Dr. Assad Loses His License

by Fred Gardner, November 11, 2009

Hany Youssef Assad, MD, who has approved cannabis use by some 40,000 Californians over the past seven years, is having his license revoked by the state medical board. The board issued its order Oct. 23. Assad can no longer see patients after Nov. 23.

Assad operates a chain, “NorCal Healthcare,” with offices in Oakland, Ukiah, Bakersfield and Arcata. He has been flying his own small plane from city to city, employing nurse practitioners and physician’s assistants to examine patients. Assad typically addresses groups of patients on the use of marijuana as medicine, signs their records and letters of approval, and flies off.

NorCal Heathcare is up for sale. Interested parties should contact Assad’s lawyer, Tim Aspinwall, at the Nossaman firm in Sacramento. The net this year will purportedly be $1.8 million. Seller strongly motivated.

News that Assad’s license was being yanked reached employees in his Oakland office on Monday, Oct. 26, causing consternation. A call to the medical board led to a policy decree: letters of approval issued by Assad post-Oct. 23 would be valid only through Nov. 23. Some patients demanded refunds, others took the approval letters and went immediately to get ID cards that would be good for a year. (There are various kinds of ID cards. County-issued state cards can get you a pass from law enforcement. Privately issued cards get you past security at the dispensary door.)

As of today, Nov. 9, NorCal staffers are telling patients that new ownership is imminent and that other doctors will be taking Dr. Assad’s place — but it’s not known when, so please call back to make an appointment.

Assad is a tall man in his mid-50s with an eager-to-please manner. He was born and educated in Egypt, graduating from medical school in 1979. He moved to the U.S. in 1992 and did a residency in Internal Medicine at Texas Tech University Medical School, then went to work for Kaiser Permanente in Vacaville. When two women complained that Assad made sexual moves on them, the medical board filed an accusation. Assad accepted a probation deal from the medical board that barred him from treating female patients for seven years.

Assad began issuing cannabis approvals in October, 2003. He was employed initially by a dispensary operator in Oakland. In July 2004 he launched NorCal, employing nurses and PAs to make possible a high- volume practice. He thus got around the ban on seeing women.

“He was trying to get away with as much as he could,” according to a healthcare worker who followed Assad’s career. “You simply cannot see 30 to 40 new patients and issue 30 renewals a day and practice good medicine. You can’t. That’s why his records were so scant and illegible — it takes time to write clearly.”

Assad’s downfall stemmed from his approval of cannabis use by SW, an 18-year-old (male) whom he diagnosed with Attention Deficit Disorder in February 2007. The case was unusual in that Assad had examined SW himself. SW's parents complained to the medical board. The ensuing investigation focused on whether Assad “departed from the ‘standard of practice’” in reaching his ADD diagnosis and cannabis recommendation (which does not require parental approval once patients turn 18). The board accused Assad of negligence and a hearing was held in August of this year, in Oakland, before Administrative Law Judge Mary-Margaret Anderson.

Philip A. Denney, MD, appeared as an expert witness in defense of Assad. Denney contended that an ADD diagnosis was not an “extreme departure” from the standard of care, given the symptoms described by the patient, which included insomnia, stress, and Intermittent Explosive Disorder. Denney could not bring himself to defend Assad’s record-keeping.

“When asked about medical literature concerning the use of medical cannabis,” ALJ Anderson wrote in her opinion, “Denney was dismissive. He finds patient reports concerning efficacy to be more useful, in part because the political climate in the United States inhibits meaningful research.” Disregarding the fact that Dr. Denney’s opinions are based on data gleaned from thousands of patients, Anderson sniffed, “Dr. Denney’s opinions were not very helpful.”

Instead she heeded the opinions of the prosecution expert, Barbara Neyhart, an expensively coiffed member of the faculty at UC Davis who limits her clinical practice to women between the ages of 40 and 60. Neyhart has issued exactly one medical-marijuana recommendation during her career, “for an elderly patient with unremitting arthritic pain in both knees who requested the recommendaton.”

The ALJ determined that Neyhart’s “analysis was objective, thoughtful, and well grounded in the facts of this case and in her education and experience. Her explanations were consistent with the standard of practice. Accordingly, Dr. Neyhart’s opinions were persuasive and significantly informed the factual findings.” The judge was especially impressed by Neyhart’s citation of a study linking cannabis use to mental health problems in adolescence.

Whether or not Hany Assad deserves to have his license revoked, authorizing cannabis use in the case of SW seems neither dangerous nor inappropriate. The young man had actually been smoking cannabis as an alternative to drinking. Alcohol addiction loomed largest among SW’s problems –a fact the young man withheld when Assad took his history, but which Assad would have ascertained if he had reviewed SW’s medical records, i.e., practiced good medicine.

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