Monday, November 20, 2006

Facing Down the Criminal Justice System

Risking His Medical Career, Dr. David Bearman
Takes the Lead in Medicinal Marijuana

Dr. David Bearman (at left)

By Eric Bailey, Los Angeles Times Staff Writer

SANTA BARBARA, Calif. -- After nearly four decades in medicine, Dr. David Bearman seems the incarnation of a trusted old-school physician. His resume is long, his record unblemished. It's his choice of treatment that makes him conspicuous.

For most patients, Bearman recommends the same remedy: marijuana. There is the young lady with epileptic seizures, the middle-age man with multiple sclerosis, the amputee bedeviled by phantom limb pain.

Bearman's practice, based on a controversial curative not found on pharmacy shelves, has proved lonely and professionally perilous.

Although the courts have upheld a doctor's right to recommend cannabis for the seriously ill, few dare do so. Among the exceptions is a tight-knit cadre of about 15 California doctors. Dubbed "pot docs," even by friends, they blithely claim credit for nearly half the estimated 100,000 marijuana recommendations issued in the eight years since California approved medical use of the drug.

There is Bearman in Santa Barbara and Dr. Frank Lucido, a family doctor in Berkeley. Dr. Tod Mikuriya, a peripatetic medical marijuana pioneer in the San Francisco Bay Area, has written approvals for 8,000 patients. A presidential drug czar once lambasted his brand of medicine as a "Cheech and Chong show."

The criticism has been accompanied by intense scrutiny. At least 11 of the cannabis doctors have weathered investigations by the Medical Board of California. Half the cases closed without formal accusations. But a few drew blood.

One Northern California physician settled for three years of professional probation rather than fight accusations that a few of his marijuana patients had no medical need. Another doctor, accused of fabricating pot approvals, lost his right to practice for two years while the disciplinary case played out. He settled for five years' probation.

Medical Board officials say the problem is not the marijuana, but the way the doctors practice medicine. Are patients thoroughly examined? Do the doctor discuss other options?

Joan Jerzak, the Medical Board's chief investigator, says that some doctors eager to legalize recreational use "don't mind flouting the law."

But to the pot docs, the attacks are about old grudges that will not die. They say they've been singled out by a law enforcement establishment still displeased over passage of Proposition 215, the 1996 ballot measure that legalized marijuana for the seriously ill.

"Their attitude is, 'This isn't medicine, but rather a way to abet drug abusers,' " said Dr. Philip Denney, who practices as if every patient is a federal narcotics agent. "They have scared the hell out of California doctors, and it's been left to us so-called mavericks."

The cannabis doctors say they practice serious medicine, focusing on the sick and weeding out habitual pot smokers simply looking for protection from arrest. Marijuana remains a remarkably safe substance, the pot docs say, with tremendous therapeutic potential for AIDS wasting, chemotherapy nausea and other grave conditions.

Aside from the pot docs, oncologists and HIV physicians write the bulk of the cannabis recommendations.

Bearman, a 63-year-old family practitioner, sees his share of serious cases every week. Sleeves rolled up, graying walrus mustache arched, he is upbeat and avuncular as the ill and injured hobble in. But he figures it may be years before marijuana is accepted by the medical establishment — and by the criminal justice system.

"There's no doubt," he said, "this is part of a larger cultural war at play."
A Delicate Dance

Jessica Griffith, a 27-year-old divorced mother of one, waddles into Bearman's office, a metal cane in hand.

She carries a 3-inch stack of medical records detailing her four-year fight against pain. She ruptured two discs in her back trying to lift a box in, of all places, a health food store. Griffith tells the doctor she will soon have surgery to fuse her spine.

Meeting such a patient, someone bearing up under a painful or debilitating condition that could be helped by marijuana, Bearman has a standard response.
"You," he tells them, "are exactly the kind of patient the voters were thinking of when they approved Proposition 215."

Bearman's father, a pharmacist, used to tell stories about marijuana's history as an accepted part of pharmacopoeia. (England's Queen Victoria turned to it for menstrual cramps at the suggestion of the court physician.)

The son was dubious. He spent his career mostly paddling in medicine's mainstream, but over the years he developed an interest in medical marijuana. When he retired three years ago as medical director of the Santa Barbara Regional Health Authority, he opened a one-room office. Word spread and the ill flowed in.

So did a problem.

One of his patients, a 21-year-old named Nathan with a history of migraines, was busted with a tiny stash of pot in April 2001 while camping in Ventura County. Confronted by park rangers, Nathan pulled out his medical marijuana recommendation from Bearman.

They let him walk, but a ranger complained to the Medical Board. The board, which receives some 12,000 complaints a year about physicians and investigates roughly 2,000 of them, decided Bearman was worth a look. They demanded to see the doctor's records on Nathan. Bearman refused, citing patient confidentiality.

A two-year legal battle ensued. Bearman at one point faced a $1,000-a-day fine. But he prevailed. A state appeals court concluded that the board's subpoena was based on "nothing more than speculations [and] unsupported suspicions."

Free of that legal threat, Bearman went back to his old ways. To cull out the fakes, he requires that patients seeking a medical marijuana referral undergo a detailed screening during their initial phone call. Then Bearman spends about an hour conducting a head-to-toe physical.

"What effect does marijuana have?" Bearman asks Jessica Griffith.

"Sleep," she replies. It also dulls the cascading pain she endures while walking. A few puffs before taking a shower and she can shampoo her hair, Griffith says. "It's not fun."

Bearman tells her about support groups for chronic pain, ergonomically designed chairs and how she can saute marijuana in butter or brew it as a tea.

Each exam is a delicate dance between advice and advocacy of a drug still wholly illegal under U.S. law. Like other cannabis physicians, Bearman does not dispense marijuana. How patients obtain pot is up to them, but he sometimes points them to websites listing cooperatives that distribute the drug.

After Griffith leaves, Bearman has a confession. Behind the cheery exam-room aplomb, he fears a patient could end up in jail. They are, he says, arrested all too often.

"Basically what we have here is a turf war between doctors and the criminal justice system,"

Bearman says. "They're second-guessing physicians."

Date: 22 April 2004 LOS ANGELES TIMES


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