DOCTOR NOT ACCOMPANIED BY CLOUD OF SMOKE

Close your eyes.

Now imagine a garden-variety marijuana doc.

You projected someone goofy, right? Dr. Feel-Good?

Or venal? Dr. Slime-Ball?

Anecdotal evidence abounds that unscrupulous marijuana doctors will
recommend weed for anyone who claims a malady, genuine or not.

I asked Dr. Bob Blake if the stories were true.

"Oh, God, yes!" he said. "Guaranteed."

Then how could this ER doctor - "highly respected," according to
Palomar Pomerado Health spokesman Andy Hoang - get involved in the
demimonde of medical cannabis?

"IT'S A NEW DAY: WE'RE REOPENING OUR SAN DIEGO CLINIC!!!!"

The bulletin atop Medical Marijuana of San Diego's Web site reflects,
one gathers, the euphoria of the cannabis community.

"Two years ago," Blake writes on his home page, "Medical Marijuana of
San Diego temporarily relocated to the San Diego/Orange County border
because there were no dispensaries or co-ops available to supply
medical marijuana to our patients in San Diego County, the Board of
Supervisors refused to implement the (medical) marijuana laws, and
the district attorney served notice that all dispensaries were to close."

During this two-year dark age, as county supervisors remained hostile
to the permissive state law, Medical Marijuana's local patients were
forced to drive to Orange County to receive their prescriptions. And then

"With the new Attorney General Eric Holder's announcement that the
federal government would leave medical marijuana alone and only go
after those breaking both federal and state laws, the climate
changed. When the Supreme Court refused to hear the final appeal of
San Diego County, dispensaries started opening up all over San Diego."

As it happens, Medical Marijuana of San Diego, one of an estimated 20
county doctor's offices that prescribe cannabis, is rebounding from
its own rough brush with the law.

In 2006, Drug Enforcement Administration agents conducted a sting at
the clinic. A Medical Board of California investigation determined
that Dr. Alfonso Jimenez, an osteopath, had recommended marijuana
without adequate exams. In April, Jimenez lost his license to
practice medicine.

This left up to 10,000 of Jimenez's cannabis patients with invalid
prescriptions. The only way to save the practice was to put it in the
hands of a doctor in good standing.

Enter Dr. Blake. For 20 years, Blake was the chair of Pomerado
Hospital's Emergency Department. For two years in the mid-1990s, he
was the hospital's chief of staff.

"Before losing his license, Dr. Jimenez turned over your care to me,"
Blake assures patients on his Web site. "I stand behind EVERY
patient's letter of recommendation for medical marijuana written by
Dr. Jimenez."

Blake's nearing 60, but the tan, lean vegetarian looks 50 in baggy
shorts, T-shirt and sandals as he sips iced tea at the Pannikin,
Leucadia's coffee hangout.

He grew up in North Park, went to St. Augustine High School and spent
his free time gliding over the water - as a sailor and a surfer - and
underneath as a diver. To stay in shape, he swims two miles most
every day, from Swami's to F Street and back.

After graduating from UC Irvine's medical school, Blake went into
emergency medicine.

In 2005, he'd had enough of the pressure and long hours. He started
looking for a niche where he could use his skill at sizing up
injuries and dealing with pain.

Around 2000, a family member had become a "chronic pain patient"
after a car accident. Having explored the usual "modalities," a
colleague of Blake's suggested cannabis.

His relative started out with two doses of cannabis a week - and then
two a month. "The metabolites continue to work after the euphoria is
gone," Blake said. Unlike opiates, "the benefits for long-term pain
management are excellent."

He thought about working with medical marijuana right after quitting
Pomerado, but "I didn't feel like getting in the middle of the firestorm."

Early this year, however, as the legal climate was shifting, Blake
contacted Jimenez and began an internship to learn the hemp ropes, so to speak.

Then Jimenez was stripped of his license. Taking a deep breath, Blake
plunged. "I had no idea what I was entering," he said of the
challenges of assuming a stigmatized practice.

I asked him if his friends and former associates were taken aback at
his offbeat course. He said no, not at all. (That's one advantage of
living in Leucadia, I suppose.)

Still, he's leery of the counterculture image of medical marijuana.
He said he'd like to tone down the Web site and advertising he
inherited from the flamboyantly hip Jimenez.

Blake's looking for an office in Mission Valley to add to his space
in Dana Point. He says he spends about 15 minutes with patients - as
much as a half an hour with new ones. He insists upon medical records
to back up claims of distress, whether mental or physical.

If anyone showed him a marijuana bud in his office, he'd kick the
person out. He practices medicine in a separate universe from
dispensaries or co-ops.

Though a strong advocate of cannabis as a pain reliever, Blake says
he opposes legislation to legalize the drug.

The country's mainstream isn't ready for such a radical change, he
says. He worries about traffic safety if pot were legal.

Besides, it would be bad for business, he says with a smile.