Health systems generally won't touch marijuana, so cannabis clinics emerge in medical marijuana states.

Sometimes, they come with ethical and legal questions.

What does "medical" marijuana mean, anyway?

That's just one of the questions prompted by St. Louis-based Health City MD, a company that puts on traveling pop-up cannabis clinics in rural Missouri towns including Fulton, Rolla and Springfield, among others.

In recent months, Health City MD's Cannabus began traveling through the state, charging $125 for physician certifications — the paperwork required by the Missouri Constitution in order to apply for a state-approved medical marijuana card.

In daylong "cannabis clinics," a team of roughly eight Health City MD staffers, helmed by psychiatrist Zinia Thomas, sees hundreds of Missouri patients over the course of eight to 10 hours. In Rolla, a pop-up clinic at a head shop called Peace of Mind recently churned through 300 patients.

"It's a whole phased thing," said Scott Micke, Peace of Mind store owner, who told the News-Leader he leased space to Health City MD for the day. "You fill out her questionnaire, it gets reviewed, then you go to the next step, then you go into a class with Dr. Thomas where she talks about your rights, then there's a congratulations speech and off you go."

Jamie Tillman's Canna Bliss store on Republic Road in Springfield hosted a Health City MD clinic on Monday. "She does the certifications in about 30 to 40 minutes," Tillman told the News-Leader. "They're in and out. It's really pretty simple."

Related: Everything you need to know about medical marijuana in Missouri

So-called cannabis clinics like these are nothing new. From the inception of medical marijuana in the United States 23 years ago, cannabis clinics have emerged to fill a perceived void in the marketplace because established health systems (think Mercy and CoxHealth) generally won't let their doctors touch anything related to marijuana. Big health systems fear lousing up their relationship with the federal government, the source of funding for linchpin health programs like Medicare and Medicaid.

Now, Health City MD's clinic events are drawing scrutiny in Missouri. On Wednesday, Sgt. Shawn Griggs with the Missouri State Highway Patrol confirmed that Health City MD is under investigation by his department, which has reviewed information gathered by a Columbia-based private investigator who went undercover at a Fulton shop where a traveling clinic took place Aug. 27.

A key reason is the Cannabus. Doctors and rival cannabis clinic operators and others accused Health City MD of selling weed from the back of the bus — a black Mercedes van has been spotted, along with a black SUV — once patients obtain their certifications. Social-media chatterers claim Health City MD is charging $25 per gram — about double the current black-market value for marijuana sold in Missouri.

Such a practice would fall outside of Missouri's medical marijuana law, which voters placed in the Missouri Constitution in November 2018. State-licensed dispensaries won't appear until sometime in mid-2020. Licenses won't be awarded until December. But currently, patients with medical marijuana cards issued by the Missouri Department of Health and Senior Services may consume or possess marijuana, and they may grow it if they have a cultivation authorization.

But there's not a provision for legal sales in Missouri at this time.

Going undercover in Fulton

Documents obtained by the News-Leader show that a Columbia-based private investigator went undercover to attend a Cannabus clinic held at Koko Vapors in Fulton on Aug. 27.

(Melinda Kidder, the investigator, allowed the News-Leader to use photos and documents she gathered on behalf of a client for this story, but said her company does not share or publish any evidence or information about its clients without the "express consent and request of said client." As a matter of journalism ethics, the News-Leader and the USA TODAY Network do not perform undercover investigations.)

The report Kidder wrote up for her client noted that she listened to a congratulations speech from Health City MD after she filled out the company's "Generalized Anxiety Disorder 7-Item Scale" questionnaire on a tablet device and paid $125 for a physician certification. (A copy of the receipt was attached to Kidder's report.)

"Once the speech was completed," Kidder wrote, "the crowd was told they could go to 'the van.' I inquired of a Koko Vapors employee as to the purpose of going to the van and was informed that was where one could immediately obtain medical-grade marijuana."

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Koko Vapors would not comment for this story when reached by the News-Leader on Wednesday, or reveal the name of the owner of that company, referring all questions to Health City MD. The following day, the News-Leader asked Kidder what she experienced at the vape shop in Fulton. Did she see or smell weed in person?

"Dr. Thomas was standing a few feet away from the employee who made the statement (that weed was for sale in the Cannabus) and did not correct him or comment," Kidder said in an email. "She simply smiled and nodded to me and did not correct his statement. I did not see, smell, or otherwise experience cannabis personally."

Kidder also stated in her report that she was never asked to present a government ID at the pop-up clinic. She also wrote that she and other patients were seen en masse — a practice that would look nothing like a traditional doctor's appointment.

"At no time was I offered, or required to have, a private / individual consultation with Thomas," Kidder wrote.

Doctor's note vs. state card

Allegations like these have provided much fodder for talk within Missouri's pro-cannabis community, with one rival cannabis clinic operator going so far as to circulate a meme on social media featuring a photograph of Thomas alongside a Cannabus logo.

"DO NOT SUPPORT ILLEGAL CANNABIS BUSINESS IN MISSOURI," states the meme, posted to Facebook the morning of Sept. 3 by Emily Branch with The Green Clinics in Kansas City. The post was later made public and shareable.

Within the pro-cannabis camp, one concern is that rural patients who may have little exposure to the finer points of Missouri medical marijuana regulations might believe someone who tells them that a physician certification is the same thing as a state-approved medical marijuana card.

More: How to get a Missouri medical marijuana card

It is not. Amendment 2 contains a provision (in subsection 3, paragraph 19) that lets the doctor paperwork stand in for the state card only in cases when state officials fail to approve or deny a patient's application within 30 days. But in general, Missouri DHSS has cleared patient applications very quickly, sometimes in fewer than 48 hours.

Another fear is that someone carrying doctor paperwork, but not a state-approved qualifying patient card, could have an unfortunate brush with law enforcement and face charges if they're caught carrying federally illegal cannabis without a qualifying patient ID.

The News-Leader was not able to reach Thomas, the psychiatrist, or another owner of Health City MD and the Cannabus to comment for this story after making numerous attempts by phone, email and Facebook Messenger.

Thursday night, someone staffing the Health City MD Facebook Messenger box said the company's "website and phone system have been hacked and we put out a message telling everyone system is currently being re-built now."

The employee also said that a company email account hosted by Google had been hacked and that Health City MD had filed a complaint with law enforcement over the alleged hacking.

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"It's not looking good for him for impersonation of a federal officer and a laundry list of other charges," messaged the employee. The person would not name the law enforcement agency with which Health City MD had filed a complaint.

As of Friday, Thomas did not appear on Missouri's list of licensed physicians with a disciplinary record. A spokesperson with the state department that oversees the Missouri Board of Registration for the Healing Arts said that all disciplinary processes remain confidential until an action (like a reprimand or suspension) is published on the list.

'They were not selling anything they shouldn't'

The portrayal depicted by Kidder's undercover investigation is not the only point of view on Thomas's Cannabus operation.

On Tuesday, the Rolla police chief, Sean Fagan, told the News-Leader his department had also performed an investigation into the Cannabus, which swung by Peace of Mind in that community at least three times in May, June and July. The events drew lines of enthusiastic people stretching down a full city block, according to social media video posted by Health City MD.

Chief Fagan said his department got a tip that samples of "medication" were being given away at the pop-up clinics in Rolla.

"We had a couple of undercover officers check that out," he told the News-Leader. "And that was completely false. They were not selling anything they shouldn't."

Fagan said his officers went undercover twice, in May and June. He added that it was outside his authority to determine if the certification procedures taking place at the pop-up clinics were "proper or not."

In Springfield, the Canna Bliss CBD shop location on Republic Road hosted a pop-up clinic on Monday. By noon of that day, 15 to 20 adults could be seen waiting outside the shop's storefront, and a black SUV had pulled up on the building's east side.

Store owner Jamie Tillman was adamant that everything at her store that took place during the clinic was legal. Health City MD certified 179 patients; that's it.

"No, I mean they just did their medical certifications in the store," she told the News-Leader Wednesday. "I hate to hear that. They're great people."

A representative for Canna Bliss had contacted the News-Leader prior to the Cannabus stop seeking news coverage — not a tactic typically used by those engaged in illegal activities.

'This is not authentic'

The News-Leader reached out to the Missouri Department of Health and Senior Services to learn how the department is reacting to claims against Health City MD.

Earlier this month, the website for Health City MD (which is now a blank white page) began to display a copy of the seal of the state of Missouri and a message stating "THIS SITE HAS BEEN SEIZED" by a number of government agencies, including Missouri DHSS.

"This is not authentic," said Lisa Cox, state health department spokeswoman, when contacted Sept. 10. "We do not seize websites. There are a few agencies listed that do not even exist."

Friday, Cox said the department has had some calls from concerned patients worrying that their state-approved cards might be rendered invalid if Thomas's physician's license were to be subject to discipline.

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That would not be the case, Cox said: The medical marijuana program verifies patient and caregiver card applications in real time, checking them against physician license records maintained by another state department.

"They're verifying it at that exact moment," she said. "If (a physician license) changes status the next hour, they're checking it every single time to make sure that doctor is in good standing."

And rather than relying on pop-up cannabis clinics for patient information that may include serious gaps and faults, Cox said people wanting cannabis as treatment should rely on the state program to educate themselves.

"Make sure that before you start this process, you use our website as the official source for information," she said. "There's a ton of information about how this process works and what's legal now and the timeline of how this program is being developed."

As for the other allegations?

"Any of these claims made against this company should be handled by law enforcement and are outside the purview of the Section for Medical Marijuana Regulation," Cox said.