your integrity and compassion. Now you seem eager to exclude at least 10,000 out of the 12,000 current medical marijuana patients. The 10,000 patients will curse your name nightly, as they remain awake in pain because you have made it impossible for them to use a natural medicine that safely works to relieve their suffering.

Marijuana is one of the safest medicines known to humans. Over 32,000 patients died last year from the proper use of NSAIDS and narcotics, yet still to date, nobody has died from medical marijuana. You are saying that I can prescribe morphine and oxycodone to patients, but not marijuana. You need to explain to the public and me, your archaic belief that medical marijuana as opposed to oxycodone needs more than a responsible qualified doctor to oversee the care of a patient. I believe your motives are strictly political and not medical. Please make explicit to me and my patients, in writing, why you believe that an expert like myself, should not be allowed to practice medicine freely with the covenant of my patient, especially with a medicine as safe as cannabis; and also explain to my patients why they have to choose a different doctor, potentially prejudiced against medical cannabis rather than the well qualified physician they prefer—just because you dictated it so!

Frankly, I think you should be ashamed of yourself for treating sincere patients and their physicians as if they are frauds. And the state should be prepared for a whopper of a lawsuit for this arbitrary restriction on the medical marijuana law. I believe it to be against the American spirit to legally require patients to go through their insurance companies to get their medical care. If I don’t like the dental hygienist my dental insurance assigns me, I can certainly pay out of pocket for another licensed dental hygienist to clean my teeth. What right does the legislature have to demand that a patient have to see the practitioner designated to their insurance? Why should I, as a primary care physician, be required to take insurance as a doctor in order to help people? You have taken the right of a patient to freely choose their doctor, and taken their preferred medicine away from them for simply arbitrary reasons. We’ll see how that works out in the Supreme Court.

Meanwhile, from the public response I have witnessed to your scheme, I assure you, that your reputation as a compassionate doctor is waning. We are waiting eagerly to understand how this arbitrary amended definition of primary care physician actually benefits the patient. Until then, you are fully known as the senator who doesn’t care about his constituents and as a doctor willing to add the suffering of patients. Prove us wrong and stand up for the patients and regain our respect! Who do you actually represent?

I believe in helping people—just ask my couple thousand patients, they are not the ones complaining so that the law needs changed. Really Dr. Green, who does it help to require a patient to choose a physician that they don’t trust or like, simply because of their insurance designation? I can’t think of anyone except the pharmaceutical companies and your ego who would benefit from your arbitrary restriction, certainly not the patients! Remember your Hippocratic oath; nowhere is it required that a doctor be designated as a primary care provider to the patient’s insurance in order to offer responsible medical assistance. It does ask that doctors ‘do no harm’. You seemed to have strayed far from the honorable medical path of truly caring.

My patients and I are looking forward to your sincere response, for no response would certainly prove your ill will. Serve the people with your wisdom, rather than your fear and show us that you do care for suffering patients; let go of this heinous amendment to the medical marijuana law.

Asking for your Hippocratic spirit,

James Berg, MD
Hawaii Medical License #11755

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