The Frivolous Investigation of Dr. Sterner
Dog stories sell newspapers, they say. As the winds were fanning the flames towards San Diego last Sunday, the Union Tribune ran one purporting to describe how a pro-cannabis doctor authorized an undercover police officer to buy some pot for his Labrador Retriever. This is writer David Hasemyer’s lead:
"When an undercover police officer asked Dr. Robert Sterner to prescribe marijuana for his dog, the doctor joked that only two-legged patients were covered by the state’s medical marijuana law. So the officer suggested Sterner appoint him caregiver for the dog, a designation that would allow him to obtain marijuana in the animal’s name, according to a Medical Board of California accusation. While a hidden camera rolled, Sterner said, ‘There you go. That’s being creative,’ according to the accusation. The police officer walked out of the doctor’s office with signed authorizations that allowed him to buy marijuana for his dog, as well as for himself."
But Sterner hadn’t "joked" about the medical marijuana law applying to people, not dogs; he had politely denied the detective’s reiterated request. Nor did he provide a caregiver form allowing the detective to buy marijuana for his dog. The Union Tribune story, even more than the police report published in the medical board accusation, falsified the doctor-patient dialog and misrepresented the law itself.
According to the accusation, Detective C. DeCastro, posing as R. Cruz, showed up at Sterner’s San Diego office May 17, 2006, claiming to be a migraine sufferer with a prescription for Relpax (Pfizer’s drug for migraine relief; it has many contra-indications and is not a preventative). DeCastro/Cruz was told by Sterner’s receptionist that he needed to bring his prescription. DeCastro/Cruz tried to skirt this requirement and had to be told again that Dr. Sterner requires proof of an existing diagnosis.
DeCastro/Cruz returned June 9 with a written migraine diagnosis from another doctor, fraudulently claiming to have made an appointment. (Why couldn’t he have really made one? Too much effort?) He pressured the receptionist until she got Sterner to agree to see him instead of taking a lunch break. The detective surreptitiously taped the visit, aware that his performance would be chortled over by his buddies back at the station house, incorporated into a report for the medical board, and possibly reviewed by the media.
DeCastro/Cruz told Dr. Sterner (a dog lover who keeps his ancient Miniature Pinscher close at hand) that he had an arthritic Lab whose nocturnal whining could only be stopped by marijuana. DeCastro/Cruz requested "a marijuana recommendation for his dog," which Sterner said he could not provide. "Respondent [Sterner] replied he was not sure if Proposition 215 applies to dogs as well as people, even though it makes sense to also be compassionate toward animals because cannabis is very safe. The detective responded he did not give his dog the good stuff because he needed it for himself. Respondent replied that the detective was not abusing his dog by giving it marijuana. Respondent then began a discussion about how cannabis is effective for migraines."
In other words, Dr. Sterner declined to honor the unusual-but-not-absurd request and tried to direct the conversation back to DeCastro/Cruz’s alleged medical problem. "Respondent then discussed with the detective headaches and the use of cannabis, recommending that it was better to keep the levels of cannabis up in attempting to control the headaches." Sterner recommended ingestion by butter for preventative effect, and better yet, by coconut oil.
"The detective then renewed his request for Respondent to provide a medical marijuana recommendation for his dog, Storm. Respondent stated the detective could share some of his ‘medicine’ with the dog, to which the detective stated that if he could be designated his dog’s ‘caregiver,’ the detective could get twice as much marijuana." Sterner humors him -"There you go, that’s being creative, yes you are right." And then, according to the report, "Respondent reiterated his belief that Proposition 215 applies to only two-legged creatures, not four-legged creatures."
In context, it’s obvious that Sterner refused to grant the detective’s request -but the Union-Tribune’s cut-and-pasted dialog makes it appear otherwise. David Hasemyer’s story is the textual equivalent of a crudely doctored photo.
Before the visit ends Sterner recommends vaporization, discusses the safety profile of cannabis, and suggests discretion in discussing its use with doctors who might disapprove. The detective asks where he can take his recommendation in order to get cannabis. "Respondent stated that he was not allowed to recommend or suggest any place." (Federal law allows doctors to approve marijuana use but not advise where to buy it.) Sterner adds a warning: some dispensaries will unnecessarily copy patients’ records. Although prodded, Sterner refuses to name any establishment where marijuana can be obtained. He mentions the risk of getting detained at a dispensary during a raid. "They hold people like for six hours for no good reason," he warns. Lastly Sterner advises DeCastro/Cruz that he has a right under state law but not under federal law to cultivate his own cannabis -"indoors under lock and key" the doctor advises.
Back in the reception area DeCastro/Cruz was given a letter of approval and a "Designation of Primary Caregiver" certificate signed by Sterner. These forms are typically provided by patients who don’t grow their own cannabis to people who are growing for them to confer some protection under state law. On June 21 DeCastro/Cruz copied the caregiver form "and completed it as directed by Respondent’s office staff, but with the name of his dog ‘Storm Cruz.’ He presented this completed certificate to a medical marijuana dispensary and he was dispensed cannabis as well as marijuana-laced edibles."
If there was any laxity in this scenario, it was not on the part of Dr. Sterner or his office staff. The dispensary should have checked DeCastro/Cruz’s ID and not admitted him. Or did he also have ID as "Storm?" Under any name, Detective C. DeCastro is a man who doesn’t accept "no" without trying to bluff and bully his way through.
Hasemyer misstated the year that California’s medical marijuana law took effect (it was 1996). He got the letter and spirit wrong, too, when he described the detectives "posing as patients complaining of insomnia and migraines, ills far less serious than those contemplated by the framers of the marijuana law."
"Migraines" is one of seven medical conditions named in the first sentence of the law as treatable by cannabis. The list of seven is followed by "…or any other illness for which marijuana provides relief." That clause reveals exactly what the drafters of the initiative were "contemplating" -widespread use for a wide range of problems.
Zenia Gilg, Sterner’s attorney, says, "I made it very clear to this reporter that the primary-caregiver document Dr. Sterner provided did not authorize the cop to obtain marijuana for his dog. When the cop filled it out with the dog’s name, it authorized the dog to buy marijuana for him. Which clearly didn’t happen."
Gilg is planning a suit on Sterner’s behalf against the San Diego Police Department and other government agencies involved in the investigation of his practice. She expects Sterner to prevail when the medical board eventually hears the case based on the report of DeCastro and another SDPD officer who feigned illness in order to get an approval. (Your correspondent does not share her confidence.) Meanwhile Sterner continues to see patients and to authorize the use of marijuana in treating migraines and any other condition for which marijuana provides relief.
As the world has learned since last Sunday, San Diego firefighters are stretched thin, they didn’t have enough "spotters" to direct the bombers dropping fire-retardant, they haven’t received a raise in three years, the city needs new stationhouses… "San Diego has been mired in a financial crisis stemming from a pension-fund deficient," the Wall St. Journal explained 10/24, "…financial challenges affect all departments, including the fire department." Yet the police have enough to spend on frivolous "investigations" of pro-cannabis doctors by crude publicity hounds. Will anyone who suffered in the fire put two and two together and work for regime change?
The Seriousness of Migraines
Belittling the significance of migraines per se and the utility of cannabis in treating them is an old and dishonorable tradition among the Drug Warriors and their flacks. "Migranes" (sic) was on the list of conditions that Barry McCaffrey cited to prove that medical marijuana was a "Cheech and Chong show…" Soon thereafter Charles Krauthammer wrote in the LA Times, "As Hanna Rosin reports in the current issue of the New Republic, the clubs are peopled not by the desperate terminally ill but by a classic cross-section of California potheads, all conveniently citing some diagnosis or other -migraines, insomnia, stress- as their tickets to Letheland."
Here’s Dr. David Bearman’s comment on the Union-Tribute piece: "To say migraines aren’t a serious pain problem is to never have had one. What is the specific objection to Sterner’s physical? Did they think he should have done a rectal exam or a pelvic exam? Maybe they didn’t care for his banter or are opposed to a doctor trying to establish rapport with the patient. Other than the stuff about the dog, which is kind of confusing, it is unclear from the story exactly what the medical quality issue is here.
"I for one am very concerned at this kind of intrusive behavior by the police. Under what authority are they doing this? It smacks of the intrusiveness of Nazi Germany. As someone whose job for 14 years involved quality of care, it’s hard to understand from the newspaper story what rises to the level of requiring a medical board investigation. What does the way in which this care was rendered have to do with quality of care? And to the extent it does, how does it differ from the many doctors who do less for prescription medication? The medical board is making it up as they go along."
Tom O’Connell, MD, also noted the double standard involved in the medical board’s case against Sterner: "I wonder how the California Medical Association would respond if orthopedists were visited by phony patients claiming to have disc disease. or psychiatrists were visited by people with alleged bipolar disorder?"
FRED GARDNER can be reached at firstname.lastname@example.org