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Doctors Philip A. Denney and Michael Gitter and businessman Omar Salah are buying NorCal Healthcare, the chain of cannabis-consultation offices whose founder, Hany Assad, has had his license revoked. Denney, 61, will be seeing NorCal patients in Oakland as of today (Nov. 19). He is past president of the Society of Cannabis Clinicians, and widely respected within the field. Denney will continue to see patients two days a week in Carmichael at the office he shares with Robert Sullivan, MD.
Gitter, 65, who has offices in Redding and Lake Forest, will recruit more doctors to help staff NorCal. Assad had been the sole MD, flying from city to city in his own small plane. He employed a nurse practitioner in Oakland and Ukiah, and a physician’s assistant in Arcata to examine patients and update charts. Assad saw patients himself in Bakersfield, and it was in this context that he conferred an ADD diagnosis on an 18-year-old after a work-up that the medical board deemed inadequate.
“The reason NorCal needed to be rescued was not because of the mid-level practitioners,” says Denney, referring to the nurse practioner and PA. “The use of mid-levels in a cannabis practice is perfectly appropriate. There’s still a stigma that keeps physicians away from the field, and perhaps millions of patients who could benefit from cannabis as medicine and need the service [a consultation leading to a doctor’s approval].” Denney will supervise NorCal’s mid-levels to ensure that patients are examined and records kept according to accepted medical standards.
The medical board insists on a “good-faith examination” prior to a cannabis recommendation. This is how Dr. Denney interprets that vague requirement:
“The patient sits down and you take a history. ‘How old are you? What do you do for a living? What medical problem brings you to see us today? Do you have a history of other illness? Have you had previous surgeries? Are you currently taking medications? What are you allergic to?’ Etc., etc. With a new patient you have to ask about family history and do a brief ‘review of systems.’ That involves asking, ‘Do you have any vision problems? Hearing problems? Headaches? Knee problems? Any problems with your teeth? Back problems? Chest problems? Cough?’ You go down the list. I like doing it verbally because the interaction with the patient can be revealing. Most doctors do it by questionnaire.
“After taking a history and reviewing what records are available, the practitioner conducts a physical examination. It can be fairly focused and brief. It includes complete vital signs -height, weight, temperature, blood pressure, pulse rate and quality, pain assessment and body-mass index. My practice involves a head-to-toe -and this is what the mid-levels will do for NorCal under my supervision. For a new patient I look in your throat, I look in your ears, I check your pupils, I check your scalp, I check the range of motion in your eyes, I palpate your neck, I look for thyroid lymph nodes. Depending on the circumstances I may listen to your carotid arteries. I will certainly listen to your chest, your heart, check your peripheral reflexes and strength. I typically do a Romberg exam, meaning you stand up with your eyes closed and your feet together. I ask patients to squat. If you have back pain I’ll do a straight leg-raising test and test the strength and sensation in your toes. If you have a history of chronic Hepatitis C I’m going to lay you down and feel your liver. I only occasionally do a genital exam. I have done one rectal exam -on a patient who had had extensive rectal surgery.
“Then I -or the mid-level- would have a discussion with the patient about cannabis. ‘How much do you use? How does it help you? Adverse effects Has it ever gotten you in trouble? Any current issues with it? Etc. etc.’ We typically have a discussion about the benefits and alternatives. We have to formulate a treatment plan- another vague term. I typically write ‘Okay for cannabis for one year. Continue primary care. Call or come in if any questions or problems.’
“And then of course the exam has to be properly recorded in the patient’s chart.”
Under Assad, NorCal was charging new patients $125; renewals, which were available by phone, cost $100. The new owners plan to charge new patients $150 -“for superior service,” says Denney- and have yet to define their policy on renewals. The ballpark price for a medical practice is one year’s net income. Assad was reportedly asking $1.2 million.
Assad Defends His Approach
Hany Assad, MD, the prolific issuer of cannabis approvals whose license was revoked Oct. 23, emailed a response to our account of his downfall in CounterPunch (which, he acknowledged, “did not depart from the facts.”) His English is funky but some of his points are well taken. The first refers to SW, an 18-year-old alcoholic whose cannabis use Assad authorized after diagnosing him with Attention Deficit Disorder (ADD). SW’s parents complained to the Medical Board of California (MBC) which, after an investigation and a hearing before an administrative law judge (ALJ), determined that Assad had not conducted a proper exam to support the ADD diagnosis. (The parents pressured the kid into testifying against Assad. Could the family dynamic have something to do with his problems?)
1 RE the charge of the way I have approached for evaluating and then making the new diagnosis of ADD. The patient while under oath announced, as a surprise to the ALJ and to everyone at the court at that time, that a diagnosis of ADD was made 4 months (about 19 months after my diagnosis was made) prior to that hearing through an expert psychiatrist out of Kaiser with tests that complies with the “Standard of Care”. That was not taken into consideration by the judge. Did she missed or just ignored it? Is there any questions will be asked why that diagnosis was missed by his treating psychiatrists at Kaiser for many years till Hany Assad can make it without following the standard of care???
2 RE charge of failure to obtain ‘Medical Records’ from treating physician. It is a known fact that the previous medical records for a patient are only critical within first 12 hours of treatment on emergency setting ER or ICU.
3 Charge of illegible hand writing in the records. Still I prefer to have my treating physician caring about my health and the best to be done at the time allowed vs caring to have nicely written medical records for the satisfaction of the MBC.
4 It is a fact that if the case against a physician after investigation initiated by a consumer is closed no cost recovery will be done. On the other hand, if MBC can find a way to file charges through their paid AG Office they can request cost recovery to be paid by the physician as a condition of his probation. YES cost recovery of exaggerated expenses. I have to admit that I had mine at that time at a sale price with discount of 50% so I had to pay only $50,000 initially then $4000 for each year of probation. I found accepting a deal of that nature instead of going to a trial by an administrative Judge paid by MBC is the least harmful of the two options. FYI MBC had to stop that “Bully” strategies after the Precedential case of Dr Mikuriya.
5 The only interview by MBC for me in the presence of my attorney was conducted by 2 ignorant investigators asking me how did I evaluate my patient. Yes two ignorant police officers reading questions from a piece of paper in their hands. I got the impression that one of the Gods (one of the 12 members of MBC) dictated them these questions in a hurry while awaiting for the elevator. It is sad and actually disgusting to find interrogation of a physician by an agency licensing already almost 200,000 physicians could not find one of them to conduct that meeting.
6 RE safety for the patients. I have to clarify that for 30 years as a physician who treated thousands of patient each year there was not even one case RE safety of the patient. Many of them in ICU or ER, before that case!!!!!!!!!!!!!!
FRED GARDNER edits O’Shaughnessy’s, The Journal of Cannabis in Clinical Practice. He can be reached at firstname.lastname@example.org