Pubdate: Tue, 04 Sep 2001
Source: Los Angeles Times (CA)
Copyright: 2001 Los Angeles Times
Contact:  http://www.latimes.com/
Details: http://www.mapinc.org/media/248
Author: Kim Murphy, Times Staff Writer
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)

MEDICINAL POT IS DOCTOR'S SPECIALTY

Health: Physician Has OKd Marijuana For 1,000 Patients--40% Of The State 
Total, Attracting Official Scrutiny.

PORTLAND, Ore. -- Dr. Phillip Leveque feels his patients' pain. Ten years 
ago, an accidental overdose of spinal anesthetic left his feet and tailbone 
with a burning sensation. He's also been in three bad auto accidents.

Leveque tried painkillers, but they didn't work. So he simply lives with 
it, stoking up on sleeping pills at night. But for patients with chronic 
pain, Leveque offers another alternative: marijuana. Well more than 1,000 
patients have gotten authorization from the 77-year-old osteopath to use 
the drug under Oregon's 2-year-old medical marijuana law. That's 40% of all 
authorizations in the state and eight times more than any other doctor.

State health authorities would like to know why, and they have launched a 
controversial inquiry into Leveque's patient records.

The answer, Leveque said, is simple:

"When you step down on your foot, you feel pressure. When I step, I feel 
fire. . . . I know exactly what [people who get medical marijuana cards] 
are going through."

Oregon's inquiry has raised troubling questions about doctor-patient 
confidentiality in a state that, unlike California, maintains a central 
registry of all medical marijuana patients and the doctors who oversee them.

Under temporary regulations issued in response to Leveque's hefty client 
base, new medical marijuana patients in Oregon--including more than 800 who 
have pending applications for access to the drug signed by the Molalla, 
Ore., doctor--will have to allow authorities to review their records or 
face automatic denial.

Leveque's supporters say that the state is placing roadblocks in the way of 
a doctor who has been the only resource for many patients turned away by 
physicians leery of dealing with marijuana cases.

Since Oregon in 1998 became one of nine states with laws allowing patients 
to use small amounts of marijuana for medicinal purposes, Leveque has run 
makeshift clinics in towns all over the state. He's also offered telephone 
and mail consultations to patients in areas too remote for a personal visit.

"My name has spread through the jungle telegraph: people who know people 
who know people," Leveque said. "I have physicians [as patients]. I had a 
phone call from a dentist who wants to get a marijuana card. Lots of 
nurses. Lots of doctors' wives. . . . I must have about 30 ladies with PMS 
[premenstrual syndrome] that have cards."

Leveque is so popular that state officials have trouble believing he has 
the time to act as an actual attending physician on so many cases.

"To qualify for a card, you have to have a debilitating medical condition 
and you have to have an [attending] physician provide a written statement 
that says . . . you might benefit from the use of medical marijuana," said 
Grant Higginson, Oregon's public health officer.

When officials moved last month to scrutinize Leveque's patient records, 
they were met with stiff opposition from the Oregon Medical Assn. "Our 
position is, nobody examines a patient's medical chart, by rule or 
otherwise, without the patient's consent or a court order," said Robert 
Dernedde, executive director of the physicians' group.

So temporary rules were adopted this summer requiring patients seeking a 
medical marijuana card, which grants them access to the drug, to agree to 
have their records reviewed by the state. That alleviated the medical 
association's concerns but not those of medical marijuana advocates who say 
the rules still are too intrusive and unwieldy.

"It is going to . . . create more burden on these patients. They are sick 
and suffering, and it's basically unnecessary," said John Sajo, who heads 
Voter Power, the citizens group that backed Oregon's marijuana ballot 
initiative.

"We pretty much think this is a witch hunt. . . . They don't have a single 
complaint from a patient, or a single patient who's been harmed or had an 
adverse impact on their health from Dr. Leveque qualifying them for medical 
marijuana," Sajo said.

The state Board of Medical Examiners is conducting a separate inquiry into 
an allegation that Leveque authorized a medical marijuana card without 
adequate examination, consultation and follow-up. In one case, Leveque 
allegedly signed for a patient with a previous history of drug abuse. The 
osteopath was placed on licensing probation for 10 years in 1986 for 
allegedly overprescribing pain medications to patients.

To Leveque, the controversies come from a medical establishment unequipped 
to deal with the ravages of chronic pain and unrealistic about the medical 
conditions that give rise to marijuana use under the Oregon law.

Almost none of the conditions for which marijuana is authorized in 
Oregon--cancer, glaucoma, AIDS, Alzheimer's disease, wasting, severe pain 
or nausea, seizures and persistent muscle spasms--can be detected with a 
simple physician examination, he said.

Instead, Leveque requires patients to give him a copy of their diagnosis 
from another physician, and he makes detailed inquiries about their 
experiences with other medications.

"I have patients that live nine hours from Portland, 10 hours," Leveque 
said. "These people are going to have to endure a nine-hour drive both ways 
to see me."

Leveque has received as many as 40 new requests a day from potential 
patients since last month, when his name hit the Oregon newspapers. "The 
important part of this story is not that Dr. Leveque has signed [hundreds 
of] applications but that there are 7,000 physicians in Oregon who haven't 
signed one," Leveque said.

As in California and other states with medical marijuana laws, many doctors 
fear the prospect of Drug Enforcement Administration action, since federal 
law considers marijuana an illegal drug. The Board of Medical Examiners' 
investigation into Leveque has made other doctors even more reluctant, Sajo 
said.

Higginson said more than 500 physicians in Oregon have provided 
authorizations for marijuana cards. "On the other hand . . . that's one of 
the most common questions we get asked: 'Can you tell me where we can get a 
physician who's willing to do this.' In some cases, the doctors of a whole 
community--or even a whole county--aren't willing to do it."

Under the temporary rules, which will be reviewed in public hearings this 
fall, the state has set minimum standards for qualified attending 
physicians. They must review medical records, conduct a physical exam, 
develop a treatment plan and provide follow-up care that is documented in 
an ongoing patient file.

"If [Leveque] is doing this strictly over the phone, then I don't think he 
would qualify," Higginson said.

Sajo said he thinks most physicians, including Leveque, will be able to 
meet the standards. Litigation over the rules "seems quite inevitable," he 
said, with the American Civil Liberties Union looking at the issue now.

Charles Brookman, a 54-year-old former Green Beret from Salem, Ore., said 
Leveque signed his marijuana authorization to ease the crippling pain he 
suffers as a result of Vietnam War injuries and multiple sclerosis, which 
also has left him blind.

"The big thing about Dr. Leveque is he really goes out of his way to help 
veterans," he said. (Leveque is a World War II infantry veteran.) "A vet 
will go to the VA hospital where they're getting their primary treatment, 
and there's no doctor there that will sign the application form. I went to 
12 doctors before I found one that would sign, and that was Dr. Leveque."
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