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HomeMy WebLinkAboutCAM2022-00293 Shannen Cartmel From:Shannen Cartmel Sent:Monday, August 1, 2022 8:20 AM To:Rhea Graham Subject:RE: Rhea, here are your CAM results Attachments:Medical Marijuana Authorization Form Guidelines and Instructions.pdf; Medical Marijuana Authorization Guidelines.pdf Good morning Rhea, I have worked with our planning manager and Prosecuting Attorney’s office to get you a preliminary answer on your proposal. It does appear that we could permit this as a cottage industry approval. However, this could not reach the scale of being a “hospital” or true medical clinic. Those types of proposals are prohibited in rural residential zones. The proposal would be subject to meeting all conditional use and cottage industry criteria. In addition for us to permit this, you would need to make sure you have met and maintain all Washington State Department of Health (DOH) requirements and certifications. (see the attached). To begin this process, you would need to apply for a pre-application conference, where we can discuss the criteria and allowed activities in greater detail. Here is the link to the form: https://www.co.jefferson.wa.us/DocumentCenter/View/1182/Pre-Application-Conference-PDF?bidId= You would need to pay for all departments to be included (see the bottom of the form for fee schedules). Respectfully, Shannen Cartmel Planning Supervisor Jefferson County Community Development scartmel@co.jefferson.wa.us 360-379-4454 From: Rhea Graham <rheag123@hotmail.com> Sent: Friday, July 22, 2022 12:21 PM To: Shannen Cartmel <SCartmel@co.jefferson.wa.us> Subject: Re: Rhea, here are your CAM results ALERT: BE CAUTIOUS This email originated outside the organization. Do not open attachments or click on links if you are not expecting them. Fabulous - there were just so many blanks, I wasn't sure if everything was filled that was supposed to be. I appreciate your time. Rhea https://www.theackr.com 541-981-2620 1 From: Shannen Cartmel <SCartmel@co.jefferson.wa.us> Sent: Friday, July 22, 2022 11:58 AM To: rheag123@hotmail.com <rheag123@hotmail.com> Subject: RE: Rhea, here are your CAM results Rhea, As we discussed in the meeting, our administrator is still determining if this would fit into a cottage industry proposal. I will touch base with you once we have a chance to fully review. It is on his radar and we will be setting up time to discuss with him. Respectfully, Shannen Cartmel Planning Supervisor Jefferson County Community Development scartmel@co.jefferson.wa.us 360-379-4454 From: DCD Front Staff <dcd@co.jefferson.wa.us> Sent: Thursday, July 21, 2022 2:44 PM To: Shannen Cartmel <SCartmel@co.jefferson.wa.us> Subject: FW: Rhea, here are your CAM results CAM2022-00293 Not sure what’s missing? Jodi Adams she/her/hers Permit & Admin Manager Jefferson County Department of Community Development Phone 360-379-4494 From: Rhea Graham <rheag123@hotmail.com> Sent: Thursday, July 21, 2022 2:05 PM To: DCD Front Staff <dcd@co.jefferson.wa.us> Subject: Re: Rhea, here are your CAM results ALERT: BE CAUTIOUS This email originated outside the organization. Do not open attachments or click on links if you are not expecting them. Good afternoon, I believe there is information missing? Thank you! Rhea https://www.theackr.com 541-981-2620 2 From: Department of Community Development <scheduling@acuityscheduling.com> Sent: Thursday, July 21, 2022 1:41 PM To: rheag123@hotmail.com <rheag123@hotmail.com> Subject: Rhea, here are your CAM results Thank you so much for your CAM appointment. Here are the results of your conversation with Shannen Cartmel on July 19, 2022 1:30pm: Parcel Number: 601021007 Information Requested: We are interested in opening the ACKR Canna-it-ALL Healing-Life Center on our 5 acre parcel. We will need to discuss: Solar Septic Water Tiny Homes/Yurts? Aspects of having a Healing Center Thank you! CAM Number (Reference this number in all future communications): CAM2022-00293 Recommended Next Steps: Zoning: Shoreline Designation: Specific Requested Information: Geologically Hazardous Areas: Geologically Hazardous Areas Notes: Wetlands: Wetlands Notes: Fish & Wildlife Habitat Conservation Areas: Fish & Wildlife Habitat Conservation Areas Notes: FEMA Flood: FEMA Flood Notes: Critical Aquafer Recharge Area: Critical Aquafer Recharge Area Notes: 3 Seawater Intrusion Protection Zone (SIPZ): Seawater Intrusion Protection Zone (SIPZ) Notes: Reports Required for Development or Project: Reports Required for Development or Project Notes: Setback Notes Specific to Property: Typical Setbacks:  The shoreline setback is 150 feet + 10-foot building setback.  20-foot setback off of private roads, local access roads and minor collector roads as defined in Jefferson County Code (JCC) 18.30.050 Table 6-1 Notes.  30-foot setback off of major collector roads including: SR 116, Center Road, Chimacum Road, Irondale Road, Quinault South Shore Road, and Upper Hoh Road.  35-foot setback off of minor arterial roads including: SR 19.  50-foot setback off of principal arterial roads including: US 101, SR 104, and SR 20.  5- foot setback from adjacent residentially zoned property.  250-foot setback from commercial forest zoned property.  100-foot setback from rural forest zoned property. Stormwater Notes: Stormwater Information: Jefferson County has adopted the most current edition of the Stormwater Management Manual for Western Washington produced by Washington State Department of Ecology.  Stormwater Clearing Permits are required for ALL property clearing of 7000 square feet or greater. This can be obtained through a building permit or if you wish to clear the property prior to developing you must obtain a separate stormwater permit. This is required prior to clearing for septic installation  Impervious surface includes gravel surfaces.  Building permits must address stormwater. o A small project is any impervious surface under 2000 square feet. You must meet minimum requirement #2. o A medium project is any impervious surface from 2000 to 4999 square feet or 7000 or more square feet of clearing. You must meet Minimum requirements #1-#5. Including on site stormwater management. Jefferson County will request you to design a stormwater management system as part of your building permit to address roof and other hard surfaces. o A large project is any impervious surface from 5000 square feet or greater. You must meet all minimum requirements. Jefferson County will request you to design a stormwater management system as part of your building permit to address roof and other hard surfaces. If you reach a large project and your parcel is 5 acres or larger and you are not within an Urban Growth Area, an engineered stormwater plan is required to ensure low impact design standard is met.  If you plan on clearing the property and qualify under Department of Natural Resources (DNR) classification of needing a Forest Practices Application (FPA) you must work with our department first to obtain a Class IV General Stormwater Permit with SEPA to avoid a Development Moratorium. Jefferson County recommends you contact DNR to determine if your project meets their standard. Zoning Notes: Shoreline Notes: 4 Parcel Tag Notes: Additional Notes: Unsubscribe 5 Medical Marijuana Authorization Form Guidelines and Instructions These instructions intend to clarify requirements and purpose of a medical marijuana authorization form per chapter 69.51A RCW. Guidance for Healthcare Practitioners To issue a medical marijuana authorization to your patient, health care practitioners: o Must have a Washington State-issued health profession license type defined under RCW 69.51A.010(5) – see Who can authorize? o Refer to the professional practice standards established by the regulating Boards and Commissions: Medical Marijuana Authorization Guidelines o Complete and sign the current Medical marijuana authorization form (DOH 630-123 November 2019) and print on authorization tamper-resistant paper. Do not mail, email or fax a copy to the Department of Health. Keep a copy of the authorization in the patient’s medical record. Special Considerations A qualifying patient is defined under per RCW 69.51A.010(19) as one who has been diagnosed by that health care practitioner as having a terminal or debilitating medical condition and is a resident of the state of Washington at the time of such diagnosis – see Qualifying Conditions. A DP must be twenty-one years of age or older and is typically the patient’s care giver or the parent or legal guardian of a qualifying patient who is under the age of eighteen. o A DP may only be designated to serve one patient at a time and vice versa; a patient may only have one designated provider at a time. o If the patient has a DP, issue two original authorizations printed, signed and dated on authorization tamper-resistant paper. The designated provider must have their own authorization even if they reside at the same address. This includes minor patients under the age of eighteen. For patient’s unable to physically sign the form to designate a care giver as required under RCW 69.51A.010(4): o A qualifying patient’s mark is acceptable as the signature on the authorization form when a patient is unable to apply a full handwritten signature. o A family member may assist a qualifying patient to apply a signature, initial, or make a mark when completing the attestation on the authorization form. DOH 608-024October2020 1|Page Form Instructions The medical marijuana authorization (authorization) form (DOH 623-123 November 2019) is divided into three sections with each line item numbered for reference: Section I – Patient and Designated Provider (DP) Information o Line items 1 and 2 - Use full legal name of the patient. No nicknames. “Street address” means the physical street address for the person’s residence where plants may be grown under RCW 69.51A.210.DO NOT use a post office box. o Line item 3–Mark “Yes” if the adult patient has a DP who will be purchasing or growing marijuana for the patient. Always mark “Yes” for minor patients (under age 18). Mark “No” if patient does not have a DP and continue on to Section II. o Line items 4 and 5 – enter the patient’s DP name and address. This includes the parent/or legal guardian who will be acting as DP for the minor patient. o Line item 6 – A designated provider must be designated in writing by a qualifying patient to serve as the designated provider for that patient per RCW 69.51A.010 . Line item 6 provides a method for adult patients (age 18 and older) to designate a person. Minor patients or their DP (parent/legal guardian) are not required to sign. Section II – Healthcare Practitioner Information o Line items 7 and 8: Use the full name listed on the Washington State-issued healthcare practitioner license. Address must be the business location from which the authorization was issued. Enter the phone number where the authorization can be verified during normal business hours as required under RCW 69.51A.030(3). Section III – Healthcare Practitioner’s certification and recommendation o Line item 9 - mark the patient’s qualifying condition(s) o Line item 10 – Indicate patient eligibility for a compassionate care renewal of his or her authorization and/or registration in the database and card per RCW 69.51A.030(2). Important to note regarding database registration renewals: Adult patients are not required to have a designated provider but will have to renew their registration in-person if they do not. A patient who was not previously registered will need to visit the store in-person for initial entry. o Line item 11 – An authorization allows a patient to grow up to four plants within their domicile; if registered in the database and has a card, the patient may grow up to six. A practitioner may recommend additional plants (no more than 15 plants) to meet the patient’s medical needs by marking “Yes” and indicating the number of plants on the form - RCW 69.51A.210 o Line item 12 - For an adult patient (age 18+) an authorization may be valid for up to one year after issuance; a minor patient (under age 18) may be valid up to six months after issuance. o Line item 13 – The healthcare practitioner issuing the authorization must sign and date the form for it to be valid. DOH 608-024 October 2020 2 | Page Information forPatients and Designated Providers A qualifying patient (or their designated provider) may: With an authorization, a patient or their designated provider may grow up to four plants within their domicile. If registered into the Medical Marijuana Authorization Database (database), a patient or their designated provider may grow up to six plants, or additional plants if authorized by their healthcare practitioner. Adult patients (18 or over) with a valid authorization may voluntarily join the database (database) to receive a medical marijuana recognition card and benefits . Minor patients (under 18) and their DP (parent/legal guardian) are required to join the database. To register in the database, a patient may schedule an appointment with a Medical Marijuana Consultant at a nearby medically-endorsed retail store who may assist the patient with the registration process and issue a recognition card. Note: Unless compassionate care renewal eligible, the adult or minor patient and their designated provider are required to be registered together and will be required to bring with them their valid authorization form and state-issued identification. A qualifying patient (or their designated provider) may not: Sell, donate, or otherwise supply the patient’s marijuana to another person, except as authorized in RCW 69.50.4013. Use or display marijuana in a manner or place that is open to the view of the general public. Grow, possess, or use marijuana on federal property. Grow more than 15 plants in any one housing unit even if multiple qualifying patients or designated providers reside in the housing unit, unless growing within a cooperative registered with the Washington State Liquor and Cannabis Board (WSLCB), which allows a maximum of 60 plants (up to 15 per participant). Grow, store, produce, or process marijuana or marijuana-infused products if any portion of such activity can be readily seen by normal unaided vision or readily smelled from a public place or the private property of another housing unit. Questions? MedicalMarijuana@doh.wa.gov | Phone: 360-236-4819 DOH 608-024 October 2020 3 | Page Medical Marijuana (Cannabis) Authorization Guidelines April 2020 1.1 P URPOSE To improve patient safety and maintain the dignity of healthcare practitioners, the regulating boards and commissions adopted professional practice standards expected of authorizing healthcare practitioners who recommend medical marijuana under Washington State law. 1.2 D EFINITIONS Authorization. A form developed by the Department of Health that is completed and signed by a healthcare practitioner and printed on tamper-resistant paper containing the RCW 69.51A.030 logo. An authorization is not a prescription as defined in RCW 69.50.101.A patient with a valid authorization is allowed to grow up to four plants within their domicile under RCW 69.51A.210. Authorizing healthcare practitioner. The following types of healthcare practitioners licensed in Washington State are allowed to authorize the use of marijuana to medical patients: Medical doctor (MD) – licensed under chapter 18.71 RCW Physician assistant (PA) – licensed under chapter 18.71A RCW Osteopathic physician (DO) – licensed under chapter 18.57 RCW Osteopathic physician assistant (OPA) – licensed under chapter 18.57A RCW Naturopathic physician (ND) – licensed under chapter 18.36A RCW Advanced registered nurse practitioner (ARNP)– licensed under chapter 18.79 RCW Certified Medical Marijuana Consultant. A person who has completed a 20-hour state-approved Medical Marijuana Consultant Certification training program and holds a valid medical marijuana consultant certificate issued by the Department of Health - WAC 246-72-010. A certified consultant works in a licensed marijuana retail store that has a medical endorsement. A certified consultant’s role is to assist a patient with registration into the medical marijuana authorization database, create and issue a recognition card to the patient and assist the patient with the selection of marijuana products that may benefit the patient’s medical condition - WAC 246-72-030. Designated provider. A person who is twenty-one years of age or older and is the parent or guardian of a qualifying patient who is under the age of eighteen; or has been designated by the qualifying patient to purchase, provide or grow marijuana for the patient and has an authorization from the patient’s healthcare practitioner. A designated provider can only serve one patient at any one time – RCW 69.51A.010(4). Medical marijuana authorization database. A secure and confidential database administered by the Department of Health and used by medically-endorsed marijuana retail stores to register, issue and verify recognition cards to qualifying patients and their designated providers (if any); and, used by healthcare practitioners to access health care information on their patients for the purpose of providing medical and pharmaceutical care as established under RCW 69.51A.230. DOH 631-053 April 2020 Source: Washington State Department of Health Page 1 of 6 Medically-endorsed marijuana retail store. A marijuana retailer that has been issued a medical marijuana endorsement by the state liquor and cannabis board pursuant to RCW 69.50.375. Qualifying patient. A person who is a patient of a healthcare practitioner; has been diagnosed by that practitioner as having a terminal or debilitating medical condition defined under RCW 69.51A.010(24); is a resident of Washington; has been advised by that practitioner about the risks and benefits of the medical use of marijuana; has been advised by that practitioner that they may benefit from the medical use of marijuana; and has an authorization from his or her healthcare practitioner to use marijuana for medical purposes – RCW 69.51A.010(17). Recognition card. A card issued to qualifying patients and designated providers by a marijuana retailer with a medical marijuana endorsement that has entered them into the medical marijuana authorization database – RCW 69.51A.010(20). With a recognition card a patient can purchase up to three times the recreational amount of product, is allowed to grow up to six plants (or up to 15 plants upon their practitioner’s additional plant recommendation), and can purchase sales tax free from a medically endorsed marijuana retail store – RCW 69.51A.210. Tamper-resistant paper.Paper that meets industry-recognized security features to copying, erasure or modification of information on the paper, and to prevent the use of counterfeit authorization – RCW 69.51A.010(23). Terminal or debilitating medical condition. Means a condition severe enough to significantly interfere with the patient's activities of daily living and ability to function, which can be objectively assessed and evaluated and limited to the conditions outlined under RCW 69.51A.010(24). Compassionate Care Renewal. A renewal of an authorization by a health care practitioner through the use of telemedicine if the health care practitioner determines that requiring the qualifying patient to attend an in-person physical examination would likely result in severe hardship to the qualifying patient because of the qualifying patient's physical or emotional condition. A compassionate care renewal of a qualifying patient's registration and recognition card also allows the qualifying patient's designated provider to renew the qualifying patient's registration in the database and recognition card without the qualifying patient being physically present at a retailer and without a new photograph being taken per WAC 246-71-010(2). Telemedicine. Has the same meaning as the definition of that term adopted by the authorizing health care practitioner's disciplining authority, whether defined in rule or policy per WAC 246-71-010(15). 1.3 H EALTHCARE P RACTITIONER S TATUTORY L IMITATIONS The healthcare practitioner shall not (RCW 69.51A.030): a. Accept, solicit, or offer any form of pecuniary remuneration from or to a marijuana retailer, marijuana processor, or marijuana producer; b. Offer a discount or any other thing of value to a qualifying patient who is a customer of, or agrees to be a customer of, a particular marijuana retailer; DOH 631-053 April 2020 Source: Washington State Department of Health Page 2 of 6 c. Examine or offer to examine a patient for purposes of diagnosing a terminal or debilitating medical condition at a location where marijuana is produced, processed, or sold; d. Have a business or practice which consists primarily of authorizing the medical use of marijuana or authorize the medical use of marijuana at any location other than his or her practice's permanent physical location; e.Except as provided in RCW 69.51A.280,sell, or provide at no charge, marijuana concentrates, marijuana-infused products, or useable marijuana to a qualifying patient or designated provider; or f. Hold an economic interest in an enterprise that produces, processes, or sells marijuana if the health care professional authorizes the medical use of marijuana. 1.4 A UTHORIZATION P RACTICE G UIDELINES A healthcare practitioner may provide valid documentation to authorize medical marijuana (cannabis) to a qualifying patient under Chapter 69.51A RCW under the following conditions: S ECTION 1:P ATIENT EVALUATION A healthcare practitioner should obtain, evaluate, and document the patient’s health history and physical examination in the health record prior to treating for a terminal or debilitating condition. a. The patient’s health history should include: i.Current and past treatments for the terminal or debilitating condition; ii. Comorbidities; and iii.Any history of substance misuse or abuse using a risk assessment tool. b. The healthcare practitioner should: i. Complete an initial physical examination as appropriate based on the patient’s condition and medical history; and ii. Check of the Prescription Drug Monitoring Program database for the patient’s receipt of controlled substances iii. Review the patient’s medications including indication(s), date, type, dosage, and quantity prescribed. iv. Provide the qualifying patient and their designated provider (if any) each with a medical marijuana authorization form printed on tamper-resistant paper containing the RCW 69.51A.030 logo as required under WAC 246-71-010. DOH 631-053 April 2020 Source: Washington State Department of Health Page 3 of 6 S ECTION 2:T REATMENTPLAN A healthcare practitioner should document a written treatment plan that includes: a. Review of other measures attempted to treat the terminal or debilitating medical condition that do not involve the medical use of marijuana; b. Advice about other options for treating the terminal or debilitating medical condition; c. Determination that the patient may benefit from treatment of the terminal or debilitating medical condition with medical use of marijuana d. Advice about the potential risks of the medical use of marijuana to include: The variability of quality and concentration of medical marijuana; i. Adverse events, including falls or fractures; ii. The unknown short-term and long-term effects in minors, as more fully explained in Section 4, below; iii. Use of marijuana during pregnancy or breast feeding; and, iv. The need to safeguard all marijuana and marijuana-infused products from children and pets or domestic animals. v. Additional diagnostic evaluations or other planned treatments; e. A specific duration for the medical marijuana authorization for a period no longer than 12 months for adults (age 18 and over) and 6 months for minors (under age 18); and, f. A specific ongoing treatment plan as medically appropriate. S ECTION 3:O NGOING TREATMENT A healthcare practitioner should conduct ongoing treatment and assessment as medically appropriate to review the course of the patient’s treatment, to include: a. Any change in the medical condition; b. Any change in physical or psychosocial function; c. Any new information about the patient’s terminal or debilitating medical condition; and d. An authorization may be renewed upon completion of an in-person physical examination. e.Following an in-person physical examination, evaluate patient eligibility for a compassionate care renewal of their authorization per RCW 69.51A.030(2)(c)(iii). DOH 631-053 April 2020 Source: Washington State Department of Health Page 4 of 6 S ECTION 4:T REATINGMINORPATIENTSORPATIENTSWITHOUTDECISIONMAKINGCAPACITY The risks of marijuana use in minors are substantial, particularly given its well-documented adverse 1 effects on the developing brain. While research demonstrates that the use of marijuana can be helpful for adults with specific debilitating conditions, there are no published studies on the use of medical marijuana for minors. A health care practitioner should strongly consider limiting the authorization of marijuana to minors in palliative pediatric care when short-term symptom relief outweighs long-term risks. The most common symptoms that may justify the use of medical marijuana for minors are pain, 2 nausea, vomiting, seizures, and agitation. Under RCW 69.51A.220 and RCW 69.51A.230(4),a healthcare practitioner considering authorizing marijuana to a patient under the age of 18 or without decision making capacity must: a. Ensure the patient’s parent, guardian, or surrogate participates in the treatment and agrees to the medical use of marijuana; 3 b. Evaluate and document history of substance misuse or abuse using a risk assessment tool; c. Consult with other healthcare practitioners involved in the patient’s treatment, as medically indicated and as agreed to by the patient’s parent, guardian, or surrogate, before authorization or reauthorization of the medical use of marijuana; and d. Include a follow-up discussion with the minor’s parent or patient surrogate to ensure the parent or patient surrogate continues to participate in the treatment; e.Ensure the patient’s parent, guardian, or surrogate acts as the designated provider; and f. Reexamine the minor at least once every six months or more frequently as medically indicated. Additional requirements to note when treating minor patients: a. Qualifying patients (adult or minor) can only have one designated provider under RCW 69.51A.010. This can be challenging for minor patients who live in divorced families. 1 https://pediatrics.aappublications.org/content/135/3/584 2 The federal Food and Drug Administration (FDA) has approved medications related to marijuana that are available in pharmaceutical grade by prescription for rare conditions. One of the medications is approved for the treatment of seizures associated with Lennox-Gastut syndrome or Dravet syndrome in patients over two years of age. This medication is not considered medical marijuana and is not available at marijuana dispensaries. This medication is prescribed by subspecialists with expertise in these conditions. 3 The use of a risk assessment tool is particularly important in the treatment of minors. The American Academy of Pediatrics developed a guide to help providers incorporate screening, brief intervention, and referral for the use of alcohol, tobacco, marijuana and other drugs among adolescent patients. https://pediatrics.aappublications.org/content/138/1/e20161210 DOH 631-053 April 2020 Source: Washington State Department of Health Page 5 of 6 a. School districts must permit a designated provider (parent/legal guardian) to administer marijuana-infused product to a minor qualifying patient (under age 18) in accordance with school policy at the request of a parent –RCW 69.51A.225 b.The minor may not grow plants or purchase marijuana (cannabis) -RCW 69.51A.220. c. Both the minor and the minor's parent or guardian who is acting as the designated provider must be entered in the medical marijuana authorization database and hold a recognition card - RCW 69.51A.220. S ECTION 5:M AINTENANCE OF HEALTH RECORDS A healthcare practitioner should maintain the patient’s health record in an accessible manner, readily available for review, and include: a. The diagnosis, treatment plan, and therapeutic objectives; b. Documentation of the presence of one or more recognized terminal or debilitating medical conditions identified in RCW 69.51A.010(24). c. Documentation of other measures attempted to treat the terminal or debilitating medical condition that do not involve the medical use of marijuana; d. A copy of the signed authorization form for both the patient and their designated provider (if any); e.Results of ongoing treatment; and f. The healthcare practitioner’s instructions to the patient. S ECTION 6:C ONTINUING EDUCATION A healthcare practitioner issuing authorizations or valid documentation for the medical use of marijuana on or after the effective date of these guidelines, should complete a minimum of three hours of continuing education related to medical marijuana. Such program should explain the proper use of marijuana (cannabis), including the pharmacology and effects of marijuana (e.g., distinction between cannabidiol (CBD) and tetrahydrocannabinol (THC); methods of administration; and potential side effects or risks). 1.5 R ESOURCES Washington State Department of Health Medical Marijuana Program DOH 631-053 April 2020 Source: Washington State Department of Health Page 6 of 6