An Assault on My Medical License
Lester Grinspoon, MD
As we continue to make great progress in understanding how cannabis is useful as a medicine and discovering more symptoms and syndromes for which it appears to be at least as useful and both less toxic and less expensive than the pharmaceutical products it is replacing, I am increasingly discouraged by the slow pace that practitioners of allopathic medicine (Modern Western Medicine) are embracing it. In a recent poll of physicians in one of the major Harvard Teaching Hospitals, the percentage of respondents who would be willing to provide patients with the necessary document to allow them to purchase it from the soon-to-be opened dispensaries is now 7.2%. Sadly, I am reminded of an exchange which occurred between the Massachusetts Board of Registration in Mediciine and me:
A Summary of the Correspondence Surrounding the Attempt by the Drug Free America Foundation to Persuade the Commonwealth Of Massachusetts Board of Registration in Medicine to Rescind Lester Grinspoon's License to Practice Medicine
In a letter from the Commonwealth of Massachusetts Board of Registration in Medicine dated September 7, 2001 I was told that the Board had "received a complaint regarding [my] conduct.... The Board is obligated by law to investigate such matters relating to the proper practice of medicine. In compliance with this mandate, the Board's Complaint Committee has directed the staff of the Board to gather information..." "Please provide a written response to the issues raised in the enclosed material.... Under the law, the person filing the enclosed complaint may have access to your response. Your response should be sent to me... within 30 days of your receipt of this letter." The letter was signed by Kathleen M. Shea, Consumer Protection Manager, Commonwealth of Massachusetts Board of Registration in Medicine. The "enclosed material" consisted of a letter and a number of attached documents. The letter on Drug Free America Foundation, Inc. letterhead was dated July 31, 2001 and reads as follows:
I am writing to you out of concern about the legal and ethical conduct of a physician who is reportedly licensed to practice medicine in the state of Massachusetts. It was reported in the August issue of the pro-drug magazine, High Times, in a portion of a report on the annual conference of the National Organization for the Reform of Marijuana Laws (NORML), that Dr. Lester Grinspoon had divulged his own personal use of marijuana. The article quoted him as saying "I was 44 years old in 1972 when I experienced my first marijuana high. Because I found it both useful and benign, I have used it ever since."
As an organization that has dealt with substance abuse for years, we have seen the devastation to lives caused by the use of marijuana. We are keenly aware of the fact that marijuana not only destroys the health of the user, but, it also impairs the user's ability to function in a logical and safe manner. Our knowledge of the effects of marijuana use causes us to question the wisdom of a doctor being allowed to practice medicine when he admits to using a dangerous, mind-altering drug.
Doesn't Dr. Grinspoon's use of an illegal drug put his patients in danger and doesn't this in some manner violate the laws and code of ethics that govern the conduct of physicians in the state of Massachusetts?
Calvina L. Fay
The attachments were as follows:
(1) The article from the August issue of High Times titled " NORML Turns 4/20". The offending paragraphs were highlighted by Drug-free America Foundation and read as follows:
Amid individual pronouncements by big-time politicians and sermons from ever-grayer movement luminaries, the event's emotional peak came in a personal testimonial from an elderly doctor on just what cannabis, as he primly called it, had done for him. Yes, the life-enhancing, creativity-fueling, sex-stimulating and munchie-eating joys of getting stoned were elucidated in courtly fashion by Dr. Lester Grinspoon, formerly a Harvard Medical School professor and chairman of the NORML Board. A man of serious mien as well as mind, he said that while pot's recreational uses are well known, and its medicinal benefits increasingly accepted, what's left woefully unsaid is its capacity for sheer enhancement.
"I was 44 years old in 1972 when I experienced my first marijuana high," Dr. Grinspoon explained. "Because I found it both useful and benign, I have used it ever since." He spoke of resolving challenging life issues by pondering them both stoned and straight. In fact, he credited "stoned self-critiques" with helping him reject the ultimately stultifying practice of psychoanalysis (that is, with the patient prostrate on the couch before the omniscient doctor) in favor of less-distancing therapies.
He called for people in the business, academic and professional worlds to come out of the closet regarding marijuana. To that end, he's pursuing what he calls the "Uses of Marijuana Project" (marijuana-uses.com), an ethnographic exercise on how pot has enhanced users' lives. As Dr. Grinspoon put it, "I cannot possibly convey the breadth of things it helps me to appreciate, to think about, to gain new insights into."
(2) A copy of the Introduction to The Uses of Marijuana Project web site in which I identify myself as a cannabis user and invite other users who find cannabis enhances some aspect(s) of their lives to submit an essay for possible inclusion in the collection.
(3) A copy of an essay I wrote for The Uses of Marijuana Project web site (Some Introductory Remarks for the Uses of Marijuana Project) in which I provide some details of the history of my discovery of marijuana's usefulness to me.
(4) A copy of a short essay I wrote for The Uses of Marijuana Project web site ("Mr. Barr and the Fountain of Youth"), a brief account of my appearance before the Subcommittee on Crime of the House Judiciary Committee on the subject of medical marijuana. Mr. William McCollum, Mr. Asa Hutchinson, and Mr. Bob Barr were particularly hostile. The essay speaks to some later stoned reflections on Mr. Barr's insistence that I had outdone Ponce de Leon inasmuch as I had apparently discovered the Fountain of Youth (he spoke sarcastically of his misinterpretation of the chapter title "Marijuana and Aging" in Marijuana, the Forbidden Medicine, a book he had not read).
After consulting with Professor Charles Nesson (Harvard Law School), I responded to the letter from Ms. Shea on September 18, 2001 as follows:
Re: Calvina Fay
Dear Ms. Shea,
Thank you for giving me the opportunity to respond to the complaint filed by Ms. Fay on behalf of the Drug Free America Foundation, Inc.
The complaint was not brought by a patient of mine, or by anyone who has had any personal contact with any of my patients. In my more than 40-year practice of psychiatry in Massachusetts, I have received only the most favorable feedback from my patients. The complainant here, the Drug Free America Foundation, Inc., is a private, highly partisan, political-advocacy organization whose positions on certain drug policy issues sharply conflict with those I have taken throughout my academic career at the Harvard Medical School. This complaint seems to be political in its aims, a cynical and inappropriate attempt to make use of the Board's investigatory procedures to discredit me.
With respect to the subject matter of the complaint, it does not allege any specific misconduct in the practice of medicine, inadequate medical care or patient harm. Rather, the complaint is based on the complainant's anachronistic belief that any use of cannabis "impairs the user's ability to function in a logical and safe manner". In "question[ing] the wisdom" of my "being allowed to practice medicine," Ms. Fay has filed a complaint, which is both frivolous and lacking in merit.
I respectfully request that the Board dismiss this complaint.
Lester Grinspoon MD
In November, I was asked by Professor Nesson to attend his class in Evidence as he was using this case for heuristic purposes. Because by that time two months had elapsed since I had replied to the Board, I called Ms. Shea to determine the status of this complaint. She told me that the reason it was taking so long was because the Board found this case to be "most consternating." She told me further that my response of September 17th was rejected by the Board which then instructed its lawyer to send me a second letter. However, the lawyer had had difficulty formulating the letter and for that reason had requested further instructions from the Board. I was told that the Board was about to meet again and that I should hear from them shortly after that meeting. She also assured me that no one outside Board offices would know about this, that everyone was pledged to confidentiality. When I sought reassurance that that restriction did not apply to me, that I was free to share it with whomever I wished, she expressed surprise that I would do so. I soon received the following letter dated December 5th:
Re: Calvina Fay
Dear Dr. Grinspoon:
The Complaint Committee of the Board of Registration in Medicine met on November 28, 2001 and considered the above-referenced matter. The complaint and your response were reviewed. After that review the Committee felt [it] could not make a decision because your response did not adequately address all of the allegations included in [the] complaint. Specifically the Committee did not believe that you address[ed] the issued [sic] raised by Ms. Fay in paragraph[s] 2 and 3 of her letter.
Please provide a more detailed response to this matter on or before December 18, 2001. If you need further time to respond or if you have any other questions, I can be reached at 617-727-3086, X. 334.
Very truly yours,
Kathleen M. Shea
In a letter dated December 17, 2001 I replied to the above letter as follows:
Re: Calvina Fay
Dear Ms. Shea,
I write in response to the letter that you wrote on December 5, 2001 on behalf of the Commonwealth of Massachusetts Board of Registration in Medicine. You wrote that the Complaint Committee of the Board "felt" that I, in my letter to the Board of September 18, 2001 "... did not adequately address all the allegations in the complaint...", specifically did I did not "... address the issue[s] raised by Ms. Fay in paragraph[s] 2 and 3 of her letter."
By "allegations" I assume the Board is referring to "devastation to lives caused by the use of marijuana", "[destruction of] the health of the users", [impairment of] the user's ability to function in a logical and safe manner", "[questioning] the wisdom of a doctor being allowed to practice medicine when he admits to using a dangerous, mind-altering drug", "[putting] his patients in danger" and "[violation of] the laws and code of ethics that govern the conduct of physicians in the state of Massachusetts." While I found the "allegations" to range from vague to preposterous, I nonetheless read the relevant parts of the Board of Registration in Medicine regulations to try to determine which of the allegations may represent violations of these regulations. It was because I was unable to find that I had violated any regulation, that I requested of the Board in my letter of September 18th that it dismiss the complaint as both frivolous and lacking in merit. I am unable to respond further until the allegations are made more specific.
Lester Grinspoon MD
On February 25th I called Ms. Shea again. I explained that it had been almost three months since I had heard from the Board and that, in addition to me, there were other people who are interested in the outcome of this action on the part of the Board. Could I assume that because I have not heard from the Board in a quarter of a year that it had decided to drop the matter? She said that I could make no such assumption, that in fact, the Board was going to meet in two days (on February 27th) to consider the matter again; she invited me to call on February 28th to learn what the Board had decided. I asked her why it was taking so long; she replied that it was because I have refused to respond to the allegations and she hinted that the Board was having difficulty in figuring out how to deal with that. I asked her what she thought the Board was likely to decide to do in this next meeting. She replied that she thought they would again demand that I respond to the allegations. I asked her why she thought they would do that inasmuch as I had already twice refused. At that point she said that she really didn't know what the Board would decide to do and that terminated our conversation.
When I called her on February 28th, she began by telling me that, "The Board is very disappointed that you have not responded to the allegations and they have closed the case." Puzzled by this statement, I said something to the effect that I was surprised that they would close the case in the face of my not having responded to the allegations. She then went on to say that I would shortly receive a letter from the Board in which it will be explained that the case was closed but should any other complaint about a violation be received, it would be reopened immediately. This statement furthered my confusion because it implied that they had found some basis for a violation. When I told her that I did not understand, she urged me to wait for the letter that would make it clear.
That letter was dated March 8, 2002 and read as follows:
Re: Calvina Fay
Dear Dr. Grinspoon:
The Complaint Committee of the Board met on February 27, 2002, and carefully considered the above referenced complaint. The members determined that no further action is warranted. The complaint has been closed. Please note that although the Committee voted to close this complaint, they reserve the right to reopen this case should you commit any violations of Board statues or regulations in the future.
If you have any questions, I can be reached at the number or address listed above.
Very truly yours,
Kathleen M. Shea
On March 18,2002 I sent the following letter to the Board of Registration in Medicine with a copy to The Foundation for a Drug-free America Inc.:
March 18, 2002
Re: Calvina Fay
Commonwealth of Massachusetts
Dear members of the Board of Registration in Medicine:
I am both puzzled and concerned by Ms. Shea's letter of March 8, 2002 indicating that the above referenced complaint has been closed. It is as puzzling to me that you closed the complaint as it was that you opened it in the first place. You demanded twice that I respond to the allegations proffered by Ms. Fay of the Drug Free America Foundation, and I failed to respond each time. Now you inform me, without explanation, that the case is closed. What am I to understand? Are you now satisfied with your investigation of this complaint? Or have you belatedly come to realize that the complaint has no more relevance to my competence to practice than would a complaint from a temperance organization which learned that I drank whiskey, and thought it appropriate to "question the wisdom of a doctor being allowed to practice medicine when he admits to using a dangerous, mind-altering drug"? And what does Ms. Shea mean when she says that the Board "... reserve[s] the right to reopen this case should you commit any violations of Board statutes or regulations in the future"? The implication is that at the time you sent the letter of September 7, 2001, you believed I might have violated some statute or regulation, but now, because of my failure to respond to your demands, you no longer believe that to be true. This is incomprehensible to me. Furthermore, why would my committing some hypothetical future violation cause you to reopen this particular case?
Something else about this episode concerns me both as a physician and as a citizen. I have a great deal of respect for the Board's very important work in protecting patients from physicians who are incompetent or harm them in other ways. However, the Board also has a responsibility to protect physicians from harassment. I am particularly concerned about the consequences of this kind of action for the ability of physicians to pursue legitimate clinical and research interests. Because I have retired, this is not a major personal concern, but for a physician with an active practice, the effect could be chilling indeed.
Ms. Fay's letter of July 31, 2001 should have been rejected immediately as an irrelevant and insubstantial accusation. This complaint did not come from a health provider, and certainly not from a patient. The Drug Free America Foundation is an out-of- state organization that has had no contact with me or with any of my patients. The purpose of the complaint was to further a political agenda. By pursuing the matter, the Board of Registration has aided this organization in its goal of harassing a physician who differs from its officials and sponsors in his understanding of a drug he has been studying for 34 years.
Why did the Board treat the letter from the Drug Free America Foundation as a serious complaint of physician incompetence or misbehavior? Are the members of the Board ignorant of a modern understanding of cannabis? Is the Board unaware that the Drug Free America Foundation is a propaganda organization? Is the Board so naive that it could not see that it was being used?
I believe the Board owes me both an explanation and an apology.
Lester Grinspoon M.D.
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