PITTSFIELD — Larry Spatz of Lanesborough couldn't sit by and see a family member in such pain.
A case of the shingles — the malady that results from reactivation of the chickenpox virus — can feel like "piercing needles in the skin," according to WebMD.
To help his suffering relative, Spatz set out to explore use of medical marijuana, after standard treatments offered no relief. That's where the family hit a wall.
"Although our local doctor was very supportive, neither she nor anyone in her office could certify or prescribe," Spatz told The Eagle.
Though medical marijuana dispensaries may open next year in Berkshire County, prospective patients may still face a geographic hurdle. Only one county physician has registered to certify patients.
And that doctor says he only sees existing patients.
That means people seeking the therapeutic option voters approved in 2012 must go outside Berkshire County.
"It's been a challenge to get doctors to register," said Tom Lyons, spokesman for the state Department of Public Health, which oversees the medical marijuana program. "Not enough physicians have registered at this point."
To address that shortage, the state Public Health Council is considering a rule change that would allow certified nurse practitioners to register to certify patients for medical marijuana use. A public hearing on the proposal is planned Jan. 5 at at Holyoke Community College.
The point, said Lyons, is "to provide safe access for patients."
Access now is virtually nonexistent in Berkshire County — as Spatz discovered.
Faced with the prospect of having to travel to a medical appointment in Northampton or Springfield, where there are doctors who take part in the DPH's medical marijuana program, the family opted out. Spatz said the travel felt too onerous.
"I am fairly certain that in our case, had our local doctor been able to certify and prescribe my affected family member would now be using medical marijuana and would be getting some relief from it," Spatz said.
In Berkshire County, the only physician who has registered with the DPH, Dr. Joshua Yurfest, said he works only with current patients.
Yurfest said emphatically in a phone interview that the 2012 law clearly states doctors can only prescribe for patients with whom they have an ongoing relationship.
The law says that certification is permitted "in the course of a bona fide physician-patient relationship," according to the DPH. That relationship must include having "a role in the patient's ongoing care and treatment."
Yurfest said abiding by those rules limits his use of the therapeutic option. "I have a very few number of patients because I don't want to go askew of the law," he said. "I follow the strict letter of the law."
Yurfest is on the staff with Berkshire Health Systems and works with the Center for Rehabilitation at 44 Charles St., according to his webpage.
Yurfest said he believes medical marijuana is an appropriate choice for some patients, but only "if you select correctly [and] very judiciously."
As of Oct. 31, 172 physicians had completed training and paperwork required by the health department. That's up 33 percent from the start of the calendar year, when 129 doctors had registered.
In Massachusetts, 14,617 primary care doctors were working as of September, according to the Henry J. Kaiser Family Foundation. That means that less than 1.2 percent of primary-care physicians have chosen to be certified to prescribe medical marijuana. Of all doctors practicing in the state, including specialists, the percentage is 0.5 percent.
The number of prescribing physicians available in Massachusetts means there is one doctor for each 188 patients, based on the 32,416 active medical marijuana patients registered with the health department as of Oct. 31.
The Massachusetts Medical Society opposed the 2012 referendum question.
Richard P. Gulla, the society's spokesman, said it took that position for several reasons.
"Most of all, that the evidence on the medicinal qualities of medical marijuana was quite thin," Gulla said, "and had not undergone the rigorous examination that other medications do."
Three doctors registered in October to prescribe medical marijuana, two in September and six in both August and July.
The slow gain in participating physicians may stem, in part, from the many steps doctors must take to secure DPH approval. Those include obtaining continuing education credits related to proper use of medical marijuana. That training must address dosage, side effects and the ability to recognize substance abuse, among other topics.
A June 9, 2015, packet created by the DPH for physicians closes by addressing a question doctors are known to ask: "Can I be punished pursuant to state or federal law for my involvement with recommending/certifying medical use of marijuana to a qualifying patient?"
Not under Massachusetts law, the DPH guide says, underlining the last two words.
But it goes on to suggest doctors consult their own lawyers "and/or legal counsel for any health care facility with which the physician is affiliated."
The Massachusetts Medical Society offers a similar caution on its website. A section advising doctors on the law notes: "Physicians interested in certifying an individual patient should carefully review the liability coverage and policies of the group, facility or setting in which they practice.
Mike Leary, spokesman for Berkshire Health Systems, declined to say whether the organization has offered a legal opinion to doctors it works with on whether they should or should not pursue medical marijuana registration.
"We're not going to comment on the medical marijuana issue," Leary said.
The medical society notes that a 2002 federal appeals court case, Conant v. Walters, protects a doctor's First Amendment right to discuss the advantages of medical marijuana with a patient. To fit within that ruling, the state law was carefully structured.
In the Massachusetts system, a doctor certifies a patient as a potential beneficiary of medical marijuana, leaving it to the state to issue a card and a dispensary to provide the drug. The doctor does not write a prescription or directly refer a patient to a source of marijuana.
To improve access to health care professionals able to prescribe medical marijuana, the state is seeking to extend that responsibility.
It must first hold public hearings. In addition to one in Boston Jan. 3, the DPH will take testimony Jan. 5 at HCC's Kittredge Center for Business and Workforce Development, at 303 Homestead Ave. in Holyoke.
Starting at 10 a.m. that day, people can comment on a change to allow certified nurse practitioners to prescribe medical marijuana and on other changes under review by the Bureau of Health Care Safety and Quality.
That office's director, Eric Sheehan, said in a memo to the Public Health Council that the change responds "to feedback from the medical community, the industry and patients."
Another change being considered would streamline the medical marijuana application process, clarify how dispensaries go about registering and update rules on dispensary operations.
Speakers at the Jan. 5 public hearing are asked to provide written copies of their remarks. Testimony can also be emailed to firstname.lastname@example.org with a Word attachment and "Medical Use of Marijuana" in the subject line.
Reach staff writer Larry Parnass at 413-496-6214 or @larryparnass.