"PROPOSED DECISION" IN MIKURIYA CASE

The Medical Board of California has received a "proposed decision" from
Administrative Law Judge Jonathan Lew in the case of Tod Mikuriya, MD. Lew
ruled that Mikuriya made "extreme departures from the standard of care" in
his treatment of 17 patients (one a narcotics agent posing as a patient).

All the patients had told Mikuriya they had been self-medicating
successfully with cannabis; all received his written approval to continue
doing so.

Mikuriya's handling of the 17 cases was reviewed in detail at a six-day
hearing conducted by Lew in September 2003. No harm was alleged to have
been done to any of the patients; in fact, all have expressed thanks and
praise for Mikuriya.

The prosecution case was made by an expert witness, a Kaiser psychiatrist
named Laura Duskin, who had read Mikuriya's files but did not interview any
of his patients.

The good news for Mikuriya is that the sanctions do not include suspension
or revocation of his license, nor does Lew propose that Mikuriya attend
remedial classes. Such indignities would have driven the 70-year-old
psychiatrist to contemplate early retirement (although he has a 10-year-old
daughter whose education he intends to pay for.)

Appeal Planned

No sooner had Mikuriya perused the 46-page decision, received by certified
mail on March 5, than he declared his intention to appeal two of the
sanctions: paying $75,000 in "cost recovery" to the Medical Board and the
Attorney General's office for prosecuting him; and losing the right to see
patients at an office in the basement of his house in the Berkeley hills
(for which he's had a use permit from the city since 1970).

Lew also proposed putting Mikuriya on probation for five years, during
which time his practice must be monitored by another physician. The
monitor, Lew specified, could be a physician who specializes in cannabis
consultations, such as Philip Denney, MD, who appeared as an expert witness
for the defense. Mikuriya says he would not object to being monitored by
Denney.

Mikuriya is the best-known proponent of cannabis therapeutics among
California physicians. He says he feels impelled to fight the $75,000 fine
not just for personal economic reasons but because "there are thousands of
doctors who are waiting for the political climate to feel safe so they can
discuss cannabis with their patients. This exorbitant fine will send a
chilling, inhibiting message to them."

A six-member panel of Board members will meet April 13 in Sacramento,
behind closed doors, to decide whether to adopt or modify Lew's decision.
If their "verdict" is unacceptable, Mikuriya will appeal to a Superior
Court judge. In the meantime, he continues to practice.

Guidelines Old and New

Lew's ruling relied heavily on a statement issued by the Medical Board in
1997 in response to the passage of Prop 215: "While the status of marijuana
as a Schedule I drug means that no objective standard exists for evaluating
the medical rationale for its use, there are certain standards that always
apply to a physician's practice that may be applied. In this area, the
Board would expect that any physician who recommends the use of marijuana
by a patient should have arrived at that decision in accordance with
accepted standards of medical responsibility i.e., history and physical
examination of the patient' development of a treatment plan with
objectives; provision of informed consent, including discussion of side
effects; periodic review of the treatment's efficacy and, of critical
importance especially during this time of uncertainty, proper record
keeping that supports the decision to recommend the use of marijuana."

Mikuriya had objected to this guideline from the time the Board issued it.
In 1998 he and about a dozen like-minded colleagues formed an organization,
the California Cannabis Research Medical Group (CCRMG), that drafted
practice standards appropriate to their unique real-world situation-meeting
the tremendous pent-up demand by countless thousands of patients who have
been self-medicating safely and effectively with cannabis but who are
unwilling to seek or unable to get approval from their regular doctors.

In March 2003 Mikuriya and Frank H. Lucido, MD, formally asked the
California Medical Association to adopt the CCRMG "minimum practice
standards" and lobby the Medical Board follow suit. (The Board's 1997
statement had been drafted with CMA input; but since then the CMA had
abandoned its opposition to California's medical marijuana law.)

At its March 2003 meeting the CMA adopted a modified version of the CCRMG
minimum practice standards and delegated its lawyers to work with the
Medical Board on revising its 1997 statement. As of January 2004 a joint
CMA-Medical Board task force had finished drafting a revision of this
all-important guideline. But at the Jan. 30 meeting of the Board,
Enforcement Chief Joan Jerzak said the draft was not yet available for the
members to review.

So... it is possible that the Medical Board will adopt guidelines in the
months to come that will make Mikuriya's practice standards acceptable in
retrospect. Whether or not that happens, the six-member panel that reviews
Judge Lew's "proposed decision" can decide to modify it in the direction of
leniency (or otherwise).

Professional Courtesy

William Eidelman, MD, had his license suspended by the Medical Board in May
2002, after he'd approved marijuana use by four undercover police officers.
At the time the Santa Monica-based general practitioner had issued more
approvals than any doctor in Southern California. Last month in Los Angeles
Administrative Law Judge Stuart Waxman heard two days of testimony in the
Eidelman case, including two hours from the expert witness for the defense,
Tod "Quixote" Mikuriya.

It was brave -some might say "foolhardy" or "self-destructive"- of Mikuriya
to take the stand, because Eidelman has been tarred as a pariah. The
Medical Board's former Chief Investigator referred to him as an "egregious
example... whose medical office contained a computer, a printer and a cash
register. There were no other instruments in that office. There was very
little the physician was doing medically in that office to determine
whether there had been an indication for a prescription. You walked in, you
paid your money, your name was put in the computer, and a letter was
generated."

Even some of Eidelman's patients complain that he conducts a cursory exam.
But he also has his supporters. Sister Somayah, a respected Los Angeles
activist, told C-Notes that Eidelman was the only doctor who'd ever shown
interest when she reported that cannabis helped ease the symptoms of Sickle
Cell anemia.

Mikuriya says that his testimony in L.A. was not an endorsement of
Eidelman's practices, per se, but an explanation to Judge Waxman of the
"minimum practice standards for the cannabis consultant practice model."
Get the distinction? Mikuriya assumes the Medical Board panelists -who now
hold his fate in his hands-will.

"Cannabis consultations are medical forensic interactions with much more
narrow and specific goals as compared with general medical practice," says
Mikuriya. "Specifically, 'In your medical opinion does this individual
qualify to be protected from marijuana law for self-medicating?' Period.
Anything else lies beyond the scope of this circumscribed medical
consultation. No police-or prosecution-fantasized comprehensive medical
diagnostic workup.

"Cannabis consultancy is in the same area as a Medical Review Officer
reviewing results of drug testing -a forensic practice, but different. The
minimum practice standard of the California Cannabis Research Medical Group
mandates an initial face-to-face interaction and collection of ID and
code-able diagnostic information."

The cannabis consultant, according to Mikuriya, understands that cannabis
has been used to treat an extremely wide range of conditions. He or she "is
retained to both diagnose and make the judgment" of whether cannabis is an
appropriate treatment in a given case. If such a subspecialty didn't exist,
says Mikuriya, cannabis would be available only to those afflicted with "a
short list of politically correct medical conditions."

"The specialty of cannabis consultancy did not exist before the passage of
Proposition 215," Mikuriya observes, and there would have been no need for
it if the law had specified the conditions for which cannabis could be
used. (It was Mikuriya who insisted that the phrase "...any other condition
for which marijuana provides relief" be included in the ballot initiative.)

The Medical Board's expert witness in the prosecution of Eidelman, Jeffrey
Barke, MD, will be recalled to testify when the hearing resumes April 7.
According to an Eidelman supporter: "Barke stated that because Dr. Eidelman
didn't do a physical examination and because he did not order lab tests,
MRIs, etc., he was a danger to the public. He was not a danger for
recommending marijuana... he was a danger for recommending ANYTHING, even
exercise or vitamins, without doing a thorough primary care workup....

"A member of Eidelman's legal team felt that Dr. Barke was selling the
Medical Board's case too hard, that Dr. Barke himself couldn't abide by the
absurd criteria he applied to Dr. Eidelman. Thus it was that this member of
the legal team had several conversations with Dr. Barke, though they never
met. The final conversation led to a call-in prescription for Viagra. There
was no history and no physical exam."

When the hearing resumes, "Dr. Barke will have to answer to the court...
how, in the face of his testimony against Dr. Eidelman, he could prescribe
Viagra, a drug known to cause death in vulnerable patients, without taking
a history or doing a physical."