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Concerned Physicians working for safe and appropriate use of Medicinal Cannabis

 

Help for doctors, attorneys and patients legal documents, decisions, precedents, opinions etc.
Proposition 215
(read the text -- its short)
Also known as: California Compassionate Use Act of 1996 (CCUA) Health and Safety Code 11362.5 (HSC 11362.5).
Conant v. Walters
(complete text version)
summary | .pdf (35 pages)
Bearman v. Joseph
with commentary by Dr. Bearman, Attorney Weisberg, and Dr. Lucido
Implementation of the Compassionate Use Act in a Family Medical Practice: Seven Years Clinical Experience by
Frank H. Lucido, MD

Selections from above:

Marijuana Myths,
Marijuana Facts
Cannabis resource list

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About Frank Lucido, MD

11/05/04

November 5, 2004 -- Statement Reiterating the need for monitoring

Frank H. Lucido  M.D.
Diplomate A.B.F.P.
2300  Durant Avenue
Berkeley, Ca, 94704
510-848-0958
fax 510-848-0961

                              [email protected]

November 5, 2004

Members of the Medical Board of California's Division of Medical Quality,


It is a pleasure to again be able to address you, in this, my 7th consecutive appearance before your committee.

MEDICALBOARDWATCH.COM
As I said at your July 30th meeting, I am monitoring all cases that come to my attention of doctors being investigated for having recommended cannabis.
I will be posting all pertinent documents on my new website MedicalBoardWatch.com (also MedBoardWatch.com) which went up in September.

My intention is to be of help to physicians in safely and appropriately recommending medical cannabis.

All my previous statements to the Board, and the documents I have given you can be found on my website.

Cannabis is a safe and effective medicine.  The evidence of this, which I have given you in previous appearances is also on my website.
I have also begun posting the relevant laws, and analyses of them.

In addition, I have posted the Medical Board's May 7, 2004 statement "California Physicians and Medical Marijuana", as well as my own published standards "Implementation of the Compassionate Use Act in a Family Medical Practice: 7 Years Experience".  These 2 documents compare quite favorably to each other, and are both a higher than the average standard for the practice of the limited medical-legal consultation which is characterized by the typical medical cannabis evaluation.

I hope for this site to be of use for physicians and attorneys in general.  In addition,  the Medical Board and the Board's medical experts should also apprise themselves of this knowledge, as it is clear from reading their depositions, that they are quite deficient in this knowledge.

INAPPROPRIATE INVESTIGATIONS:
As I review these cases, I see the same pattern:
None of these cases were initiated by a patient or legal guardian. 
These cases have almost all been initiated by law enforcement.
Mr. David Thornton, at the May, 2003 DMQ meeting, denied this, listing several categories (all of which were law enforcement) and then said; "and maybe a parent". 
The only parent I have heard about was the parent of an adult!

LAW ENFORCEMENT'S INSTITUTIONAL BIAS:
I also need to remind the Board of the well-documented institutional bias of law enforcement to cannabis.  I checked again at midnite, and the California Narcotic Officer's Association website (http://www.cnoa.org/position-papers-1.htm) still has the following untruth: "There is no justification for using marijuana as a medicine."   This lie is thoroughly contradicted by the federal government's own 1999 Institute of Medicine report.
http://books.nap.edu/books/0309071550/html/137.html

THE RANGE OF ACCEPTABLE STANDARDS
As I mentioned, my standards compare quite favorably to the Medical Board's May statement.  Both of these are quite higher than is actually generally practiced in California.  This is arguably much safer for both patient and physician, although perhaps more costly to the patient, as they involve not only appropriate patient concerns, but the old "CYA" (Cover you're A..) that has driven costs of medicine up drastically in the past 30 years of my medical career.  (Incidentally, the inappropriate Board investigations and undercover police investigations, with police posing as legitimate patients, have not only contributed to rising costs, but have also caused tremendous damage to the trusted doctor-patient relationship.)

THE  LIMITED MEDICAL-LEGAL CONSULTATION MODEL
Your legal staff and medical experts have very limited knowledge of the safety and effectiveness of medicinal cannabis and seem to be unaware of the  limited medical-legal consultation model wherein a doctor is consulted to give an opinion on a very narrow question, in this case:  "Is medical cannabis appropriate for this patient under the law?
Other examples of the limited medical-legal consultation is the DMV exam, the Aviation Medical Examiner physical, or the camp or sports physical (all of which I have performed), wherein the doctors assumes no primary care (and often does not practice primary care), but is merely making a medical-legal decision of approving a patient's driving a car, flying a plane, or participating in camping or sports activities.  Then there is  the case of the insurance company doctor, who merely decides if a patient is insurable or not, and often never sees the patient.  And of course, there's the doctor who's name is on the order for flu shots at shot clinics, who isn't even present when they are given.  These are all valid physicians in California.

MBC LEGAL STAFF AND MEDICAL EXPERTS IN NEED OF EDUCATION
Your legal staff ignores the substantial difference between prescribing and recommending.
This completely ignores Conant v Walters (and Conant v. McCaffrey).
I want to point out that the California Medical Association, which was represented on the MBC's medical cannabis "working group", did not concur with your May 5th statement.  Specifically, they state: "CMA does not concur with the Board's conclusion that the accepted practice standards for recommending  or approving medicinal cannabis  should be those applicable to "prescription drug treatment".  (page 5 of CMA On-Call; The California Medical Association document #1315;  June, 2004)

Your legal staff still ignores Bearman v. Joseph.
I have some comments on the Bearman decision from the Dr. Bearman's attorney, Seymour Weisberg:

Comments on Bearman v. Superior Court (Joseph) by  Seymour Weisberg
"Medical Board subpoenas should be resisted unless the patient has waived privacy.  The administrative subpoena can't be enforced until the Board goes to Superior Court and convinces a judge that good cause has been shown to override the patient's constitutional right to privacy.  A letter from the physician to the Board explaining why s/he won't turn over medical records that the patient does not want to disclose should be included, and in Dave's case was included, in the Board's Petition to the Superior Court to enforce the subpoena.  The patient must be notified of the Petition and the patient has a right to appear and contest the subpoena, although the physician can also assert the patient's rights.  In short, a physician should not turn over an objecting patient's records without, at least, an order from a Superior Court judge.
    Dave Bearman took it to the next level when the Superior Court judge ordered him to comply with the subpoena.  Acting upon the advice of his attorneys that the judge was wrong and her ruling was contrary to clearly established legal precedent, Dave incurred the expense of going to the Court of Appeal where he was vindicated, but not before the Board attempted to get the state Supreme Court to either reverse the Court of Appeal's decision or order that it not be published.  It is published:  117 Cal.App.4th 463.
    Dr. Bearman's case should also be cited to resist subpoenas for medical records issued by the prosecution in criminal cases against a patient unless the patient consents to the disclosure."

Again, I call upon the members of the Medical Board of California to cease the inappropriate investigation of physicians for having recommended cannabis, and try to regain the credibility that this has cost you.  You have more important work to do in protecting California patients from actual harm.

WE ALL NEED MORE EDUCATION, INCLUDING MYSELF
Not only will your legal staff and medical experts more knowledge about medical cannabis consultation practice, but I also will have to learn more about how the board works, and under what rules.
In my work in reviewing cases of doctors being investigated, I will need your cooperation.  I will need access to all available documents that the medical board possesses or uses to define standards of care.
Specifically, I will need the MBC's definitions of "simple" and "extreme" departures. 
I suspect the definition will show it is a subjective decision, rather than anything objective, and will therefore be dependent on the bias, and/or experience, or inexperience, of the MBC expert witness, rather than dependent on any analysis of how medicine is actually practiced in California, and as I have already asserted, many of the doctors most knowledgeable about medical cannabis have been inappropriately investigated.

I thank you for your attention.

Sincerely,


Frank H. Lucido MD

Attachments (2):
CMA On-Call document #1315
Implementation of the Compassionate Use Act in a Family Medical Practice

Go ahead and search us:

Input to the Medical Board of California by year:
2005
February 18, 2005 -- Statement
  Quarterly meeting MBC DMQ
January 25, 2005 -- Statement
  Statement to State Sen. Liz Figueroa's Committee
January 21, 2005 -- Statement
  Special meeting of the MBC to discuss the Enforcement Monitor's preliminary report on their 2 year investigation of the MBC
2004
November 5, 2004 -- Statement
  Reiterating the need for monitoring
 
July 30, 2004 -- Reply
  Regarding the MBC statement of 7/03
May 7, 2004 -- Transcript
  Various question raised to the MBC. Comments on MBC positions.
January 30, 2004
  Packet contents summary and statement calling to cease targeting doctors.
  Dr. Lucido reports on 1/30/04 MBC meeting
  Transcripts: 1/30/04 meeting
2003
November 7, 2003
  Will medical practice be determined by doctors or police?
August 1, 2003
  A cannabis resource list
  Associated risks
  Review of therapeutic effects
May 8, 2003
  Defining standards of care, complaint initiation and responsibility

 


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