DR. LEVEQUE'S LICENSE REVOKED

He Will Appeal

Phil Leveque of Molalla is the first doctor in any of the states that have
legalized marijuana for medical use to lose his license for approving it.
The Board of Medical Examiners issued a formal revocation order Oct. 15.
Leveque has 30 days to appeal, and will.

The Board's action comes as Oregonians prepare to vote on an initiative to
legalize cannabis dispensaries, increase the amount patients can grow and
possess, and lower the cost of a state registration card.

Leveque, 81, is a doctor of osteopathy with a PhD in pharmacology, which he
spent many years teaching at the medical-school level.

He was a sponsor of Oregon's 1998 medical marijuana initiative, and when it
passed he was sought out by thousands of patients who were too afraid to
ask their regular doctors for approval to use marijuana, or who'd been
turned down by their regular docs.

Leveque was investigated by the Board of Medical Examiners and his license
was suspended for three months, May-July 2002, for failure to conduct
physical exams and keep copies of his records (which he forwarded to the
state office that issues cards to patients). When Leveque resumed practice
it was in concert with a nurse practitioner authorized to conduct physical
exams, and clinic operators committed to thorough record keeping.

He traveled up and down the state to see patients. By the spring of 2003
some 6,500 Oregonians had gotten medical marijuana cards, and about half of
them had submitted applications signed by Leveque, who assumed that his
problems with the Board were in the past.

But in November 2003 Leveque came under investigation again, and in March
of this year his license was suspended, based on charges that the physical
exams conducted under his supervision were too perfunctory, and that he had
violated the standard of care in his treatment of six patients.

None of Leveque's patients had complained. According to Leveque's lawyer,
Ann Witte, all the complaints against him came from doctors annoyed that
Leveque had helped their patients obtain cannabis.

At a three-day hearing in May before the Board's administrative law judge,
Rick Bayer, M.D. appeared as an expert witness and defended Leveque's
decision to approve cannabis use, patient by patient.

Patient A was most problematic - a 55-year-old woman employed by the state
Fish & Wildlife department whose job description included operating heavy
equipment.

Leveque, according to his accusers, "signed a form attesting to the
employer that she could safely function on the job while under the
influence of marijuana." But, Bayer pointed out, " Dr. Leveque told her not
to smoke marijuana within four hours of going to work... Dr. Leveque was
following a standard that any doctor might follow who reads certain
references." Bayer went on to cite studies showing that cannabinoid levels
return to baseline within four hours after smoking.

Patient A had been in an auto accident and was subsequently prescribed
oxycodone, valium, vicodin, trazadone, as well as aspirin and other
over-the-counter painkillers. Patient A told Leveque that she only used
marijuana after work, and that she'd been performing her job successfully
for years. She wanted to be legal, and he obliged.

What the Board really disapproved of was Leveque's taking his patients at
their word. "The Board finds that Licensee [Leveque] was content to accept
whatever a patient said about complaints and symptoms at face value," the
revocation order states, "with no effort expended to confirm a patient's
complaint with a tailored evaluation... Licensee relied on his patients'
statements that using marijuana provided them better relief from pain and
other debilitating conditions than the use of other pharmaceuticals...

"Licensee testified as follows, 'The patients tell me how many times a day
they use marijuana and for how many years they've been using it and so
forth, and that's what they want to continue to use, and I have no argument
with whatever works as far as the patient is concerned... the patient is
self-adjusting, self-administering and so forth, so... there's no way that
I can tell them this is how you should use this. They know how to use it.'

"This manner of practice indicates that Licensee allowed his patients to
dictate the amount and frequency in which they would use this controlled
substance, often to the detriment of the patient's health and safety."

Patient B was described by the Board as having "a history of psychosis,
hallucinations, multiple admissions to the VA hospital and was frequently
noncompliant with medication regimens prescribed by physicians treating his
pain." Leveque allegedly "did not request complete medical records, failed
to conduct a mental health history, and did not consult with his care
providers."

Bayer eloquently pointed out, "Sometimes noncompliance is due to adverse
effects, inability to pay, miscommunication or the underlying illness.
Noncompliance should not be pejorative." And "Often, patients do not want
consultants to share information with other providers and that is within
the patient's right to privacy... Dr. Leveque did not jeopardize the health
and safety of this patient by signing an application to remove criminal
penalties for someone with a brachial plexus [spinal nerves] injury who
reported good pain relief from therapeutic cannabis.

It is also difficult to understand why treating pain and decriminalizing or
'medicalizing' anyone for his/her medicine -even if they have a history of
substance abuse-is endangering that patient.

Patients should never be prohibited from receiving adequate pain and
symptom control... One might interpret a patient reporting success for
three years before signing an application as good evidence of ability to
tolerate cannabis... It is very important to realize that nearly all of Dr.
Leveque's signatures on application forms are for patients who have
reported a history of success with medical cannabis."

Patient C presented "with complaints of chronic pain, a history of
marijuana use, and adverse consequences associated with that use, to
include prison sentences for drug related offenses.

Patient C said he used marijuana three to four times per day for four years.

Patient C's primary physician contacted Licensee to inform him that this
patient was not an appropriate candidate for medical marijuana.

Nevertheless, Licensee conducted an inadequate history and physical
examination, failed to establish a diagnosis or discuss treatment
alternatives, risks or benefits, and signed the Attending Physician
Statement form attesting that 'Cannabis gives best relief.'"

Bayer responded, "Dr. Leveque reports the patient has painful spine disease
and hepatitis C. He has used regularly for four years and reports success
with controlling his pain. It is unethical if prison time related to our
prohibitionist politics should determine clinical therapeutics. It is not
uncommon that physicians disagree on therapy and patient's doctor is
certainly free to call and talk to the patient as to why marijuana is a bad
idea. Ultimately it should be the patient's decision as to which doctor's
advice s/he chooses... Many patients who have seen Dr. Leveque feel they
get a good history and physical exam -much more than they get from other
doctors."

Patient D's was the only case in which the Board's revocation order says
that actual harm "may have been related" to marijuana use. Patient D was an
emotionally troubled 19-year old male who had dropped out of school in the
ninth grade.

He had a history of severe pain and nausea stemming from back injuries, and
prior to seeing Leveque had been prescribed oxycodone, Valium, Percocet,
Vicodin, Tylenol/codeine and NSAIDS for pain, and Tagamet for nausea.
According to the Board's own summary, "When Patient D had trouble obtaining
marijuana, he became very agitated and sometimes would sit and rock
muttering to himself that he needed to smoke.

Patient D's mother reported that her son had violent outbursts when he did
not have marijuana." Leveque, the Board found, "disregarded the patient's
history of possible substance abuse or dependence, failed to conduct an
adequate examination, consider treatment alternatives or establish a
diagnosis and signed the Attending Physician Statement form attesting that
'Cannabis gives best relief.' Licensee failed to follow this patient.

Patient D's mother subsequently observed that Patient D's pattern of
behavior was to smoke marijuana from the time he awoke in the morning until
he went to be at night.

Patient D was ultimately hospitalized for seizures that may have been
related to his use of marijuana."

A diagnosis of epilepsy was made by Heidi Anne Loganbill, MD, a neurologist
at Salem Hospital, whose reading of the literature is that "substances in
marijuana... can contribute to seizures." She consulted with Danielle
Kizer, MD, a psychiatrist, who attributed Patient D's cognitive problems,
violence, agitation and behavioral problems to his use of marijuana (rather
than to his epilepsy).

According to Bayer, "Dr. Leveque reports the patient's mother brought him
in for severe pain from two back injuries.

He had used cannabis for pain for four years and tolerated it. Severe pain
qualified as the debilitating condition... Although cannabis can cause
anxiety or even panic attacks, this is usually in new users involved in
anxiety-provoking circumstances. Cannabis is also reported to help many
persons with chronic epilepsy in case reports... These are usually people
who have tried everything else... Although it may be possible in rare
circumstances for THC to contribute to seizures it is not a high probability."

Patient E "presented with complaints of chronic back pain and migraines.
Licensee failed to conduct an adequate history or physical examination,
disregarded his history of using marijuana two to three times a day for
five years, or the patient's felony conviction of manufacturing and
delivering marijuana as possible substance abuse or dependence, failed to
consider treatment alternatives, and failed to establish a diagnosis.

Licensee authorized marijuana for this patient by signing the Attending
Physician Statement form, 'Cannabis gives best relief.'"

Bayer countered that Leveque did not ignore the fact that Patient E had
used cannabis successfully for five years. "As discussed earlier, some
think it is unethical that our prohibitionist politics should determine
whether or not a patient is treated for pain. A diagnosis of substance
abuse requires more than a felony drug charge.

And even patients with substance abuse need to have pain treated."

Patient F had been injured in an auto accident and also presented with
irritable bowel syndrome and nausea. "Patient F reported a history of
smoking marijuana for or five times a day for 15 years," according to the
Board. Leveque "failed to conduct an adequate history or physical
examination, disregarded his history of extensive marijuana use as evidence
of possible substance abuse or dependence, failed to consider treatment
alternatives, and failed to establish a diagnosis. Licensee authorized
marijuana for this patient by signing the Attending Physician Statement
form, writing 'Cannabis gives best relief.'"

As noted by Bayer, Leveque authorized cannabis use for chronic severe pain
stemming from the auto accident. "Again, the 15 years' use may relate to
therapeutic success rather than describe evidence for abuse."

Bayer concluded: "In summary, there are disagreements between Dr. Leveque
and the BME. In my opinion, Dr. Leveque does not represent a danger to
patients for whom he signs an application form. Nearly everyone who sees
Dr. Leveque is a regular user of cannabis who has found therapeutic success
managing severe pain or another debilitating illness.

They have used cannabis a long time and tolerate it. They are pre-screened
to make sure they have a qualifying condition and records to document
this... Totally removing Dr. Leveque's license alleging he is a danger to
Oregonians based on these cases seems more like anti-medical marijuana
politics than science-based medical therapeutics."

But the fix was in. Leveque's license was revoked on the grounds that his
"continued practice of medicine constitutes an immediate danger to the
health and safety of the public.

He will see no more patients unless Ann Witte can convince the state court
of appeal that the Board erred.

Witte is planning to cite a case called Spray vs. the Board of Medical
Examiners, which requires the Board to specify the care that an accused
doctor should have provided (instead accepting an expert's opinion that it
was inadequate)., According to Witte, "They should have had testimony about
the standard of care when you're treating a patient wants to use medical
marijuana. Is it the standard of care to discuss with him the potential
for addiction or whatever it is that they think Dr. Leveque should have
done that he didn't do."

Leveque, a tough old bird, is not giving up. He was a combat infantryman in
World War Two, a forward scout. "I walked most of the way under fire from
Luxembourg almost to Dresden. Under fire on a daily basis.

I spent more time on the point than anybody else in my battalion and more
time on the observation post than anybody except my own six guys. I don't
have any idea how I got out of that alive... I couldn't get a commission
because I didn't have a trigger finger. [The tips of several fingers on
Leveque's right hand were severed in a childhood accident; the index finger
was damaged the worst.] You couldn't be an officer if you didn't have a
trigger finger, but you could be rifleman.

That I couldn't understand, and still don't... I guess I survived because I
have good reflexes and I'm not afraid to dive in the dirt."

Leveque's sharp-tongued wife Eve died earlier this year. He didn't want to
sit at home feeling useless, so as of last week he began working as a
receptionist at the clinic in Portland where once he saw patients. "He
helps people with their paperwork and keeps them company while they're
waiting," says clinic director Paul Stanford. "His spiris are high. The
patients love seeing him and talking to him."

Ordinary patients like Phil Leveque for the same reason the MDs on the
Board of Medical Examiners don't: he's a gruff country doctor, he doesn't
put on airs, he talks straight, he assumes people are telling the truth.

A danger, indeed, but not to the public.

David Dodge, MD, a pathologist who came out of retirement to see patients
at Stanford's clinic two years ago, is now working there three days a
week... More than 12,000 Oregonians have been approved by the state program
to date, but the rate at which citizens get cards may slow as the Board
picks off the pro-cannabis doctors.

About 80% of all the applications were signed by just six doctors; Leveque
was foremost with 4,000. Lawrence Bogart, MD, who had approved some 1,500
applicants, had his license suspended in recent weeks.

Others known as cannabis specialists are in retreat, according to Stanford.

Unsolicited Plug

The approximately 100 cannabis dispensaries now operating in California
fall into two broad categories: those who view their customers strictly as
customers, and those who relate to them as potential participants in a
political movement or a clinical trial.

It's not merely a matter of semantics or image -everybody calls their
customers "patients," and anybody can dub themselves "compassionate" and
tack up a marijuana leaf imposed on a red cross.

Cannabis dispensaries that merely give lip-service to Dennis Peron's
radical ideals have something in common with the early Christian churches
after Jesus was offed and his disciples began the long segue from the
sermon on the mount to supremacy in the real estate market.

One club proprietor with a sense of political responsibility is Martin
O'Brien, founder of the Berkeley Patients Care Collective on Telegraph
Avenue. Over the years O'Brien has attended many a meeting and rally and
trial, some of which he recorded on video. Now he has incorporated his
high-quality footage -and more, from TV news sources-into a 30-minute
documentary called "Regarding Medical Marijuana," produced in association
with Americans for Safe Access. It's available free on-line at
http://www.medicalmarijuanainfo.com/.

The trouble is, there are too many snippets and no unifying framework, so
the movie is way too choppy for this old print journalist. It's said that
people raised on MTV are accustomed to absorbing information in quick
little bites; but not every story can be told in a snappy couple of
sentences. I recommend O'Brien's debut documentary as a kind of video
scrapbook, a way for people who have followed their exploits from afar to
see close-ups of Dennis and Tod Mikuriya and Phil Denney and Terence
Hallinan and Valerie and Mike Corral and Mike Alcalay and Ed Rosenthal and
Steph Sherer and Don Duncan and other greats and near greats of the medical
marijuana movement in California.