Members of the Medical Board of California’s Division of Medical Quality:

As always it is a pleasure to address you again.

As many of you know, I appeared recently on The O’Reilly Factor, based on an acknowledgement that I was a medical cannabis consultant with high standards and ethics.

One of his producer/reporters had gone to 3 cannabis dispensaries in L.A., and tried to buy cannabis without a doctor’s recommendation. He was refused at all three, but 2 of them gave him the card or number of a clinic nearby, where in a 15 minute interview, he obtained a recommendation, and then was able to purchase cannabis.

When asked my opinion, I responded that it sounded like poor quality medicine, but that this was the minority of cannabis recommending doctors.

A more complete story on the O’Reilly segment will be given to you in with my written statement, so I won’t go into that more here.

Interestingly, not only did I receive the Bill O’Reilly “seal of approval” for my standards, but Joan Jerzak, the MBC Chief of Enforcement, called me and asked me to please have a talk with Dr. Anonymous.

Now, I believe that Dr. Anonymous has low, embarrassing standards, but to his credit, he states that the 15 minutes spent were a detailed discussion of the patient’s migraine history.

The fact is that there is a wide range of acceptable standards when recommending a medicine that is so safe and effective.   And even the lowest standard doctor I have heard of has not harmed a patient, and probably never will.

Their business ethics may be questionable, but what I call greed is, unfortunately, called capitalism in the U.S.

The worst thing about the low standards clinics isn't the unlikely possibility of physical harm, but the poor medical-legal protection that they are offering the patient.

Those with higher standards offer more medical-legal protection along with their evaluation.

Some, by requiring documentation of diagnosis, and at least yearly follow-up by their own doctor, as I do.

Others, by taking a careful, extensive history, and confirming the stated diagnosis, or by making a diagnosis de novo based on that evaluation, and clearly documenting how they arrived at their diagnosis.

I have gotten at least a couple messages from doctors to "give the MBC the green light to go after the bad apples."

As if I had that power!

On the other hand, I was contacted by Ms. Jerzak as noted above.

I actually appreciated the validation of my standards given to me by that call, and pledge to continue to support the higher standards.  

Right now, the way it is, most of us do an excellent job in our medical-legal consultations.

Let’s be clear: Over 1,500 different California doctors have written recommendations to at least one patient, so I do not and cannot speak for all doctors.

But I have definite ideas about service to patients in primary care, and also in a purely medical-legal consultation, like a medical cannabis recommendation. Right now, I am of the position that their are at least 2 tiers of recommendations.

“A” Level Work

There is the “A” work, characterized by care taken to document the clear benefit in a professional, appropriate, credible, and defensible way, as the Board has described“in accordance with accepted standards of medical responsibility”.  C I'm always thinking about how I can defend my patient to law enforcement, and myself to the Board. Besides the obvious basic medical judgment of weighing benefit against risk, as one always must do in medicine, when you get down to it, the difference between the high standard recommendations and low standards, is the level of medical-legal protection offered the patients.   Personally, I take it as my responsibility to tell patients when they don’t qualify by virtue of my evaluation, and/or have, in medical parlance: "piss-poor documentation”.    

“C” Level Work

“C” work is the minimum or low standards clinic, which MAY technically protect the patient, but is more likely to be challenged by overzelous law enforcement. My position on the “quickie consultation” is that although they MAY be legally valid, they will more likely be challenged by law enforcement, and that can be expensive for the patient. (My opinion/soundbite: “They offer the best $50 value you could spend $100-200 on!" and what’s worse, Dr. Anonymous charged $250 for his $50 value!)    

I am not sure what, if anything, the Board should, or can, do about the low standard clinics if no patient or legal guardian complains and no patient is harmed.  

As I’ve said before, the Medical Board has allowed medicine to be run by law enforcement, as evidenced by the well-established revolving door between the Medical Board of California, the Bureau of Narcotics Enforcement, the Attorney General’s office, and possibly the DEA.    

Personally, I am allergic to poor medicine. I don’t want to be around when it happens.  

I, for one, will continue to promote the standards that are safest for: 1.patients to protect themselves from overzealous law enforcement 2.doctors to protect themselves from overzealous law enforcement at the MBC and AG’s office.   I will uphold the position of higher standards as articulated in my article: “Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience” http://www.medboardwatch.com/implementation-of-7-year-plan.htm but also recognize that other standards could be acceptable.  

I will work with Society of Cannabis Clinicians to develop standards comparable to mine. And that includes giving patients not only a good MEDICAL evaluation, but the best MEDICAL-LEGAL consultation that I can.  

If this is unsuccessful, then I will develop my own list of medical cannabis consultants, that I have identified as the most knowledgeable, and most ethical and find a way to get that list out to the ethical medical cannabis community, either through MedicalBoardWatch.com or on my own, as Frank Lucido MD.    

Thank you.    

Frank H. Lucido MD  

Attachment: "Dr. Frank Treats Mr. Bill"

Copyright pending. All rights reserved medboardwatch.com.