Pubdate: Wed, 10 Sep 2003 Source: Anderson Valley Advertiser (CA) Column: Cannabinotes Copyright: 2003 Anderson Valley Advertiser Contact: http://www.mapinc.org/media/2667 Author: Fred Gardner Bookmark: http://www.mapinc.org/find?115 (Cannabis - California) Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) 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- - --- MAP posted-by: Jay Bergstrom