Hours before a new law takes effect on cannabis for dying hospital patients, it remains unclear how MarinHealth Medical Center will implement it.
Senate Bill 311, also known as Ryan’s Law, requires hospitals to allow terminally ill patients to use cannabis on their premises. Gov. Gavin Newsom signed the legislation on Sept. 28, and it will take effect Saturday.
Before Newsom signed the bill, David Klein, chief executive officer of both MarinHealth Medical Center and the Marin Healthcare District, wrote the governor a letter to urging him to do so. Klein noted that the elected Marin Healthcare District board, which partially oversees the public hospital, had unanimously voted in support of the law.
Klein has since sought to clarify that he was speaking for the district board, not the medical center.
At the district board’s meeting on Nov. 9, several members of the public asked the board to agendize a discussion on implementing Ryan’s Law at MarinHealth Medical Center.
One of those who spoke was Jim Bartell, the father of Ryan Bartell, for whom the bill is named. The elder Bartell had campaigned for the law.
Ryan Bartell was diagnosed with stage 4 pancreatic cancer at the age of 41. As he grew sicker, he was admitted to the palliative wing of a hospital and given fentanyl to treat his pain. The painkiller, however, made him too sleepy to interact with family and friends.
“During one of his rare waking moments, he asked me to get him off the fentanyl,” Jim Bartell told the district board, “so we could spend together during the last couple weeks without him falling asleep all the time.”
After trying unsuccessfully for four and half weeks to get the hospital to allow his son to substitute cannabis for the fentanyl, Bartell moved his son to another hospital that complied with the request.
“After his first treatment, he woke up the next morning wide awake and pain free,” Bartell said, “and that is the way he was for two and half weeks before he died. That energized me to do something about it, because I was so angry with the first hospital for not allowing him to use the cannabis instead of the fentanyl.”
Following the Nov. 9 meeting, district board member Larry Bedard asked that a discussion of the new law’s implementation at MarinHealth Medical Center be added to the board’s meeting agenda for Dec. 14. His request was denied.
Klein wrote in an email to Bedard saying that he had reviewed the request with Jennifer Rienks, the district board’s chair, and they agreed “that implementation of Ryan’s Law at MarinHealth Medical Center is an operational and compliance matter internal to the hospital corporation and not germane to the business of the district and its board.”
“This is the critical ‘firewall’ that exists between the hospital and the district,” Klein wrote. “Because of this, the subject should not be agendized for our meeting on Tuesday.”
While the district board ensures that MarinHealth Medical Center adheres to certain benchmarks of performance, MarinHealth Medical Center’s separate 11-member hospital corporation board governs its day-to-day operations.
The two-tiered structure was created in 2010 when Sutter Health returned control of Marin General to the district in 2015. It was deemed necessary to insulate the hospital’s management from divisive political battles that had roiled the district board in the past.
Klein did speak briefly about Ryan’s Law during the district board meeting on Dec. 14, but he did not say definitively if the hospital plans to follow the law.
Klein said he had discussed the law “at length” with MarinHealth’s chief of staff, Douglas Cohen, and Dr. Jennifer Voss, who will take over as chief of staff on Saturday.
“They are very interested in scheduling an educational session with the medical executive committee,” Klein said. “We are also keeping a very close eye on regional activities and have been in discussion with a half a dozen Bay Area hospitals about how folks are approaching it.
“We’re going to be real mindful of it, but I think the first step is to get our MEC involved and brought up to speed,” he said. “Then we can talk about next steps.”
At Kaiser Permanente, the company says it is working on plans to implement SB 311.
Novato Community Hospital, which is managed by Sutter Health, did not respond to a request for comment.
Ryan’s Law permits a health care center to suspend compliance if a federal regulatory agency initiates enforcement action against it. The law does not, however, allow a health center to prohibit the use of medical cannabis solely because cannabis is a Schedule I drug or because of other federal constraints.
“There is no waiting to implement this law,” said Steph Sherer, founder and president of Americans for Safe Access, said Thursday. “Just like there is no waiting for terminally ill patients.”
Americans for Safe Access said it alerted all health care centers in California that SB 311 will go into effect on Saturday. It provided tools for facilities to implement the law.
The law prohibits compliance from being a condition for obtaining, retaining or renewing a license as a health care center. Sherer, however, said his organization will take legal action if necessary to see that hospitals comply.
“I’m really hoping we don’t have to do that,” Sherer said. “But we definitely have our ear to the ground.”