DR. MIKURIYA DEFENDS HIS PRACTICE

The Medical Board of California's prosecution of Tod Mikuriya, MD, began
Sept. 3 with the testimony of an expert witness, Kaiser psychiatrist Laura
Duskin. The scene was a fluorescent hearing room at the state office
building in Oakland, presided over by Administrative Law Judge Jonathan
Lew, a trim, soft-spoken man with a businesslike air. About 20 of the 30
seats were taken by Mikuriya's friends and well-wishers on opening day.

Duskin said she had read 17 of Mikuriya's patients' records (which had been
subpoenaed by the MBC after the doctor wouldn't hand them over) and
determined that he had failed each patient, not by approving their use of
cannabis but by stating on their letters of approval that they were under
his "supervision and care" for their various conditions. In the Court of
Common Sense such phrasing would be considered, at worst, a semantic error,
not "an extreme departure from the standard of care."

In some of the 17 cases, according to Duskin, Mikuriya had failed to
conduct an adequate exam, specify a treatment plan, or arrange proper
follow-up. Duskin said she could adduce all this from the files because,
"From day one in medical school they teach us, 'If you didn't write it
down, it didn't happen.'" She quoted this literally wrong dictum as if it
were some sanctified truth, as if the paperwork really is more important
than the actual interaction between doctor and patient.

Duskin went to medical school at UCSF and she did a residency in psychiatry
there. She retained her UCSF affiliation while working at San Francisco
General and, for 10 years, at Laguna Honda Hospital. She taught
interviewing techniques to resident physicians at UCSF and still gives "the
occasional lecture," she said.

Laura Duskin is the personification of the San Francisco medical
establishment in her attitude towards marijuana. Although she/they never
challenged the prohibition, they now claim to believe in its relative
safety and limited efficacy. "Marijuana can be very helpful for certain
conditions for certain patients," Duskin asserted as the Assistant AGs -two
remnants from the Lungren regime-nodded understandingly. On at least eight
occasions during her day and a half on the stand Duskin repeated her fair
and balanced view. She said she had been favorably impressed by a talk
she'd heard Mikuriya give c. 1997 at a conference of addiction specialists,
and also by his files on nine nursing-home patients that the Medical Board
had once assigned her to review as part of a separate investigation.

There wasn't the slightest self-critical edge to Duskin's testimony. She
didn't acknowledge that she had been taught nothing about cannabis -zero,
zip, nada word-during her pharmacy classes at UCSF. Nor did she reveal that
during her years at Laguna Honda, patients were denied access to cannabis.
Dr. Duskin said that she has never issued an approval for a patient to use
marijuana, but she hopes that someday somebody will ask her to do so. (At
the S.F. district attorney's office I used to hear bitter complaints from
Laguna Honda residents who had been punished for copping a smoke on the
grounds. If only I'd known, I could have turned them on to Laura Duskin.)

The prosecution called only one other witness, Steve Gossett, a deputy
sheriff who heads Sonoma County's marijuana investigations unit and is
known to the locals as a zealous drug warrior. The Attorney General's
office had threatened to add a complaint involving Gossett if Mikuriya
didn't accept their settlement offer. (Such blackmail is the "standard of
practice" in the legal world.) And Mikuriya didn't accept the deal, the
A.G. carried out the treat. Gossett testified that he had visited Mikuriya
at an ad hoc clinic in Oakland in January '03 and obtained a letter of
approval based on bogus claims of shoulder pain, stress, and sleep problems.

On Friday, Sept. 5 the defense called its expert, Philip Denney, MD, an
experienced family practitioner from Loomis, CA. Denney said he'd reviewed
the 17 files and determined that Mikuriya had, in each case, elicited
enough information to justify approval of continued cannabis use. (All the
patients, including Gossett, told Mikuriya that they had been
self-medicating prior to seeking his approval.)

Denney defined Mikuriya's as a "medical cannabis consultation practice" in
which "patients are seeking the answer to one specific question: 'Do I have
a medical condition for which cannabis might be a useful treatment?'" He
faulted the Board for not issuing guidelines relevant to such practices.

Denney testified that the records of at least one other Northern California
medical-cannabis consultant had been seized by government agents, and that
the threat of confiscation was "a good reason for noting the minimum amount
necessary" on patients' charts. Denney said he was "scared to death" by the
prospect of reprisals from law enforcement as a result of his support for
Mikuriya.

But he exuded confidence intellectually. He said he kept up with
developments in the field of cannabis therapeutics, and had monitored its
use by some 7,500 patients. Denney explained that the cannabis plant
contains active ingredients other than THC, and that Duskin's definitions
of Marinol as "synthetic marijuana" and "a pharmaceutical form of
marijuana" were inaccurate. He said that the Medical Board's classification
of cannabis as a "dangerous drug" was "scientifically invalid."

As this report is filed at mid-day on Tuesday, Sept. 9, nine patients have
testified. Although the Medical Board is prosecuting Dr. Mikuriya in their
names, none had filed complaints against him. All the patient-witnesses
recalled Mikuriya as being thorough, attentive, and empathetic when he took
their medical histories. All expressed gratitude to him for authorizing
their cannabis use. All were either visibly ill or had records from other
doctors establishing and/or confirming the seriousness of their problems

In fact, given the severity of the illnesses of the patients named in the
Accusation, one could conclude that the Medical Board was not out to "get"
Mikuriya. If they had been, they would have chosen younger patients with
milder ailments. On the other hand, the Board's investigators might have
believed what their physician-experts told them, i.e., that Mikuriya's
records were so cursory that a sampling of any 15 patients would suffice to
hang him.

The patients' testimony has been extremely moving and believable. More
details next week. Mikuriya is about to take the stand in his own defense.
He hopes he can testify that all the complaints investigated by the Medical
Board came from law enforcement -a pattern the prosecution has tried to
keep out of the record.

Add ironies: In 2001 Laura Duskin commented to Bruce Mirken of the Bay
Guardian about the costly, ineffective treatment of far-gone addicts and
alcoholics in San Francisco: "The Community Health Network is not savvy at
all about figuring out how to serve these complex patients. They don't ask
their frontline providers..." The Mikuriya defense can be summarized in a
paraphrase: "The Medical Board is not savvy at all about doctors who serve
medical cannabis patients. They don't ask the frontline providers."

Herb Caen item: The hearing is being held in a building named in honor of
an Oakland pol named Elihu Harris. Monday morning your correspondent
overheard a 50ish white woman at a pay phone in the lobby say, "I'll be
waiting on Clay Street, in front of the Emmy Lou Harris state office building."

- -30-