January 30, 2004 Medical Board Meeting Partial Transcript

JERZAK: …approving medical marijuana.

This dialog has raised several issues which need to be resolved before we can finalize the final draft.

We are also aware that a medical marijuana taskforce is in place in another section of the AG’s office. We believe it is critical that any draft we develop at MBC be shared with the AG’s office, and we want to be able to have a monitoring of what is going on with that other taskforce.

We are mindful that Proposition 215 allows California physicians to recommend or approve marijuana for medicinal purposes, however we want to avoid giving California physicians the impression that any guideline by the board will offer them legal protection from federal prosecution as marijuana remains a Schedule 1 controlled substance.

So we have had ongoing meetings. We are… we will have to get that timeline moved up to have those meetings be faster in this next quarter, to be able to provide some kind of a final product for… to present to the committee as a draft format.

LINDA LUCKS: I’m very disappointed that we don’t have the document to look at today, at least to review and to distribute among us for comments and to the public. It has been my understanding that we would. I wasn’t really aware that it was going to be circulated to the AG’s Office. If it was, I missed that somehow, because we did come up with a really good document that I really wanted to have on the agenda today, and was expecting to have on the agenda. So I apologize to board members and to the public, who were expecting to have something to look at, at least.

If you look at today’s Sacramento Bee, I think we’re behind the curve, is the problem. We were working on this, and working on this, and I think we came up with a draft document that’s fair to all the parties that were on the taskforce. We're all happy with it. The Sacramento Bee’s article, front page, ‘Backing For Law on Medical Pot Climbs in Poll. Now is a much higher percentage, three our of five people want this to be available to the public. It’s just disappointing that we don’t… that we can’t look at it, and have the members and the public look at it before it went to the AG’s Office, whatever the AG’s Taskforce said. And I just… I wasn’t aware or missed somehow in the conversation that was going to happen…

JERZAK: So we’re monitoring…

LUCKS: We’re not happy campers.

JERZAK: We are monitoring what is happening in the other AG section, but our own HQE Deputy was not involved with some of the early discussions about that for the meetings, and we wanted to be able to include a representative from Health Quality Enforcement…

LUCKS: No, but nobody told me, and I was on the Taskforce. So that’s what I’m upset about, because that wasn’t clear to me, and if it was made clear to me, I missed… I missed it somehow, which is possible; I’m not saying it didn’t happen, but I don’t remember. And I just think in good faith we need to… It was supposed to be on this agenda, in the minutes we mentioned having this on the agenda, and it’s not. And there are people here from the public who are prepared to discuss it. And I was prepared to proudly present a document for review and comments and suggestions and criticism, but Sandra Dresser from the CMA, Alice Mead, who was an attorney on the Conant case, Anna Facio, myself, and Mary Agnes… I can’t pronounce her last name…

JERZAK: Matyszewski.

LUCKS: … Matyszewski, all agreed on a document, and it was a… it was… I was very proud of it.
So I’m hoping… is it possible for it to be circulated way before the May meeting, so there’s plenty of time for written comments to be written and returned to the board before the meeting? How soon could this happen?

JERZAK: I’m sure that we can get a document circulated before the May meeting. It is not ready at this point.

LUCKS: Okay. Well, our… well, OUR document was ready. The document that our committee worked on is ready. It just hasn’t been vetted, I guess, by the AG’s Office, is what you’re saying, by the taskforce from the AG’s Office.

JERZAK: I’m not sure it’s in a… in a final stage that… but we can certainly… and I’ll, I’ll make every effort before the May meeting to have a document circulated perhaps, you know, mid-March, or the first part of March, to have some concerns that were raised to ensure that…

LUCKS: What… see, no one’s gotten back to me with any concerns that were raised. That’s the… that’s the thing… I thought it was a done deal, and nothing… I don’t know if any…

RONALD WENDER: I think that we've probably gone beyond the bounds of the report here, and I would suggest that Ms. Lucks, … Ms. Jerzak [...unintelligible...],. Mr. Alexander?

ALEXANDER: Well, yeah, I… I just want to comment briefly on this, because our next meeting is probably going to be mine and Linda’s last meeting, because our terms expire. And I was a little disturbed by this as well. I think Ron does an incredibly efficient job… Ron Joseph does an incredibly efficient job of picking up in the minutes, and making certain that this committee or board, division, or panel, whatever we are, reflects what we said. And I even noticed on page 9 and 11 when I read the minutes that Ron Wender specifically asked for this to be on the agenda on page 9. And on page 11, it says ‘Agenda items for January 2004,’ and this is specifically listed there.

Now, I can’t help but think that the people who have been very vigorous, and I don’t have a position on this one way or another, but the people who have been very vigorous in attending our meetings also saw that, because I assume they see our minutes and such, and came here with that intention. When I see it as sort of not even a part of your report, in terms of listing out what you’re reporting on, and comes at the very, very end, it can’t help but create that sense that, you know, things are not all copasetic and things are not being dealt with in a fair and honest and straightforward manner. So…

(TOD MIKURIYA, MD, videographer) ("sotto voce") One might say…

ALEXANDER: …that may not be the case, but as Ron Wender said earlier, it’s perceptions that we deal with that matter the most. It’s not on the agenda. It is not listed as a separate item. It was called out by our chair in the separate items. It’s listed in our minutes that it’s going to be reflected on our agenda as a separate item. Linda has worked hard on this, you know, she’s got one more meeting to go. And what I just heard is, ‘I’ll make every effort to sort of try to, maybe if I can, get to you something in advance of perhaps a May meeting if it’s time to do that.’ And something being diverted from being part of a conversation that one of our board members is a taskforce on.

So it leaves me with a real bad taste in my mouth, not from an after-effect of marijuana, that, you know, something isn’t right here. This is an issue we’ve battered around. It’s a political football. We know it is a drug of the 60’s that has a very big political sort of baggage caught on with it. And we’ve taken a very, in my opinion, heavy-handed enforcement approach to this. There are doctors on this board who have medical experience—I don’t—that have a very strong medical opinion about this one way or another. I don’t think we’re ever getting to that debate because we’re never getting the issue before us in a manner that we could hear from our Medical Board member colleagues, their medical background and medical perspective on this. All we’re hearing all the time is the enforcement, enforcement, enforcement. I saw the article in this morning’s paper, and I e-mailed it, like I do to you guys every morning. This issue is a popular public issue, and county-by-county, counties are taking positions, cities are taking positions. I feel bad that the Medical Board isn’t taking a medical position on this that helps lead those counties, so this isn’t led by enforcement. This is not an enforcement issue, in my opinion, this is a medical issue. And I want to hear the benefit of our Medical Board members commenting on it. It’s been a year since this issue first came up.

RON JOSEPH:If I may, I, I at first came up here because I’d like to separate the issue into two, and I think you raise, perhaps, a third element of this issue that I would like to address. Let me separate it in this way: Fully respectful of a very important point that’s been raised is that irrespective of where this Board comes down on the matter, the perception of how we handle the process is equally as important, and I’m very sensitive to that. And I would at first like to address the fact that it is not on the agenda. And I will take full responsibility for that because, as you say, it is my job to monitor the directives that come out of one meeting, and make sure they’re adhered to in the next meeting. And I.. that is not Ms. Jerzak's responsibility; it is mine, and I will take responsibility for it not being on this agenda.

Secondly, however, I would like to separate the matter and say here having already admitted that perception is very important here, I want to assure this Board and the public, there is nothing surreptitious going on, there is no agenda that the Medical Board staff has relative to this matter. And I do want to state publicly that we are handling this as objectively and forthrightly as we do any matter, and there is no agenda.

Thirdly, you raised the question of the medical input… or the input of the physician members of this board. And while I concur that it’s going to be extremely important, this board does not set medical policy. And I heard a tone in that statement that you were looking for this board to take a lead on what the right medicine is, which is really not the charge of this board. It is to administer the laws relative to the physicians’ concurrence with the community standards of practice. And I think we always have to be mindful of that as well.

ALEXANDER: Thanks, Ron, I appreciate that clarification on the last issue. You know, I often get comments from the board members about the standards of care, and the community standards, and such, and that’s what I think… you know, that’s what I’m alluding to, is what are the standards of care, and what are this medical board’s view, because I think we are in a position, and I’ve heard it from the Medical Board members that are licensees to help establish that. And we do that in cooperation oftentimes with the California Medical Association as they've testified before us.. That we’re setting policy, oftentimes, on those kinds of things. So… And, you know, by virtue of how we deal with our cases, that dictates, as well, the standard of care. So… And I appreciate clarification of the others, as well as your taking of responsibility, which I wanted to give you the opportunity to do.

WENDER: I’m certain this will be on the agenda for the next meeting.

LUCKS: May I just add one comment?

WENDER: You may.

LUCKS: I would urge you to get the document circulated as soon as possible. Even if it hasn’t gone to the taskforce, let us at least look at it, so that we know and we’re well prepared.

JERZAK: That finishes my report.

WENDER: …we will have a response from Mr. Joseph and probably our legal counsel.

JOSEPH: Between now and the next meeting, Ms. Yaroslavsky and I will discuss that request. I think… I think we can get there, but I’m not sure it is possible or appropriate to request a sitting jurist from the 9th Circuit to come and explain. I just don’t know yet. I’m going to have to sit…

WOMAN: It was more for the information, just the person that’s written the law, just to put it in lay terms so that this board can understand, as well as the general public and media out there what the implications of it will be.

JOSEPH: Okay. We will… we will pursue that more understandable clarification. I’m just cautioning that I need to sort through working with the Office of the Attorney General how that’s achieved.

WENDER: Any other…? Yeah, Ms. Lux and then Dr. Breall.

LUX: Yes, I’d like to put on the agenda the issue of sexual misconduct. At the Ethics Committee held several weeks ago, one of the committee members, who name I can’t remember, who is a [...unintelligible...]… whatever... It had mentioned that, uhm…

WENDER: Dr. Breall.

DR. BREALL: Well, with so many things going on next time’s agenda, I, ah… I’m somewhat hesitant to propose this, but I think that this is an exceedingly important topic, probably just as important as medical marijuana, if not more important. And that is, consideration of the electronic practice of medicine. I’ve been trying to get it on the agenda, either an entire board meeting, or this meeting. This is a whole big can of worms that I think this board, or at least this committee, and then going up to the regular board, has to take… has to consider to take a stand on. And the reason it is so important, and I would invite you if it does get on the agenda to inform other individuals that we are going to discuss this, because this is being looked on kindly—and I have some information here to back this up—this is being looked on kindly by the American Medical Association, by the American College of Physicians, and the American Academy of Family Practitioners. So I’m not going to say anything more about that, but I think it really is a hot agenda item.

WENDER: Would it be possible to have someone speak to us about what the legal ramifications of… what currently is legal with prescriptions and electronic medicine, so that we can at least better educate ourselves? I know that there are a lot of individual biases either for or against what’s going on, but I would really like to have a better understanding of what is legitimate. I mean, I think everyday all of us on… you know, look at our e-mail, and there are 42 requests for why don’t you, you know, order this, that, and the other. We had presentation from the Cleveland Clinic previously about their consulting…

BREALL: e-Mail second opinion.

WENDER: …e-mail second opinion. I would really like a better explanation of what is within the frameworks of the current law, both state and federal. And I think from that point on, we can get into a more intelligent discussion using less personal bias, and have a better framework within which to work. Yes, Ms. Yaroslavsky

YAROSLAVSKY: I would put also there for radiology… radiological, x-ray…

BREALL: Everything.

YAROSLAVSKY: Out of state.

BREALL: Everything, whether it’s…

YAROSLAVSKY: Out of the county.

BREALL: …whether it’s x-rays, electrocardiograms, prescribing of medicine, ah, prescriptions, and so forth. With all due respect, Mr. President, what we do in this group should be done in concert with our legislators to make it a law. I’m not aware that anything that is done now has any major legal challenges. But I think that it’s important to, to stand up and be proactive in this case. And I don’t care what the Feds want to do or what the AMA wants to do, we are here to protect the public.

WENDER: Thank you. I’m glad you don’t express your opinions. Ms. Rice.

RICE: You know, we did have a discussion about this the other day, and because it is… it’s such a big issue, uhm, and, and I agree with Dr. Breall, it’s not just a question of what is… what is current law. There are all sorts of technologies that are being developed even as we sit here now. So I’d like to know what’s on the future, so… in the future, so we can be thinking about what we think should be, uhm, codified, or whatever, and is there a need for change of statute. So I would just like to weight in and to say that I don’t think that this general discussion really can be confined to, to this division meeting. I would like us to entertain the possibility of having at least, you know, a two-hour really thorough discussion from all side, either within the committee, or a special meeting of the Board, or an evening, or something where we can really have a discussion, and not limit it to a half-an-hour.

WENDER: Well, I certainly don’t think this is… like I said this is the beginning of the discussion. And, certainly, within one meeting or within two-hour, three-hour, four-hour, it’s going to be very difficult to come to any conclusion. But I do think we need a lot more information about what’s being done, because, you know, there are many major university health systems that are into electronic medicine, and outreach into communities that don’t have a gastro neurologist, for example, they’re able to do very legitimate types of work. So I think what we’re really looking at is, you know, the fly by night type of operations that people who we think or feel are practicing medicine in a very skewed fashion, I look at this as the beginning, probably a regular agenda item, and maybe even a suggestion that underlines a taskforce to look at this. But I do think we need a lot more education for this group to put it into a framework that we can actually deal with. Yes?

JOSEPH. As Ms. Rice referenced, this was discussed in the Executive Committee yesterday, as well. If I can put together what I heard yesterday and I just heard now, and propose a framework. What I believe I’m hearing you say is the first venture should be a complete description… a comprehensive description of what the laws are today guiding the various practices that utilize emerging technology to deliver health care, appropriately or inappropriately. So that would be the next… and it could be full board, or a Division of Medical Quality, as you see appropriate.

It strikes me, though, that coming out of that there is still going to be the question of what… what practices this board will wish to encourage or discourage, which is going to be an extremely complex undertaking, which I would just offer that you might think about a committee to pursue this, rather than to try and do it within the confines of either a division or a board meeting.

WENDER: No, I think that that’s definitely what’s going to come. I would just like to be able to define… better define the problem. I think that the issues of consultation, again, can become a very different issue than, you know, saying, ‘Give us your credit card, and we’ll send you whatever drug you want.’

RICE: A CT scan...

WENDER: Yes.

WOMAN: [...unintelligible...].

WENDER: I don’t think you’re on.

WOMAN: Oh, there we go.

WENDER: Okay.

WOMAN: I would just suggest if we could possibly have an overview of what is being done in electronic medicine, and that if there is… if there are laws, and may be some new and some areas may not be [...unintelligible...]. So I would like to know those areas and then if there’s laws, so we don’t limit it to only the things where there’s legal constraints.

MAN: Yeah, what’s on the horizon as well.

WENDER: It’s a huge topic that’s going to be a long-term project, I don’t think there is any doubt about it. Mr. Alexander.

ALEXANDER: Yeah, just real quickly, I think that there’s sort of three areas as I see them in what we’ve been dealing with from the public education committee. One is the technology, just the sheer technology and what’s happened with the changes in technology. The second is medicine, the practice of medicine, and how those two interface. And then the third is the law, and how the law with technology and the medicine work together. So I think whoever suggested that we have like a panel of experts in those three areas that have expertise and interface that could come in and educate us first would be, I think, very valuable.

WENDER: Any other recommendations? I do not have the sign-up sheet for public comments. Uhm, Dr. Mikuriya.

MIKURIYA: Just a couple of things. Number one, I’m disappointed that it’s been taking such a long time to get minimum practice standards and guidelines in place, and, hopefully, this will be taken care of by the next meeting and it will be on the agenda.

Second, is wondering what happened to the agenda item from last time about the physicians’ recognition program?

WENDER: That will be mentioned at the board meeting, the full board meeting.

MIKURIYA: Thank you.

WENDER: You’re welcome. Dr. Lucido.

LUCIDO: Members of the Medical Board of California, Division of Medical Quality, it’s a pleasure to be able to speak to you all again. More and more I believe we share a commitment to bettering California medicine. I want our relationship to continue to build on honesty and respect.

I have given you on previous occasions substantial documentation of the safety and efficacy of cannabis as a medicine for a wide range of symptoms and illnesses. If anyone has misplaced or lost any of what I consider these core documents on medicinal cannabis, please feel free to e-mail me, and I can send the documents back as attachments. I have a number of other documents I will be giving you.

I want to remind you of the inappropriate targeting and investigation of doctors for having recommended cannabis as medicine. This is evidenced by the investigations having begun on 9 or 10 now, I’ve heard, of the 15 to 20 most outspoken doctors in California regarding this safe and effective medicine. To characterize this as 9 out of 60,000 reports as was done at the last meeting is misleading. I still contend that almost all of these investigations were initiated by some element of law enforcement, and probably none by a patient or legal guardian.

I also need to remind the Board of the well-documented cultural bias of law enforcement of cannabis. I checked again at 11 p.m. last night, and the California Narcotics Officers Association website still has the following untruth: ‘There is no…’ quote, ‘There is no justification for using marijuana as medicine.’ This is thoroughly contradicted by the federal government’s own 1999 Institute of Medicine Report.

As you recall, last meeting I flatly contradicted Deputy Attorney General Mary Agnes Matyszewski’s characterizations of what doctors can and can’t do. I think by now that Dr. Wender has a letter from Ann Brick, one of the attorneys who represented the physicians and patients throughout the litigation that led to victory for physicians in Conant v. McCaffrey in the U.S. District Court under Judge Alsop, and was reaffirmed by the U.S. Court of Appeals for the 9th Circuit in Conant v. Walters. Her letter, as well as the confirmatory interview with Graham Boyd, another of her co-counsel in this case, are presented to you in my packet, and point out the inaccuracies of Ms. Matyszewski.

Lest this look like I am picking on her, I should point out that NONE of the other attorneys corrected her error, and, in fact, the current Chief of Enforcement, Ms. Joan Jerzak, was seen nodding adamantly during Ms. Matyszewski’s comments. I hope the attorneys are now willing to acknowledge their misinterpretation, and that the Medical Board can begin to rethink how it wants to approach a new field of medicine, where those with the most knowledge are overwhelmingly the ones under investigation, and, therefore, muzzled from speaking of their case. And in a shameful display by our legal counsel last meeting… by your legal counsel last meeting, one was effectively muzzled from saying things that had no relevance to his case, except for one accidental word.

Now, where do we go from here? First, I would like some accountability for the misinformation that has been generated by your legal staff, both present and past. I was surprised to hear at the last meeting that Mr. Thornton was still being used as a consultant. His mischaracterizations at the May meeting were enough to make me think he had been fired. An acknowledgement from the attorneys of their misunderstandings and willingness to learn the law will be a good start and a necessary beginning.

In summary, I suggest that you continue to educate yourselves and your attorneys on this safe and effective medicine, and the laws that apply. I will be happy to help organize a teaching session for your staff and any board members interested. I have a number of knowledgeable attorneys and experienced doctors who would be well qualified to put on a half-day seminar, which would contain what I consider core knowledge for your staff, as well as for board members. I suggest that when there are inappropriate complaints from someone who doesn’t know or misinterprets the law, and this includes most of law enforcement, unfortunately, you are obligated to inform them of the law. If there continue to be inappropriate or harassing reports, there have to be sanctions against the reporters who have an agenda other than appropriate medicine. The Medical Board of California as a guardian of medical quality in California cannot continue to allow itself to be used in this inappropriate and destructive way. Your charge is much too important to be diverted this way.

On a complementary note, I am heartened to hear that the CMA and Medical Board Working Group on Medical Cannabis has been making some progress in discussing cannabis practice standards, but I am disheartened that none of the most knowledgeable doctors have been consulted on this. I would hope to be able to help review the work before it is set in stone. In case you didn’t know it, my ridiculously inappropriate investigation was closed last June (correction: August, 2003), one full year after it was started.

The California Medical Association and the California Medical Board should stand up to law enforcement and make a statement that they should cease interfering with California medicine. I call on the Medical Board to cease and desist the inappropriate investigations and legal proceedings against doctors, and try to regain the credibility that this has cost you. Sincerely, Frank Lucido.

WENDER: Thank you.

DR. LUCIDO: I have a number of documents. Should I give them to you to copy for the rest of the board, or…?

MAN: [...unintelligible...](instructed to give to Ron Joseph).

DR. LUCIDO: Okay, great. What I have, let me just tell you what it is, the packet will contain my statement from today, my statement from 11/7/03, the full con… full text of Conant v. McCaffrey, which is 23 pages. Attention should be given to page 19 through 21. Full text of Conant v. Walters, 36 pages. A statement by Attorney Graham Boyd to O’Shaughnessy's editor, Fred Gardner, in response to the interpretation of Deputy AG Mary Agnes Matyszewski on Conant v. McCaffrey and Conant v. Walters. And the letter from Ann Brick, the ACLU attorney, concerning same. And my CV—my CV has been updated from last time to reflect that I gave a talk to the Alta Bates Medical Staff Grand Rounds last Tuesday, entitled, ‘Medical Cannabis and Medical Board Investigations.’ That’s the only change in my CV. Soon to be available, my piece to be published in the next O’Shaughnessy's on Practice Standards for Medical Cannabis—Seven Years Experience, a Work in Progress. Thank you.

WENDER: Thank you.

ALEXANDER: Ron?

WENDER: Yes.

ALEXANDER: I just want to comment real quick, even though I know this is public comment section, and just make an observation. It just seems like for some reason or another, I can’t put my fingers on it, I do a lot of public facilitation and meeting management, that we’re creating a polarization here. I’m watching the looks on people out in the audience. Eighty percent of communication is non-verbal, so it doesn’t matter what people say oftentimes, it’s how they say it and how they deliver it. I don’t know you at all, and I don’t know your background, so I can’t have any opinion on that. I’ll state for the record, I’ve never smoked marijuana. I was a product of the 60’s. I went to Woodstock. I just was raised by a family and in a culture that I didn’t do drugs. You know, I’m anomaly, I guess, for my era. But, nonetheless, my dad died of cancer and went through that process, and I saw the benefits of what he derived from this process.

It just strikes me as odd, Barbara asked if we could have someone from the courts talk to us, Carlos (Ramirez) got up and said, ‘We’ll tell you.’ Well, they’re cops, they’re the Attorney General, they are not the courts. We are not hearing from the courts, we’re hearing opinions about the courts, and I’m watching Nancy (Vedera) here, sort of looking and, you know, the bottom line is what you communicate by your body language to us is really disrespectful for the public that are coming up and testifying to us. I don’t have an opinion on this, but I’m watching the polarization that we’re creating between our staff and I don’t mean Ron, and the public that are trying to educate us.

Now, you could be 100% wrong on this issue, I don’t know. But I’ll never know that, because all we’re doing is hearing the filtered side of things. And I don’t appreciate that. That’s not helpful to me as a board member. It shows a bias coming in. So now the paranoia or suspicion that you raise says to me, ‘Pay attention, Steve.’ Several people have come and testified to us, I think over a year, and they continue to testify with this… that sense of animosity toward this board, toward our staff, toward the AG’s Office. I, for one, as a board member would like to end that. And, again, get to the medical basis for these issues, the medical issues that we’re dealing with, and get out of the enforcement versus the public phenomena that I think we’ve fallen into somehow.

And if nobody else senses it than me, then I’ll take full responsibility for it being my issue and no one else’s. But I’m watching it happen at every single meeting. These guys get up and testify, and the AG’s guys get up, or our attorneys get up, and they either smirk at them, or they dish them, or something happens that creates a tension. And it’s not an either/or or a right/wrong. I just think that this board’s authority and ability to investigate this issue, just like with electronic medicine, find out the facts, find out the trends, find out what’s emerging here, and then for us to take some position on that relative to that. And in the meantime, I think we’re basically the tail is wagging the dog. That’s just my perspective, for what it’s worth.

WENDER: All right. Mr. Ramirez or Ms. Vedera, do you want to comment?

VEDERA: I just want to say that with regards to the 9th Circuit coming to speak before the board, the 9th Circuit speaks through its decisions.

ALEXANDER: I, I… Listen, I know that, and I don’t care. I heard one of our board members says, ‘Can we have someone from the judiciary come to us.’ If that’s possible, great; if it’s not, it’s not. It’s not up to you two, Carlos and you, Nancy, to tell us, whether or not that’s possible. It’s up to Ron to step up like he did and said, ‘I’m not sure what we can do, but we’ll explore it.’ The intent that you have, not to have the AG come tell us, but instead to have the judiciary, if that’s possible. But it’s up to Ron, our executive officer, to tell us that. And, I’m sorry, I take that personally as a board member, when I keep hearing the same story over and over and over. And I’d rather hear what Ron had to say, which is, ‘We’ll explore this and we’ll give you an answer.’

RAMIREZ: When I offered the services of the Attorney General’s Office to explain what the decision meant, it was never my attempt to filter any information that this board wants to hear.

Now, I’ve sat in the audience and heard the advice, the explanation that Mary Agnes gave to this board in the last meeting. What I recall, [...unintelligible...], what I recall was that Mary Agnes was actually reading verbatim from the Conant decision. That was my just recollection. I don’t think, and, again, I could be wrong, that she was interpreting anything besides reading from that decision.

WENDER: Okay. Ms. Lucks?

LUCKS: Yes, and thank you, Steve, for your comments. And I think there has been a very big disconnect in the public’s perception of the what this board is doing and what this board’s intent is to do. And… just what happened at this meeting that we didn’t have a document which we thought we would and have it on the agenda, it’s just feeds into that perception. We’ve been trying to educate this board for the last year. We had Dr. Thomas Ungerleider and Alice Mead address us, if you remember, within the last year, about a year ago, to try to educate the board, and we’ve been trying to learn about the issues, the medical efficacies, etc. We are on the right track, I think, and I’m very sorry that the paranoia is still as bad as it is about this board, because that intent of this board is clearly to do the right thing and to do it as soon as possible. It’s just taking a long time.

And this issue is very charged politically. Hopefully, it will be resolved during my tenure on this board. That is my… that is my goal. Hopefully, I will be reappointed, we don’t know. But I appreciate your concerns, but it is not the intent of this board to do anything but educate the public, educate enforcement, and educate ourselves, and do the right thing.

LUCIDO: I believe that about the board, it’s the staff, and I’ve been on the Steering Committee of San Francisco Bay Area Chapter of Physicians for Social Responsibility. And I know that we as board members, you have limited time, and you do depend on the staff. But if they’re incorrect then you have to stop that dependency.

WENDER Thank you. Nathan Sands.

NATHAN SANDS: Good morning. I’m Nathan Sands. I’m here with the Americans for Safe Access to Medical Marijuana. And we’ve been following this issue, as you know, and we look forward to the guidelines coming out. But in their absence, we… I have taken the time… let me explain, to copy, the old statement from 1997 from this board, and also suggest a new statement that could be adopted. You know, I was going to comment on the one that you were putting out, but this…

WENDER: Give that to….

SANDS: And I won’t go into too much detail, except to say that when there were comments about enforcement versus public… I’m sorry… yeah, the enforcement versus the public, there’s this phenomena going on, what’s happening, I would suggest that by not updating the statement you’re leaving the door open for this. This is what’s going to happen as long as you don’t come out with a clear statement saying, ‘We’re following California law. This is what physicians can do without being afraid.’

And, lastly, I would like to say physicians still are afraid. My position is some physicians are being threatened by their HMO’s that their careers will be damaged if they recommend medical marijuana.

And so now that the Supreme Court of California and the Supreme Court of United States has upheld a doctor’s rights to recommend medical marijuana, it’s time for this board to also make it clear for physicians.

Thank you.

WENDER: I’m unclear, Dr. Ellis did you want to speak?

ELLIS: No, thank you.

WENDER: Okay, Mr. Gardner.

GARDNER: If you will allow me to… I won’t keep you. I just wanted to say that in addition to being the editor of that journal, O’Shaughnessy’s that you may have seen, I’m the father of somebody with intractable epilepsy, who has not been helped by Dilantin or Tegretol or all the experimental drugs in the pipeline at UCSF all these years, or surgery, a desperate situation. So I’ve looked to the possibility that a cannabanoid other than THC in the marijuana plant can be developed for its anti seizure properties. And I’ve followed that progress of G.W. Pharmaceuticals in England, enviously, knowing that there’s been a brain-drain, that some of the group doing research there are Americans who can’t do it here. This is an urgent situation for those of us with seriously ill loved ones. And every stall, every three months could go by, every six months that go by, every time we hear, ‘Oh, well, the attorney general has got a taskforce. We’re going to have to run it by them.’ I can’t help thinking that’s a stall.

And, you know, we all have our legacies at the end of our careers, and this board is going to be judged historically. This is an historical time. It’s like the end of segregation was. This period will be reviewed, and people say, ‘How did we all act in this hour? And did we welcome this progress? Did we end the prohibition, or did we fight a rear-guard battle like at the end of the Civil War to restore slavery and restore segregation, and keep progress from really taking place?’

So I want to thank those of you who have tried to move things forward. I’m deeply hurt by the smirks that I saw in the audience just now when Dr. Lucido was trying to speak. It showed bias. It showed prejudice. It’s scary for a member of the public. And I hope you keep up the good work, and we get some real serious guidelines that enable the courageous doctors to practice without fear. Thank you.

WENDER: Any other public comment? Yes?

(TOD MIKURIYA MD, videographer: Sandra Bressler. Far out.

SANDRA BRESSLER: Sandra Bressler, the California Medical Association. In hopes of contributing to the to dialogue and not any paranoia or whatever has been going on in this context, I would like to tell you that I personally have been working with staff, as has Alice Mead on developing some statement that this board could come out with. I think that those discussions… and actually with board members as well… those discussions have been sincere, good faith, honest, and productive, and we look forward to something coming from this board that will be a good statement that you all can be proud of. And I just wanted to say that because it does reflect that there is a honest dialogue going on, and its intentions are all good. And I think and hope that we’ll come out with a statement that we can all agree with, that is, the pubic and the board.

WENDER: Lori.

RICE: On the issue of medical marijuana, just so that we don’t get lost, and we could see the forest for the trees, at the next board meeting what is the goal of the discussion with respect to medical marijuana for our next meeting? At the end of the meeting, what will we have?

LUCKS: I’m hoping that we will have a document that will be circulated well before the meeting to ourselves and possibly to the public, so that if there be written comments submitted before the meeting for us to read, if that’s possible, and to have us have a full discussion, and best of all worlds an adoption of language for what the informational guidelines are, so that doctors have, and enforcement staff have direction… And it is a document that I think will not… I think it will be pretty well accepted. There may be some other additions, but I think we’re pretty happy, the working group is pretty happy with the language of that document as it exists… as it… which no one has seen, but it does exist. And it is very clear about what is fair and what should not be enforced, and that recommendation is okay under most circumstances, and they’re clearly spelled-out.

So, hopefully, that this board the next meeting will be in a position if it’s done in enough time to adopt a document.

RICE: So just… I’m going to sound like Steve Alexander right now, which is a compliment, I hope.

ALEXANDER: You never know.

RICE: My understanding is that there is a few taskforces going on right now, there’s a few documents floating around. Linda, am I correct?

WENDER: One document from this group…

LUCKS: I’m sorry?

RICE: There’s more than one taskforce going on right now, so there’s probably more than one document. All I want… all I would like is just some clarification as to what is going to transpire between now and the next meeting, what the board members have to review, so that if there are a number of documents that we’re going to review, and anybody thinks that within one meeting there’s going to be some consensus about a final document, I’m a little bit concerned. So when you say at the end of the meeting you would like a final document, I’d like to have a little bit more of a framework for that discussion so that we know that we’re on the right track, and at the end of the meeting we’re all happy and no one’s disappointed.

LUCKS: A very good point. The document that I worked on with Sandra Bressler and Alice Mead, and two of our AG’s, …[unintelligible], and Mary Agnes, we all agreed on the language. Okay. I was on… participated by phone, so either I didn’t hear it, or I wasn’t on the phone, or something happened, because I was not aware that that document was going to be sent to an AG taskforce, which I just found out about. I did not know it existed. So apparently is being sent to... a different taskforce, I don’t know what the difference in language, if any, that there is going to be, but it’s news to me as of today.

RICE: Well, are we going to get language from AG taskforce?

LUCKS: I would like to see the language that we come up prior to, and if there’s any post language, because I was very happy with that language.

JOSEPH: Excuse me. I think, perhaps, there’s been a misconception of what this AG or DOJ taskforce is. Yes, they have one, they have a number of them, etc. Our document has not been sent to them for approval or screening or anything else. Our goal as a staff… one of the worst things we could do is present a set of guidelines, and tell the medical community, ‘Go forward,’ if we know that where we’re sending them forward is only going to result in them running into a legal problem with another state agency, or federal agency, or the like. We’re trying to make sure that we can provide the fullest information. The guidelines will be this board’s guidelines. Whether they conform or agree with anyone else in the world is meaningless. They will be this board’s guidelines. But we feel we have a responsibility to also make sure that full education and information is available to the medical community, because there are other agents in this process. That’s all we’re trying to do.

RICE: So can we anticipate that with our… with our whatever we get that we will have comments from anybody else at the same time?

JOSEPH: You will. You will have a core document, and you will have the environment, to the extent that we can discern what that environment is at the moment.

LUCKS: And understand, our document had disclaimers: ‘Please know that the federal laws are different from the state laws.’ So it wasn’t like we were ignoring other laws. Our document made it clear that even though we have these guidelines, there could be other people that prosecute, but we won’t.

ALEXANDER: Right. So one rule of thumb we adopted at the Public Education Committee, I don’t know how we got away with it but we did, and we asked, for example, in the case of the enforcement agreements, Sandra Bressler, who was the main proponent or test [...unintelligible...] and part and parcel of resolving that issue, to have her document to us out loud over the microphones like this by a certain date, so that we didn’t get it the day before. And what Sandra did was do that. And as a result, we were able to review that in advance, and then by the time we got to the committee we were thoughtful in our deliberation.

So I would suggest you put a schedule together that would help expedite this in the three months that we have between now and whatever the next meeting is, and there will be milestones by which people have to submit things, including the folks who have been testifying to us today—again, government is supposed to be transparent—so that they can also submit things, we can see a package in toto which represents Linda’s committee and taskforce that’s been working with the staff, be viewed… that would potentially be separate from that from DOJ or the attorney general, and those experts that have worked on this at a national or state level. So that then we as a board, or a committee, however this is going to happen, can take that recommendation and make our own deliberative decisions about that.

JOSEPH: I do hear that.

RAMIREZ: I want to try to explain how I believe the AG’s taskforce got injected into this process, because I don’t think it was intention. I believe that during the course of the discussion with the HQE, as to what this board was doing…

WOMAN: What’s HQE?

RAMIREZ: Health Quality Enforcement, our section. There was… someone suggested, ‘There’s an AG taskforce perhaps that can be used as a resource, as a resource.’ It was never meant… and that’s an independent taskforce, like yours is independent. It was never suggested that whatever recommendations came out of this board or the taskforce of this board would be submitted to the AG Office for approval.

LUCKS: That’s the perception because we don’t have a document.

WENDER: Like I said, we deal with perceptions of the truth, unfortunately. Any other public comment? Hearing none, this meeting is adjourned. I would ask Mr. Joseph to come up to the podium and Ms. Yaroslavsky to wait.

MAN: Thank you.

WENDER: Thank you for your input and your attendance.