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Summer 2003
O'Shaughnessy's
Journal of the California Cannabis Research Medical Group

Patients Testify for Mikuriya

To refute the state Medical Board's Accusation against Tod Mikuriya, MD, the defense has called to the witness stand nine of the patients who allegedly received substandard care from him. Each patient described Mikuriya as a thorough, empathetic, and helpful consultant who never passed himself off as a primary care provider. Each confirmed that s/he had been self-medicating with cannabis before seeking Mikuriya's approval to do so.

The prosecution's expert, Laura Duskin, MD, had claimed that reading Mikuriya's files enabled her to detect "extreme departures from the standard of care" in his treatment of 16 patients. She felt no need to get input from the patients themselves. "We're taught from day one in medical school that if you didn't write it down, it didn't happen," Duskin testified in all seriousness. But it became obvious, as the patients recalled their encounters with Mikuriya, that a great deal had happened between them that Duskin failed to discern.

¥ First to testify was D.K., a middle-aged woman from Humboldt County who walked and spoke slowly and with obvious effort. At 21 she'd suffered a stroke brought on by the combination of smoking cigarettes and taking birth-control pills. ("The pill" was originally approved by the FDA in a dosage many orders of magnitude greater than required for efficacy. A safer formulation was introduced quickly in the U.S., less quickly in South America.)

D.K.'s enunciation may not have been crisp, but what she had to say was eloquent. "None of you have ever had a cerebral hemorrhage. I'm always the wrong one, the one who doesn't get the joke... I get feeling like I'm up against a wall. A couple of puffs and I can come back to myself, I can grip reality again." D.K. said she first consulted Mikuriya in June, 1998. "He had been recommended to me as a compassionate doctor... I was totally honest with him. I had discovered for myself that marijuana helped more than anything. And I don't need more and more -the same amount works!"

In response to questions from attorney Susan Lea, D.K. testified that Mikuriya had written her a prescription for a neuropsychiatric evaluation, but it had been confiscated along with other papers in her husband's possession when he was busted for cultivation. Mikuriya had also urged her to quit or reduce her cigarette smoking, and had suggested that she substitute cannabis leaf for tobacco. "And it worked," D.K. reported. She mimed hand-rolling a joint and drawing on it as she explained "You get to do the same thing with your hands, and with your mouth..."

Assistant A.G. Jane Zack Simon asked, on cross-examination, if D.K. had obtained from Mikuriya a second prescription for a neuropsych eval. D.K. replied as if Simon was the slow one and had missed the key point: "It got taken by the cops when they took our marijuana." D.K. also testified that she'd had four follow-up visits with Mikuriya over the years, and that he'd billed her on a sliding scale.

Prior to the next swearing in, Administrative Law Judge Jonathan Lew commented that he'd never had a case in which patients's names had been kept from him. Simon said, "We often have cases where patients names aren't used -but of course they never testify." Which shows how far removed from reality the Medical Board's procedures have become. Why shouldn't patients be testifying about mistreatment by physicians? The Mikuriya case is highly unusual in that no patients contend they were victimized. Quite the contrary -the alleged victims are coming forward to say "Thank you, doctor."

¥ D.H., another middle-aged woman who didn't look as if life had been a bed of roses, testified that she'd found on her own that cannabis provided relief for severe itching and stress headaches "so bad I can't even function." Tests couldn't determine the causes of her problems. Other doctors had given her "medicines that didn't help. They put me out and deprived me of feeling in control." She'd brought Mikuriya records from her previous doctors and told him that when she smoked cannabis, "the itching is less and I don't go to sleep with headaches." Mikuriya gave her an approval for cannabis and taught her a method of rolling the shoulders to reduce headache-inducing tension. She said she couldn't see him again "money-wise."

On cross, Simon asked D.H., "Did you ask Dr. Mikuriya if there was anything you should do about the itching?" -ignoring the woman's testimony that cannabis had been an effective treatment. The prosecution apparently hopes to show that Mikuriya provided substandard care by not pushing the available corporate products! It so happens that California doctors who are monitoring their patients's cannabis use are hearing reports of efficacy in the treatment of pruritis (itching)! Because the cannabis specialists are collecting data to which the medical establishment has been unreceptive, it is the establishment docs who are, in many instances, providing outdated, substandard care. As noted before, the Mikuriya case takes us through the looking glass.

¥ R.B. a man of about 30 with black hair and Buddy Holly specs, had been incapacitated by nausea, vomiting and dizziness. His Kaiser doctor conducted tests and diagnosed severe acid reflux, but couldn't come up with a cause or a cure. R.B. testified, "I lost my job because I was sick all the time, and then I lost my health insurance because I was unemployed... I spent a lot of time just rolled in a ball... I was ready to off myself." He first sensed the medical potential of marijuana after using it socially. He learned more via the Internet, he said, but was concerned about its addictive potential. Mikuriya spent more time with him than any doctor he'd seen. "When you call Kaiser, a nurse takes your info and they call you back and you pick up some medicines," said R.B., accurately describing the REAL standard of care provided by the medical establishment.

¥ E.K., a middle-aged Christian Scientist, listed his problems as insomnia, high blood pressure, hypertension, and back pain when he saw Mikuriya in February, 1997. Except for the Army doctors who'd declared him 4F, he hadn't visited a doctor since childhood. He had self-medicated with cannabis for years. He'd sought a letter of approval from Mikuriya so that he could ingest THC without violating the terms of probation. E.K. (who also has cognitive problems) said Mikuriya had spent an entire morning with him and wound up prescribing Marinol.

Assistant A.G. Larry Mercer tried to make something of the fact that E.K. had no other doctor -as if that made Mikuriya his primary-care physician. E.K. patiently explained that it was his choice not to see doctors, and he only consulted Mikuriya to legalize his use of THC. Mercer asked if E.K. ever tested his blood sugar "by pricking your finger." E.K. looked confused. "Did you ever prick your finger to measure your blood sugar?" Mercer repeated. E.K. looked at the red-faced prosecutor carefully and asked, "Are you a doctor?"

¥ Next came R.H., your basic American alcoholic working man in his 60s, beat to shit physically but far-gone enough to stand up to the Inquisition. In 1997 he was on probation (for cultivating three plants) and couldn't sleep. "I must have slept 100 hours in those eight months," is how he put it. "Nothin' worked. Cannabis worked. It ain't no miracle but it sure helps. It just makes things a little better and I can sleep at night."

On cross-examination Mercer inquired about Mikuriya's billing practices. R.H. testified that he paid $120 on his initial visit but follow-ups had been free. "What are you doing to this guy, anyway?" R.H. asked Mercer, whose face got even redder than usual. "He helped me! And you're trying to screw him!!! Even my regular doctor at Kaiser told me to smoke as much weed as I wanted, off the record. He wouldn't give me a letter because he didn't have enough guts!" Mercer also tried to make something of a note on R.H.'s chart that he drank 8 to 10 cups of coffee a day. Did Mikuriya approve of that? "He told me I should stop, but I didn't."

¥ J.C., a woman in her early 20s, had been severely anorexic since childhood -a response to sexual abuse by a relative, she testified. She was throwing up five, six, seven times a day. "One time I fell in the shower and couldn't get up, I was too weak." Her obstetrician advised that if she didn't eat, the baby wouldn't live and she might not either. She was prescribed antidepressants. She discovered on her own that marijuana made food palatable and enabled her to keep it down. She informed her primary-care physician who, J.C. said, "was so scared of the law, the cops, and the medical board" that he wouldn't write her a letter of approval. Only Mikuriya, whom she consulted in December 1998, was "willing to make me legal."

J.C.'s testimony evoked tears from a spectator who whispered, "The saddest part is that we have to be paraded out like this and have our private lives exposed." Earlier testimony had your correspondent grieving for a loved one who has to live with brain damage. Some bells seem to toll especially for thee.

J.C. brought with her an inch-thick stack of medical records, which she said Mikuriya reviewed when she consulted him. The defense also called J.C.'s mother, whose testimony about harassing visits from the local cops was cut short by prosecution objections on grounds of relevancy. Mercer's mantra: "The question is what Dr. Mikuriya did, not what law enforcement did."

Also accompanying J.C. were her husband and their healthy-looking four-year old boy. (The Medical Board had been keen to name J.C. in the Accusation because she was pregnant and a minor when Mikuriya saw her. Will the happy real-life outcome count for anything or will the Cult of Documentation prevail?) There was a moment of levity when the little boy's handheld computer game beeped. Judge Lew looked sternly at Mikuriya, whose cell phone had gone off twice during the course of the proceedings. "It was the Gameboy," said Dr. Tod, swiveling to point at the guilty little towhead.

¥ S.F. was also a minor when she saw Mikuriya in 1999. From the age of 12 she had suffered from migraine headaches. She first smoked mj with some girlfriends when she was 13, and soon associated it with relief from migraines. She'd had an abortion at 15, after which the migraines and her menstrual cramps seemed more severe. Marijuana provided relief. S.F.'s father, who had raised her after her mom split when she was five, was also a migraine sufferer and had used marijuana to reduce the pain. When she decided to seek an approval from Dr. Mikuriya -"Why should I spend time in juvenile hall if I'm not really a criminal?"- he accompanied her.

¥ K.B. looked like a rugby player -a big, well-muscled man in his 40s with long blond hair. He'd consulted Mikuriya in August '98 after his back was injured in a car crash. He'd brought documentation of his degenerative disk disease (narrowing of space between L4 and L5) and reported that he couldn't sleep when he didn't have cannabis because his legs would "jump." K.B. said he could feel the muscles seizing up and going into spasm. Another doctor prescribed Valium which K.B. took only once; he hated the effect. "I don't really believe in taking narcotics," he testified. K.B. had read extensively on the topic of cannabis as medicine, including the voluminous Institute of Medicine Report. Why had he consulted Mikuriya? "He was the world's expert, so why not go to the best?" On cross it emerged that Mikuriya had provided four follow-up consultations, and they were all face-to-face.

¥ F.K. a disabled 66-year-old Navy vet, testified that he discovered the medicinal effects of cannabis in the early 1970s. "It relieved my back pain and allowed me to continue my dry wall work." He later used it to control a tendency to binge on alcohol. After Prop 215 passed, F.K. asked for a letter of recommendation from a Veterans Administration hospital doctor, who told him to consult Dr. Tod Mikuriya... F.K. was the last patient called by the defense, and his cross examination -after it was established that F.K. paid on a sliding scale- was Mercerfully short. It had not been an easy task trying to trip up and discredit and find holes in the stories of these people who described their encounters with Mikuriya in such consistent yet individual terms. Maybe Mercer and Medical Board Investigator Tom Campbell had such rosy cheeks because they were blushing from shame; or maybe it's capillary damage from some other source.

 

The hearing didn't end on Sept. 9, the last of five days that had been set aside for it, so proceedings were broken off and will resume Sept. 24. Mikuriya has spent about five hours on the stand describing the evolution of his "medical cannabis consultation practice" and being questioned by attorney John Fleer on every issue raised by Laura Duskin's critique of his files. The dignified psychiatrist, whose 70th birthday is Sept. 19, has explained and defended his approach, patient by patient, point by point.

Duskin had found an "extreme departure from the standard of care" every time Mikuriya issued an approval letter stating that a patient was under his "supervision and care" for the given condition(s). The phrasing implies an ongoing relationship instead of a one-time consultation -a semantic error, at worst, in the real world. Mikuriya said he'd lifted the phrase verbatim from a California Medical Association advisory letter sent to doctors after Prop 215 changed the law.

If this matter was being heard in the Court of Common Sense, the judge would direct the doctor to re-word his letter of approval; advise the Medical Board to stop pursuing complaints from law enforcers that don't involve harm to patients; and spare California taxpayers any further expense on such an absurd prosecution. But Common Sense is just the name of some old leaflet, and the legal string must be played out, however long it takes, however much it costs. Mikuriya's testimony resumes on Sept. 24 in the hearing room of ALJ Jonathan Lew, 1515 Clay St., Oakland, California. The subject will be Mikuriya's encounter with an undercover Sonoma County narc named Steve Gossett, who received an approval based on false claims of sleep, stress, and shoulder problems.

Then comes Mikuriya's cross-examination by Mercer and Simon -the very same prosecutors who were sicced on Dennis Peron by former Attorney General Dan Lungren. "Why did Bill Lockyer assign those two to prosecute Dr. Mikuriya?" is a FAQ among spectators at the hearing. It appears that he's trying to mollify a rightwing faction within his office... When Terence Hallinan was elected District Attorney of San Francisco in '96, he could change the culture of the office overnight because SFDA employees serve "at the pleasure of" the DA, and TH could and did fire 14 rightwing stalwarts. Lockyer, elected in '98, was stuck with the career Assistant AGs because they have civil service protection. But he didn't have to allow them to prosecute California's foremost proponent of cannabis therapeutics; and he certainly didn't have to assign the job to two Lungrenite dead-enders.

Maybe Gray Davis will save the day. The Medical Board members are his appointees, and it's they who will ultimately act on Judge Lew's "recommended decision." They can follow it or depart in either direction -punishment or leniency... But they have a problem analogous to Lockyer's. Whereas the Med Board's appointed members come and go, the staff consists mainly of career law enforcers -more than 100 Investigators under Enforcement Division chief Joan Jerszak- who have social and political connections to the prison guards, the narcotics officers, the sheriffs, the police chiefs, the police officers, the DAs, and others who think the War on Drugs has been good for business and/or the will of God.

 

 

O'Shaughnessy's
O'Shaughnessy's is the journal of the CCRMG/SCC. Our primary goals are the same as the stated goals of any reputable scientific publication: to bring out findings that are accurate, duplicable, and useful to the community at large. But in order to do this, we have to pursue parallel goals such as removing the impediments to clinical research created by Prohibition, and educating our colleagues, co-workers and patients as we educate ourselves about the medical uses of cannabis.
 
SCC
The Society of Cannabis Clinicians (SCC) was formed in the Autumn of 2004 by the member physicians of CCRMG to aid in the promulgation of voluntary standards for clinicians engaged in the recommendation and approval of cannabis under California law (HSC §11362.5).

As the collaborative effort continues to move closer to issueing guidelines, this site serves as a public venue for airing and discussing these guidelines.

Visit the SCC Site for more information.