Pubdate: Wed, 11 Feb 2004 Source: Anderson Valley Advertiser (CA) Column: Cannabinotes Copyright: 2004 Anderson Valley Advertiser Contact: http://www.mapinc.org/media/2667 Author: Fred Gardner DENNEY OPENS ORANGE COUNTY OFFICE On Feb. 9, Philip A. Denney, MD, started seeing patients at a "cannabis evaluation practice" in Lake Forest, a city at the intersection of Freeways 5 and 405 in Orange County. If the demand is as great as Denney anticipates, he hopes to interest other physicians in the new specialty, which he defines as "determining whether a patient has a serious medical condition that could be treated safely and beneficially with cannabis." Denney has already recruited Robert E. Sullivan, MD, a former associate in a Sacramento practice, to join him in Orange County. An estimated 60,000 patients have gotten physician approvals to use cannabis In the more-than-seven years since it became legal. "That represents a very small set of the population that could be helped by cannabis if knowledgeable doctors were available throughout the state," says Denney. Twelve doctors specializing in cannabis evaluations have issued approximately half the approvals to date, and all but one of those doctors are in Northern California. For most of his 27-year career Denney was a family practitioner. In the late 1990s, having become aware that doctors who approved cannabis in treating conditions other than AIDS or cancer were few and far between, he began studying the available medical literature and corresponding with specialists in the area. In January, 1999, Denney opened an office in Loomis, East of Sacramento, specializing in cannabis evaluations. "It was obvious when we had our practice in Loomis," says Denney (the 'we' refers to his wife Latitia, who manages his office), "and people kept showing up from all 58 counties, that there was a tremendous need and demand throughout the state." A related need, according to Denney, is for a Continuing Medical Education course that would bring California doctors up to speed on a subject they learned nothing about in Med School. By the fall of 2002 Denney had approved cannabis use by some 8,000 patients and decided he would take early retirement. He transferred his practice (to William Turnipseed, MD) and devoted himself to reading, gardening, spending time with his family, and doing all the projects that needed doing on his hilltop spread in rural Greenwood. But he didn't entirely withdraw from the fray -he helped defend colleagues under attack by the Medical Board of California, and he kept abreast of the medical literature and cannabis-related political developments. In May 2003 Denney appeared before the Board to protest the investigation of nine doctors specializing in cannabis consultations. "When you mention that nine investigations is a small number, you must consider the effect of those investigations on the rest of the physicians in California," Denney reminded the Board. "The sanction of even one physician will have a dramatic impact on the practices of all others." (Denney himself has never been investigated by the Board, a fact he attributes to the rigor with which he takes histories, reviews records, and conducts physical exams.) Denney also served as an expert witness in defense of Tod Mikuriya, MD -one of the cannabis specialists whom the Medical Board's Enforcement Division had chosen to prosecute. Denney reviewed the relevant files and testified that Mikuriya had elicited enough information in each case to justify approval of continued cannabis use. Mikuriya's practice should not be evaluated by the same standards as a conventional practice. "Patients come to a medical cannabis consultant seeking the answer to one specific question: 'Do I have a medical condition for which cannabis might be a useful treatment?'" Denney faulted the Board for not issuing guidelines relevant to such situations. A key factor in Denney's decision to resume practicing medicine was the October 2003 decision by the U.S. Supreme Court to let stand the ruling in the Conant v. Walters case: federal authorities are permanently enjoined from threatening or punishing California doctors who approve cannabis use by their patients. "The Conant ruling," says Denney, "was tremendously reassuring." Denney says that "more than 95%" of the patients to whom he has issued approvals had been self-medicating with cannabis before consulting him. The conditions with which they present, he estimates, are: chronic pain (50%); neurologic (20%); psychiatric, including ADHD and as a "harm reduction" substitute for alcohol (15%); gastro-intestinal (10%); other (5%). None of Denney's patients have reported serious adverse reactions or drug interactions. "Cannabis has been used medicinally for thousands of years," Denney says, "and has a remarkably benign side-effect profile." For more information, or to arrange an appointment, contact the office of Drs. Denney and Sullivan at 949-855-8845. PS. Denney and Sullivan are announcing their presence through an ad in the Orange County Weekly (whose commercial mainstays are tacky Botox and plastic surgery ads). The first D&S ad ran on Feb. 5 -an expanded business card with a small boldface headline: "Medical Cannabis Evaluations." By the end of opening day there had been three or four calls from young men who thought the ad was offering employment as taste testers. Where there's youth, there's hope! Mikuriya Case Update By now Administrative Law Judge Jonathan Lew has presumably filed his "Proposed Decision" advising the Medical Board whether or not to punish Tod Mikuriya, MD (and if so, by what measures. At a lengthy hearing this fall, the Attorney General, representing the Board, charged that Mikuriya had violated the prevailing standard of care in approving cannabis use by 17 patients (one an undercover narc). The Board's expert witness had come to this conclusion by reading Mikuriya's patients1 charts -but she hadn't contacted any of the patients to determine if their treatment at his hands had actually been harmful or beneficial. Mikuriya defended his methods of determining whether patients were using cannabis appropriately and rightfully. The evidence showed that all his patients -except the narc, of course-had benefited from cannabis use. Nine patients testified that Mikuriya had conducted thorough and empathetic exams. At the very end of the hearing, ALJ Lew asked Mikuriya if he would be willing to modify his procedures in the future, and Mikuriya said "Absolutely." The exchange left him hopeful that a career-ending stand-off might be averted. The Board has 30 days to review the judge's Proposed Decision. In this period a six-member panel from the Board's Division of Medical Quality votes by mail on whether or not to adopt the Proposed Decision. Four "adopt" votes suffice. If two members vote 3Hold,2 the panel will discuss the case behind closed doors at the May Board meeting. (Two 3hold2 votes prevail over four 3adopt2 votes.) In deciding whether to accept the Proposed Decision, the panel can order and review the transcript of the hearing and take oral and written arguments from Mikuriya and the AG1s office. SO, Mikuriya's fate could hang in the balance for a long time. Some generalize that delays are good for the defendant -in this case, the doctor who stands to lose his license-because life goes on in the meanwhile... But the law's delays can also be a mild form of torture (see Hamlet's Top 10 reasons to commit suicide). "Let him twist slowly in the wind" Nixon told his henchmen -Don't let Patrick Gray know his job status. It's been years since Mikuriya felt he could make longterm work plans. If the Medical Board allows him to keep practicing, he says, he sees himself sharing an East Bay office with other cannabis specialists, gladly adhering to whatever clear-cut, sensible guidelines the Board has established for them. - --- MAP posted-by: Jay Bergstrom