Marin hospital backs bill to allow cannabis use inside health care facilities

By RICHARD HALSTEAD | Marin Independent Journal
PUBLISHED: September 26, 2021

MarinHealth Medical Center is calling on Gov. Gavin Newsom to sign a bill that would require hospitals and other health care facilities to permit terminally ill patients to use medical cannabis in their institutions.

The legislation, Senate Bill 311, has become known as Ryan’s Law – named after Ryan Bartell, who was forced to move from California to Washington state in order to use cannabis instead of coma-inducing morphine for his pain while in end-of-life hospice care. Jim Bartell, Ryan’s father, has campaigned tirelessly for a change in the law.

The bill passed with overwhelming support in the Legislature and was sent to Gov. Newsom on Sept. 17 for his signature. It would prohibit smoking or vaping as methods to use medical cannabis.

“Our district board unanimously voted in support of Ryan’s Law SB 311 this year and I am writing in support of that bill being signed into law,” David Klein, CEO of both MarinHealth Medical Center and the Marin Healthcare District, wrote in a letter to Newsom on Wednesday.

MarinHealth is a publicly owned hospital overseen by the publicly elected Marin Healthcare District board. Dr. Larry Bedard, a longtime member of the district board, has been championing the cause of medical cannabis for years. He is a member of the American Medical Association’s cannabis task force.

“Maybe MarinHealth can show some leadership and be one of the first hospitals in California, if not the country, to approve the use of cannabis,” said the retired emergency medicine physician.

Managers at Marin’s other two hospitals operated by Kaiser Permanente and Sutter Health did not respond to a request for comment.

Bedard said the district board voted in March to endorse Ryan’s Law and ask Klein to write a letter of support. In his letter, Klein notes that in 2016 the district board voted to explore allowing cannabis in MarinHealth facilities.

“This was done in recognition of the fact that patients and their families were already bringing cannabis to the hospital,” Klein wrote. “It was also put forward with the knowledge that medical cannabis could be treated like any other patient-submitted medication, or (over-the-counter) product, by our pharmacy and staff.”

Bedard said MarinHealth patients may be using cannabis without informing their physicians, risking dangerous interactions with other medications they are taking. He said cannabis can interact with anticoagulants, which thin blood to prevent strokes; painkillers such as Vicodin and Oxycontin; and anti-anxiety medications such as Valium.

“It’s really an argument for physician education,” Bedard said. “The vast majority of the physicians are completely unaware.”

The resolution approved by the district board in 2016 quoted from a Journal of the American Medical Association article, which reported that medicinal cannabis is significantly helpful with chronic pain, neuropathic pain, muscle spasms in multiple sclerosis and paraplegia, cancer chemotherapy nausea, and AIDS wasting syndrome.

Marin Public Health Officer Dr. Matt Willis wrote in an email, “Cannabis is a psychoactive substance, and while we have real concerns about the known harms of its use among youth, potential palliative effects at the end of life are a different question. If cannabis is being used by terminally ill patients, it makes sense for hospitals to find ways to take it into account in their pain management plan.”

In 2019, Gov. Newsom vetoed a nearly identical bill, SB 305.

“This bill would create significant conflicts between federal and state law that cannot be taken lightly,” Newsom wrote at the time. “Therefore, I begrudgingly veto this bill.”

The California Hospital Association, which opposed adoption of SB 305, has drafted a letter to the governor calling for him to veto Ryan’s Law.

“We do not oppose the use of medical cannabis — or even necessarily its use in a hospital — as a matter of principle,” the letter states. “While California has legalized both the medical and recreational use of cannabis, it remains a Schedule I controlled drug (no accepted medical use) and is illegal under federal law.”

The association notes that the law would require health care facilities to treat medicinal cannabis as a medication and comply with the same storage and dispensing rules required under state and federal law for other controlled substances by requiring a physician order and dispensing from the pharmacy.

“This puts the facility/pharmacist in direct violation of the federal Controlled Substances Act, as the DEA license does not allow for purchase or dispensing of Schedule I substances,” the letter states. “It also puts the pharmacist in charge in direct conflict with the federal Controlled Substances Act, which will put their personal professional license in jeopardy.”

When Bedard testified before the State Assembly Committee on Health on June 8, he said, ““The Center for Medicare and Medicaid Services does not prosecute hospitals for in-facility use. They have no federal mechanism to do so.” Donald Lyman, a retired physician and former board member at the California Medical Association (CMS) who testified at the same hearing, said, “They (CMS) have no regulatory mechanism for penalizing medical facilities regarding cannabis use. Nor is there any record of the CMS ever penalizing a facility for cannabis use.”