When the Board of Medical Examiners last month suspended the license of Dr. Anthony Anzalone, arguably the busiest marijuana-authorizing physician in New Jersey, it sent reverberations far and wide.

His patients believe he's a savior. His attorney calls him a "pioneer." But the state Attorney General's Office contends Anzalone "exploited his patients and the medical marijuana program" to "create a multmillion dollar enterprise."

In a complaint to the board, the attorney general alleges Anzalone indiscriminately authorized medical marijuana for patients without doing proper medical examinations or, in some cases, even speaking to them.

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In other instances, according to the complaint filed in December, Anzalone authorized medical marijuana use for patients who weren't qualified to receive it.

A settlement will temporarily suspend Anzalone's license as of Friday as the two sides try to work out a final settlement, according to an interim consent order entered by the medical examiners board.

What happens next will command the attention of many New Jersey doctors, patients and policymakers on all sides of New Jersey's marijuana debate — in no small part because of the timing of the action and who Anzalone is.

The case unfolds as Gov. Phil Murphy's administration has been promoting the view that the Garden State is ready for legal weed for recreational use and an expanded medical marijuana program — and that the state can police both.

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Under pending legislation, registered marijuana patients would be able to purchase tax-free medical marijuana and possess it in quantities greater than new legal recreational users.

Marijuana, for any use, remains illegal under federal law.

Anzalone, known as "Dr. Marijuana" to his many faithful followers, is perhaps the public face of medical marijuana in New Jersey, advertising his practice on billboards and online and seeing patients en masse at hotels across the state.

State officials have decried Anzalone's alleged conduct, even as the Murphy administration has campaigned to make marijuana more available than ever in New Jersey — to more prospective medical patients and recreational users age 21 and over.

"We are making it clear that we will not allow unscrupulous doctors to enrich themselves at the expense of the safety and welfare of their patients and the public,” Division of Consumer Affairs Acting Director Paul R. Rodriguez said in announcing the state's case against Anzalone.

Rodriguez said Anzalone disregarded the regulations "meant to protect patients and promote the efficacious use of medicinal marijuana.”

The state is trying to revoke Anzalone's medical license indefinitely. He could face a trial before a judge to determine the final disposition of his license, if no settlement is reached. No criminal charges have been filed.

Jef Henninger, an attorney representing Anzalone, denied in a Press interview that his client had done anything wrong. He said Anzalone's prominence had put him in the sights of state regulators.

“My client is a pioneer who's trying to be one of the few doctors that's trying to service as many patients as possible and handle this new industry," Henninger said. "He has a very high patient volume and was doing things that were unique.

"Whenever you’re doing that in a highly regulated industry, I think at some point the state is going to take a look. He did everything he could to make sure he was following all the regulations as he understood them," Henninger said.

Henninger denied a USA TODAY NETWORK New Jersey request to interview Anzalone.

In the view of some medical marijuana patients and their advocates, the action against Anzalone already represents a setback to medical marijuana, seen as an alternative to highly addictive and potentially deadly painkillers like opioids.

MORE: NJ wants to use medical marijuana to combat opioid crisis

"We have a state with 9 million people in it and countless numbers of them could benefit from the therapeutic effects of medical marijuana," said Ken Wolski, executive director of the Coalition for Medical Marijuana New Jersey, the most prominent medical marijuana advocacy group in the state.

Wolski said charges that Anzalone was "only in it for the money ring hollow in the U.S. health care industry, where nearly everything is about the bottom line. Even hospitals take out full page ads trying to attract patients."

An Attorney General's Office spokeswoman said the state had never before taken action against a doctor for violating the rules governing the medical marijuana program, of which the Department of Health says now serves over 40,000 patients.

A good number of them, in locations throughout New Jersey, crossed paths with Anzalone.

Dr. Marijuana

Anzalone, 66, hardly flew under any radar.

He advertised himself online and on billboards as "Dr. Marijuana." He also saw large groups of patients assembled in hotel meeting rooms, according to the attorney general's complaint.

On that basis alone, Anzalone may be the most prominent physician in the New Jersey medical marijuana program.

Most medical marijuana-authorizing physicians stay out of the spotlight because marijuana, for both medicinal and recreational use, remains illegal under federal law.

Only de facto indifference from Washington permits states to authorize medical marijuana and, in the case of 10 states, legalize weed completely.

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Anzalone registered for the New Jersey program in 2012 and began taking medical marijuana patients in 2014. His practice, now known as "NJ Green MD," has over 2,000 active patients, according to the Attorney General's Office.

That's more than 5 percent of the number enrolled in the state's entire medical marijuana program.

The rules the state alleges Anzalone broke are numerous, including approving medical marijuana for patients he never met or who didn't qualify.

He also held appointments en masse at hotel conference ballrooms, the state alleges, in violation of a federal law protecting patients' privacy,

Lisa Coryell, a spokeswoman for the Attorney General's Office, declined to comment on the details of the Anzalone case or disclose if the office had investigated other doctors for medical marijuana violations.

According to Henninger, Anzalone's practice grew gradually over its first four years, similar to the New Jersey medical marijuana program, which was one of the nation's most restrictive during it first years.

Only a handful of qualifying conditions were included and doctors were required to sign up for a public registry, which many feared would put them in the sights of the federal government.

In a 2013 interview in NJ Spotlight, Anzalone said doctors were "aware of (marijuana) but they're not aware of the medical benefits.

"They don't want to risk their licenses. They don't want to be an outcast by recommending it," Anzalone said. "Unfortunately, this is a medication that people don’t recognize and it has a bad rap."

With marijuana still illegal on the federal level and the Food and Drug Administration overseeing prescriptions, doctors in medical marijuana states cannot actually "prescribe" it.

Instead, they recommend the drug as a treatment option and refer the patient to the state Department of Health.

MORE: How one Colorado university is getting around federal law to study marijuana

After registering with the state, the patient can make an appointment at one of the state's six marijuana dispensaries, with another six recently approved and expected to open this year.

"It was very difficult for patients and so, to me, (Anzalone) was fulfilling a need that exists in this state to make it easier for patients to get into the program,” said Wolski from the medical marijuana advocacy group.

"He wanted to be the ‘Green MD.’ He wanted to take the bull by the horns and make medical marijuana available to patients. That was his mission and he dedicated his practice – and basically his life – to it."

Over the last 13 months, coinciding with the start of Murphy's term in the Governor's Office, the New Jersey medical marijuana program has grown exponentially.

The physician registry requirement was lifted and new qualifying conditions were added, including anxiety, chronic pain, migraines and Tourette's syndrome.

As a result, the patient population in New Jersey more than doubled, from about 18,000 patients in March 2018 to over 40,000 in January 2019.

NJ MEDICAL MARIJUANA: A beginner's guide to the process

NJ Green MD saw a similar, exponential increase in new patients, Henninger said.

The state Department of Health, which oversees medical marijuana dispensaries and doctors, has actively promoted its medical marijuana program.

Health Commissioner Dr. Shereef Elnahal has delivered grand round lectures at hospitals with the hope that more doctors will turn to medical marijuana.

By taking action against Anzalone, the state is sending mixed signals, said Alma Saravia, a health care attorney who heads up the cannabis law division at the Flaster Greenberg firm.

"We have the commissioner of health, in good faith, giving these grand rounds at hospitals because we need more doctors to handle the high volume of patients that suffer from these very legitimate medical conditions," said Saravia, a former member of the Board of Medical Examiners.

“I don’t know if one should jump to the conclusion that the patients treated by this doctor did not have legitimate medical conditions," Saravia said.

Those patients must find a new doctor to authorize their medical marijuana use after Friday, when NJ Green MD must shut down until the case against Anzalone is resolved, under terms of the consent decree.

The shutdown has patients like Don Adelman, a 42-year-old Jackson medical marijuana user, afraid that doctors will try to scale back their patient rolls to avoid scrutiny from regulators.

"There are less places to go, as if they're afraid that something's going to happen to them," Adelman said.

Ballroom blitz

Adelman estimated that he's visited Anzalone at 15 different locations over the last three years. Anzalone's transience is well-known.

In 2016, he was evicted from his office space at a Meadowlands building when the leasing agent said that drugs of any kind — including medical marijuana — violated its rules, according to an account in The Record.

The practice's website currently advertises office hours only in a Tinton Falls warehouse building; it still listed Rutherford and Iselin practices on Jan. 10, the day Anzalone's license suspension was announced.

Over the last three years, Anzalone's practice has advertised office locations across northern and central New Jersey, including multiple Rennaissance and Marriott hotels in Lakewood, Lincroft, Rutherford and Woodbridge.

The hotel appointments, which make up the crux of the state’s complaint against Anzalone, began due to the practice’s inability to find a traditional office that would have them, Henninger said.

Adelman said he saw dozens of people at the few appointments he scheduled at the Lakewood Marriott hotel. As he recalled, one of Anzalone's staff members gave a brief lecture on the basics of the medical marijuana program,.

After that brief lecture, Adelman said he met with Anzalone for five or six minutes to go over the basics: Does the program help you? Have you had any side effects? Have you been able to reduce your use of other medications?

"Everything with the guy was fine,” Adelman said. "I can’t say he met with everybody, but with me? He took the time to do what he was supposed to do. It was a typical doctor's visit."

If a medical marijuana doctor takes on a new patient, they're expected to conduct their own independent examination, Saravia said. That independent exam should occur even if the patient brings along medical records or X-rays from their previous physician, she said.

"This doctor still has an obligation to assess the patient and come up with a treatment plan," Saravia said. "What they’re expected to do is the same as if they’re treating any condition, the same as if they’re prescribing pain medication.

"The thought process a doctor uses is consistent — whether it’s the flu or a chronic pain condition."

In its complaint, the state alleges that Anzalone never maintained a "bona fide relationship" with his patients, as required by the laws governing the medical marijuana program.

The only way to prove such a relationship exists is with documentation, Saravia said. The case against Anzalone may serve as a warning shot to other medical marijuana doctors, encouraging them to ensure their record-keeping is scrupulous, she said.

"The whole key is going to boil down to what’s in the paperwork. That’s the No. 1 thing the Board of Medical Examiners looks at in cases like this – how do they know the standard of care was adhered to," Saravia said.

"You can’t change your records — signed, sealed and dated — so you have evidence you’ve done your job as a physician."

Wolski called the “bona fide” concept an “artificial” requirement, one of the earliest restrictions placed on the New Jersey medical marijuana program by former Gov. Chris Christie’s administration.

It was designed to keep the program as small as possible, Wolski said.

"There was no outreach in the eight years of the Christie administration, Wolski said. "I think there was one mention of the medical marijuana program during all that time. They really downplayed access and inhibited access to it."

Patient care

According to the attorney general's complaint, two undercover investigators received medical marijuana clearances from Anzalone's practice despite never meeting with Anzalone.

One investigator was authorized for medical marijuana based solely on their medical records and proof of New Jersey address; the investigator was not examined by Anzalone or anyone else on his staff, according to the complaint.

Another undercover investigator was told by a staff member that her condition didn't qualify her for medical marijuana, the complaint states.

The staff member then walked across the room to check with Anzalone and showed him an X-ray.

Anzalone, according to the complaint, simply stated: "It's fine." The investigator was authorized for medical marijuana without any further examination.

According to the attorney general's complaint against Anzalone, that doesn't constitute a "bona fide" relationship, as state law requires.

Henninger said he was still collecting evidence and could not comment on specific allegations against his client. He allowed for the possibility of a "misunderstanding" or "miscommunication," declining to be more specific.

"If you’re doing something new and unique, and if you’re doing a lot of it, could there have been mistakes that were made? Possibly,” Henninger said. “But this is not a case where, if you just showed up and said, ‘I want medical marijuana,’ you got a prescription. My client is not one of those doctors."

Social media has been abuzz with remarks from those who wrote that they were patients, most coming to Anzalone's defense and others contending such action was inevitable.

"Dr. Anzalone corrected a state malfunction and saved patients a lot of pain by not making them wait for New Jersey to do what they should have already done," one Facebook user wrote.

Rahway resident Diane Juliana said she was "in tears about what they're doing" to Anzalone. She credits Anzalone with saving a relative's life after a painkiller addiction and giving another relative a "break" on his $350 consultation and $100 quarterly renewal fees.

"He has gone over and above and beyond for me and my family. He has helped us so much, it’s unbelievable," Juliana said.

"I don’t want to see any other doctor. I want him."

As part of the Jan. 9 order by the Board of Medical Examiners, Anzalone was given 30 days to "wind down" his practice. Until Friday, he's permitted to authorize marijuana for patients due for quarterly recertification, but barred from taking on any new patients.

NJ Green MD will close completely — at least until the case between Anzalone, the Attorney General and the Board of Medical Examiners is resolved for good.

Mike Davis; @byMikeDavis: 732-643-4223; mdavis@gannettnj.com

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