A Los Alamitos doctor, who was punished last year after a plastic
surgery patient died, is facing more California Medical Board
discipline stemming from his work at a beach-front medical marijuana
clinic in Venice.

In the latest medical board case, Dr. Lawrence H. Hansen is accused of
dishonest or corrupt acts for practicing medicine in a clinic owned by
non-doctors, a violation of state law.

While California allows seriously ill patients to obtain medical
marijuana recommendations from their doctors, solicitors for Kush
Doctor in Venice stood outside with fliers inviting passersby to come
in for a recommendation, according to accounts from undercover medical
board officers.

In April of 2011, the medical board and law enforcement agencies
raided the Kush clinics, seizing large bags of marijuana. Last year,
the Los Angeles County district attorney’s office filed felony
criminal charges against two clinic operators for allegedly possessing
and distributing marijuana for sale and for practicing medicine
without a license, according to Superior Court records.

Hansen was reached Monday at a different Kush clinic in West Los
Angeles and said he was unaware of the latest medical board accusation
against him.

“I haven’t done anything wrong,” Hansen said. “I’ll have to check into
it.”

Legal documents recently made public by the medical board give this
account:

In January 2010, the board was alerted that non-doctors were operating
Kush Doctor, a collection of medical marijuana clinics along Ocean
Front Walk in Venice. State law says only licensed physicians can own
and operate medical clinics.

In June 2010, an undercover medical board officer visited two Kush
clinics. The officer met Hansen, who said he had worked there for the
past 18 months. The officer told Hansen it was unethical to provide a
medical marijuana recommendation without a proper physical exam.

In August 2010, the board sent two undercover officers to pose as
patients. An officer was asked if he wanted to get “legalized” to use
marijuana for $150. The officer said the price was too much and agreed
to pay $70. The officer said he was seeking marijuana for relief from
headaches resulting from heavy drinking and inability to sleep.

He saw an unidentified doctor who briefly examined him before he was
given a medical marijuana recommendation card. Hansen is not mentioned
in the description of the August visit.

At another Kush clinic, the officer asked another unidentified doctor
where he could buy marijuana after receiving the recommendation. The
doctor told him it was illegal to give information and then whispered
“next door, upstairs.” The officer then went to the upstairs
dispensary and bought $20 worth of marijuana.

In February 2011, Hansen was put on 35 months of medical board
probation and barred from performing surgeries after the death of a
patient he operated on. (http://www.ocregister.com/articles/surgery-288471-board-documents.html
)

Hansen had retired from active practice in 2003 but in 2008 performed
a vaginal reconstruction at an unaccredited outpatient surgery center
in Anaheim Hills.

The medical board documents say Hansen met the patient, Maria Garcia,
for the first time shortly before the surgery and failed to take a
thorough medical history or perform a comprehensive exam. During the
surgery, Garcia, 39, began to bleed. Afterward, she underwent
liposuction, which was performed by a different doctor.

Garcia suffered a heart attack and died an hour later at a hospital.
Hansen was accused of incompetency for failing to verify that the
surgery center was accredited or check on his patient at the hospital
after he learned of her complications.

To check a doctor’s disciplinary record visit mbc.ca.gov/

Contact the writer: Twitter: @cperkes 714-796-3686 or cperkes@ocregister.com

http://www.ocregister.com/articles/medical-348615-board-marijuana.html

My first patient was a 94 year old women who has end stage pancreatic cancer.   Her son said that she has no appetite and is nauseated constantly.   Her weight is down to 89 pounds and she has been throwing up the majority of the nutrition she tries to eat.   In this case, I advised my patient to vaporize as much as possible to reduce the nausea and stimulate her appetite.   She ended up using an indica strain which worked “tremendously” per her son.

My second patient was a 77 year old women who has breast cancer with metastases to her brain.  While in my office she threw up three times secondary to the tumor in her brain.   Like my first patient she is having a difficult time eating and has lost 30 pounds in the past 2 months.

I receive emails from hundreds of families across the country who have family members in situations just like this who do not have access to medical marijuana.   The stories are all similar.  They just want some relief from the suffering associated with advanced disease and end-stage illness.

In my experience medical marijuana has worked excellent for relieving nausea, reducing pain, increasing appetite and improving sleep.   Most patients in home hospice suffer from one of these symptoms and can benefit.   Unfortunately only 16 states approve the use of medical marijuana.   In California, patients can easily purchase medicine from local collectives and choose from over 20 strains.   Many dispensaries have edibles in the form of sodas, teas, chocolate, lolly pops, cookies, brownies and even ice cream.    I have also had hospice patients use tinctures sublingually and also take cannabis in pill form.  The great thing is that patients can also vaporize the medicine which is smoke free and odorless.

If you have questions about end of life care and medical marijuana feel free to contact my office. We are located in Irvine and Long Beach, CA.

Here are some common questions I get from patients?

1. How can I legally grow 99 plants?

The answer is that you can’t in the state in California unless you can prove that you medically need that much cannabis to treat your condition.   Many patients argue that because they make edibles they need this number of plants to produce enough medicine.   What will happen is that the prosecutor will place the burden of proof on the patient to prove they use this much medicine.   They will argue to the court that 99 plants will produce over 100 pounds of medication every 90 days which is virtually impossible for any one patient to use.

2 What if my doctor gives me a plant exemption to grow more than 12 plants?

I have seen doctors sell “Growers Certificates” for $250 which authorizes the patient to grow up to 99 plants.  The problem is that a “Growers Certificate” from a doctor will NEVER hold up in court for a few reasons.

a. There is no FDA recommended dose established therefore there is no way for a doctor to determine how much medicine a patient will need.

b. There is no training that doctors receive which gives them the credentials to know how much medicine a patient will need.

I have testified in court on more than one occasion for patients who were arrested for plant numbers.  In both cases it was clear they were going to lose and both had to take a plea bargain.   They could have one but it was costing them in the $75,000 range to find out.

3. Can I grow 12 plants and sell my cannabis to a local dispensary?

If you are a member of that collective and also have a growers agreement with them (ask Mr Curiale about this) you are legally allowed to do this.   The members of a collective are supposed to get their medicine from within the collective.

4. Can I travel out of state with my cannabis?

The short answer is that prop 215 only applies to California and you are not able to legally transport cannabis to other states.

5. Can I fly with medicine if I am traveling within California?

The answer is that the airlines have their own rules and you have to check with your airline prior to flying.

6. Can I legally use cannabis if I am under 21?

The answer is that a doctor can recommend cannabis to a patient of ANY age.   However, most doctors, including myself, are not recommending cannabis to patients under 21 because of federal guidelines that treat cannabis as a schedule 1 drug.   You may have to call around to find a doctor willing to recommend it to you.    For the record, the percentage of patients who are under 21 seeking medical marijuana recommendations that are MALINGERING (lying) is VERY high.

7. What is a primary caregiver?

Someone who is a designated primary caregiver for another patient is allowed to purchase, transport, possess and grow marijuana for that patient.  They can not however use the medication personally.   To be a primary caregiver you have to someone who regularly provides services for that person.  For example,  you must house, feed or regularly assist them with daily tasks outside of just getting them their medical marijuana.

Here is the email I received from her today.  It is truly amazing how cannabis can be a “Godsend” for some patients.

Hi Dr. Breen,

I met you yesterday. I have Cervical Dystonia and I am currently battling Botulism because I contracted it from my last treatment of Botox for the Dystonia. I tried the Medical Cannabis for the first time last night and I want to thank you. It is the first time in YEARS that I have slept a full nights sleep. I am crying as I write this to you. I can’t thank you enough. My husband and I were so scared to try this for me because he is in law enforcement and I used to be and we are also both Christians. I thank God that he lead us to you. I know that God did and I thank you for what you do.

From the bottom of my heart THANK YOU!!
LOVE,
XXXXXXXXX

I went on to explain to her that I have treated hundreds of patients going through chemotherapy and that I expected her to do very well.    She can expect: 1. Less pain 2. Less nausea 3. better sleep 4. Improved appetite and hopefully 5. An improved mood.

Most patients will stop their narcotics all together.   They also stop taking any sleeping pills or antiemetics (anti-nasuea pills).   Most oncologists acknowledge the benefits of using medical marijuana but few are willing to recommend it to their patients.   This patients oncologist was compassionate enough to give her a direct referral to my clinics.

I expect that she will do well.   There is a great dispensary in Long Beach called Herbal Solutions that will take the time to find a strain that works best for her.  Even though she is 77 years old I anticipate that she will be able to use the vaporizer without difficulty.

Lastly, all of our prayers are with her and her husband as they go through this difficult time.   Expect a miracle!!

Many of these fly-by-night clinics try and capitalize as quickly as possible without following state medical board guidelines.  They see patients over skype on the computer, require no medical records and do not maintain HIPAA compliance.   If patients have any issues with law enforcement there is no one that they can rely on to produce medical records or write letters on the patients behalf.

What has happened over the past 12 months is that many clinics that were directly affiliated with dispensaries also closed.   Many of them were controlled by the dispensary itself which is a felony in california (see “The Corporate Practice of Medicine).   Dispensaries would open clinics, hire a doctor at an hourly wage and advertise low recommendation prices to lure them into their dispensaries ultimately.    Unfortunately these clinics turned into “mills” for recreational users to legally use cannabis.   It is for this reason why I believe the communities got fed up with the industry and why no one takes “medical” marijuana seriously anymore.

My entire staff takes medical marijuana recommendations very seriously and we only want to attract the most qualified patients.   It has been a blessing to give hope to so many patients over the past 4 years.    Most return with incredible stories of healing and relief.   It would be an honor to take care of you.

Be blessed,

MCSoCal Staff

I can not begin to tell you how many patients are prescribed xanax by their primary care doctors for chronic issues like insomnia and “stress”.    Very few patients understand how addictive these medications are.    It is only because of cases like Michael Jackson and Whitney Houston that patients are beginning to understand why they do not want to take them.   In addition to being highly addictive and dangerous, they do not address the underlying cause and only treat symptoms.

More and more patients are turning to cannabis for sleep and anxiety and ditching their Xanax in the trash.    They are finding that they are getting good control of their symptoms and their sleep improves dramatically.    Cannabis also does not have any of the addictive properties that we commonly see with benzodiazepines.   Patients simply vaporize one or two doses and go to sleep.

The federal government has basically taken a stance that when it comes to medical marijuana the states have no rights.   They are determined to make it difficult for store front dispensaries to operate.   How long this will last is the question.   The California Supreme Court has decided to review the Pack Case to see if the feds can legally interfere with state law and shut down local collectives.  That will take at least 12-24 months. 

Because of the federal governments stance the city of Long Beach is voting on February 14 whether or not to reverse its ordinance that created a safe haven for a few well run dispensaries to operate.    Los Angeles is in the process of figuring out what to do with its few hundred dispensaries as well.   In the next 2-3 months the landscape could change even more.

So what does this mean for patients?    Certainly they may have to drive a little bit further to find a great collective.  Many will simply turn to delivery services. Many will learn how to grow their own.  Industry experts have been telling patients how hard it is to grow quality medicine but that simply is not the case.    For most patients, a small up front investment and a little time is all it would take to get enough medicine to last an entire year.   The state allows you to grow 12 plants (6 mature at any given time) which should yield 4 ounces per plant.   The average patient uses between 1-5 eighths of an ounce per month.   That means an ounce would last them 4 months.   If you do the math one harvest can yield enough medicine to last a few years.  There are plenty of good resources for patients to grow their own medicine.  Many hydroponic shops have instructions on exactly how to do it.

How did this happen?  How did we go from President Obama saying he was not going to use federal resources to go after states medical marijuana laws to regular raids using federal resources?     In my opinion the industry has no one to blame but themselves.  Let me explain.

1. Lets start with the doctors.  It is inexcusable how doctors have distorted the law for $25 have handed out recommendations to anyone who can fog a mirror.  The state medical board set guidelines for recommending medical marijuana and the bottom line is that they are not being followed.   I can not count how many times over the past 6 months I have told patients that they do not qualify who have presented recommendations previously from other doctors.  The majority of these cases is because the patients have not been adequately evaluated by doctors for the condition they are telling me they are using medical marijuana for.   For example, a 23 year old male came in with a previous recommendation to use cannabis for migraine headaches.   He was never evaluated or even diagnosed for his headaches.  In fact he had not been to a doctor in over 7 years.  The last time he did see a doctor for for a sports physical in high school.    Yet, despite having no documentation of having migraine headaches he was given a medical marijuana recommendation. As a result of this blatant disregard for the state guidelines we had half of the senior graduating high school class partying with medical marijuana.

2.  Dispensaries:  The reality is that the many of the dispensaries were not helping the cause.   Many were blatantly providing marijuana to recreational users and drug dealers.    Many would sell ounces at a time on more than one occasion in the same week to the SAME patient. Clearly they know that he/she was selling it and not using all that medicine for personal use.    Secondly, how many raids of dispensaries also turned up cocaine?!!  Clearly these dispensaries were illegally dealing drugs under the guise of medical marijuana.    When dispensaries advertise “happy hour” and put girls in thongs behind the counter they are not giving any city official the impression that they are interested in taking care of patients.

3. HempCon:   all you to do is walk through a hemp con convention to realize that much of medical marijuana is recreational use.   “Hot girl contests”, “Smoke rooms” and the in your face advertising only hurt the genuine medical marijuana community.   It’s pretty hard to stand in front of the city council and argue why we need good dispensaries in the community when there are so many bad apples hurting the cause.

The difficult thing to accept about this recent crack down is that there are genuine patients who need this medicine who are going to suffer.    I wish the legitimate patients could have a voice in all of this.    Last week I took care of a 61 year old man with end stage cancer who really needs safe access to medical marijuana.  He would not know what to do without it other than suffer tremendously.   It breaks my heart to see good dispensaries go down as a result of all the bad apples.

If you are a patient who suffers from insomnia I would like to give you some alternatives to try if you are not a fan of medical marijuana.

1. Melatonin:  before you skip to the next suggestion you must read this.   Many patients try over the counter Melatonin and say that it does not work.   The typical dose is 3mg.   The problem with over the counter melatonin is that it is not sustained release and has a very short half life.    Secondly, ver the counter products have no standardization which means the dosing can vary and you have no idea how many milligrams you are actually getting.   They are typically NOT micronized and have poor absorption.   Lastly, the ingredients can be contaminated because you ahve no idea where they are being sourced from.

Melatonin should only be used if it comes from a compounded pharmacy.  This insures perfect accuracy in the dose and guaranteed to have no contaminants.   It should also be a micronized (broken down to tiny particles for better absorption) and in a sustained release formula (has a longer half life and lasts through the night).  The typical starting dose is 3mg for men and 1mg for women.   You simply go up by 1mg per night until you find the dose that works.   If you wake up feeling groggy than simply take it 2 hours prior to going to sleep.  Typically doses are between 9-12 mg/night and in some cases up to 30mg.  So it is no surprise that the over the counter products do not work well.

It is very safe and actually extremely good for you.   It is normally secreted by the Pineal Gland in the brain.  It was anti-oxidant and anti-inflammatory properties.   There are no adverse effects other than the potential for morning grogginess.   Check with you doctor before you start.

2. Turn it off and shut em down!  How many of you take your iPhone into bed and search the net for a few hours.  How about having the TV on in front of you?   Laptop?      Melatonin is what is secreted and starts you sleep cycle when you go to bed.  However melatonin is inhibited or blocked by any light or stimulus.   Therefore, the room needs to be completely dark (pitch black) for you to enter your normal first stage of sleep.    The constant stimulation of the phone, computer and TV disrupts this natural rhythm and makes it very difficult to maintain a normal sleep cycle.  Only two things should happen in the bed room! Sex and Sleep.

If you can accomplish #2 and try #1 many of you would sleep much better.

1. There will always be safe and professional locations to get quality medicine.   You do not want to rely on the black market where ultimately you do not know what element of society your money is supporting.

2. With a medical marijuana recommendation you can medicate ANYWHERE smoking is legal.  You are not confined to your house and do not have to hide.  If you are suffering you can medicate without worry of arrest.

3. You still have the ability to cultivate 12 marijuana plants at your house, indoors or outdoors.   This process is actually not that difficult and the average patient can harvest enough medication with one grow to last them the entire year.

4. Delivery services are thriving and getting much more professional and proficient.   More and more patients are turning to these services for the convenience.

5. You have the ability to choose the specific marijuana strain that works to control your symptoms.   If left to the black market you will only be able to get what they have which is typically one or two strains at most.

6. You at least will receive a medical exam to include blood pressure annually.  You also have the opportunity to ask the doctor any medical question you may have.    For example, you can him look at a suspicious mole or listen to your heart or a sore knee.  Take advantage of it!

The bottom line is that what is happening to many dispensaries is a minor set back but rest assured you will be able to continue to access the highest grade and quality medicine on the planet by using dispensaries and delivery services.

Dr. Sean Breen has been providing medical marijuana doctors recommendations to patients since 2008 and has offices located in Irvine and Long Beach, CA.