Prior misconduct rarely an obstacle for doctors in Pennsylvania’s medical marijuana program

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HARRISBURG — Matthew Roman used to be Pennsylvania’s top doctor for getting a medical marijuana card.

In 2018, the year dispensaries began selling cannabis in the state, Roman was the only doctor to issue more than 3,000 medical marijuana certifications in Pennsylvania, according to health department records obtained by Spotlight PA through a Commonwealth Court decision.

Back then, Roman was more than just a prolific certifier.

He sued federal officials in 2018, claiming they unconstitutionally blocked people enrolled in state medical cannabis programs from buying a gun.

On social media, he showed off his medical marijuana card and offered the chance to win free card consultations. In a late 2017 video viewed by Spotlight PA, he appeared to roll and smoke marijuana while in Delaware.

Underneath all the attention, Roman had a drug problem, he later said. And soon it all came crashing down. A state medical board disciplined him in 2019. The consent agreement he entered into said he displayed a problematic pattern of cannabis use “leading to clinically significant impairment” and met the criteria for cannabis use disorder. He lost his ability to certify patients for the state’s medical marijuana program.

Roman, by his own account, worked hard to get back on track. In a letter to the health department last year, he described the effort he put into addressing his cannabis use disorder diagnosis, including inpatient rehab, group therapy, individual therapy, as well as drug testing. He wrote that “after over four years of sobriety from marijuana and alcohol,” his views on medical marijuana have changed, saying that “it should be a last resort.”

But after Roman’s medical license was reinstated in 2023 and his probation was lifted, the health department denied his application to return to the medical marijuana program.

Officials with the agency have since fought to keep him from returning.

The health department has rarely blocked practitioners from joining Pennsylvania’s medical program based on past discipline, records obtained by Spotlight PA show. And while Roman was denied, several other physicians who are active in the program — some of whom have been among the top doctors for issuing certifications — also have past disciplinary history.

Roman’s case highlights an under-the-radar debate over who gets to certify patients to use medical marijuana and whether past misbehavior should bar people from the program indefinitely.

The case, and a review of certification records, also shows how the program has changed in recent years.

State regulators have expanded who is eligible as a patient, including adding anxiety as a qualifying condition in 2019. In 2020, they temporarily eliminated the requirement for patients to meet with a doctor in person for a certification — a change lawmakers made permanent in 2021. More doctors now issue thousands of certifications a year.

While Roman was the only doctor in Pennsylvania’s medical marijuana program to issue more than 3,000 certifications in 2018, 30 physicians reached that number four years later.

Roman continued his push to return to the program. From the start of 2017 to at least mid-May, he was the only denied doctor whose appeal reached a hearing, records released by the department show.

After his November hearing, a state examiner agreed with him, recommending he be allowed back in.

Despite the department’s concerns over Roman, hearing examiner Peter Kovach in April recommended he be allowed to return to the program. Kovach cited the State Board of Medicine’s order reinstating his license as evidence that the reasons for the disciplinary actions have been resolved.

Roman “credibly testified that he believes he is in a better position now to understand when patients are at risk of cannabis use disorders and that this additional knowledge and experience actually improves his ability to certify patients for cannabis cards,” the hearing examiner later added.

But an attorney for the health department objected, warning that the hearing examiner’s rationale could give any doctor who’s ever been disciplined standing to force their way back into the program once their license is restored.

As of July, Roman was still waiting for a decision from the health secretary.

“At some point, doesn’t a human being have a right to restore credibility through hard work?” Roman told Spotlight PA. “I feel like I’ve reached that point.”

Disciplined doctors rarely denied

In Pennsylvania, patients need a physician’s approval to legally purchase cannabis from dispensaries.

The health department isn’t the state agency that decides whether doctors have a medical license, but it does have the power to determine who enters the medical marijuana practitioner registry.

To better understand the department’s practices, Spotlight PA reviewed disciplinary records for the 100 doctors who issued the most certifications in 2022. Of those, at least four had prior discipline on their medical license.

Unlike Roman, none of them had to file an appeal to be admitted into the program, records released by the department show.

Under administration of former Democratic Gov. Tom Wolf, state regulators sent denial letters to four doctors, according to records provided in response to Right-to-Know requests covering the start of the medical marijuana program to mid-May of this year.

The cases followed a similar pattern: The department denied the doctor, saying it was because their license was suspended or on probation; the license restrictions were later lifted; and the doctor ultimately joined the program. None of those four doctors ranked high for approving medical marijuana cards in 2022. The number of certifications they issued that year ranged from about a dozen to under 260.

The Wolf administration didn’t deny any doctors based on prior discipline, according to the letters released by the department.

But the administration of Democratic Gov. Josh Shapiro, by contrast, cited prior discipline when it denied Roman and another doctor last year. Both had unrestricted medical licenses at the time of the denials. The other doctor also appealed, but withdrew before his hearing, records show. A third denial letter from January 2024 cited a doctor’s prior discipline and his failure to submit documentation to allow the department to complete its review.

The department denied changing its processes for reviewing which doctors to admit into the program and said it continues to follow the state’s medical marijuana law and regulations.

The agency declined to comment on decisions about specific doctors, citing confidentiality practices. The Bureau of Medical Marijuana may ask physicians with prior disciplinary actions to provide additional information before making a decision, said department spokesperson Mark O’Neill.

Patrick Nightingale is a criminal defense attorney, Pennsylvania medical marijuana patient and advocate, and supporter of legalizing cannabis for all adults 21 and over.

He said he wants as many physicians as possible participating in the program, so that patients have options. But he also thinks it’s appropriate for state regulators to use discretion when choosing which formerly disciplined doctors can join the program.

“I think that some additional scrutiny should be applied,” Nightingale told Spotlight PA. “... But I would hate to say just across the board if you have any disciplinary actions whatsoever, you’re out.”

Karen O’Keefe, director of state policies for the Marijuana Policy Project, described recommending cannabis as “one of the more innocuous” and “low-risk” activities for a doctor. In terms of doctors with prior discipline, she doesn’t think certifying for cannabis should be treated more strictly than performing surgery or prescribing opioids.

“If they don’t think the doctor is safe to perform duties as a doctor, they shouldn’t do any of those duties,” said O’Keefe, whose group supports cannabis legalization for adults and patients.

To read the complete investigation, visit

https://www.spotlightpa.org/news/2024/08/medical-marijuana-card-doctor-misconduct/

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