The patients seeking medical marijuana inquire almost daily with Dr. Rahul Khare at his storefront health care clinic in Lincoln Park.

Some have been turned down for a cannabis referral by the doctors they see regularly, not because they might not qualify, Khare contends, but because many physicians are hesitant to refer anyone for marijuana.

Khare, who said he has been writing marijuana referrals for only a few weeks, sympathizes with doctors who don’t want to put patients on pot, but believes some are unfairly withholding a drug that could bring relief to many.

“Three months ago, marijuana was an illicit drug [in Illinois]. If a patient said they were using it, it was my responsibility to put my hand on their shoulder and say, ‘I must tell you, it’s illegal.’ Now – boom! It’s a very different mindset for physicians,” said Khare, a former Northwestern University physician who now runs the Innovative Express Care clinic in Chicago. “… Patients [I’ve recommended for marijuana] are so appreciative.”

Medical marijuana industry advocates and observers say a dearth of doctors willing to recommend patients is among the hurdles the state’s fledgling industry needs to overcome. Some detractors believe Illinois’ efforts to make its program stricter than those of other states has created a situation where too much is required of doctors and patients before they can be certified.

That also may be one reason why a single doctor was responsible for writing the referrals for almost one-third of the 3,300 patients who completed the certification application as of last June, according to the state’s last annual report on the medical marijuana pilot program. Another doctor was responsible for referring an additional 101 patients, the report said.

State authorities have not identified those doctors or revealed whether they are being investigated. But the state agency that regulates physicians has so far filed medical marijuana-related complaints against four doctors.

Under state law, doctors must have a “bona fide relationship” with a patient to provide him or her a medical pot referral. The physician must assess the patient’s medical history, review relevant records from the past year, conduct a physical exam, confirm that a patient has one of about 40 qualifying ailments and then provide ongoing care for that condition.

Khare said that, after a basic screening process to eliminate those who don’t appear to have a qualifying condition or proper medical records, he seeks to “build a relationship” with patients, talking about their medical history, how the certification works and what the admittedly limited body of scientific study says about the effectiveness of marijuana to treat pain, nausea and other symptoms. Khare said he sees patients at least twice before agreeing to do a cannabis referral and has turned many people away.

One patient seeking his help Tuesday was 18-year-old Lydia Shoup, who in recent years has struggled with two autoimmune disorders — both of which are on the qualifying conditions list — and surgery to remove a tumor from her pancreas. Like many would-be patients, Shoup, of Chicago, said she was looking for alternatives to the prescription opiates she currently uses for pain she experiences because of her chronic conditions, including rheumatoid arthritis.

“That’s just not something I want to be on for a long-term solution,” she said of the prescription painkillers.

Shoup said her pain management doctor is supportive of her trying medical marijuana but didn’t know enough about the program to write her a recommendation himself. Her rheumatologist is “skeptical” about marijuana because of the lack of medical research, she said.

As more patients like Shoup seek out doctors specifically for medical marijuana — and as more physicians like Khare advertise certification among their services — state regulators say they’re committed to investigating any complaints of illegal or unprofessional behavior by medical cannabis physicians.

State officials have not confirmed whether the agency is looking into the doctor who, as of last June, had handled referrals for nearly one-third of all of the medical marijuana applicants.

A spokesman for the Department of Financial and Professional Regulation said the agency recognizes that no medical specialty treats all of the conditions listed in the medical marijuana law.

“In other words, one physician could not properly treat all patients eligible to use medical cannabis,” spokesman Terry Horstman wrote in an email.

Of the four medical marijuana-related complaints brought against the four doctors, three are still pending.

The most high-profile case against an Illinois physician involves Dr. Bodo Schneider, who operates clinics in Orland Park and Marion in southern Illinois. Regulators said he served about 250 patients as the owner of Gateway Enterprises. Applicants who called were directed to an out-of-state call center and told to pay $305 for three office visits.

In effect, regulators said, Schneider was charging a pre-certification fee without conducting physical exams or establishing a legitimate doctor-patient relationship.

Schneider’s attorney, Luke Baumstark, said Schneider was properly screening out patients and turned down about 20 percent of his applicants.

“He’s doing what the law requires him to do,” Baumstark said. Such complaints, the lawyer said, scare off doctors.

“It seems like they don’t want doctors using this [medical marijuana] law,” he said.

Schneider’s case is also pending.

One patient of his told The Associated Press that he had to drive 500 miles to sit in packed waiting rooms to see Schneider in hopes of getting marijuana to help control his epilepsy, because so few doctors handle medical marijuana in southern Illinois.

Southern Illinois Healthcare in Carbondale, for instance, does not allow its doctors to certify medical marijuana because it remains illegal under federal law, spokeswoman Rosslind Rice said.

In general, marijuana advocates complain that not enough doctors are certifying patients in Illinois.

The first brought by the state was against Dr. Brian Murray, a Lake Forest physician who regulators said charged applicants a fee for pre-certification without conducting physical exams or establishing a legitimate doctor-patient relationship. He helped open the Good Intentions Clinic in Chicago in 2013, before the state program took effect.

Murray did not admit the allegations were true but agreed to pay a $10,000 fine and to work under the supervision of another doctor during a minimum of two years of probation, according to state records. Neither Murray nor anyone at the clinic could be reached for comment.

In the still-pending case of Dr. Joseph Starkman, of Highland Park, regulators said that in 2013 he relied on another doctor’s diagnosis of glaucoma, without performing his own eye exam, and that he sent the elderly patient a certification that improperly bore a state seal. He charged marijuana patients $250 for a one-time visit, the complaint states.

Starkman’s attorney, Mike Goldberg, said it’s common for general practitioners to rely on specialists to diagnose particular conditions.

“They say he has to separately diagnose, which is not what a [general practitioner] does,” he said.

Goldberg also asserts that the case against his client has a “chilling” effect that is making other doctors leery of certifying patients for medical marijuana.

In a separate complaint, the state asserts that Dr. Jesus Rene Dadivas charged patients $150 each to pre-certify them for medical cannabis in 2013, before the rules for the program had been set. The doctor’s office, Green Bliss Clinic in Niles, had a sign in the front window with the words “MEDICAL EVALUATION” and a picture of a marijuana leaf.

Reached by phone, Dadivas declined to comment on the pending complaint. His attorney could not be reached.

As of last June, according to the state’s annual report, 1,175 physicians had submitted patient certifications. Ninety-nine percent of the doctors certified fewer than 25 patients.

The latest state report, out last week, found that the number of qualifying patients has reached about 4,400, a recent expansion but still far below projections. Most patients are older, with three-quarters over 40. The most commonly certified conditions were cancer, severe fibromyalgia and multiple sclerosis.

The state is in the middle of a four-year pilot program, due to expire in 2018, but after some delays, marijuana only became available in November. Gov. Bruce Rauner’s administration has repeatedly rejected requests to add new qualifying medical conditions, such as chronic pain, saying it is premature to evaluate the program.

Tribune reporter Duaa Eldeib contributed.

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