INVITATION TO AN AMBUSH

As reported here last week, Dr. Phil Leveque -the pro-cannabis Oregon
osteopath whose license was suspended March 4- has been invited to appear
before the House Government Reform Subcommittee on Criminal Justice, Drug
Policy and Human Resources. Claudia Jensen, MD, got invited, too. No other
doctors have, as far as we know. The "investigative hearing" is scheduled
for the afternoon of April 1.

The Subcommittee is chaired by Rep. Mark Souder, an Indiana Republican who
wrote the grotesque bill that cuts off financial aid from students who have
committed "drug crimes" (including marijuana possession in high
school). Souder's proudest accomplishment of 2003 was legislation
reauthorizing the Drug Czar's office and its operations for five more years.

The Souder aide who's organizing the April 1 hearing, Nick Coleman, says
that the committee's interest in Jensen stemmed from an L.A. Times article
that focused on her recommendation of cannabis for ADHD patients -including
a teenager. Jensen's colleagues assume Souder's purpose is to show
pro-cannabis clinicians in a bad light and to develop neo-prohibitionist
legislation. Some have advised her to decline the invitation to appear.

But Jensen relishes the chance to discuss the safety and efficacy of
cannabis in the hallowed halls of Congress, and she is not reluctant to
tell Rep. Souder about the teenager whose cannabis use she authorized. She
plans to bring her two daughters, ages 16 and 13, who have never seen
Washington, D.C. April's a good time to go there.

Most influential among Rep. Souder's corporate sponsors is Eli Lilly,
headquartered in Indianapolis. Lilly is in the midst of a major marketing
push for "Stratera," an ADHD drug. With millions of American school
children taking drugs for ADHD, is it pure coincidence that the gentleman
from Indiana is contemplating legislation that would eradicate the
strongest potential competition?

Mikuriya Decision Ratified

The Medical Board of California has ratified without modification the
"proposed decision" from Administrative Law Judge Jonathan Lew that will
put Tod Mikuriya, MD, on probation for five years, during which time he
must be "monitored" by a fellow physician. The pro-cannabis psychiatrist
was also ordered to pay $75,000 towards the cost of his own prosecution,
and to stop seeing patients at his home office in the Berkeley Hills.

Mikuriya says he can accept the prospect of a monitor -Lew specified that
it could be a fellow cannabis specialist-but not the fine or the constraint
on where he can practice.

A panel of six Medical Board members reviewed Lew's decision and agreed
that Mikuriya had made "extreme departures from the standard of care" in
his treatment of 17 patients. The "departures" generally involved failure
to conduct a physical exam or devise a treatment plan, and issuing letters
of approval implying that patients were under Mikuriya's ongoing care.
Mikuriya argued that as a "cannabis consultant" his role was narrower than
a primary-care physician's, and that none of his patients had been misled
or harmed.

The hearing last September came down to a clash between two expert
witnesses on the procedures required of a doctor approving cannabis use by
a patient. For the prosecution, Kaiser psychiatrist Laura Duskin said the
standard of care was determined by a 1997 "statement" by the Medical Board
directing doctors to conduct a physical exam and to follow the same
procedures when recommending cannabis that they would in prescribing any
other drug.

For the defense, Philip A. Denney MD said that the 1997 statement should
not apply to physicians whose sole function is to determine whether a given
patient has a condition for which cannabis is an appropriate treatment.
Lew's decision referred respectfully to Denney's testimony, but noted that
Denney, as a practitioner, takes his patients' vital signs and conducts
physical exams.

Mikuriya intends to appeal the Medical Board's order. He has two basic
options: ask the Board to reconsider (this must be done before April 19,
when the order takes effect), or appeal to the Superior Court.

Some lawyers experienced in dealing with state boards say it's a waste of
time to ask the board itself for reconsideration. "Why bother with
reconsideration?" sayeth the smart money, "Why put more energy into going
back to the same board that's just hosed you? You don't have to do that to
go on [with an appeal], so why do the exercise?"

In Mikuriya's case there is a special circumstance that might warrant his
asking for reconsideration. The Board's 1997 guideline defining the
standard from which Mikuriya was found to have made an extreme departure is
being revised by a working group that includes representatives from the
California Medical Association and the Board's Enforcement Division. If the
working group -to which Board members William Breall, MD, and Linda Lucks
have recently been added- comes up with practice standards that don't
require a physical exam, Mikuriya would have a common-sense basis on which
to request reconsideration. The revised guidelines are supposed to be
discussed at the Board's May meeting.

Attorney John Fleer thinks the Board's decision to fine Mikuriya and put
him on probation "shows everyone's unease with imposing the standard
they're imposing. In most cases involving the medical board, or any state
board, where you have even one extreme departure, let alone this many, it
would follow that they'd revoke a license. That the order doesn't do that
shows some recognition that this is a developing issue. Dr. Mikuriya wasn't
found to be operating in bad faith -just wrong about the standard he had to
follow."

If Mikuriya's lawyers choose to appeal directly to the Superior Court, they
can do so either in Alameda County, where the hearing was held, or in
Sacramento County, where the Medical Board is headquartered. Fleer says the
advantage of Sacramento is that two judges are assigned to this
administrative-law appellate-type work. "They are more experienced, they
take it real seriously, and they understand how boards work - how arbitrary
they sometimes can be. This would not be a matter of first impression for
the judges in Sacramento as it may be for judges in other county superior
courts."

If and when Mikuriya files a writ to appeal the order, the Superior Court
judge would read the entire record and decide the matter anew. "It's not
just a question of saying 'Was there substantial evidence to support what
the [lower-level] judge did?' It's a trial de novo, based on the hearing
record," Fleer explains.

In other words, a Superior Court judge would read what Laura Duskin said
was the proper standard of care, and would read what Mikuriya and Denney
proposed, and evaluate their reasoning, and give weight to who was in a
position to know best. "It's not unusual for there to be two different
standards being proposed by two different experts," says Fleer, who remains
hopeful. "What the Board has done is accept the testimony of a physician
who doesn't do cannabis recommendations over that of two who do. There
might be judges who think that's an absurdity."

Fleer also used "absurdity" to characterize the $75,000 bill for cost
recovery the board has ordered Mikuriya to pay. "It's a stunning amount
for investigative and prosecution costs. It shows how much effort was put
in by the state to dredge up a case where there was no complainant," says
Fleer. (None of the complaints against Mikuriya came from patients, they
all came from law enforcement.)