Dr. Allan Frankel’s fitness to practice medicine was the subject of a four-day hearing that concluded yesterday in Los Angeles. The background -the Medical Board of California’s case against Frankel- was recounted here as testimony began Dec. 27.
Imagine having to attend a public hearing at which a psychiatrist to whom you told the unguarded truth discourses on your apparent “anti-social personality disorder?” That was Allan Frankel’s situation on Monday. Lucky for him he was surrounded by anti-social friends, including Tyler Strause, who kept Frankel’s whole anti-social community up-to-date by Twitter.
Daniel Fast, the Beverly Hills shrink playing Expert Witness for the medical board, stopped short of making a formal diagnosis -that would take more treatment and ob$ervation, he testified. He explained that Frankel manifested certain “elements” and “characteristics” of the disorder, such as arrogance and narcissism. He said that he had done eight previous psych evals for the med board. He always asks doctors to come 15 minutes early to fill out some paperwork, and most arrive 15 minutes earlier than requested. Allan Frankel, however, arrived at Dr. Fast’s office seven minutes late. And he was not wearing a suit and tie, he was wearing slacks and a sports shirt. [Rosie asks, “Who wears a suit and tie in LA?” And, “Those doctors who came a half hour early -how guilty were their consciences?”]
Frankel, according to Fast, was dismissive of the medical board’s charges against him. He believed the prosecution to be “a witch hunt” that was “politically motivated.” Yes, Frankel was contrite about the self-prescribing episode and some bad choices he’d made involving women, but not sufficiently contrite. In other words, Frankel, even facing loss of his license, remained his brash and breezy self.
The expert Fast testified that he himself had never approved marijuana use for depression, anxiety, or insomnia, preferring to prescribe pharmaceutical-industry synthetics. The psychoactive effects of marijuana, he mentioned, last for 14 days. An anti-social friend of Frankel’s whispered, “Where can we get some of that stuff?”
There was time for about an hour of cross examination by Frankel’s lawyer, John Fleer, in which he established that all Fast’s testimony about why someone with an “anti-social personality disorder” was not fit to practice medicine did not apply to Dr. Frankel because no such diagnosis had been conferred on Dr. Frankel.
A key piece of prosecution evidence is the written report Fast based on his 63-minute conversation with Frankel. Here are some nuggets from that document:
? Dr. Frankel was born in New York City and moved to Redwood City, CA at age 7. He was captain of the football team and valedictorian in high school but never had sex. His father, who had lost a son in the concentrations camps, was never happy.
? Of these relationships, Dr. Frankel said “I’m attracted to borderline women” and that it was “sloppy and wrong” [to prescribe for her and her daughter] but he was “in love” and “will never do it again.”
? He has a good relationship with his sister, several old friends, his three adult children and a 16-month old grandson.
? He loves his work as CEO of Green Bridge Medical Services. 25% of his referrals are from doctors in the community. He loves to help patients, especially those with MS, HIV and cancer. He is active and excited about his new ventures -testing, developing tinctures [solutions of active cannabis] and medical education about cannabis. He currently acts as a “greeter” in his business and has hired another physician to see patients.
? He reports that “life is good, even now.” The worst is the “humiliation” by the Medical Board which he believes is “political.” He has no issue with the Medical Board restrictions, i.e. to prescribe no scheduled medication or to give marijuana recommendations… He accepts being unable to enjoy wine and won’t go back to doing what he was doing.
? Affective status: Mood is cheerful, optimistic and confident, inappropriate in this context.
? There is no evidence of alterations of reality testing -no hallucinations, illusions or delusions. There is flight of ideas… There is preoccupation with the medical uses of marijuana.
Fast’s bottom line: “I believe that Dr. Frankel suffers from a variety of psychiatric conditions which significantly interfere with his ability to process information, form judgments or relate a coherent history.
Diagnosis based upon DSM-V Criteria:
? Axis I
? 304.30 Cannabis Dependence
? 305.20 Cannabis Abuse
? 292.89 Cannabis Intoxication
? Rule out underlying 296.89 Bipolar II Disorder or 301.13 Cyclothymic Disorder, Hypomanic.
? Rule out 314.9 Attention-Deficit/Hyperactivity Disorder Not Otherwise Spcified.
? 301.9 Personality Disorder Not Otherwise Specified with Antisocial, Histrionic and Narcissistic features.
John Fleer’s cross-examination forced Fast to retract all the above-listed diagnoses. He began by calling Fast’s attention to the fact that the Diagnostic and Statistical Manual itself requires the doctor to select two of the three conditions that he had pinned on Frankel. Fast reportedly said, “Oh, you’re right. Well, I’ll choose dependence and abuse.”
Fleer then had Fast read aloud from the DSM ?the so-called “Bible of the American Psychiatric Association”? all the symptoms and traits that warrant these diagnoses, and got him to admit that Frankel did not manifest them! According to Tyler Strause, “Fast was kind of puny to begin with and he seemed to be withering away on the stand. He wound up saying, ‘I was incorrect. I’m sorry.'”
John Fleer has been handling med board cases for more than 20 years; they constitute about 80% of his current practice. He matter-of-factly called Fast’s inaccurate diagnoses “irresponsible” and moved on to the “Not Otherwise Specified” personality disorder. He got Fast to acknowledge that Frankel did not exhibit more signs of a personality disorder than most people he knows!!
And there went the last of the prosecution case, if the Med Board v. Frankel was being tried in the Court of Common Sense. But an administrative law hearing is more like the Court of Alice in Wonderland, and the hearing went on.
In Defense of Frankel
The doctor who approved Allan Frankel’s cannabis use, Christine Paoletti, MD, is a Santa Monica obstetrician whose practice has expanded to include cannabis consultations. Her testimony was “considered and deliberate,” according to our source in the gallery. She had recommended that Frankel seek out and use CBD-rich cannabis, which is reported to be more effective against anxiety than high-THC strains. The judge picked up on this and Dr. Paoletti got to explain how Cannabidiol had been bred out of the Cannabis bred for maximum psychoactivity.
According to Paoletti, the judge took over her cross-examination from Deputy AG Kim because “he wasn’t cutting to the chase and she got frustrated. She knew very little but asked good questions. She asked why I hadn’t asked for a note from his psychiatrist [confirming his diagnosis]. I had asked, but he hadn’t brought it. But he did have his primary care records documenting Insomnia and Anxiety. And that was substantial enough to justify the recommendation.”
Paoletti also noted that she had attended meetings of the Society of Cannabis Clinicians at which Frankel took an active part “and was always very cogent.”
Paoletti was asked by ALJ Formaker whether she had questioned Frankel about his past drug dependence. She said, “‘No, he volunteered his history. I asked him to elaborate on certain aspects of it. When he was recovering from his cardiomyopathy he became concerned about addiction and went through a program.”
Paoletti considers Frankel’s use of cannabis as an alternative to opioids and SSRIs, “a classic example of harm reduction. I have several patients who have been able to get off their pain medications thanks to cannabis.”
Formaker asked Paoletti if she had drug-tested Frankel. She said no, but she knew that he was being drug-tested as a condition of his probation. “My job,” she informed the judge, “was to determine ‘Did he have a medical condition that merits the use of cannabis?’ And ‘Is he stable?’ Yes and yes.”
Two other MDs testified that Frankel is fit to practice: Robert Gerner, who is seeing Frankel on a weekly basis (in according with the terms of his probation), and Glenn Gorletski, a psychiatrist who has been his friend for more than three decades. Gerner said that Frankel was coping very well. “His treatment regimen is working,” he said. “My advice is: don’t change anything.
Frankel himself took the stand to state that he was aware of his prior transgressions and appropriately remorseful. His goal was simply to show the judge that he could think and speak coherently. By design, he did not expound on medical cannabis. Fleer was concerned that his expertise could be mistaken somehow for “megalomania” or “narcissism.”
Kim’s cross-examination was “lame,” according to Tyler Strause. “I was amazed how much of his time Kim devoted to flipping through his notes and papers trying to find some point with which he could contradict Dr. Frankel. He would flip through his papers for 30 seconds, then ask a three-second question. Over and over.”
At the very end of the hearing, the judge told the lawyers there was an issue on which she needed clarification, either via briefs or right then and there. Fleer said best to deal with it now if we can, what is it? The judge asked whether depression and anxiety were conditions to which Prop 215 applied. The relevant sentence was read to her (the first sentence of the initiative), and she acknowledged that the conditions were covered. Frankel’s friends were shocked by her level of… let’s call it naivete at that stage of the proceedings.
In both his written report to the medical board and his direct testimony before ALJ Formaker, Daniel Fast lingered on the transgressions involving women and prescription drugs that got Allan Frankel in trouble initially. But Frankel hasn’t skirted any med board guidelines since he started Green Bridge Medical Clinic in 2006, and he isn’t accused of having done so. The present accusation boils down to Frankel’s insufficient show of remorse over things that happened before he became a medical cannabis proponent. It is, as John Fleer put it, “desperately flawed.”
See you in 2011, the Year of Cannabidiol.
FRED GARDNER edits O’Shaughnessy’s, the journal of cannabis in clinical practice. He can be reached at email@example.com.