Health Care & Reproductive Rights

Sacramento – Attorney General Edmund G. Brown Jr. today urged a federal appeals court to block the court-appointed Receiver from “commandeering $8 billion” from the shrinking California Treasury for extravagant prison construction.

“Federal law does not allow the Receiver to commandeer the finances of the state to spend $8 billion for unaccountable and extravagant prison construction,” Attorney General Brown said. “The court should rein in the Receiver, who is now spending more than $2 billion per year on inmate health care. This is almost $14,000 per inmate and nearly double what it was just three years ago.”

In a reply brief filed today with the United States Court of Appeals for the Ninth Circuit, Attorney General Brown describes the fundamental legal errors that the court-appointed Receiver has made in attempting to force the state to fund his prison construction program against its will.

Brown argues that the Prison Litigation Reform Act, signed into law in 1996, bars federal judges from ordering the construction of new prisons and that any relief must involve the least intrusive means necessary.

A just-released draft of the Receiver’s plan, however, demonstrates the unbridled scope of the Receiver’s plan.

The plan calls for the construction of 7 new prisons with 10,000 new beds -- the size of 70 Walmarts. It envisions yoga rooms, regulation basketball courts with electronic bingo boards, music and art therapy, horticultural therapy, and landscaping which shields fences from inmates’ view. While some details have been deleted in a subsequent draft, the fundamental structure and many of the extravagant amenities remain.

Brown argues that to force such an $8 billion plan on California against its will—particularly at a time when the state must make huge budget cuts to programs including health care, infrastructure, and schools—violates federal law and the state’s sovereign immunity under the 11th Amendment to the Constitution.

The appellate court, therefore, should reverse the District Court’s order of a $250 million down-payment toward the $8 billion plan.

The State of California has acknowledged the need to provide health care that meets Constitutional standards, and has taken a series of steps to improve prison health care. This includes increasing the numbers of qualified medical staff at prisons and improving the process by which inmates are assessed and how they are treated.

Under the Receivership, healthcare spending has increased from $7,601 per inmate in 2005-2006 to $13,778 per inmate in 2007-2008. That’s far more than the average citizen in California pays for healthcare coverage.

Background
In August of this year, the court-appointed Receiver filed a motion seeking to compel Governor Arnold Schwarzenegger and Controller John Chiang to allocate $8 billion from the California Treasury over the next 5 years, including $3 billion in this fiscal year, for prison healthcare facility construction. Attorney General Brown has argued that the federal court does not have the authority to mandate state prison construction, nor has the Receiver justified the massive sums called for in his plan.

SACRAMENTO- Attorney General Edmund G. Brown Jr. today announced that California will recover $112 million for its Medi-Cal program as part of a national settlement with Eli Lilly and Company for the unlawful off-label marketing of its anti-psychotic drug Zyprexa, which the company aggressively marketed for such unapproved uses such as treatment for depression, anxiety, irritability, disrupted sleep, nausea and gambling.

“This settlement means that Eli Lilly can no longer reap massive profits by aggressively marketing this drug for unapproved uses at the expense of state health care programs for seniors and the infirm,” Attorney General Brown said. “California’s Medi-Cal program will receive almost $112 million, which is more than welcome at a time when the state faces massive budget deficits.”

Eighteen percent of the $112 million recovered for the Medi-Cal program will go to relators (whistleblowers) – the remainder will be split between the State, which will receive $54 million and the federal government, which will receive $41 million.

Beginning in 2001, Eli Lilly launched a marketing campaign called “Viva Zyprexa!” which encouraged physicians to prescribe Zyprexa for children, adolescents, and dementia patients.

In October 2008, the California Attorney General entered a settlement with Eli Lilly over the Zyprexa marketing campaign. In his original complaint, Attorney General Brown alleged that Eli Lilly engaged in unfair and deceptive practices when it marketed Zyprexa for off-label uses and failed to adequately disclose the drug’s potential side effects (including diabetes and hyperglycemia) to healthcare providers.

Under this settlement, Eli Lilly agreed to change its marketing practices and to cease promotion of its off-label uses. Off-label uses are those not approved by the FDA when it approves the sale and use of a particular drug. Physicians are allowed to prescribe drugs for off-label uses, but federal law prohibits pharmaceutical manufacturers from marketing products for off-label uses.

The total settlement is $1.415 billion—the largest recovery in a health care fraud investigation in U.S. history. The settlement includes $800 million in civil damages to be paid to the States and $615 million as a result of criminal charges brought against the company for illegal marketing.

Although both California and the U.S. contribute 50% to the funding of the Medi-Cal program, California’s share is larger than the federal share due to the federal Deficit Reduction Act, which provides monetary incentives to states to use False Claims Acts to pursue Medicaid fraud.

SACRAMENTO—California Attorney General Edmund G. Brown Jr. today joined a lawsuit against the United States Department of Health and Human Services (DHHS) to halt the implementation of a Bush Administration “midnight regulation” that could potentially “endanger a woman’s right to contraception,” including emergency contraception given to rape victims.

“California has carefully and thoughtfully struck a balance between the right to use contraceptives and the right of healthcare providers to abstain from administering them,” Attorney General Brown said. “This illegal and stealth regulation threatens to erode women’s hard fought privacy rights.”

Poised to take effect on the day of President-Elect Barack Obama’s inauguration, the regulation undercuts state contraception laws and jeopardizes billions of dollars in federal public health money.

On December 19, 2008, DHHS issued the regulation, one of several highly controversial “midnight regulations” issued in the waning days of the Bush Administration. The regulation purports to implement three federal funding restrictions designed to force states to permit healthcare providers to refuse to provide certain health care to which the providers have a religious, moral or ethical objection. If California does not comply with the new federal regulation, it stands to lose millions, if not billions, in federal funding.

One of the most objectionable aspects of the new federal regulation is its failure to define the word “abortion.” An earlier draft contained a very broad definition that would have clearly included some forms of contraception, including emergency contraception. In comments filed with the DHHS in September, Attorney General Brown pointed out that the failure to include a definition of so critical a term would allow the term to be “improperly extended beyond the scope of the authorizing statutes and does not afford meaningful protection for a woman’s access to other healthcare services, including those involving contraception and fertility treatments.” Instead of addressing widespread concern about the term, the DHHS eliminated the definition entirely.

California law allows healthcare workers and providers to object to dispensing contraception or performing abortions for moral or ethical reasons if they notify their employer of their objection in writing. The new federal regulation would reduce the healthcare protections afforded to women in California by allowing a healthcare provider to refuse procedures or referrals to which the provider objects without notifying the employer, the facility or the patient.

In today’s lawsuit, California joins six other states in challenging the regulation on the grounds that it :
• Fails to define “abortion.” By failing to define the term, DHHS created unnecessary ambiguity, allowing the term to be interpreted as encompassing all forms of contraception.
• Deprives patients of the right to receive factual and objective medical information and access to medical information.
• Overrides states’ rights to promote the general health and welfare of their citizens.

“We applaud Attorney General Jerry Brown’s proactive stance in protecting patients’ access to vital health care services and information,” said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. “This HHS regulation poses a serious barrier to the states’ enforcement of their laws protecting patients.”

The complaint and accompanying exhibits are attached.

LOS ANGELES – Attorney General Edmund G. Brown Jr. today announced a multi-state agreement with Shell Oil Company to stop young people from purchasing tobacco products at its convenience stores.

“I commend Shell for joining the growing list of companies that are demonstrating their commitment to prevent illegal access to tobacco,” Attorney General Brown said. “Smoking remains a serious public-health problem in our country, and we need to do everything possible to keep young people from picking up the habit.”

Attorneys General throughout the country won this agreement after a nationwide investigation of tobacco selling practices at convenience stores affiliated with Shell.

The agreement includes the following provisions:

• Retail personnel will receive training about the health risks associated with childhood tobacco use.
• Shell will administer independent compliance checks to monitor sales practices at certain Shell convenience stores, to ensure they are not selling tobacco to minors.
• States will impose sanctions against contract operators that sell tobacco to minors.
• Vending machines and self-service displays that sell tobacco products will be forbidden at Shell-associated convenience stores.
• In-store tobacco advertisements will be limited to reduce youth demand for tobacco products.
• Shell will require all convenience store operators to notify the company if tobacco products are sold to minors in violation of the law.

In the U.S., more than 14,000 gas stations sell Shell gasoline with more than 13,000 of them in states joining this agreement. There are more than 1,200 Shell stations in California, and most stations include convenience stores that sell tobacco products. Although Shell does not directly own or operate the convenience stores at its stations, Shell has agreed to adopt these procedures designed to reduce sales of cigarettes to minors.

Nationwide, 47% of underage youths who reported buying cigarettes said they got them at gas station convenience stores. Studies have linked retail tobacco marketing with underage smoking. In addition, many convenience stores are located near schools and playgrounds.

Recently, there have been other multi-state agreements to curb the sale of tobacco to minors at gas station convenience stores, including Conoco, Phillips 66, 76, Exxon, Mobil, BP, ARCO, and Chevron, as well as retail and pharmacy outlets operated by Kroger, 7-Eleven, Walgreens, Rite Aid, CVS, and Wal-Mart. Grocery stores are also participating, including Ralphs, Safeway, and Vons.

Studies show that most adult smokers began smoking before the age of 18. Young people are particularly susceptible to the hazards of tobacco, often showing signs of addiction after smoking only a few cigarettes.

In addition to California, the following states have signed on to the agreement: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wyoming. The District of Columbia is also participating.

LOS ANGELES--California Attorney General Edmund G. Brown Jr. today announced a crackdown on rampant prescription drug fraud in California, including the top fifty abusers who average more than 100 doctor and pharmacy visits to collect massive quantities of addictive drugs like Valium, Vicodin, and Oxycontin.

“These prescription drug addicts are abusing the system, draining time and money from hundreds of doctors and pharmacies who are there to help real sick people, not con artists,” said Attorney General Brown. “On my order, California Department of Justice special agents launched a statewide search for the most aggressive prescription drug addicts. We want to end these dangerous cycles of fraud and abuse.”

Launched in June this year, the new crackdown has already led to the arrest of dozens of suspects, including Frankie Greer, 53, who visited 183 doctors and 47 pharmacies to feed a prescription drug habit that included some of the most dangerous painkillers in lethal combinations. In a one-year period, Greer sought out multiple doctors at hospital emergency rooms to prescribe her over 4,830 hydrocodone tablets, 2,210 oxycodone tablets, 156 Oxycotin, along with a variety of additional addictive painkillers.

Greer is not alone. The National Survey on Drug Use and Health estimates that 20 to 30% of the state’s drug abusers primarily use prescription drugs. In addition, the National Institute on Drug Abuse has estimated that 48 million Americans have used prescription drugs for non-medical reasons. A 2005 survey by the Drug Abuse Warning Network estimates the non-medical use of pharmaceuticals accounted for more than 500,000 emergency room visits in California, an enormous drain on the state’s healthcare system.

In addition to costing the state millions each year, prescription drug abuse can have serious public safety consequences, as many of the top abusers hold down regular jobs including truck drivers, transit operators and medical practitioners. The Attorney General has been working in cooperation with the Troy and Alana Pack Foundation, founded by Bob Pack, whose 7 and 10-year old children were killed by a driver who was under the influence of prescription drugs obtained from multiple doctors.

This initiative is part of the Attorney General’s comprehensive plan to address prescription drug abuse in the state and make it easier for doctors to keep track of prescription drug records. Earlier this year, Attorney General Brown unveiled a plan to provide doctors and pharmacies with real-time Internet access to patient prescription drug histories. Under Brown’s proposal, health professionals would have computer access to the drug histories of patients, replacing the current outdated system that required mailing or faxing written requests for information. Each year, more than 60,000 such requests are made to the California Department of Justice.

The state’s database, known as the Controlled Substance Utilization Review and Evaluation System, contains 86 million entries for prescription drugs dispensed in California, giving healthcare professionals the technology they need to fight the prescription drug abuse currently burdening California’s healthcare system.

“Doctors and insurance companies should be on the alert,” added Attorney General Brown. “We are aggressively pursuing the top prescription drug abusers, and we’re also making it easier for doctors to verify health history information provided by new patients. We encourage insurance companies to develop a similar system for protecting themselves against prescription drug fraud.”

SAN FRANCISCO – California Attorney General Edmund G. Brown Jr. today filed a motion in federal court demanding public disclosure of Federal Receiver J. Clark Kelso’s $8 billion prison construction plan.

“If public money is being spent, the public has the right to know how it’s going to be spent,” said Attorney General Brown. “To date, the proposed $8 billion medical upgrade for California’s prisons has not been shared with the public. The people of California are entitled to see for themselves whether or not the plan meets constitutional minimums or instead goes way beyond what the Constitution requires under the Eighth Amendment, prohibiting cruel and unusual punishment.”

The Receiver’s plan for prison facility construction is a 917-page document containing information on the layout, design and amenities of the seven prison healthcare facilities the Receiver seeks to build. The Attorney General contends that only 23 pages of the 917-page document fall within the terms of the protective secrecy order granted by the court earlier in the proceedings.

The court’s protective order, by its terms, only protects confidential medical records or information that may threaten the safety or security of prison personnel. Specifically, the protective order covers “Department of Corrections’ records that identify any inmate or parolee or that are designated by defendants as threatening prison safety and/or security if disclosed without protective conditions, and which are produced by defendants in informal and/or formal discover in this action.”

The Receiver’s 917-page plan forms the basis for his request to seize $8 billion from the State Treasury to build prison facilities. Attorney General Brown’s motion honors the California Constitutional principle that government is accountable to the people. Article I, Section 3 (b) of the California Constitution declares “The people have the right of access to information concerning the conduct of the people’s business…” As the Supreme Court has recognized, “informed public opinion is the most potent of all restraints upon misgovernment,” which is why, as Justice Brandeis so famously said, “Sunlight is said to be the best of disinfectants.”

The Attorney General’s motion is attached.

LOS ANGELES—California Attorney General Edmund G. Brown Jr. today announced the takedown of a drug-trafficking organization believed to be responsible for stealing the identities of local doctors to write false prescriptions for more than 11,000 pills of highly addictive drugs like Oxycontin and Vicodin.

“Prescription drug fraud is becoming a street crime problem and is growing more and more prevalent in California,” Attorney General Brown said. “What we’re finding now is that it’s no longer individual addicts obtaining a few prescription drugs; there are dangerous criminals running these underground organizations.”

In August 2007, special agents with the California Department of Justice’s Bureau of Narcotic Enforcement (BNE) teamed up with the Simi Valley Police Department to investigate Ricky Washington, known to police for his violent history, gang-affiliation, and previous-drug trafficking arrests. The 12-month investigation revealed that Ricky Washington and associates had stolen the identities of eight doctors, which they used to illegally write prescriptions. The drug-trafficking group also stole the identities of dozens of innocent citizens, designating them as “patients” in order to fill the fraudulent prescriptions. The drug ring obtained thousands of Oxycontin pills, as well as other dangerously addictive prescription drugs like Vicodin.

Agents served multiple arrest warrants and two search warrants at residences in Palmdale. Members of the drug ring arrested today included Josalyn Morales, Beverly Carter, Richard West, Danesha Bentley, Natassha Diaz, Phylicia Mitchell and the group’s leader, Ricky Washington. Law enforcement officials seized evidence that the drug ring was planning to steal the identities of even more doctors and other individuals. The charges include:
• Transportation of a controlled substance
• Possession for sale of controlled substance
• Obtaining a controlled substance by fraud
• Conspiracy on all above listed charges.

As demand increases for prescription drugs, illegal prescription-drug markets are luring violent, organized crime members. California is at the forefront of developing technology that makes it more difficult for criminals, like Washington, to operate prescription-drug rings. The California Department of Justice, in coordination with the Bob and Alana Pack Foundation, has created a new, real-time, prescription drug database. The database tracks information about all prescription drugs dispensed in California and is a powerful tool for law enforcement to combat prescription-drug trafficking.

According to the latest Department of Justice “Drug Trends” report, Valium, Vicodin, and Oxycontin are the most prevalent pharmaceutical drugs obtained fraudulently. Vicodin and Oxycontin are the two most abused pharmaceutical drugs in the United States.

LOS ANGELES – California Attorney General Edmund G. Brown Jr. and the New York and Idaho Attorneys General today announced a settlement agreement with Los Angeles-based First Regional Bank to prevent the bank from providing payment-processing services to online retailers who illegally sell cigarettes and other tobacco products over the Internet.

“Stopping the illegal sale of cigarettes, especially to minors, is a major step in protecting public health. These online tobacco retailers are known to be a major source for young people to get their illegal cigarettes,” said Attorney General Brown. “We’re pleased that First Regional has agreed to take measures to address this important issue and hope that other banks and companies involved in online tobacco sales will follow suit.”

An investigation by Attorney General Brown, in cooperation with New York Attorney General Andrew Cuomo and Idaho Attorney General Lawrence Wasden, determined that First Regional processed income from online tobacco retailers throughout the United States. The investigation included a sting against one of the largest online tobacco retailers, Scott Maybee. It was found that First Regional broke the law by allowing Maybee to process thousands of tobacco sales through the bank.

In June 2008, Attorney General Brown sued Scott Maybee for violating California laws designed to prevent cigarettes from falling into the hands of minors through online purchases. These laws include failing to call the cigarette buyer after 5 p.m. to confirm the sale, failing to impose a two-carton minimum purchase and failing to provide adequate purchase information to credit-card companies so that “Tobacco Products” can be printed on the credit card receipt. Maybee also violated the law when he sold thousands of cigarettes to California consumers that were not fire-safe.

The investigation uncovered evidence that First Regional knew it was facilitating Maybee’s illegal online tobacco sales since 2006. The bank was repeatedly advised to discontinue its practices by the California and New York State Attorneys General. Since June 2008, the Attorneys General of California, New York and Idaho have been working on an agreement with First Regional Bank to ensure that it no longer facilitates the illegal online purchase of tobacco products.

Under the settlement agreement, First Regional will:
• Pay $60,000 in civil penalties, fees and costs
• Maintain and adhere to a formal policy prohibiting the facilitation of online tobacco sales
• Train its employees on the tobacco policy requirements
• Publish its tobacco policy on its public website
• Obtain basic information about its customers and their business operations
• Conduct a background check on potential customers
• Adopt procedures to terminate merchants who violate First Regional’s tobacco policy

Many online tobacco retailers fail to follow laws enacted by states to prevent online cigarettes from falling into the hands of minors. These laws include violating state age-verification laws. Many online retailers also violate numerous other state laws, which include failing to file required monthly sales reports with state tax agencies, selling cigarettes not certified and approved for sale and selling cigarettes that are not be fire-safe, as required by California law.

This agreement furthers the efforts of California and other states to fully implement the tobacco Master Settlement Agreement, a public health agreement that aims to reduce the use of tobacco products and to stop the flow of cheap cigarettes to minors.

Through these efforts, major credit-card companies have already agreed to prevent their cards from being used to facilitate unlawful tobacco sales, and several major shippers refuse to deliver cigarettes purchased online. Clamping down on electronic sales, such as those facilitated by First Regional, will make it more difficult for these retailers to continue their illegal operations.

The settlement agreement is attached.

SAN FRANCISCO– California Attorney General Edmund G. Brown Jr. today filed a motion in federal court to oppose Federal Receiver Clark Kelso’s motion to hold California Governor Arnold Schwarzenegger and Controller John Chiang in contempt for failing to release $8 billion in state funds for a massive prison healthcare facilities construction project.

“Last year, the Legislature approved $7.4 billion in prison construction funds. That money hasn’t even been spent yet, and the Receiver wants $8 billion more,” said Attorney General Brown. “We simply can’t afford to keep throwing billions of dollars of public money into our state correctional system under the veil of secrecy. Once we spend the billions already allocated to improving healthcare in our prisons, then we can determine if more is needed.”

In August, Federal Prison Receiver Clark Kelso filed a motion compelling Governor Arnold Schwarzenegger and Controller John Chiang to hand over an additional $8 billion from the California Treasury over the next 5 years, including $3 billion in this fiscal year, for prison healthcare facility construction. Attorney General Brown argues that the federal court does not have the legal power to mandate state prison construction and there is no evidence in the record justifying the massive sums sought by the Receiver.

The Prison Litigation Reform Act (PLRA), approved by Congress in 1996, makes clear that a court may not force a state to pay for prison construction without its consent. The Receiver’s $8 billion demand includes construction of new prison healthcare facilities containing 10,000 new beds for prisoners with acute and long-term health needs. While California has acknowledged the need to provide constitutionally adequate healthcare, the Receiver has not presented convincing evidence that his wide-ranging plan is “necessary and the least-intrusive” plan required by the U.S. Constitution.

The Receiver has refused to disclose his plan to the public, but according to the Receiver’s motion, “the Facility Improvement project will touch virtually every prison in the state” and “will result in the construction of 7 million square feet of new medical facilities—the equivalent of 70 Wal-Mart stores…”

The $8 billion demand is an enormous increase in state spending for prisons. California built 22 new prisons in 23 years, and prison spending topped almost $10 billion in the 2007-2008 state budget. Last year, the California Legislature authorized $7.4 billion for prison construction and has instituted numerous improvements and reforms to the prison healthcare system. The Attorney General’s motion argues that these improvements should be assessed before allocating more money.

The state has made progress on prison healthcare reform. One of the fundamental problems in fulfilling the state’s constitutional healthcare mandate was the lack of qualified medical staff to treat the inmates. The eighth quarterly report of the Receiver shows that 86% of nursing positions and 81% of physician positions have now been filled. This has significantly improved the level of care provided to prisoners. The state has also implemented upgrades and improvements to its appointment-tracking, medication delivery and laboratory services.

SACRAMENTO--California Attorney General Edmund G. Brown Jr. today released guidelines that, for the first time since California’s Proposition 215 was passed in 1996, clarify the state’s laws governing medical marijuana and provide clear guidelines for patients and law enforcement to ensure that medical marijuana is not diverted to illicit markets.

“California voters approved an initiative legalizing medical marijuana, not street drugs. Marijuana intended for medicinal use should not be sold to non-patients or on illicit markets,” Attorney General Brown said. “These guidelines will help law enforcement agencies perform their duties in accordance with California law and help patients understand their rights under Proposition 215.”

This landmark document marks the first attempt by a state agency to define the types of organizations that are legally permitted to dispense marijuana. Brown’s guidelines affirm the legality of medical marijuana collectives and cooperatives, but make clear that such entities cannot be operated for profit, may not purchase marijuana from unlawful sources and must have a defined organizational structure that includes detailed records proving that users are legitimate patients.

“We welcome the Attorney General’s leadership and expect that compliance with these guidelines will result in fewer unnecessary arrests, citations and seizures of medicine from qualified patients and their primary caregivers,” said Americans for Safe Access Attorney Joe Elford. “No one benefits from confusion over the law. These guidelines will help patients and law enforcement better understand California’s medical marijuana laws.”

In 1996, California voters approved Proposition 215, an initiative that exempted patients and their primary caregivers from criminal liability under state law for the possession and cultivation of marijuana. In addition, The Medical Marijuana Program Act (MMA), enacted by the Legislature in 2004, intended to further clarify lawful medical marijuana practices by establishing a voluntary statewide identification card system, specific limits on the amount of medical marijuana each cardholder could possess, and rules for the cultivation of medical marijuana by collectives and cooperatives. According to Americans for Safe Access, California has more than 200,000 doctor-qualified medial cannabis users.

Several law enforcement agencies have requested that the Attorney General issue guidelines regarding the lawful possession, sale and cultivation of marijuana for medicinal purposes. These law enforcement agencies believe that individuals and cartels, under the cover of Proposition 215, have expanded illegal cultivation and sales of marijuana, which has led to an increase in drug-related violent crime. Most researchers agree that the U.S. marijuana crop has seen a sharp increase in the past decade. A report, “Marijuana Production in the United States” by drug-policy researcher Jon Gettman, estimated that in 2006, more than 21 million pot plants were grown in California at a street value of up to $14 billion.

Fresno Police Chief Jerry Dyer, President of the California Police Chiefs Association, praised Brown for establishing these guidelines. 'Since Proposition 215 was passed, the laws surrounding the use, possession and distribution of medical marijuana became confusing at best. These newly established guidelines are an essential tool for law enforcement and provide the parameters needed for consistent statewide regulation and enforcement.'

The guidelines encourage patients to participate in the California Department of Public Health’s registration program to obtain a medical marijuana identification card. The identification card protects the holder from arrest for marijuana possession and is one of the best ways to ensure the non-diversion of medical marijuana. Collectives and cooperatives are advised to keep files on their patients with documented verification of their qualified status.

A copy of the Guidelines is attached.