Pubdate: Tue, 02 Aug 2011
Source: Calaveras Enterprise (CA)
Copyright: 2011 Calaveras Enterprise
Author: Joel Metzger


Since mid-June, several medical marijuana patients have been denied
care at Mark Twain St. Joseph's Hospital clinics, and one doctor is
telling patients to stop using medicinal marijuana, according to
Collective Patient Resources founder Tom Liberty, of Mountain Ranch.
Several patients have been denied care unless they sign a Patient
Responsibility Agreement put out by Mark Twain St. Joseph's Family
Medical Centers that prohibits the use of marijuana.

The agreement stipulates that the patient must agree to a list of
terms and conditions in order to receive or continue his or her treatment.

"Patient will not use any illegal controlled substances, including
marijuana, cocaine, etc. Also, if provider advises, patient will not
use alcohol," the agreement reads. Based on this policy, it appears
that while some doctors working at Mark Twain's clinics are
recommending that their patients use medical marijuana, others are
refusing to provide care for patients if they do use it.

When Larry Cornish, vice president of facilities and project
management for the hospital, was asked about the reasons behind the
new agreement, he was tight-lipped.

"We're not going to provide any information on that," Cornish said.
"We decline to comment."

Hospital President Feliciano Jiron did not return a message asking for

Calaveras County Public Health Officer Dean Kelaita said Mark Twain
administration may just want this controversy to go away.

"I guess they're hoping that it will die down," Kelaita said. "That's
not an effective way to run an operation."

"If they feel that it's (using medical marijuana) not consistent with
their organization's principles or mission, explain why can't they
support it. Make it a policy decision and support it."

Kelaita pointed to the card program that has been instituted in
Calaveras County according to state guidelines that he feels helps
distinguish between medical marijuana users and recreational users.

"The law says that there is appropriate medical use for marijuana. I
think that our ID card program helps sort that out."

While state law permits medical marijuana, cannabis remains an illegal
Schedule I drug on the federal level.

When he first heard about the new policy, Liberty said he was
skeptical. At first he did not believe the reports that clinics were
denying care to patients who would not sign the agreement

"I could not believe that any doctor would let people stay in pain,
and I did not believe any hospital would implement such a legally
risky policy," Liberty said.

"Contracts between prescribing physicians and patients receiving
abusable medications are common; there is no problem with them. What
sets this contract apart is the fact that it includes a legal
substance that has been recommended by a doctor, and the circumstances
under which the contract is being presented," he said. It wasn't until
Valley Springs resident Sam Slayter told Liberty that he had been
refused treatment by Dr. Rafael Rosado, who joined the Mark Twain
staff in June, that Liberty realized patients were actually being
denied care because of their medical marijuana use.

"He did report that he had been refused treatment for his pain by Dr.
Rosado, due to his status as an MMJ (medical marijuana) patient,"
Liberty said. "He also reported that Rosado had refused to help him
find a primary care physician, and that Rosado told him the hospital
would not provide primary care for any MMJ user."

Kelaita said Rosado was brought in by Mark Twain to be the medical
director of the hospital's clinics.

"He oversees the operations of all five of the clinics," Kelaita said.
"He could recommend that the policy be changed."

As to why the policy was changed, Kelaita said he didn't believe that
it was because of an interaction between marijuana and other drugs.

"Marijuana, if used in normal amounts that people would use for a
medicinal purpose, does not interact with traditional pain medications
to any significant point that I'm aware of," he said. "If people
overdo anything, there can be side effects." Messages left at Rosado's
office asking for comment were not returned.

"Rosado's approach violates the MTSJ patients' rights policy," Liberty
said. "That policy states that if a patient is seeking medication that
a particular doctor is not comfortable with, they have the right to be
referred to another doctor  he is therefore violating hospital policy
by taking the position he has been taking."

Another patient, who wishes to remain anonymous, was refused treatment
July 6 at the hospital's clinic in Valley Springs unless he signed the

"Rosado told him that he must sign a contract in which he agreed to
refrain from the use of MMJ and also agree to submit to drug testing
for cannabis if he was to receive any pain meds. This patient signed
the form so that he could get pain relief," Liberty said.

On July 8, David Jack, 68, Volcano, said he was told by Clinic Nursing
Director Pam Cornell that he would be denied an appointment with Dr.
Paul Jacobson unless he signed the agreement.

Jack had surgery on a brain tumor in 1999 and has received care from
MTSJ for the 30 years that he's lived in Calaveras County.

He said medical marijuana allows him to avoid taking powerful opiates
for pain, helps him keep his balance and staves off trigeminal
neuralgia (a searing stabbing or electric-shock-like pain in parts of
the face).

A migraine was causing Jack horrible pain July 8, and he was concerned
that his tumor had caused something serious to go wrong, so he called
to make an appointment with Jacobson, his primary care physician.

"I was told I could only see the doctor if I signed a contract," Jack
said. "She (Cornell) went into an immediate rant that Dr. Jacobson
should have never written me a recommendation. I asked if she were
familiar with California law and she said she wouldn't discuss that."

"She told me my recommendation, as far at MTSJ is concerned, is not
valid. That's scary to me, too."

"I was really shocked. I felt like I'd been really betrayed," Jack
said. "I watch this tumor slowly growing again. I was in pain. I need
to get in to see my doctor to see what's going on, and I was denied."
A message left for Cornell and for Jacobson seeking comments were not

That evening, Jack had an episode in which he vomited on himself,
could not move for an hour and had difficulty expressing basic words.

He ended up having to go to Sutter Amador Hospital two days later to
receive treatment

"David was refused treatment and eventually ended up at the Amador
hospital with blood pressure 220/110 and being diagnosed with a
thrombotic stroke from which he still is not fully recovered," Liberty

"I'm trying to resolve with the hospital," Jack said. "They have a
policy that is detrimental to medical cannabis patients. I would like
to see that eliminated. There's no intention of any lawsuit on this.
I'm not looking for money. I'm still part of the community. I would
rather see a reform."

When Jack called the hospital to start the complaint process, he was
told that the person he needed to talk to was Cornell.

Jack instead filed a complaint with the California Department of
Health Services, after he said attempts to file a complaint with MTSJ
failed. He did not feel as though he could go through the complaint
process with Cornell.

On July 11, Brian Gerber, Mountain Ranch, said he was refused
treatment by Rosado due to his status as an MMJ patient.

"I visited the Angels Camp medical office of the MTSJ Hospital for a
head/chest issue. Dr. Rosado diagnosed an ear infection and providedme with a prescription," Gerber said. "... Then he asked if I used
marijuana. As quickly as I said 'yes,' he said I would not be treated
for pain with narcotics by the hospital."

When Rosado was asked when this new policy had begun, he was informed
that the hospital had instituted it about a month prior, due to
federal law, Gerber said.

"I felt as though I was being belittled by a person who craved
complete autonomy over my life. I then asked him to put the hospital
policy in writing. He produced a form, signed it and told a nurse to
make me a copy."

Gerber feels he can no longer receive care from hospitals affiliated
with Catholic Healthcare West.

"I reside in Mountain Ranch. The MTSJ Hospital is my local hospital. I
have been to the hospital emergency room, on occasion in tears, asking
for pain relief. I am glad I became aware of this policy before I was
in dire need of help. It will be odd to pass by a hospital on the way
to another."

Three days after Gerber's experience, Paula Stevens was seen by Rosado
at a Mark Twain clinic. She was there to renew her paid medication

"When Paula told Rosado that she was an MMJ patient, he immediately
discontinued all of her pain medication," Liberty said. "He told her
to return in eight weeks, at which time she would be drug tested for
the presence of cannabis; if she tested clean, he would agree to
provide treatment. Paula ended up in the emergency room."

"For some unknown reason, Rosado has decided that it is his job to
thwart the other doctors that are working for MTSJ by interfering in
the relationships that they have established with their patients (the
majority of patients who are being refused treatment by Rosado because
of their patient status have received their recommendations from other
MTSJ physicians.) Simply put, Rosado is at war with the other clinic
doctors and it is the patients who are being caught in the middle,"
Liberty said.

Liberty also takes issue with the agreement being presented to
patients who are in pain.

"These patients are coming to the clinics suffering from pain that is
severe enough to warrant what is essentially an emergency visit, and
they are being told by the doctor, 'I will only take away your pain if
you sign right here.' This type of coercion is unacceptable and cruel."

Liberty spoke with Rosado July 20 and asked him if he was aware of the
uproar he was causing by denying MMJ patients care.

"He smiled broadly and said, 'Yes, yes, I am very aware of everything
that is happening,'" Liberty said. 
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