POT CLINIC FENDS OFF NEW LEGAL QUESTIONS

A new marijuana clinic in Redding is raising questions among local
police about whether it's legal for a physician assistant to evaluate
a patient for medical pot use.

But the Los Angeles doctor who owns 420 Med Consultations on Iris
Drive says his operation is 100 percent above board, even though the
patients who go in for a doctor's recommendation most likely will
never meet the physician who signs the form that authorizes their
legal marijuana use.

"Some police have different opinions," said the clinic's owner, Dr.
Xueren Zhao, by phone from Los Angeles. "However, they are not expert
to this practice. In other cities like Los Angeles and Bay Area, the
PAs (physician assistants) are involved in the practice, and there's
no problem so long as the physician oversees the practice."

Redding police Capt. Damon Minor said that though the government
agency that regulates physician assistants is adamant that a doctor -
and not a physician assistant - must perform an examination before
making a recommendation, local prosecutors say the law is
"ambiguous."

That might put patients at risk of legal troubles down the road, he
said.

"The problem might be that the medical marijuana recommendation could
be deemed invalid if a licensed physician does not personally examine
the patient," Minor said.

The Iris Drive clinic, which opened in early August, joins an
ever-more crowded field of new marijuana clinics in the north state.
And the issues surrounding physician assistants performing exams adds
another layer of confusion surrounding the influx of medical clinics
and pot dispensaries that have sprung up since President Barack Obama
last fall directed federal authorities not to prosecute people if
they're complying with states' medical marijuana laws.

In 1996, California voters passed Proposition 215, which allowed
doctors to recommend marijuana to patients.

The law stopped short of allowing them to write prescriptions for the
drug, which federal law still classifies as a controlled substance
similar to heroin.

Patients - and even police - nonetheless often refer to the
recommendations as "scrips," short for prescription.

Critics say Prop. 215 gave broad discretion to doctors wishing to
recommend the drug to anyone who wants it and creates a lucrative
opportunity for doctors to make easy cash.

In Redding there are four offices in which doctors - or physician
assistants - regularly see patients specifically seeking medical
marijuana. One has been around for more than the last year or two.

Zhao's clinic is by far the cheapest of the lot.

He said it's $120 for a new patient to receive a recommendation. It's
$80 to renew a recommendation. The other three clinics in Redding
charge at least $149 for an initial recommendation.

Carlyn "Casey" Cairns, 43, of Redding, said she went to Zhao's clinic
a few weeks back for a recommendation because she was attracted by the
lower price.

She said she was surprised when a physician assistant named Elsie
Taylor evaluated her, taking her blood pressure and asking her
questions about her health.

Cairns said that she kept expecting to be examined by a doctor and was
stunned when Taylor handed her a medical marijuana license signed by
John K. Nations, a physician whose medical board license lists his
address as a post office box in Folsom.

Nations couldn't be reached this week for comment.

"I thought, 'This is just kind of strange,'" Cairns
said.

She said she went back later and asked for a refund after speaking
with one of the other medical marijuana doctors in town, who gave her
a recommendation.

Zhao said the process Cairns describes is a legitimate one that's "100
percent legal."

He said that in traditional medical clinics, doctors can review a
patient's chart and make a treatment determination based on an
evaluation by a physician assistant.

He was adamant that each patient's chart is reviewed by a physician
and that the patient's recommendation would be revoked and their money
refunded if the doctor found anything wrong, Zhao said.

Kim Brown, a spokeswoman for the state's Department of Consumer
Affairs, which regulates the state's Physician Assistant Committee,
said that's not how it's supposed to work.

"The MD does have to do an exam," Brown said. "It's so clear on our
website."

Recommendations on the committee's website say that though a physician
assistant may evaluate a patient for the use of medical marijuana,
"the attending physician himself or herself MUST perform an
examination of the patient prior to the physician making a
recommendation. This medical examination may not be delegated to a
physician assistant."

But those are recommendations. Minor said the law is more
vague.

"To my knowledge no one's recommendation for the drug has been
invalidated by law enforcement or our DA's office here because a PA
did the exam," Minor said.

In an interview this summer, Dr. Philip Denney, a Carmichael physician
who helped found Redding's oldest cannabis clinic (it's also the most
expensive at $200 per exam) said patients should be wary of getting a
recommendation signed by doctor who seems, for whatever reason,
unlikely to defend a patient in court should their recommendation come
under law enforcement scrutiny.

"I think the value of the recommendation isn't the piece of paper," he
said. "It's the person standing behind it."