A HOMEGROWN DEFENSE by Mike McKee

Signaling an escalation in the medical pot wars, the city
of San Francisco is considering picking up the legal
defense tab of cityemployed doctors if they are busted for
recommending marijuana.

But doctors might face restrictions on which illnesses
they may suggest pot be used for if the city adopts a
measure "approving" select ailments for marijuana
treatment.

The two proposals are the latest in a raft of
recommendations from the city's Department of Public Health
for implementing Proposition 215, the state initiative
approved by voters in November that allows doctors to
recommend pot as a treatment for some illnesses.

The city has long supported medicinal marijuana
legislation. A pot package, including both the legal
defense and approved ailments measures, is expected to go
before the Board of Supervisors on April 10.

The resolution to protect the approximately 315
cityemployed doctors is an especially bold move because it
would directly challenge the federal government's plans to
prosecute or terminate the prescription power of doctors
caught recommending pot.

But the proposal to identify officially treatable
diseases could create stricter controls than envisioned
under Prop 215.

"We're interested in defending those physicians who
make good clinical judgments in line with Health Department
guidelines and who are trying to provide the best care for
their patients," Deputy City Attorney Jean Fraser said
Friday. "It's not 100 percent protection, and we're trying
to make sure doctors know that." Specifically, the
resolution, already backed by Supervisors Sue Bierman,
Leslie Katz and Susan Leal, states that licensed physicians
with the city's Health Department "shall have their legal
defense provided at city expense in a federal criminal or
administrative proceeding."

That defense will be provided by the city attorney's
office as long as the doctor's marijuana recommendation was
made in the course of his or her employment with the city;
met Health Department guidelines; and was not made in
exchange for monetary gain.

Fraser said the city bases its vow to defend on
Government Code 995.6 and 995.8, which, according to the
resolution, allow counties to defend employees in
administrative or criminal proceedings that result from an
act taken in the course of the employees' work.

Neither Bierman nor Katz could be reached for comment,
but Leal said the proposal is aimed at protecting
cityemployed physicians if "in their best judgment"
marijuana was appropriate treatment for a particular
patient. The city employs doctors at places such as Laguna
Honda Hospital and neighborhood community health clinics.
Spokesmen for the Drug Enforcement Administration and the
Washington, D.C. based Office of National Drug Control
Policy didn't return telephone calls.

But the city's idea was greeted skeptically over the
weekend at the California Medical Association's annual
conference in San Francisco. In particular, some doctors
criticized the San Francisco Health Department's plan to
identify marijuanatreatable diseases.

"Clinical guidelines are best set up by a larger body,"
said Dr. Toni Brayer, immediate past president of the San
Francisco Medical Society. "When smaller factions tackle an
issue like this, it doesn't do us much good."

APPROVED ILLNESSES

The guidelines, which would apply only to doctors
employed by the city of San Francisco, could rein in Prop
215, which OK'd marijuana use for "cancer, anorexia, AIDS,
chronic pain, spasticity, glaucoma, arthritis, migraines
and any other illness for which marijuana provides
relief."

Jan Gurley, medical director of the Health
Department's AIDS office, said last week that the
guidelines for treatable diseases haven't been finished,
but that they will clearly identify illnesses for which
there is some proof of marijuana efficacy and others where
there is no proof at all.

The implementation guidelines, which refer to buyers'
clubs as " medicinal marijuana distribution centers,"
provide standards for the collection and dissemination of
marijuana; records keeping and file maintenance (which
includes the mandate that clubs "should not pay employees,
staff or volunteers with cannabis"); and operating
procedures, which likely will lead to the licensing of
marijuana clubs.

Dennis Peron, founder of San Francisco's Cannabis
Cultivators' Club, took part in the sessions aimed at
coming up with guidelines. But he wasn't aware of the
illness identification proposal, and he wasn't happy with
it.

"I don't know how they are going to do that," he said
Friday. "It's like secondguessing a doctorpatient
relationship. Anybody who tries to do that is going to
screw it up."

Peron, who has fought for pot legalization for decades,
said he has counted 105 ailments treatable by marijuana
"from alcoholism to tendinitis and a lot of things in
between, including manic depressiveness." "They're going to
end up with a list of hundreds," he said. "Why not let the
doctors decide?" Prop 215 Dominates CMA Conference By Mike
McKee

As troops of physicians lined up Saturday at the San
Francisco Hilton to discuss medicinal marijuana, Lisa
PerryGilkes summed up the prevailing opinion best.

"Proposition 215 opened Pandora's box for us," the San
Bernardino doctor said.

That was all too apparent Monday as the California
Medical Association's leaders, attending their annual
meeting, engaged in an oftencontentious debate over four
marijuana resolutions. The group, called the House of
Delegates, approved all four in its first action on the
issue since the passage of Prop 215 by California voters in
November.

Two of the resolutions were fairly benign, calling for
clinical trials testing the efficacy of marijuana as
medicine. But a couple, including the one by PerryGilkes,
were confrontational, criticizing the federal government
for threatening the licenses, reimbursements and
prescribing powers of doctors who suggest pot for patients
in the wake of Prop 215. "The threats . . . concerning
discussion of medical marijuana have acted as a _de
facto_ 'gag order' on physicians, infringing upon the First
Amendment rights of physicians and patients," says a
resolution introduced by the San Francisco Medical Society.
PerryGilkes' resolution goes further to say that the CMA
should work to have "such threats rescinded."

Yet her proposal is hardly propot. She criticized the
broadness of Prop 215's provisions for treatable illnesses
and said that despite the measure's official name the
Compassionate Use Act there is nothing compassionate or
prudent about the "unmonitored, indiscriminate use of a . .
. drug that is mindaltering" and "possibly carcinogenic."

Debates on Saturday and Monday revealed an extreme rift
between supporters and opponents within the medical
community.

Robert O'Reilly, a Kern County thoracic surgeon who is
"philosophically opposed" to marijuana as medicine, said
he simply refuses to discuss its use with patients. "It's a
closed issue with me," he said, "but that's just the way I
am."

Jane Marmor, a doctor from Redwood City who is heading
a CMA task force on pot, even had to fight to keep the word
"inhaled" in a resolution that called for research into
inhaled marijuana. Some doctors felt that would limit the
study, but Marmor pointed out that it's important to study
inhaling to examine claims that it provides more immediate
and longerlasting results.

"This has really been the block to research," she said.

Much of the debate degenerated into personal opinions
about marijuana, which some felt were beside the point.

"Even if we disapprove of smoking, it doesn't mean we
disapprove of research on smoking," said Brian Johnson, a
doctor from Los Angeles. "We shouldn't confuse the two. You
can be opposed to marijuana and still want to know what the
effect of marijuana smoking is on patients."

The CMA previously has taken the position that doctors
should feel free to discuss marijuana with patients, but
should be cautious about recommending it. They also have
questioned the wisdom of a suit filed by doctors in San
Francisco federal court earlier this year claiming
government threats to prosecute doctors for recommending
marijuana violate First Amendment rights.

"It may actually impede cooperative efforts to promote
and facilitate research," the association said in a March
14 letter, "and divert important resources from the areas
where further progress can be made."

NO LAUGHING MATTER

In another issue, Kenneth Hoffer faced a few giggles
and snickers when he got up at a CMA committee meeting
Saturday to make his presentation. And he faced a few jokes
when the House of Delegates voted Monday.

Hoffer, an ophthalmologist from Santa Monica,
introduced a resolution asking the association to support
legislation making it illegal for California bartenders to
give free drinks to patrons.

"Bartenders, in trying to increase their tips and keep
their customers there longer, tend to give away free
alcoholic beverages," said Hoffer, who 'fessed up to owning
an establishment that serves drinks. He said he fears that
people will leave bars inebriated, and defended his
proposal by noting that Arizona already prohibits
bartenders from buying drinks for customers.

The resolution, which would have exempted bar and
restaurant owners from the giveaway ban, was overwhelmingly
rejected Monday, with one speaker suggesting everyone buy
Hoffer a drink. But Hoffer had his supporters. Two doctors
rallied to his side Saturday, with one saying it would be a
"danger to trivialize this." Free drinks by bartenders, he
said, "increase the number of drunk drivers on the road."

Another doctor, noting that the House of Delegates had
just agreed to push for a ban on land mines, pointed out
Monday that everyone in the room was " much more likely to
hit a drunk driver on the way home than a land mine."

Still, most doctors agreed with one man who predicted
that the CMA would become "the laughingstock of the state
and the nation" if it approved the resolution.