Pubdate: Sun, 05 Nov 2006
Source: Desert Sun, The (Palm Springs, CA)
Copyright: 2006 The Desert Sun
Note: Does not accept LTEs from outside circulation area.
Author:  Lisa Leff
Bookmark: (Cannabis - Medicinal)


Vague Language In Proposition Left Doctors In Sticky Situation

COOL - When Dr. Mollie Fry opened a storefront clinic next to the 
only post office in this Gold Country town, she did not think that 
telling her patients where to get the medicine she recommended for 
pain, depression and nausea would be a problem.

The federal drug agents who raided her home and office thought 
otherwise. So did the grand jury that indicted Fry last year on 
felony charges of conspiring to distribute marijuana.

"I assumed the fact that I had 'M.D.' at the end of my name gave me 
the right to make judgments about people's health," said Fry, who 
estimates she has issued thousands of cannabis recommendations since 
setting up her thriving practice northeast of Sacramento in 1999.

Since California passed the nation's first medical marijuana law a 
decade ago, among the provisions that has been tested in courts, and 
proven troublesome in buyer's clubs and clinics like Fry's, was one 
requiring ill patients to obtain a doctor's written approval before 
they could legally grow or buy pot.

The tension between the mandate and federal drug laws that presume 
marijuana has no medicinal value has left room for plenty of errors 
and trials, as well as confined the conventional doctor-patient relationship.

Until the stalement is resolved, doctors recommending marijuana do it 
with trepidation and a good deal of risk.

A brave contingent Medical marijuana advocates estimate that 1,500 
doctors have authorized pot for at least one patient, most of them 
oncologists or AIDS specialists. But the vast majority of 
recommendations have come from a close-knit cadre of about 15 
self-appointed specialists, the so-called "pot docs" who charge $150 
and up to walk what the California Medical Association calls "a gray 
area between the clearly permissible and clearly impermissible 
categories of action."

Following complaints by local law enforcement, just about all have 
been investigated by the state board that licenses and disciplines 
physicians. Four were doctors who devoted their practices to acting 
as medical marijuana consultants and ultimately received sanctions 
ranging from the public rebuke that Fry got to having their licenses suspended.

California's medical marijuana law, also known as Proposition 215, 
established a pivotal role for doctors in the measure's 
implementation, holding that seriously ill patients had the right to 
use pot "where medical use is deemed appropriate and has been 
recommended by a physician who has determined that the person's 
health would benefit."

The law named a host of ailments for which marijuana might prove 
helpful in easing symptoms: cancer, anorexia, AIDS, glaucoma, 
arthritis, migraine. And unlike the medical marijuana laws that would 
eventually be enacted in 10 other states, the California measure also 
gave doctors discretion to certify patients with "any other illness 
for which marijuana provides relief."

That vague language left it up to doctors to decide what constituted 
a serious illness for which marijuana was the best treatment option 
and opened the door for recommendations being given to people who did 
not need them.

David Thornton, executive director of the California Medical Board, 
said an obvious red flag for the agency would be a doctor whose 
patients are primarily men between the ages of 18 and 25. But he 
allowed that until the board issued guidelines two years ago 
outlining what constituted "accepted medical standards" under the 
1996 voter initiative, physicians pretty much had to figure it out on 
their own. Most concluded it was not worth the risk.

"The role of physicians was not that clearly explained (in the 1996 
law), although it was left to physicians to be the ones, in their 
informed opinion, to determine whether a patient would benefit from 
marijuana," Thornton said. "Until federal and state law are 
harmonized, it's going to be difficult."

Although a federal appeals court ruled four years ago that the U.S. 
Drug Enforcement Administration cannot go after doctors merely 
because they recommend marijuana to patients, the state medical 
board's guidelines make it clear the ruling did not amount to 
immunity either from prosecution or disciplinary proceedings.

The board advises doctors, for instance, that relying on a patient's 
word instead of prior medical records to determine whether a 
marijuana recommendation is appropriate could constitute medical 
negligence. Failing to conduct an independent exam or to consider 
whether another drug would be just as effective could similarly lead 
to charges of unprofessional conduct.

The company line The California Medical Association is even more 
explicit, warning doctors never to tell patients where to get pot and 
urging them to remind patients of possible side-effects. Discussing 
dosages with patients, opining on whether they should smoke or eat 
marijuana, and signing a form that enables patients to obtain a 
state-issued medical marijuana ID card also are steps the medical 
association cautions its members to avoid if they don't want to end 
up like Fry.

Frank Lucido, a Berkeley family physician who devotes about 30 
percent of his practice to working with medical marijuana patients, 
said he abides by those recommendations, but thinks pot docs are 
being held to higher standards than doctors who prescribe lots of 
Viagra, prescription painkillers and other abused medications. 
Doctors who prescribe sleeping pills for patients who complain of 
insomnia, Lucido noted, are not at risk of being called quacks if 
they don't do a hands-on exam or develop a long-term treatment plan.
- ---
MAP posted-by: Beth Wehrman