His Pot Use at Issue: Dr. Frankel Fights For His License
by Fred Gardner, December 28, 2010
The Medical Board of California is trying to revoke the license of a pro-cannabis doctor -for using cannabis. A hearing held in Los Angeles this week is supposed to determine whether or not Allan Frankel, MD, is fit to practice medicine.
Frankel is 59, barrel-chested, curly-haired, and jolly -amazingly so, given that his parents were Holocaust survivors. His looks and something about his manner remind me of the comedian Albert Brooks. He is divorced with three grown children -two who are practicing MDs and one with a business degree. (The businessman, Josh Frankel, was the place-kicker for the University of Oregon Ducks. In 1999 he booted the winning field goal against USC in triple-overtime.)
Most of Frankel's career was spent practicing internal medicine. "I had a hotsy-totsy office on Wilshire Boulevard in Santa Monica," he says, and an affiliation with UCLA. In 34 years of practice Frankel never had a problem with the medical board. He used marijuana on rare social occasions, and knew nothing about its medical aspect. In 2001 Frankel underwent disk surgery for intractable back pain. In 2002 a viral infection of the heart almost killed him (he was given a prognosis of one year to live) and left him "in general, permanent discomfort."
He was disabled -bedridden for most of the ensuing three years. Relief came when some of the cancer and AIDS patients for whom he had written recommendations urged him to try cannabis. "My patients did a reverse intervention on me," Frankel recalls. "Cannabis helped me get better. A part of me thinks it saved my life."
While recovering Frankel designed software that is still used to run the Bowyer Cancer Center at UCLA Hospital. He describes it as "a specialized medical language that enables them to build very complex what-if scenarios involving drug interactions, allergies, insurance, all the factors that have to be taken into account in a treatment plan."
In March, 2006, Frankel opened a new office in Marina Del Rey dedicated to cannabis consultations. "I really didn't know anything about cannabis except what I learned from my patients," he reflects. He joined the Society of Cannabis Clinicians, read the relevant medical and scientific literature, attended conferences, and did everything he could to educate himself about the body's cannabinoid signaling system. He began tracking strain differences and encouraged patients to find the type of cannabis and the delivery system best suited to alleviating their symptoms. In other words, Allan Frankel was serious about mastering his new specialty.
Early on, Frankel says, "I realized that my patients were lying about how much they used -as if they feared my disapproval. Finally I would tell them, 'I use an ounce a month. How much do you really use?' And then they would level with me -about dosage, about everything."
In June 2007 two agents from the medical board's enforcement division "walked into the office and announced that I was under investigation," says Frankel. "They showed their badges in front of all the patients -it was terrible." A vindictive ex had filed a complaint against him. In addition to several false charges, he says, was a true one. As he would eventually acknowledge when he agreed to accept probation from the medical board, he had prescribed Vicodin for himself, "less than one pill a day on average," while recovering from back surgery.
Although the self-prescribing had occurred years before Frankel become a cannabis specialist, the terms of his probation included a punishment never before imposed on a California MD: for one year "Respondent shall not issue an oral or written recommendation or approval to a patient or a patient's primary caregiver for the possession or cultivation of marijuana for the personal medical purposes of the patient."
Friends and colleagues urged Frankel not to accept this punishment, which the med board had recently added to its arsenal. He says he didn't have money to fight it (having just put two kids through med school) and he felt truly foolish and embarrassed about his self-prescribing. Cannabis had politicized him and he had become self-critical. When he accepted probation it was partly by way of penance.
As of April 22, 2010, Allan Frankel, MD, stopped issuing approvals for patients to use cannabis. Other terms of his probation, which have been met, included taking courses in "prescribing practices," "medical record keeping," "ethics," and "professional boundaries;" undergoing a psychiatric evaluation by a psychiatrist chosen by the board; seeing a psychotherapist on a regular basis; abstaining totally from alcohol (which had never been a problem for him); and submitting to random "biological fluid testing."
The probation requirement that Frankel has allegedly violated reads, "Respondent shall abstain completely from the personal use or possession of controlled substances... and any drugs requiring a prescription. This prohibition does not apply to medications lawfully prescribed to Respondent by another practitioner for a bona fide illness or condition."
Frankel was and is using cannabis with the approval of Christine Paoletti, MD, and Cymbalta and Dalmane prescribed by Robert Gerner, MD, for anxiety and insomnia. He was first prescribed Dalmane when he was in his twenties to quell "recurrent nightmares I'd been having since I was a kid in which the Nazis were coming to get me."
The case developed by med board investigators against Frankel is being prosecuted by lawyers from the state attorney general's office. (His name is Jerry Brown and he approved this prosecution.) The key witness against Frankel has been Daniel Fast, a psychiatrist chosen by the board for this purpose. Fast is a member of numerous establishment and gay psychiatric associations. On his resume he lists participation in "National Depression Screen Day," an Eli Lilly scam intended to boost the number of Americans getting Prozac prescriptions.
"I actually knew him slightly when I was at UCLA," says Frankel of Fast. "Like I'd nod to him in the cafeteria." On April 28 Frankel went to Fast's Beverly Hills office for "a 70-minute talk session." Fast subsequently reported to the board that Allan Frankel was unable to practice medicine safely because of impaired cognitive function and "chronic marijuana usage."
Frankel's lawyer, John Fleer, has been handling cases before the med board for more than 20 years and says he has rarely seen an accusation as "desperately flawed" as the one the med board is pressing against Frankel. "The board is ignoring its own prior Decision and Order," says Fleer, "by overruling Dr. Frankel's personal physicians" in regard to appropriate treatment for his condition.
The hearing before Administrative Law Judge Susan Formaker began Monday with opening statements, followed by Daniel Fast's testimony. Cross-examination began in the late afternoon and resumed Tuesday (see below). Frankel's expert witnesses are set for Wednesday: Robert Gerner, MD, a psychiatrist who sees Frankel regularly and does not discern cognitive impairment, and Christine Paoletti, MD, who approved his cannabis use and will testify that it does not render him unsafe to practice medicine. Then the ALJ will recommend to the board whether they should or shouldn't revoke Frankel's license. The board, which consists mainly of ambitious MDs appointed by the governor, can accept, reject or modify an ALJ's recommendation.
"The irony is," says Frankel, "that all my work is directed towards safety. Finding the right strain, the right delivery method, the right dosage ... Working with an analytic chemist so that potencies can be known and consistent... Promoting cannabidiol in hopes of developing less psychoactive strains... Always issuing warnings and reminders to patients... It's just ironic."
HUMAN SMOKE: Some might call it coincidence but in fact it's a politically consistent pattern: Frankel is the second member of the Society of Cannabis Clinicians (1) whose parents were Holocaust survivors, (2) who practiced medicine for decades without running afoul of the medical board, (3) who got investigated and charged soon after becoming a Cannabis specialist, and (4) against whom the board deployed a veteran of Eli Lilly's National Depression Screening Day. The other was Hanya Barth, MD, whose cruel ordeal was reported in O'Shaughnessy's, Spring 2007... Frankel says that the "Nazi dreams," which he hasn't had since he was 30-something, are waking him up again. You don't have to be a psychiatrist to figure out why. ¥¥
Fred Gardner is a co-founder of ProjectCBD.org. He can be reached at firstname.lastname@example.org.