pot smoking documenting Re: (unknown)

[Guest guest]

I wonder what the lawyers-among-us have to say about this. But, on legal

terms, I believe that what a patient says to us and we note in the record is not

admissible in court because it is hearsay. That is, evidence in court can not

include someone saying, " they told me such-and-such happened. " So,

on legal terms, I don't think our noting in the social history that patient smokes

pot matters.Now, in terms of patients signing for records to be sent to

life insurance companies, I wonder what the experience is. Do any of us know

whether life insurance companies include smoking pot noted in the medical record as

a reason to decline someone? I doubt it. I think the actuaries have likely

calculated that as a low-rate risk for increase of death, likely much less than

smoking cigarettes, but even less than family health history, sedentary lifestyle,

etc.Finally, if a patient has a significant problem with marijuana use,

and either has a legal problem or is getting mental health services for it, and it's

something we discuss, I have no problem noting it and coding for it. In that case,

the " cat's out of the bag " already. And, actually, I seem to see it

often when I get a report from a mental health center. Patient may be seen for other

issues, like depression or bipolar, but then cannibis abuse is listed on one of the

other Axis lines (I always forget which one).TimOn Thu, December 4, 2008 2:12 pm EST,

joanne holland wrote:

From Drain, Oregon

From Drain,

Boy, what a variance of opinion. This is one of those

subjects that is fraught with emotion. I do not believe we can make a

standard rule on this list serve as the legal issues vary from state to

state so much. People from Ohio are in a state that has a

decriminalized system that has a medical marijuana rule, mandatory

sentencing and a drugged driving regulation (which is what the law is,

however psychiatrists may know the drug is bad for their patients) , but

people from Missouri have only the federal regulations and a standard

set of regulations for the felony possession. Here in Oregon there is a

medical cannabis law that is rather liberal; but when the law is broken

the law is strict.

I suggest that we stay out of the frey as much as possible and

don't recommend reporting unless it is part of our legislated

requirement or part of an agreement with other physicians. Of course

one would put the use of it in health records. Incidentally, there could

be situations where you might be in personal or legal danger if you

called someone to report use of this drug by someone else.

Joanne Holland DVM/MD Drain, Oregon---

On Tue, 12/2/08, Pedro Ballester

wrote:

From: Pedro Ballester Subject: Re: (unknown)To:

Date: Tuesday, December 2,

2008, 5:40 PM

I had a conversation with a Psychiatrist in WV in charge of a

Suboxone clinic, he does not tolerate THC use.You need to

individualize each case, why is the person using THC?Do they

need motivation to get on with their life?Is it affecting

their existence?What do you do for alcohol abuse? Should you

apply the same decisions?If a terminal cancer patient wants

to use THC, I would not ask, nor tell anybody. If I knew where a cancer

patient could obtain a safe source, I would inform a patient that would

need it. (I just don't know what would be a safe source, maybe the NIH

will explore medical applications and allow medical cultivation! )If my patient was a productive member of society, and had to

undergo screening I would direct him or her to information to escape

detection if possible, all verbally, nothing that could be traced to a

DEA investigation.I agree with the approach of the

Suboxone clinic Psychiatrist, if somebody has a problem with abuse

of narcotics, they should remain as sober as possible, you would not try

to adjust antidepressants in an active alcoholic, neither in a THC

abuser.I avoid even listing ED as some companies will deny

payment if the diagnosis is present, knowing that THC is illegal in this

country I would not list it in the claim forms at all-- Pedro Ballester, M.D.Warren, OH

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

[Guest guest]

Don't worry about your records revealing pot smoking. Life insurance labs now include not only a lipid panel. The last one I saw screened for lipids, A1c, creatinine, LFTs, THC, opiates, narcotics, several TCAs and SSRIs, and diuretics and beta blockers.... better buy your kids life insurance while they are still in elementary school and keep it in force.

I wonder what the lawyers-among-us have to say about this. But, on legal

terms, I believe that what a patient says to us and we note in the record is not

admissible in court because it is hearsay. That is, evidence in court can not

include someone saying, " they told me such-and-such happened. " So,

on legal terms, I don't think our noting in the social history that patient smokes

pot matters.Now, in terms of patients signing for records to be sent to

life insurance companies, I wonder what the experience is. Do any of us know

whether life insurance companies include smoking pot noted in the medical record as

a reason to decline someone? I doubt it. I think the actuaries have likely

calculated that as a low-rate risk for increase of death, likely much less than

smoking cigarettes, but even less than family health history, sedentary lifestyle,

etc.Finally, if a patient has a significant problem with marijuana use,

and either has a legal problem or is getting mental health services for it, and it's

something we discuss, I have no problem noting it and coding for it. In that case,

the " cat's out of the bag " already. And, actually, I seem to see it

often when I get a report from a mental health center. Patient may be seen for other

issues, like depression or bipolar, but then cannibis abuse is listed on one of the

other Axis lines (I always forget which one).TimOn Thu, December 4, 2008 2:12 pm EST,

joanne holland wrote:

From Drain, Oregon

From Drain,

Boy, what a variance of opinion. This is one of those

subjects that is fraught with emotion. I do not believe we can make a

standard rule on this list serve as the legal issues vary from state to

state so much. People from Ohio are in a state that has a

decriminalized system that has a medical marijuana rule, mandatory

sentencing and a drugged driving regulation (which is what the law is,

however psychiatrists may know the drug is bad for their patients) , but

people from Missouri have only the federal regulations and a standard

set of regulations for the felony possession. Here in Oregon there is a

medical cannabis law that is rather liberal; but when the law is broken

the law is strict.

I suggest that we stay out of the frey as much as possible and

don't recommend reporting unless it is part of our legislated

requirement or part of an agreement with other physicians. Of course

one would put the use of it in health records. Incidentally, there could

be situations where you might be in personal or legal danger if you

called someone to report use of this drug by someone else.

Joanne Holland DVM/MD Drain, Oregon---

On Tue, 12/2/08, Pedro Ballester

wrote:

From: Pedro Ballester Subject: Re: (unknown)To:

Date: Tuesday, December 2,

2008, 5:40 PM

I had a conversation with a Psychiatrist in WV in charge of a

Suboxone clinic, he does not tolerate THC use.You need to

individualize each case, why is the person using THC?Do they

need motivation to get on with their life?Is it affecting

their existence?What do you do for alcohol abuse? Should you

apply the same decisions?If a terminal cancer patient wants

to use THC, I would not ask, nor tell anybody. If I knew where a cancer

patient could obtain a safe source, I would inform a patient that would

need it. (I just don't know what would be a safe source, maybe the NIH

will explore medical applications and allow medical cultivation! )If my patient was a productive member of society, and had to

undergo screening I would direct him or her to information to escape

detection if possible, all verbally, nothing that could be traced to a

DEA investigation.I agree with the approach of the

Suboxone clinic Psychiatrist, if somebody has a problem with abuse

of narcotics, they should remain as sober as possible, you would not try

to adjust antidepressants in an active alcoholic, neither in a THC

abuser.I avoid even listing ED as some companies will deny

payment if the diagnosis is present, knowing that THC is illegal in this

country I would not list it in the claim forms at all-- Pedro Ballester, M.D.Warren, OH

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com

--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

-- Annie SkaggsLexington, KY

[Guest guest]

Don't worry about your records revealing pot smoking. Life insurance labs now include not only a lipid panel. The last one I saw screened for lipids, A1c, creatinine, LFTs, THC, opiates, narcotics, several TCAs and SSRIs, and diuretics and beta blockers.... better buy your kids life insurance while they are still in elementary school and keep it in force.

I wonder what the lawyers-among-us have to say about this. But, on legal

terms, I believe that what a patient says to us and we note in the record is not

admissible in court because it is hearsay. That is, evidence in court can not

include someone saying, " they told me such-and-such happened. " So,

on legal terms, I don't think our noting in the social history that patient smokes

pot matters.Now, in terms of patients signing for records to be sent to

life insurance companies, I wonder what the experience is. Do any of us know

whether life insurance companies include smoking pot noted in the medical record as

a reason to decline someone? I doubt it. I think the actuaries have likely

calculated that as a low-rate risk for increase of death, likely much less than

smoking cigarettes, but even less than family health history, sedentary lifestyle,

etc.Finally, if a patient has a significant problem with marijuana use,

and either has a legal problem or is getting mental health services for it, and it's

something we discuss, I have no problem noting it and coding for it. In that case,

the " cat's out of the bag " already. And, actually, I seem to see it

often when I get a report from a mental health center. Patient may be seen for other

issues, like depression or bipolar, but then cannibis abuse is listed on one of the

other Axis lines (I always forget which one).TimOn Thu, December 4, 2008 2:12 pm EST,

joanne holland wrote:

From Drain, Oregon

From Drain,

Boy, what a variance of opinion. This is one of those

subjects that is fraught with emotion. I do not believe we can make a

standard rule on this list serve as the legal issues vary from state to

state so much. People from Ohio are in a state that has a

decriminalized system that has a medical marijuana rule, mandatory

sentencing and a drugged driving regulation (which is what the law is,

however psychiatrists may know the drug is bad for their patients) , but

people from Missouri have only the federal regulations and a standard

set of regulations for the felony possession. Here in Oregon there is a

medical cannabis law that is rather liberal; but when the law is broken

the law is strict.

I suggest that we stay out of the frey as much as possible and

don't recommend reporting unless it is part of our legislated

requirement or part of an agreement with other physicians. Of course

one would put the use of it in health records. Incidentally, there could

be situations where you might be in personal or legal danger if you

called someone to report use of this drug by someone else.

Joanne Holland DVM/MD Drain, Oregon---

On Tue, 12/2/08, Pedro Ballester

wrote:

From: Pedro Ballester Subject: Re: (unknown)To:

Date: Tuesday, December 2,

2008, 5:40 PM

I had a conversation with a Psychiatrist in WV in charge of a

Suboxone clinic, he does not tolerate THC use.You need to

individualize each case, why is the person using THC?Do they

need motivation to get on with their life?Is it affecting

their existence?What do you do for alcohol abuse? Should you

apply the same decisions?If a terminal cancer patient wants

to use THC, I would not ask, nor tell anybody. If I knew where a cancer

patient could obtain a safe source, I would inform a patient that would

need it. (I just don't know what would be a safe source, maybe the NIH

will explore medical applications and allow medical cultivation! )If my patient was a productive member of society, and had to

undergo screening I would direct him or her to information to escape

detection if possible, all verbally, nothing that could be traced to a

DEA investigation.I agree with the approach of the

Suboxone clinic Psychiatrist, if somebody has a problem with abuse

of narcotics, they should remain as sober as possible, you would not try

to adjust antidepressants in an active alcoholic, neither in a THC

abuser.I avoid even listing ED as some companies will deny

payment if the diagnosis is present, knowing that THC is illegal in this

country I would not list it in the claim forms at all-- Pedro Ballester, M.D.Warren, OH

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com

--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

-- Annie SkaggsLexington, KY

[Guest guest]

Don't worry about your records revealing pot smoking. Life insurance labs now include not only a lipid panel. The last one I saw screened for lipids, A1c, creatinine, LFTs, THC, opiates, narcotics, several TCAs and SSRIs, and diuretics and beta blockers.... better buy your kids life insurance while they are still in elementary school and keep it in force.

I wonder what the lawyers-among-us have to say about this. But, on legal

terms, I believe that what a patient says to us and we note in the record is not

admissible in court because it is hearsay. That is, evidence in court can not

include someone saying, " they told me such-and-such happened. " So,

on legal terms, I don't think our noting in the social history that patient smokes

pot matters.Now, in terms of patients signing for records to be sent to

life insurance companies, I wonder what the experience is. Do any of us know

whether life insurance companies include smoking pot noted in the medical record as

a reason to decline someone? I doubt it. I think the actuaries have likely

calculated that as a low-rate risk for increase of death, likely much less than

smoking cigarettes, but even less than family health history, sedentary lifestyle,

etc.Finally, if a patient has a significant problem with marijuana use,

and either has a legal problem or is getting mental health services for it, and it's

something we discuss, I have no problem noting it and coding for it. In that case,

the " cat's out of the bag " already. And, actually, I seem to see it

often when I get a report from a mental health center. Patient may be seen for other

issues, like depression or bipolar, but then cannibis abuse is listed on one of the

other Axis lines (I always forget which one).TimOn Thu, December 4, 2008 2:12 pm EST,

joanne holland wrote:

From Drain, Oregon

From Drain,

Boy, what a variance of opinion. This is one of those

subjects that is fraught with emotion. I do not believe we can make a

standard rule on this list serve as the legal issues vary from state to

state so much. People from Ohio are in a state that has a

decriminalized system that has a medical marijuana rule, mandatory

sentencing and a drugged driving regulation (which is what the law is,

however psychiatrists may know the drug is bad for their patients) , but

people from Missouri have only the federal regulations and a standard

set of regulations for the felony possession. Here in Oregon there is a

medical cannabis law that is rather liberal; but when the law is broken

the law is strict.

I suggest that we stay out of the frey as much as possible and

don't recommend reporting unless it is part of our legislated

requirement or part of an agreement with other physicians. Of course

one would put the use of it in health records. Incidentally, there could

be situations where you might be in personal or legal danger if you

called someone to report use of this drug by someone else.

Joanne Holland DVM/MD Drain, Oregon---

On Tue, 12/2/08, Pedro Ballester

wrote:

From: Pedro Ballester Subject: Re: (unknown)To:

Date: Tuesday, December 2,

2008, 5:40 PM

I had a conversation with a Psychiatrist in WV in charge of a

Suboxone clinic, he does not tolerate THC use.You need to

individualize each case, why is the person using THC?Do they

need motivation to get on with their life?Is it affecting

their existence?What do you do for alcohol abuse? Should you

apply the same decisions?If a terminal cancer patient wants

to use THC, I would not ask, nor tell anybody. If I knew where a cancer

patient could obtain a safe source, I would inform a patient that would

need it. (I just don't know what would be a safe source, maybe the NIH

will explore medical applications and allow medical cultivation! )If my patient was a productive member of society, and had to

undergo screening I would direct him or her to information to escape

detection if possible, all verbally, nothing that could be traced to a

DEA investigation.I agree with the approach of the

Suboxone clinic Psychiatrist, if somebody has a problem with abuse

of narcotics, they should remain as sober as possible, you would not try

to adjust antidepressants in an active alcoholic, neither in a THC

abuser.I avoid even listing ED as some companies will deny

payment if the diagnosis is present, knowing that THC is illegal in this

country I would not list it in the claim forms at all-- Pedro Ballester, M.D.Warren, OH

---------------------------------------- Malia, MDMalia

Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton

Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com

--

Confidentiality Notice --This email message, including all the attachments, is

for the sole use of the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended recipient,

you may not use, disclose, copy or disseminate this information. If you are not the

intended recipient, please contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.----------------------------------------

-- Annie SkaggsLexington, KY