Journal of the California Cannabis Research Medical
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.