DENNEY OPENS ORANGE COUNTY OFFICE

On Feb. 9, Philip A. Denney, MD, started seeing patients at a "cannabis
evaluation practice" in Lake Forest, a city at the intersection of Freeways
5 and 405 in Orange County. If the demand is as great as Denney
anticipates, he hopes to interest other physicians in the new specialty,
which he defines as "determining whether a patient has a serious medical
condition that could be treated safely and beneficially with cannabis."

Denney has already recruited Robert E. Sullivan, MD, a former associate in
a Sacramento practice, to join him in Orange County.

An estimated 60,000 patients have gotten physician approvals to use
cannabis In the more-than-seven years since it became legal. "That
represents a very small set of the population that could be helped by
cannabis if knowledgeable doctors were available throughout the state,"
says Denney.

Twelve doctors specializing in cannabis evaluations have issued
approximately half the approvals to date, and all but one of those doctors
are in Northern California.

For most of his 27-year career Denney was a family practitioner. In the
late 1990s, having become aware that doctors who approved cannabis in
treating conditions other than AIDS or cancer were few and far between, he
began studying the available medical literature and corresponding with
specialists in the area. In January, 1999, Denney opened an office in
Loomis, East of Sacramento, specializing in cannabis evaluations.

"It was obvious when we had our practice in Loomis," says Denney (the 'we'
refers to his wife Latitia, who manages his office), "and people kept
showing up from all 58 counties, that there was a tremendous need and
demand throughout the state." A related need, according to Denney, is for
a Continuing Medical Education course that would bring California doctors
up to speed on a subject they learned nothing about in Med School.

By the fall of 2002 Denney had approved cannabis use by some 8,000 patients
and decided he would take early retirement. He transferred his practice (to
William Turnipseed, MD) and devoted himself to reading, gardening, spending
time with his family, and doing all the projects that needed doing on his
hilltop spread in rural Greenwood. But he didn't entirely withdraw from the
fray -he helped defend colleagues under attack by the Medical Board of
California, and he kept abreast of the medical literature and
cannabis-related political developments.

In May 2003 Denney appeared before the Board to protest the investigation
of nine doctors specializing in cannabis consultations. "When you mention
that nine investigations is a small number, you must consider the effect of
those investigations on the rest of the physicians in California," Denney
reminded the Board. "The sanction of even one physician will have a
dramatic impact on the practices of all others." (Denney himself has never
been investigated by the Board, a fact he attributes to the rigor with
which he takes histories, reviews records, and conducts physical exams.)

Denney also served as an expert witness in defense of Tod Mikuriya, MD -one
of the cannabis specialists whom the Medical Board's Enforcement Division
had chosen to prosecute. Denney reviewed the relevant files and testified
that Mikuriya had elicited enough information in each case to justify
approval of continued cannabis use. Mikuriya's practice should not be
evaluated by the same standards as a conventional practice. "Patients come
to a medical cannabis consultant seeking the answer to one specific
question: 'Do I have a medical condition for which cannabis might be a
useful treatment?'" Denney faulted the Board for not issuing guidelines
relevant to such situations.

A key factor in Denney's decision to resume practicing medicine was the
October 2003 decision by the U.S. Supreme Court to let stand the ruling in
the Conant v. Walters case: federal authorities are permanently enjoined
from threatening or punishing California doctors who approve cannabis use
by their patients. "The Conant ruling," says Denney, "was tremendously
reassuring."

Denney says that "more than 95%" of the patients to whom he has issued
approvals had been self-medicating with cannabis before consulting him. The
conditions with which they present, he estimates, are: chronic pain (50%);
neurologic (20%); psychiatric, including ADHD and as a "harm reduction"
substitute for alcohol (15%); gastro-intestinal (10%); other (5%).

None of Denney's patients have reported serious adverse reactions or drug
interactions. "Cannabis has been used medicinally for thousands of years,"
Denney says, "and has a remarkably benign side-effect profile."

For more information, or to arrange an appointment, contact the office of
Drs. Denney and Sullivan at 949-855-8845.

PS. Denney and Sullivan are announcing their presence through an ad in
the Orange County Weekly (whose commercial mainstays are tacky Botox and
plastic surgery ads). The first D&S ad ran on Feb. 5 -an expanded business
card with a small boldface headline: "Medical Cannabis Evaluations." By the
end of opening day there had been three or four calls from young men who
thought the ad was offering employment as taste testers. Where there's
youth, there's hope!

Mikuriya Case Update

By now Administrative Law Judge Jonathan Lew has presumably filed his
"Proposed Decision" advising the Medical Board whether or not to punish Tod
Mikuriya, MD (and if so, by what measures. At a lengthy hearing this fall,
the Attorney General, representing the Board, charged that Mikuriya had
violated the prevailing standard of care in approving cannabis use by 17
patients (one an undercover narc). The Board's expert witness had come to
this conclusion by reading Mikuriya's patients1 charts -but she hadn't
contacted any of the patients to determine if their treatment at his hands
had actually been harmful or beneficial.

Mikuriya defended his methods of determining whether patients were using
cannabis appropriately and rightfully. The evidence showed that all his
patients -except the narc, of course-had benefited from cannabis use. Nine
patients testified that Mikuriya had conducted thorough and empathetic
exams. At the very end of the hearing, ALJ Lew asked Mikuriya if he would
be willing to modify his procedures in the future, and Mikuriya said
"Absolutely." The exchange left him hopeful that a career-ending stand-off
might be averted.

The Board has 30 days to review the judge's Proposed Decision. In this
period a six-member panel from the Board's Division of Medical Quality
votes by mail on whether or not to adopt the Proposed Decision. Four
"adopt" votes suffice. If two members vote 3Hold,2 the panel will discuss
the case behind closed doors at the May Board meeting. (Two 3hold2 votes
prevail over four 3adopt2 votes.) In deciding whether to accept the
Proposed Decision, the panel can order and review the transcript of the
hearing and take oral and written arguments from Mikuriya and the AG1s office.

SO, Mikuriya's fate could hang in the balance for a long time. Some
generalize that delays are good for the defendant -in this case, the doctor
who stands to lose his license-because life goes on in the meanwhile... But
the law's delays can also be a mild form of torture (see Hamlet's Top 10
reasons to commit suicide). "Let him twist slowly in the wind" Nixon told
his henchmen -Don't let Patrick Gray know his job status. It's been years
since Mikuriya felt he could make longterm work plans. If the Medical Board
allows him to keep practicing, he says, he sees himself sharing an East Bay
office with other cannabis specialists, gladly adhering to whatever
clear-cut, sensible guidelines the Board has established for them.