The state's top health official wants an investigation of eight Arizona doctors who together have written nearly half the nearly 10,000 recommendations for medical marijuana since the program started.
Will Humble said the voter-approved law making medical marijuana legal denies him the legal authority to discipline or even question the doctors. But the state health director said that does not preclude him from turning their names over to the regulatory boards that do have that power.
At this point, he said, it is up to those boards to decide whether the doctors have violated professional standards.
Humble also is legally precluded from making the names public. And officials at both the Arizona Medical Board, which regulates medical doctors, and the Naturopathic Board of Medical Examiners who oversees that specialty said investigations are confidential unless and until there is action against a practitioner.
He was able to say, though, that while some are from the Phoenix area, at least one practices in Tucson.
In an interview with Capitol Media Services, Humble said his staff extracted the names of any doctor who had written at least 200 recommendations in the 100 days since the law took effect.
"I'm not saying that just because you wrote 1,200 certifications in the last 100 days that you weren't doing your job,'' he said.
But what Humble found among that list were eight doctors who were not complying with the requirement of the regulations that they check a statewide database of people who already have prescriptions for controlled substances. That database is designed to help doctors determine if patients are "shopping around'' for drugs.
In fact, Humble said, three of the doctors did not even have a sign-on to access the database.
The other five were registered to use the site but Humble said they rarely, if ever, checked in.
"But in all cases, they attested that they had,'' Humble said.
Humble said he fears that is just an indication of how little attention these eight doctors are paying to their patients.
He pointed out that doctors also are required to attest on the recommendation that they have looked at 12 months' worth of medical records for the patient and that they have talked to the patient about alternative treatments and strategies.
"If you haven't done one thing, what else haven't you done?'' he said.
Humble said while he can't demand doctors produce those records, the regulatory boards can.
Humble said of the eight, five are naturopaths and three are medical doctors. And one of those doctors alone had more than 1,300 recommendations in just 100 days.
He said his decision to seek investigations of the eight doctors is not over some hyper-technical requirement.
"It's about patient safety and making sure that physicians are focusing on the best interests of their patients and not just revenue coming into their clinic,'' he said.
Humble also said he wants to be sure that what the state has is a true medical marijuana program and not simply a thinly disguised method of getting the drug into the hands of "recreational'' users.
"If we were to look the other way ... we really do head down that recreational road because there's no accountability or oversight,'' he said.
The doctors are the focus because, under the voter-approved law, they are the gateway to what Humble called "those little green cards'' which show someone is a state-approved marijuana user.
Only individuals with a state-issued ID card are permitted to obtain up to 2 1/2 ounces of marijuana every two weeks. But to get that card, a patient first needs a doctor to formally recommend, on a form approved by the health department, that the patient needs that particular drug.
The law lists the kinds of medical conditions that would qualify a doctor to recommend marijuana. These range from cancer and Crohn's disease to any condition that causes "severe and chronic pain.''
More than 80 percent of the recommendations fall in that last category, though that figure includes applications with multiple conditions.
But the law gave Humble broad authority to enact rules governing the process. And he came up with the regulations about reviewing medical records, discussing alternatives and checking the controlled substances database.
Joe Yuhas, spokesman for the Arizona Medical Marijuana Association which crafted the law, said the organization has "no problem with the rules and regulations being enforced.'' He said Humble is correct to act if he believes some doctors are acting improperly.
What the association does object to, Yuhas said, are the rules being enforced selectively.
He pointed out that the law required Humble to enact regulations to set up about 125 state-regulated dispensaries where medical marijuana card holders could legally obtain the drug. But Humble, acting on orders from Gov. Jan Brewer, has refused to accept applications.
Brewer and Attorney General Tom Horne said they fear state health officials, in processing the applications, could run afoul of federal laws which make it a crime not only to possess and sell the drug but also to facilitate anyone getting it. Brewer said no applications will be accepted until a federal court rules on a lawsuit they filed seeking clarification of whether the state law provides any sort of shield from prosecution under federal laws.
As far as the doctors go, it could be months before either board acts.
Lisa Wynn, executive director of the Arizona Medical Board, said her members need to review the allegations and decide what course to follow.
She said it could be a relatively simple inquiry if the board decides to look only at the question of false certifications on checking the controlled substances database. But Wynn said the board might have to retain an outside expert in the relatively new field of medical marijuana if the board decides to review the records of doctors to see see if they followed proper medical protocols before recommending the drug.