“This board has been scaring doctors. That’s what they’ve been doing, scaring doctors.”
By Wesley Muller, Louisiana Illuminator
The Louisiana State Board of Medical Examiners is temporarily halting enforcement actions against doctors who recommend medical marijuana via telemedicine. The pause on enforcement comes days after a state Senate committee threatened to revoke the board’s rule-making authority for refusing to lift the in-person visit requirement.
LSBME Executive Director Dr. Vincent Culotta confirmed the news in a phone interview Monday after the board published a notice on its website stating: “The Louisiana State Board of Medical Examiners will take no enforcement action against a licensee who, prior to an update of this notice, recommends medical marijuana without an initial in-person visit. Clarification and further deliberations are in process.”
Culotta pointed out the notice does not signal a reversal of the board’s position and said the in-person visit requirement remains in effect despite the temporary pause on enforcement.
The medical board requires physicians to establish a doctor-patient relationship with at least one initial in-person visit before prescribing controlled substances or recommending cannabis through subsequent remote video appointments with a patient.
The LSBME, which is composed of 10 members the governor appoints and the Senate confirms, licenses doctors in Louisiana and writes the specific rules of practicing medicine derived from broader state laws. It has the power to enforce those rules through various sanctions, fines and suspensions if it receives a specific complaint about a doctor.
The board has been at odds with state legislators who passed Act 491 earlier this year in an effort to lift the in-person visit requirement for doctors who recommend marijuana. Legislators learned in September that the LSBME was interpreting the new law differently from what lawmakers intended and had not updated its rules to accommodate the change.
The board has maintained its position even after several meetings in which legislators clarified the original intent of the law. The disagreement came to a head last week when the Senate Health and Welfare Committee threatened to revoke the board’s rule-making authority if it continues to refuse to rewrite its telemedicine rule.
Culotta said the pause on enforcement will remain in place pending an opinion from the Louisiana Attorney General’s Office that state Rep. Joe Marino (I) requested last week.
In a phone call Monday, Marino said he’s confident the attorney general’s office, which is expediting the opinion, will agree with the legislature. However, it’s possible either side could ignore the opinion.
Attorney general’s opinions are written interpretations of existing statutes but are not binding. They have no force of law and can inject partisanship or more controversy into a debate.
The in-person visit requirement was suspended for nearly two years, along with other telemedicine restrictions, under Gov. John Bel Edwards’s (D) COVID-19 public health emergency proclamation, which expired in March as the coronavirus pandemic waned.
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Consequently, Marino said, patients in rural areas and patients with debilitating conditions who have difficulty leaving their homes have been unable to find doctors who would recommend cannabis remotely. The legislature intended to fix that problem with Act 491, but Marino said many doctors are still afraid to use telemedicine with marijuana patients because of the medical board’s rules.
Marino said he believes some of the medical board members haven’t fully embraced marijuana as a therapeutic drug or the advent of telemedicine.
“We need people with debilitating conditions and people in rural areas to be able to get this medicine,” he said. “This board has been scaring doctors. That’s what they’ve been doing, scaring doctors.”
Culotta said the LSBME is only concerned with the good practice of medicine and has received testimony from doctors across the state who support the requirement of an initial in-person visit. It allows doctors to physically assess a patient in ways that are impossible through a computer screen, he said. For example, a glaucoma patient might need an eye exam before a doctor would recommend cannabis.
“The board is not opposed to marijuana at all,” Culotta said. “The board is opposed to any bad practices of medicine. It’s not about marijuana; it’s about the good practice of medicine and the use of controlled and dangerous substances.”