Pubdate: Wed, 11 Jun 2003 Source: SF Weekly (CA) Contact: 2003 New Times Inc Website: http://www.sfweekly.com/ Details: http://www.mapinc.org/media/812 Author: Matt Smith Bookmark: http://www.mapinc.org/find?115 (Cannabis - California) Bookmark: http://www.mapinc.org/soros.htm (Soros, George) Bookmark: http://www.mapinc.org/find?168 (Lewis, Peter) HEY, MAN, GOT ANY ID? Why The Legislature Shouldn't Extend The City's Medical Marijuana Identification System Statewide Imagine a health care system in a republic we'll call Doobieland, where public health is overseen by frightened, distracted bureaucrats who don't really believe in the medicine they're supposed to administer, and are fearful that administering it will send them to prison. They'd rather do anything than deal with this situation, so that is exactly what they do. As the bureaucrats go about ignoring, or otherwise distancing themselves from, the task of running a health care program they feel uncomfortable with, that program careens, unsupervised, out of control. Before long, phones go unanswered, medical files lie strewn where they oughtn't be. "Medical records were spread everywhere, where everyone could see them, including AIDS information, where people could see the documents," says Hank Schulz, who until five weeks ago was a clerk in the Doobieland medical world, otherwise known as the San Francisco Department of Public Health, where he helped provide medical marijuana users with identification cards designed to protect them from arrest. Then Schulz was fired, he says, because he complained about problems in the pot-ID program, which was overseen by senior managers. The California Legislature is now considering whether to expand such an ID program statewide. Schulz is, to put it mildly, skeptical. "That's why I laugh when they say they're taking the program statewide," Schulz says. "Because here, it's a joke." San Francisco's pot-ID program exists in the trippy new world of Proposition 215, a ballot measure, passed six years ago, that requires the state to implement the legalization of medical uses of marijuana in defiance of federal anti-drug laws. Prop. 215, of course, didn't provide any real guidance on addressing the minor problem of federal law, which prohibits almost all uses of marijuana. Last Monday, the California Senate took a stab at addressing the conflict, passing a bill modeled on San Francisco's marijuana-ID program, instituted three years ago to provide law enforcement officers with an efficient way to sort medical pot-holders from people who possess bud for mere personal gratification. The bill is set to go to the state Assembly. But perhaps it shouldn't. Problems with the San Francisco pot-ID program, as detailed by Schulz, suggest that other cities and counties may also run into difficulties when they issue medical marijuana identification cards. The cards are based on letters from doctors who say their patients have a legitimate use for medical marijuana. But in San Francisco, Schulz says, a handful of prescription-mill doctors have issued thousands of recommendations that people get medical marijuana ID cards -- at a fee of $250 per recommendation. As these questionable recommendations rolled in, Schulz says, senior Health Department officials appeared to distance themselves from the pot-ID program, apparently fearful of legal ramifications. "The DPH was paranoid about it the whole time. The two direct supervisors who were supposed to be in charge of this program never talked to me, ever. They never responded to our phone calls. We helped six other counties set up programs. I found out later [DPH officials] were angry I had done all this," Schulz says, adding that his nominal supervisor, Josh Bamberger, seemed anything but interested. "He never talked to me about it. It's indicative of the department's attitude. It's such a low priority. Their attitude seems to be, "We kind of want to do this, but we don't want to do it.'" Bamberger, medical director for the department's division of housing and urban health, says that the marijuana-ID program is humming along quite well, and that he knows nothing of Schulz's complaints. "I can't be responsible if a particular employee has made certain claims," he says, contending that the department has complied with federal laws guaranteeing medical privacy. San Francisco Assemblyman Mark Leno, who sponsored the city ordinance enabling the pot-ID program, says he doesn't believe alleged difficulties in San Francisco will hamper the prospect of a statewide ID program. "All I can say is, the program we designed is not that complex, and it can be easily implemented. If there are problems in implementation, I don't think it has to do with the program. I think the program is fairly straightforward and implementable," Leno says. The program may sound simple, on its face. But through the haze, some questions loom: Which communities in California have health departments staffed by medical professionals who are unafraid of DEA agents? Which county or city has a health department staffed by doctors who believe marijuana represents an important area of medical practice? - ----------------------------------------------------------- Though the emphatic statements of a few doctors who believe strongly in medical marijuana can make headlines, medical science as a whole is actually a long way from becoming a pot advocate's club. The primary medical use of marijuana is the supposed alleviation of nausea and vomiting associated with chemotherapy. But chemotherapy and its associated anti-nausea drugs have advanced greatly since pot was observed to provide some relief in the 1970s. Now the active drug contained in the marijuana plant, THC, is considered a third choice in the treatment of chemotherapy-induced nausea; there are plenty of medications that are considered more effective. But the medical marijuana movement has never really been based, primarily and overwhelmingly, on pot's supposedly medicinal powers. Health care in Doobieland has been burdened since its inception by the ambiguous motives of medical marijuana's sponsors, who have appeared to see medicinal pot less as a means to alleviate the suffering of a small group of medical patients than as a first step toward completely legalizing pot. Proposition 215 wouldn't have even made the ballot without financing from a pair of billionaires bent on legalizing drugs for recreational use. Prop. 215 backer George Soros is a financial speculator who in 1994 funded the creation of the Lindesmith Center, a New York think tank that has called for the legalization of marijuana and other drugs. Co-backer Peter Lewis is a billionaire insurance executive who has also spent millions fighting drug laws. In 2000, Lewis was arrested in New Zealand after customs agents caught him with 103 grams of marijuana and hashish, assorted smoking pipes, and bongs. Soros and Lewis' measure may well have helped hasten the day recreational marijuana use becomes legal; it's impossible to know for sure. But it's clear that as a health initiative, Prop. 215 has been a harsh toke. - ----------------------------------------------------------- In place of ordinary health care of the sort that endeavors to identify, and then treat, the ailments of patients, Prop. 215 has created a reefer-blurred medical underground. Shuffling through this world are the tens of thousands of conniving potheads who know that "medical marijuana" bought with city ID cards can be cheaper, of higher quality, and less likely to result in arrest than street weed. They're the ones lining up at the script-doc clinics, at the medical cannabis clubs, and on "cannabis medicine" Internet bulletin boards. This world is populated with profiteering drug dealers -- "medical cannabis clubs," in this world's parlance -- who've enjoyed a multimillion-dollar windfall, often tax free. (Many of these groups are organized as nonprofits.) In place of legitimate medical professionals, Reefer Rx has script-churning M.D.s with Web sites such as potdoc.com or cannabisdoctor.com. Their approach to medicine, which involves writing thousands upon thousands of identical prescriptions for a flat fee of around $250 each, appears to run afoul of ordinary medical ethics. According to Schulz, just three aggressive script doctors have provided approximately a third of the 7,500 prescriptions San Francisco has used as evidence for issuing medical marijuana ID cards. James Green, owner of the Market Street Club, which seeks to provide marijuana only to legitimate patients, says he believes the San Francisco ID program makes his task more difficult, rather than less. Green demands doctor recommendations of medical marijuana use, regardless of whether patients have city pot-ID cards. He says that he's recorded some 10,000 cases where documents came from doctors he considers illegitimate profiteers. "I refuse 24 out of the 25 [S.F. pot-ID] cards that are handed to me," Green says. "I've always been kind of surprised the Department of Public Health isn't concerned about this. Why can't I buy a letter of recommendation for Demerol? Why can't I buy a death certificate for somebody I have life insurance on? Why can't I buy a certificate to verify a workman's comp claim? I can't believe these people haven't noticed this." Bamberger, the city bureaucrat who helps supervise the pot-ID program, defends his department's practices in regard to doctor recommendations. "Are doctors doing this for the right reason? Or are they just being paid to do it? We don't feel that's something our Health Department or any other department should be involved in," Bamberger says. "The relationship between doctor and patient is a sacrosanct relationship we don't wish to undermine." There are other reasons why public health officials such as Bamberger might want to distance themselves from the details of medical marijuana. Despite widespread sympathy for the theory that marijuana can have legitimate medical uses, George Bush's Justice Department remains bent on enforcing federal narcotics laws that prohibit pot. Bureaucrats assigned to the implementation of medical marijuana programs look over their shoulders and imagine handcuff-toting federal agents. "Anything that normally is done with any other DPH program, such as talking to the public, is not done with the medical cannabis program," Schulz says. "It's schizophrenic." As bureaucrats distance themselves, prescription-mill doctors make fortunes, and perfectly healthy "medical" pot smokers get high as kites, the AIDS patients, leukemia patients, and glaucoma patients whom Prop. 215 was meant to help suffer in Doobieland. They have heard that the THC in marijuana may help alleviate their suffering, but when they look for health care providers who will help educate them about it -- and provide or not provide it, depending on what is the appropriate medical course -- they find themselves in the company of people who seem unconcerned with the spirit of the Hippocratic oath, which precludes prescribing inappropriate drugs. And then, they have to deal with a city bureaucracy that strews the medical records of AIDS patients willy-nilly on the desks of well-trafficked offices. - ----------------------------------------------------------- When Hank Schulz entered the world of medical marijuana three years ago, he was a true believer in the potential for implementing Prop. 215. "Marijuana is really a fantastic drug. I have seen it make huge differences in people's lives," he says. "It was really changing people's lives. People couldn't eat. They'd come back and say, "I've gained 15 pounds.'" But Schulz says he couldn't get his superiors to focus on creating a quality pot-ID program. The word from those superiors, he says, was, ""Don't talk to me about that -- it's the lowest priority.'" So Schulz, a former college anthropology instructor who had worked in the DPH's disease control division for the previous five years, says he went about fashioning a program on his own, sans supervision. This task was difficult; the issuance of medical marijuana IDs had been shunted to the department's vital records counter, an area run so inefficiently that employees feared a furious customer might come in and shoot the place up, an area so disorganized it was known in the department as "hell." Mail requests for birth or death records, for instance, typically took six months. "They had a person whose job it was to open the mail, take the check off the order, put the order aside, then process the check. The check would come through, or the credit card would come through, and the documents wouldn't come," Schulz recalls. "Talk about making people angry." Even within the Siberia of vital records, the medical marijuana ID program was given lowest priority, Schulz says. So he and his fellow vital records clerks began dealing with obvious needs. Though plenty of potheads and street people came to the window, some customers were elderly cancer patients, or young people with AIDS. They were squares, straights -- people ignorant and nervous about the possible implications of toking up. "They'd come in paranoid, asking, "Is this going to get us addicted?' We ran such a spectrum of people to help that people would come in crying at times, all upset, questioning and wanting information. At the doctors' level -- doctors will only give their patients a recommendation. What they all did was say, "Go to your health department.'" So when people asked questions about medical marijuana, Schulz tried to offer answers. "We had a script that said, "Don't smoke it outside. Don't share it with friends,'" Schulz recalls. "In actuality, when it was all said and done, I wasn't supposed to do that." The AIDS sufferers and chemotherapy patients who medical marijuana advocates believe benefit from the drug tend to be shut-ins. So Schulz began making house calls during his off hours, bringing a laptop computer and camera to create medical marijuana IDs. To obtain IDs, patients submitted doctor recommendations that were often quite detailed. Patients were also required to fill out questionnaires that asked for detailed medical information; as a result, the program produced reams of sensitive medical records. The department's policy was to have the records destroyed, so there would be nothing for federal agents to subpoena in the event of prosecution. But Schulz says the records were routinely left on employees' desks, despite his complaints. (Though Schulz ran the medical marijuana ID program day to day, the vital records division had its own boss who was ultimately responsible for physical records.) "For three years, I complained; we're leaving these records scattered all over our desks where 25 people could get hold of them. That's very bad for a health agency," Schulz says. "About three months ago they gave me a lockbox. It was used for two nights in a row, and never used again." - ----------------------------------------------------------- Around that time, the San Francisco District Attorney's Office asked for a Health Department official to appear in court supporting the marijuana-ID program. Schulz says he asked for permission to testify, which was denied. The medical marijuana ID program "kind of became an issue. We were no longer allowed to tell the patient anything," Schulz says. "When the district attorney issue came up, they choked up all our ability to give information. They continued to cut our hours to only several hours a day on a random schedule. "For three years, because I was never given any direction, I created a program based on need. Little by little, as they found out what I was doing, I was chastised and reprimanded." A month and a half ago, Schulz says, he used a department photocopy machine to print 25 fliers saying the building he worked in wasn't earthquake-proof and distributed them to co-workers. He was fired, he says, for inappropriate use of DPH equipment. Bamberger would not comment on Schulz's firing. But one doesn't have to believe Schulz is the moral equivalent of Karen Silkwood to think his story raises an interesting question or two. How could a San Francisco program whose administrator was fired after complaining about mismanagement -- a program that is now "in transition," to use the words of a woman who answered the Health Department's pot-ID telephone line - -- possibly be held up as a model worthy of copying statewide? What has the Legislature been smoking? - --- MAP posted-by: Doc-Hawk