South Dakota’s fledgling medical marijuana program continues to grow at a slower pace. A local news report said this week that just 400 people have been registered since last year, when registration started.

It is done via the Argus Leader newspaper of Sioux Falls, which reported that, as of Tuesday, “the Department of Health had issued just 419 medical marijuana cards to patients.”

According to the newspaper, that has prompted MyMarijuanaCards.com, a nationally recognized telehealth company, to host the “the state’s first-ever, three-day mass patient screening event Tuesday in downtown Sioux Falls,” South Dakota’s largest city. This event will continue through Thursday.

“Despite being available since November, only a few South Dakota residents have been able to obtain a state-issued medical cannabis card due to the limited number of doctors authorized to certify patients in the state,” MyMarijuanaCards.com founder Molefi Branson told the Argus Leader.

It isn’t just patients who have been slow to enroll. Last month, local television station KELO reported that “only 90 South Dakota doctors have been approved to validate the use of medical marijuana to their patients,” which accounts for “just 4.07% of the state’s 2,214 total active physicians.”

Branson said there are aspects of South Dakota’s medical cannabis registration process that may be causing the patient enrollee numbers to lag.

The Argus Leader reported that “Branson said South Dakota’s medical marijuana law requires South Dakotans receive certification from a medical professional licensed to practice medicine before they can be considered for a card through the [state Department of Health],” and that the state’s “law also requires screenings be in person, not over the telephone or via video conference, as allowed in several other states.”

The newspaper also noted a reluctance “among the healthcare systems in South Dakota to provide direction to their physicians about certifying patients, [which] has made certification a challenge for many, including a handful of the clients who attended the event Tuesday.”

The Mount Rushmore State has had a difficult year and a half for its cannabis reform efforts. Voters there approved a pair of ballot measures in 2020—one that legalized recreational pot for adults, and another that authorized medical cannabis—but the ensuing 18 months have brought controversy with each.

Following a challenge by South Dakota Gov., the state Supreme Court struck down recreational cannabis laws. Kristi Noem.

The court concurred that the cannabis amendment violated the state’s constitution.

“South Dakota is a place where the rule of law and our Constitution matter, and that’s what today’s decision is about,” Noem said in a statement following the November ruling. “We do things right—and how we do things matters just as much as what we are doing. Our lives are still guided by the law. This decision does not affect my Administration’s implementation of the medical cannabis program voters approved in 2020. That program was launched earlier this month, and the first cards have already gone out to eligible South Dakotans.”

Although the medical marijuana law was officially implemented last July, there is still one state dispensary, which is located on Flandreau tribal reservations in South Dakota.

The Flandreau Santee Sioux Tribe, which operates the dispensary, maintains that its medical cannabis cards should be treated as legally valid, but Noem’s administration has said that it would only recognize cards issued to members of the tribe.

Tribal officials stated that 100 persons who received medical cannabis cards had been detained in February. At the time, tribal officials stated that they had distributed thousands of medical cannabis cards to both tribal and non-tribal members.