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California hospitals now may allow cannabis for the dying, but health care providers worry about federal blowback

Jim Bartell has turned his son Ryan’s death into his life’s mission, one that became reality on Jan 1.

On that date, California Senate Bill 311 — the Compassionate Access to Medical Cannabis Act, labeled “Ryan’s Law” — took effect. Under the law, terminally ill patients in hospitals and health care facilities can gain access to medicinal cannabis.

However, the question remains how many health care facilities will sign on to the new practice right away, because currently federal law considers marijuana a narcotic and therefore illegal.

Before dying from pancreatic cancer in 2018 at age 41, Ryan Bartell was subjected to the debilitating effects of more medically traditional painkillers, like morphine and fentanyl. These drugs left him incoherent in a San Diego-area hospital. He was later transferred to Swedish Medical Center in Seattle, where the use of cannabis is endorsed.

“(Ryan) was pretty much asleep (at the first hospital). But then we transferred him to a different hospital, it changed the whole experience of him being in the hospital. I had conversations with my son. He had dozens of friends come in. He was awake and had a quality of life,” Bartell said. “After he died, I was so angry at the first hospital. They took four and a half weeks of his life.”

Bartell, who has become an ardent advocate for medicinal cannabis, expects the law to help “millions of families” struggling with their worst times. For his role in getting the California law off the ground and working on 14 other states, the father has made friends in other families, along with medical practitioners, from all over the nation.

“That was my motivation in not giving up,” he said.

Gov. Gavin Newsom signed SB 311 introduced by Sen. Ben Hueso, D-Chula Vista, into law last September. While it requires medical facilities to offer cannabis as an option arranged through the patient, the law has exceptions.

The legislation prohibits smoking and vaping pot and provides safeguard for hospitals concerned about the conflict between state and federal law. The federal government, which still classifies cannabis as a Schedule 1 drug, considers the substance as illegal.

Some hospital executives, facilities managers and even pharmacists have approached the new type of pain management in a skittish manner.

“We were opposed to it at first — not on the perspective of whether it’s effective at all, but because it’s still illegal under federal law. It was a conundrum for hospitals. They’re required to be in compliance with federal law (under) Medicare regulations,” said Jan Emerson-Shea, spokeswoman for the California Hospital Association, a state advocacy group. Medicare is a federal health insurance program.

The same reluctance was shared by the California Association of Health Facilities, which as an advocacy organization representing nursing homes. It sought explicit instructions on the protocols of how cannabis would be dispensed and documented.

“We did oppose it initially, but it changed,” association spokeswoman Deborah Pacyna said, referring to the various draft amendments incorporated into the bill. “No one’s doing it (yet)— not because of the intent of the bill. No one will move forward until we have a piece of paper that tells (us how it works.)”

Hueso has addressed the opposition and concerns by working on a “clean-up bill” that clears up “how facilities should comply” since confusion emerged when the California Department of Public Health told health care facilities to treat medicinal cannabis “the same way that they do other scheduled drugs,” the lawmaker stated.

In addition, the senator approached the other fears by including a “safe harbor clause” that allows facilities to suspend the practice “if there is ever federal intervention or indication that the federal government will interfere with state medical cannabis laws,” Hueso pointed out.

“We believe the risk of federal intervention is little to none,” Hueso told the Business Journal. “We are confident that health care facilities have the necessary authority to implement this bill, while ensuring the safety of other patients, guests and employees of the health care facility, compliance with other state laws, and the safe operations of the health care facility.”

Marin Alliance CBC dispensary owner Lynnette Shaw, active for decades in getting medicinal marijuana legalized, endorses allowing it to be supplied to hospital patients.

“I’m so proud his name is on this bill. This is the basis of why the medicinal cannabis industry was formed. I think this is a breakthrough for patients,” Shaw told the Business Journal, recalling the times decades ago when she used other means to get the substance to terminally-ill MarinHealth patients during the AIDS crisis. “I had to sneak so many brownies in that place.”

It’s unclear how many hospitals and other facilities have started dispensing cannabis or plan to, despite the bill being enacted.

In the North Bay, Sutter Santa Rosa Regional Hospital staff has declined to comment on the matter. Phone calls to MarinHealth and Providence Santa Rosa Memorial Hospital officials were unreturned as of press time. Kaiser Permanente released the following statement: “Kaiser Permanente Northern California will comply with SB 311, and we are working on plans to implement this in our hospitals for those that are terminally ill.”

North Bay medicinal cannabis advocate Dr. Larry Bedard, who is serving his fifth term and 20th year on the MarinHealth board of directors, believes the practice of using substance should be widely embraced.

“First of all, they need to read the law. If the federal government comes after them, they can drop out of the program,” he said.

He’d like to see that embrace start with MarinHealth but hasn’t seen movement in that direction, despite his home Marin County’s voting in favor of Proposition 215 in 1996 by an overwhelming margin — 73%. Prop. 215 legalized the drug for medicinal use.

The Greenbrae physician, who retired from the emergency room in 2009, has seen firsthand how cannabis to alleviate pain has helped many patients.

“There’s conclusive scientific evidence from 15,000 articles that (cannabis) helps,” he said.

Bedard contends much strategic thought and work went into the bill that’s now law. The California legislation was purposely delayed because there was “legitimate fear with Trump in office,” Bedard cites of the former U.S. president’s penchant for cracking down on progressive policies under federal law.

Still, even with a new sheriff in town in the White House, Bedard expressed “disappointment” the Biden Administration has failed to do more in respect to legal support on the federal level.

There are some groups that are pushing for change.

Americans for Safe Access, which lobbies for favorable policies toward cannabis, is committed to the law being implemented in California and has drafted support policies to help health care facilities navigate these choppy waters.

“They can’t allow Schedule 1 to stop them from implementing (this law),” Safe Access founder Steph Sherer said, further insisting “there are protocols on qualifying patients.”

What happens if patients are denied access?

To that, Sherer didn’t rule out the legal means of getting the law implemented, based on claims of winning other lawsuits against high-profile agencies.

“But we don’t like suing to implement law,” she said.

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