TAKING A LEAF FROM 'POT DOCS'

Since 1996, a Tiny Cadre of California Physicians Has Been
Recommending Marijuana for Medicinal Use. They've Done So at Their
Professional Peril.

SANTA BARBARA -- After nearly four decades in medicine, Dr. David
Bearman seems the incarnation of a trusted old-school physician. His
resume is long, his record unblemished. It's his choice of treatment
that makes him conspicuous.

For nearly every patient, Bearman recommends the same remedy:
marijuana. There is the young lady with epileptic seizures, the
middle-aged man with multiple sclerosis, the amputee bedeviled by
phantom limb pain.

Bearman's practice, based on a controversial curative not found on
pharmacy shelves, has proved both lonely and professionally perilous.

Although the courts have upheld a doctor's right to recommend cannabis
for the seriously ill, few dare do so. Among the exceptions is a
tight-knit cadre of about 15 California physicians. Dubbed "pot docs,"
even by friends, they blithely claim credit for nearly half the
estimated 100,000 marijuana recommendations issued in the eight years
since California approved medical use of the drug.

There is Bearman in Santa Barbara and Dr. Frank Lucido, a family
doctor in Berkeley. Dr. Tod Mikuriya, a peripatetic Bay Area medical
marijuana pioneer, has written approvals for 8,000 patients. A
presidential drug czar once lambasted his brand of medicine as a
"Cheech and Chong show."

The criticism has been accompanied by intense scrutiny. At least 11 of
the cannabis doctors have weathered investigations by the Medical
Board of California. Half the cases closed without formal accusations.
But a few drew blood.

One Northern California physician settled for three years of
professional probation rather than fight accusations that a few of his
marijuana patients had no medical need. Another doctor, accused of
fabricating pot approvals, lost his right to practice for two years
while the disciplinary case played out. He settled for five years'
probation.

Medical Board officials say the problem is not the marijuana, but the
way the doctors practice medicine. Are patients thoroughly examined?
Do the doctor discuss other options?

Joan Jerzak, the Medical Board's chief investigator, says that some
doctors eager to legalize recreational use "don't mind flouting the
law."

But to the pot docs, the attacks are about old grudges that will not
die. They say they've been singled out by a law enforcement
establishment still displeased over passage of Proposition 215, the
1996 ballot measure that legalized marijuana for the seriously ill.

"Their attitude is, 'This isn't medicine, but rather a way to abet
drug abusers,' " said Dr. Philip Denney, who practices as if every
patient is a federal narcotics agent. "They have scared the hell out
of California doctors, and it's been left to us so-called mavericks."

The cannabis doctors say they practice serious medicine, focusing on
the sick and weeding out habitual pot smokers simply looking for
protection from arrest. Marijuana remains a remarkably safe substance,
the pot docs say, with tremendous therapeutic potential for AIDS
wasting, chemotherapy nausea and other grave conditions.

Aside from the pot docs, oncologists and HIV physicians write the bulk
of the cannabis recommendations.

Bearman, a 63-year-old family practitioner, sees his share of serious
cases every week. Sleeves rolled up, graying walrus mustache arched,
he is upbeat and avuncular as the ill and injured hobble in. But he
figures it may be years before marijuana is accepted by the medical
establishment -- and by the criminal justice system.

"There's no doubt," he said, "this is part of a larger cultural war at
play."

A Delicate Dance

Jessica Griffith, a 27-year-old divorced mother of one, waddles into
Bearman's office, a metal cane in hand.

She carries a 3-inch stack of medical records detailing her four-year
fight against pain. She ruptured two discs in her back trying to lift
a box in, of all places, a health food store. Griffith tells the
doctor she will soon have surgery to fuse her spine.

Meeting such a patient, someone bearing up under a painful or
debilitating condition that could be helped by marijuana, Bearman has
a standard response.

"You," he tells them, "are exactly the kind of patient the voters were
thinking of when they approved Proposition 215."

Bearman's father, a pharmacist, used to tell stories about marijuana's
history as an accepted part of pharmacopoeia. (England's Queen
Victoria turned to it for menstrual cramps at the suggestion of the
court physician.)

The son was dubious. He spent his career mostly paddling in medicine's
mainstream, but over the years he developed an interest in medical
marijuana. When he retired three years ago as medical director of the
Santa Barbara Regional Health Authority, he opened a one-room office.
Word spread and the ill flowed in.

So did a problem.

One of his patients, a 21-year-old named Nathan with a history of
migraines, was busted with a tiny stash of pot in April 2001 while
camping in Ventura County. Confronted by park rangers, Nathan pulled
out his medical marijuana recommendation from Bearman.

They let him walk, but a ranger complained to the Medical Board. The
board, which receives some 12,000 complaints a year about physicians
and investigates roughly 2,000 of them, decided Bearman was worth a
look. They demanded to see the doctor's records on Nathan. Bearman
refused, citing patient confidentiality.

A two-year legal battle ensued. Bearman at one point faced a
$1,000-a-day fine. But he prevailed. A state appeals court concluded
that the board's subpoena was based on "nothing more than speculations
[and] unsupported suspicions."

Free of that legal threat, Bearman went back to his old ways. To cull
out the fakes, he requires that patients seeking a medical marijuana
referral undergo a detailed screening during their initial phone call.
Then Bearman spends about an hour conducting a head-to-toe physical.

"What effect does marijuana have?" Bearman asks Jessica Griffith.

"Sleep," she replies. It also dulls the cascading pain she endures
while walking. A few puffs before taking a shower and she can shampoo
her hair, Griffith says. "It's not fun."

Bearman tells her about support groups for chronic pain, ergonomically
designed chairs and how she can saute marijuana in butter or brew it
as a tea.

Each exam is a delicate dance between advice and advocacy of a drug
still wholly illegal under U.S. law. Like other cannabis physicians,
Bearman does not dispense marijuana. How patients obtain pot is up to
them, but he sometimes points them to websites listing cooperatives
that distribute the drug.

After Griffith leaves, Bearman has a confession. Behind the cheery
exam-room aplomb, he fears a patient could end up in jail. They are,
he says, arrested all too often.

"Basically what we have here is a turf war between doctors and the
criminal justice system," Bearman says. "They're second-guessing
physicians."

Studying Pot's Potential

Dr. Tod Mikuriya churns out medical marijuana recommendations like a
factory, more than a dozen on a busy day. And he willingly
acknowledges, unlike most of his peers in cannabis consulting, that he
does indeed smoke pot, mostly in the morning with his coffee.

But the doctor is no tie-dyed hippie. He was a registered Republican
for years before becoming a Libertarian. He looks a good decade
younger than his 71 years and dresses nattily. The only giveaway of
his specialty: an embroidered logo on his white lab coat showing the
snake and staff of Aesculapius, the Greek god of medicine, atop a
marijuana leaf. Mikuriya, a psychiatrist, has studied the drug's
therapeutic potential since the 1960s, when he directed marijuana
research at the National Institute of Mental Health. He has written
books on its medical use. Mikuriya's list of more than 100 ills eased
by cannabis includes insomnia, premenstrual cramps and stuttering.

Marijuana is so effective and benign, Mikuriya said, that the bar for
patient approvals should be far lower than for prescription drugs.
Likewise, the role of cannabis consultants is not to perform
exhaustive tests, he said, but to determine whether a patient's
condition is chronic and could be helped by pot.

In 2000, the Medical Board accused Mikuriya of gross negligence,
unprofessional conduct and incompetence in recommending marijuana to
16 patients. The core of the case: that Mikuriya failed to conduct
proper physical exams and keep adequate records.

Last March, the board hit Mikuriya with five years of professional
probation and a $75,000 fine. He appealed and has continued to
practice pot medicine - with a few changed habits and under the
supervision of a state-appointed monitor.

He no longer sees patients at his home in the East Bay hills, instead
leasing a small suite above a Trader Joe's market in El Cerrito, on
the eastern edge of San Francisco Bay. A staff of three maintains
records and prepares patients for exams by taking blood pressure and
other vitals.

A typical day features a parade of ailing patients, many of them
already self-medicating with marijuana.

Jerry Smith, a burly 59-year-old drywall contractor with a
salt-and-pepper beard and crew cut, drove five hours from near the
Oregon border to get his approval to smoke pot renewed. He's got a
busted-up shoulder and diverticulitis. Smith raised his shirt to
expose a gaping hole in his gut, the product of a botched procedure.

"They just about killed me up in Yreka," he laments. "Those people are
in the horse-and-buggy days. Thank goodness there's someone like you."

Mikuriya smiles.

"Thank goodness," he gently corrects Smith, "for cannabis."

'It's Dr. Feelgood'

Ultimately, the struggle over the pot docs comes down to one
fundamental question: Are they good gatekeepers for an inarguably
controversial medication?

If they don't dig deep to diagnose a patient's ills, "there isn't good
medicine going on," said the Medical Board's Joan Jerzak. "It's just
sales of a particular prescription. It's Dr. Feelgood."

Consider how the board handled the case of William S. Eidelman, M.D.
In 2000 and 2001, undercover investigators infiltrated the Santa
Monica office of Eidelman, a longtime practitioner of alternative medicine.

Each claimed a fictitious illness, according to case records. Back
pain. Insomnia. One told Eidelman that smoking marijuana simply made
him feel better about life. All got the green light for pot.

In May 2002, the board suspended Eidelman's license, saying he failed
to give hands-on physicals, obtain medical histories, order tests. The
physician claimed entrapment.

"I was given punishment normally reserved for doctors who rape a
patient or botch a half-dozen operations," Eidelman said. "Even if I
did go over the line in one or two cases, that isn't what my practice
is all about. I treat people who are really sick."

In the end, the board hit him with a $65,000 fine and five years'
probation.

Doctors like Eidelman are not recommending pot for patients with
terminal cancer and end-stage AIDS, Jerzak said. "People with those
sorts of serious illnesses are going to obtain the recommendations
with no complaint."

The board's intense scrutiny of the cannabis doctors has drawn fire
from the state's medical establishment. Jack Lewin, chief executive of
the California Medical Assn., said the state should concentrate on
doctors who truly endanger lives. Pursuing pot docs, Lewin said,
"seems like a witch hunt."

After wrangling with the California Medical Assn., the Medical Board
in May spelled out a softened approach. If physicians follow "accepted
medical standards, they can avoid being investigated."

'What Is the Problem?'

If the board has a thorn in its side, his name is Dr. Frank Lucido. He
wears a ponytail and a beard, is a longtime peace activist and
practices in Berkeley. He also is a sort of Marcus Welby of the left,
seeing some of the same patients for a quarter of a century. Just one
in five has anything to do with marijuana.

The state investigated him a few years ago, but dropped the case. Ever
since, Lucido has religiously attended board meetings, urging
regulators to lay off pot practitioners. "If patients aren't being
harmed," Lucido said, "what is the problem?"

The doctor believes it's unfair to hold cannabis consultants to an A
standard of work when "everyone else is a C." He laughs at critics who
say such doctors -- paid $200 or more by a medical marijuana patient,
usually in cash or check -- are in it for the money. Lucido said it's
a rare year when he nets $90,000.

His office manager, Damian Disterdick, said she turns away a quarter
of the callers seeking a recommendation.

"Most get really angry," she said. "I tell them to read what
Proposition 215 says. This is for the seriously ill, not someone who
wants to be legal."

Nicholas Feldman is one of the former. He is 28 and has cerebral
palsy. Spastic paralysis knots his body. Straps hold pipe-thin legs to
a wheelchair and bind his waist, forearms and biceps. His shoes are
laced together to restrain flailing feet.

Despite his disability, Feldman lives life in full. He works with the
disabled in San Francisco, helping them find independent-living
situations. At home, Feldman takes gulps of pot from a vaporizer -
particularly right before dinner.

"Marijuana has made my life easier over the years," he says, jaw
clenched, the words rolling out slowly.

In a bright examination room, Lucido listens intently to Feldman's
heart and lungs. He feels his abdomen.

Later, turning his wheelchair, Feldman has a few parting
words.

"They're not doing any crime," he says. "They're being doctors.
They're helping people. They represent what medicine should be all
about -- compassion for people. Not simply prescribing a pill."

[sidebar]

CANNABIS CHRONOLOGY

Physicians turned to marijuana long before California voters legalized
it for medicinal use in 1996.

2,700 B.C.: Accounts of medicinal cannabis recorded during reign of
the Chinese Emperor Chen Nung.

1840s: Irish physician William B. O'Shaughnessy introduces cannabis to
Western medicine after witnessing its use in Calcutta.

1920s: Several U.S. pharmaceutical companies continue marketing
cannabis medicines; textbooks describe it as a painkiller and sedative.

1941: Cannabis removed from U.S. list of approved drugs after Federal
Bureau of Narcotics rails against "reefer madness" during the 1930s.

1970: U.S. declares marijuana an illegal drug.

1992: Medical marijuana approved in a few California cities, fueled by
anecdotal accounts and early research suggesting pot's promise for the
ill.

1996: Proposition 215 approved, legalizing medical marijuana for the
seriously ill. Nine other states adopt similar laws, most recently
Montana in November 2004.

Sources - Medical Board of California, Society of Cannabis Clinicians,
U.S. Drug Enforcement Administration, Times staff reports.