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License #: Medical Director Health Services Division Washington State Department of Corrections PO Box41123· Olympia, WA 98504-2113 To be filled out by DOC Physician: I have reviewed this verification form.fi:rtclfind that use of medical marijuana by this patient (check one) LOis ~ is not . .. . consistent with DOC Policy. . ."-. . II'. ... 817 ~ Physician's Name (Print) Physician's Signature Instructions to DOC Physician: When form is complete: 1. Email your finding above to the Assistant Secretary for Community Corrections 2. File this form and the accompanying Relea$e of Information in Liberty as a Community Corrections Health Record. Date . ··/t/· .. .;:1/· - r fe~ ~ ~, I State law (RCW 70.02; RCW 70.24.1 05; RCW 71.05.390) and/or federal regulations (42 CFR Part 2; 45 CFR Part 164) prohibit disclosure of this infomiation without the specific written consent of the person to whom it pertains, or as otherwise permitted by law. . DOC 14-053 (Rev. 7/31/08) DOC 380.200 PDU-6655-3000403
Scott L. Havsy, DO, DAApM -Board Certified in Pain Management American Academy o/Pain Management www.managedpain.com ' drhavsv@comcast.net February 9, 2009 . Karen Daniels, Assistant Secretary State of Washington Department of Corrections PO Box 41126 ' ' Olympia, WA 98504-1126 Dear Ms. Daniels: In the future, pleas'e do not forward me requests from the Department of Correction dealing with the approval or, denial of the use of medical marijuana. If you bother reading the Statute RCW 69.51A, there is no provision for ' the Department of Corrections or anyone who is under their auspices to be denied medical marijuana and treated separately if the physician feels that the patient's condition may be of benefit regarding the use of , medical marijuana. Your Department narrowly construes the statute, which I believe is unconstitutional and I am sure in the future this matter will be dealt within the court system. ' 'Mr._suffers from multiple herniated'discs in the cervical spine with'bilat~ral carpal tunnel syndrome and it is my opinion that medical marijuana is a medical necessity. I prefer him tO,be on anon addicting , substance as opposed to opioids for chronic pain. In my practice of addiction medicine, narcotics are more of a problem than marijuana. The Department of Corrections does not have any right to deny or approve the use of medical marijual"la if a li«ensed physician in the State of Washington feels that the patient, pursuant to the statute, may-get benefit from the use of marijuana. I would appreciate you having your legal counsel, ot staff physician who denies the use of marijuana contact me on this matter so I can intellectually explain this situation to them. Also please forward to me all information 1 that you currently rely on to approve or deny the use of medical marijuana for patients who are under the --auspiees-0:f-the-QQG"..... ---------------- ,.-........ .. , 1 Information includes RCW's, WAC's, memorandum, medical treatises, studies, internal memo's on any format. 3716 Pacific Ave. Suite E 253-473-2663 1 Tacoma, WA 98418 (F)253~473~0545 PDU-6655-3 000404
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