5/8/03 Presented to the Medical Board of California
Members of the Medical Board of California, As a physician practicing Family and general medicine in Berkeley for this past 23 years, and performing medical cannabis evaluations, I feel I must go on record regarding what I consider a misallocation of valuable Medical Board resources and an injustice to a number of educated, sincere, and responsible doctors, and their many seriously-ill patients. I graduated from the University of Michigan Medical School in 1974. I am trained in Family Practice through UC Davis, but have also been an emergency room physician, and medical director of skilled nursing facilities. I have done medical-legal consulting on malpractice cases, reviewing records for the plaintiff, and testifying in depositions, and trial depositions. I have been on the credentials committee of my local hospital, and been a preceptor for new doctors to the medical staff, and have therefore reviewed other doctors' work, in a variety of settings. I have been an active member of the medical staff of Alta Bates Medical Center in Berkeley, in good standing, for over 20 years. All of these factors have shown me the vast range of practice among doctors in many areas of medicine. In my 30-plus years in medicine, I have seen a broad range of medical practice, from poor quality to excellent, both in generalists, and in specialists. I suggest some important questions:
But there is a bigger issue here. A number of physicians and attorneys have been following the situation since the passage of Proposition 215 ( California Compassionate Use Act of 1996, also known as Health and Safety Code Section 11362.5 ), and it is obvious that many physicians who perform a significant number of medical cannabis evaluations have had investigations begun by the medical board, and to our knowledge, NOT ONE COMPLAINT has ever come from a patient or a patient's family. I can only conclude that these anonymous complaints have all come from law enforcement. From my discussions with physicians and attorneys, there is reason to believe that very soon after the passage of Prop 215, there were meetings between federal authorities and state authorities convened for the purpose of overturning the people's legal initiative, Prop 215. I sincerely hope that the Medical Board has not been involved in such actions. The 10 or 20 doctors I know, who perform medical cannabis evaluations, are all very knowledgeable and responsible practitioners who have educated themselves on the incredible safety and effectiveness of this classic medicine. I had the opportunity, in June 2002, to present a talk on medical cannabis at my local hospital Grand Rounds, which was very well-received. What I found out, soon into my study, was that you don't have to look very hard to find out that there is ample evidence of cannabis' effectiveness and safety, and that no one is educating doctors on this medicine. From the question and answer period, I could see that the controversy surrounding evaluations for medical cannabis has produced a palpable chilling effect among practitioners, resulting in very few doctors being willing to educate themselves on a medicine that will call attention to them from the Board or law enforcement. As you might imagine then, since most doctors are reluctant to perform medical cannabis evaluations, this needed service then falls to the limited number of physicians who have the time, interest, and initiative to pursue the knowledge that is abundantly available concerning the safety and effectiveness of cannabis. In addition, they must be willing to risk the excess scrutiny of law enforcement, and misinformation. This brings up the question of law enforcement's cultural bias. Incredibly, some elements of law enforcement itself, have been very resistant to complying with Prop 215, or of even reviewing the knowledge readily available. For example, see the position paper on medical marijuana by California Narcotic Officer's Association at: http://www.cnoa.org/position-papers-1.htm and note their obvious untruth: "There is no justification for using marijuana as a medicine." This lie is thoroughly contradicted by the federal government's own Institute of Medicine 1999 report. The MBC's 1/97 statement: Physicians, Prop 215, and the Medical Board of California is the only published piece I have found that would explain your guidelines. These appear to make the standards of care for recommending cannabis higher than standards for almost all of medicine, and thus are subject to arbitrary investigations and judgments. To remedy this, Dr. Tod Mikuriya's CCRMG proposed a resolution to the CMA this past March: Minimum Practice Standard for Medical Cannabis Recommendation/Approval forCompliance with the California Compassionate Use Act of 1996. 1. The initial examination is face-to-face, in person, confidential, and live. (Periodic follow-up may be via video, photographic, telephonic, or email means.) 2. The examination is memorialized with elements of the patient's name, sex, birthdate, address, phone number, date of examination, and coded diagnoses. 3. There is documentation supporting the diagnoses. 4. Compliance with HIPAA [the Health Insurance Portability and Accountability Act] where required.This was presented to the CMA in March of this year by Dr Mikuriya. The CMA reference committee passed the substitute resolution below, stating: "Committee believes that the author has identified a significant problem and that physicians who recommend marijuana who have an appropriate physician-patient relationship should be judged by the same standards of care as those physicians recommending any other form of treatment." The resolution as passed: "Resolved: that the CMA urge the Medical Board to revise its guidelines regarding medical marijuana so that the guidelines include the requirements for a good faith exam with diagnosis, treatment and follow-up recommendations, and more fully clarify and affirm the legitimate role of physicians in recommending marijuana to appropriate patients, "and be it further resolved: that the CMA urge the Medical Board to apply clinically appropriate standards of care to all physicians, and not to apply a higher standard of care or to require a higher degree of evidence in cases where medical marijuana is involved. The new CMA resolution more greatly clarifies what the CMA considers an acceptable standard of care. Unfortunately, there is still no medical or legal definition of "good faith exam". Remedies:Education:If members of the medical board need to expand their knowledge on medical cannabis, I or others who have been studying the literature, would be happy to present a talk on it, or provide the board with an extensive list of resources and references One board member, in a deposition of Dr. Tod Mikuriya, clearly thought that one marijuana plant would produce 4 pounds of cannabis. This disinformation is directly from law enforcement's incorrect propaganda, and does not reflect a knowledgeable search for the facts.) Discernment: The Medical Board of California must be more discerning in deciding which complaints to investigate, and from what source. The credibility of the Medical Board is at stake, and you have much too important a job to do in protecting the public from actual harm than to dilute your limited staffing and effectiveness by investigating any doctor that law enforcement dislikes for recommending a safe and effective medicine. Reviewing "Role of the Medical Board of California" from your website, we find: "The Medical Board of California is a state government agency, which licenses and disciplines medical doctors. The Board provides two principal types of services to consumers: public-record information about California-licensed physicians, and investigation of complaints against physicians." We believe you have a legitimate responsibility to see that patients are not harmed. But I urge the Board to prioritize more carefully the use of their limited and valuable resources, in investigating complaints: Suggested priority for investigating complaints should be: Top priority complaint: from a patient, family member, caregiver, or healthcare provider alleging that harm was induced by the practitioner. Second priority complaint: from other parties alleging harm to a patient induced by the practitioner. Third priority complaint: from a patient, family member, caregiver, or healthcare provider alleging standard-of-care violations (but no harm to patient). Fourth priority complaint: from other parties alleging standard-of-care violations (but no harm to patient). I urge the Medical Board to
(signed) Frank H. Lucido MD P.S.: Tod Mikuriya is a scholar in the field of cannabis as medicine, having studied it for well over 40 years. His seminal review of the literature (Marijuana Medical Papers: 1839-1972) is a highly-regarded classic, and every member of the medical board should own a copy. He has clearly been singled out by law enforcement for punishment. (Example: I have read the transcript of the Board's deposition of Dr. Mikuriya, and it is clear that many, if not most, of the complaints came from a very few county DA offices His case has dragged out for years, and recently his hearing has been postponed again. This is cruel and punitive when no punishment is warranted. (signed) Frank H. Lucido MD Curriculum Vitae |
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