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Now
Four doctors were named in a complaint
to the state medical board earlier this year by the San Diego
district attorney's office in connection with cannabis consultations.
The number of doctors investigated by the board for approving
cannabis use now stands at 20. Not one of the complaints has
come from a bona fide patient.
"SDPD used undercover
officers to talk to several doctors and obtain open-ended marijuana
recommendations based upon self-reported, vague complaints of
ailments," according to a statement issued by the DA at
a July 6 press conference (held jointly with the U.S. attorney).
That evening Deputy DA Dana Greisen elaborated to Channel 10
News: "The doctors, because they're giving it to so many
people, are basically legalizing marijuana one doctor and patient
at a time... It's being recommended for insomnia, depression,
anxiety... The law is being abused on a massive scale."
Contrary to the DA's claim,
the law created by Prop 215 in 1996 is being implemented on a
very limited scale, given how many Californians are taking corporate
antidepressants for which cannabis could be substituted if their
doctors were willing to recommend it. The doctors are constrained
by lack of training (U.S. medical schools are only just beginning
to acknowledge the cannabinoid receptor system) and fear. Every
medical board investigation of a pro-cannabis doctor keeps fear
alive.
Most outspoken of the San Diego
4 is Jimenez, 43, who grew up in Torrance. He conducts cannabis
consultations on the island of Oahu, where he runs a family-practice
clinic, as well as in Southern California. The board has subpoenaed
two of his patients' records, one of which he refused to provide
after getting a tip that the patient was actually a DEA agent.
"A woman in her 40s presented
herself as K.S. back in May 2005," Jimenez recounts. "She
visited with a caregiver. She said she had a diagnosis of chronic
insomnia and had been prescribed Lunesta." Jimenez approved
her use of cannabis for six months and requested that she provide
confirmation of the diagnosis.
"About a month later I
got a call from a dispensary saying, 'You know that woman that
you gave a recommendation for, K.S.? Well, that's really K.H.'
She had shown her badge when she busted them! Sure enough, several
months later I'm on the news, the DA of San Diego and the U.S.
attorney are smearing my name all over Southern California."
Jimenez says, "I had no problem sending them one patient's
record as an example of how I do things in my practice. But the
second one involved a person whose intention was to do harm.
The chart has a name on it that's not that person's real name."
Jiminez describes an unsatisfactory
meeting with medical board investigator Nancy Edwards:"I
told her I'd be happy to go in front of the board and explain
my thinking. She said she was going to fine me a thousand dollars
a day for each day I didn't send the record. I said, 'You can
fine me a million dollars a day, I could care less. But if you
continue, I will sue you for slander." He is represented
by Bruce Margolin, an L.A. defense specialist.
Jiminez expects the board to
find no fault with the chart he provided them. (The patient has
a 37-year history of chronic pain.) He defends his treatment
of patient K.S., who did not bring any medical records to show
that she had been diagnosed with chronic insomnia. "We know
that 40-60% of Californians don't have adequate medical insurance.
We also know that it's very difficult to obtain medical records,
especially from an HMO. It can take months and cost money -some
offices charge a dollar a page." As for not physically examining
K.S., Jimenez says, "When someone comes in complaining of
chronic insomnia, you're not going to do labs and a full exam.
You ask them questions. You observe them. You try to find out
what anxieties are keeping them awake."
The real-world standard of
practice has little to do with the textbook standard, says Jimenez.
He once attended a conference on insomnia at Stanford at which
an authority in the field described prescribing Ambien for up
to two years -although the label advises a maximum of six weeks.
"They don't have any effective drugs for chronic insomnia,"
says Jimenez. "Ambien is a very dangerous drug, known to
cause bizarre sleepwalking episodes."
Jimenez and the other doctors
about whom the San Diego District Attorney complained will not
-cannot, legally- be accused of approving cannabis in the treatment
of depression and insomnia, even though that's what galls the
DA, by her own admission. The board will have to come up with
a technical reason -a flaw in the history, or the examination,
or the treatment plan, or the provision of informed consent,
or, likeliest of all, record keeping. Attorneys for the medical
board base their definition of a "good faith" examination
on a 1983 case, Douglass v. Board of Medical Quality Assurance
(as the MBC was then called). The Superior Court based its ruling
in Douglass on a section of the Business and Professions
Code that states: "Prescribing, dispensing, or furnishing
dangerous drugs as defined in section 4022 without a good-faith
prior examination ... constitutes unprofessional conduct."
"Philip A. Denney, MD,
observes that "cannabis consultants neither prescribe, dispense,
nor furnish" cannabis, and that the Douglass precedent
is therefore inapplicable. "I would argue that Douglass
has absolutely no bearing on discussing the medical use of cannabis
with a patient," says Denney.
The board's expert witness
in Douglass opined that a physician should spend 20-30
minutes personally examining a patient on his or her initial
visit, and that the exam should include, among many other specified
procedures, "a rectal examination and a pelvic examination
for women and prostate examination for men."
Denney comments, "This
is not the real world. It's not clear how this opinion of a single
board consultant has led to the definition of what a 'good faith
prior examination' means. If, in fact, not doing one on the patient's
initial visit constitutes negligence, then 99 percent of the
doctors in California could be accused. Been to Kaiser lately?"
Fred Gardner is a former Public Information Officer
for the District Attorney of San Francisco. He can be reached
at fred@plebesite.com
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