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Patient use of cannabis-based oils a new issue in recent Memorial Hospital changes

June 13, 2015 Updated: June 13, 2015 at 4:10 am
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photo - Cora Stier, 8, is diagnosed with Macrocephaly-Capillary Malformation (MC-M) and is scheduled to have her tonsils and adenoids removed on Wednesday, while also having a vascular hemangioma removed form her tongue. A week before her daughter's surgery,Cora's mother Alicia Stier said Memorial Hospital Central officials told her to keep her cannabis-oil based seizure medication at home due to a new policy that has banned all medical marijuana use on campus grounds. Photo by Logan Riely, The Gazette
Cora Stier, 8, is diagnosed with Macrocephaly-Capillary Malformation (MC-M) and is scheduled to have her tonsils and adenoids removed on Wednesday, while also having a vascular hemangioma removed form her tongue. A week before her daughter's surgery,Cora's mother Alicia Stier said Memorial Hospital Central officials told her to keep her cannabis-oil based seizure medication at home due to a new policy that has banned all medical marijuana use on campus grounds. Photo by Logan Riely, The Gazette 

A week before her daughter's surgery, Alicia Stier said Memorial Hospital Central officials told her to keep one seizure medication home: cannabis-based oils.

The voicemail left her scrambling.

"It's just like any other medication for seizure control," she said. "You don't drop, cold-turkey, a seizure med. That's never a good idea."

The hospital later softened its stance - telling her it would make a final decision Monday on whether to allow her daughter to receive the oil, called Charlotte's Web, while in the hospital.

The confusion highlighted a side effect of Memorial Hospital's decision to take over all pediatric operations from Children's Hospital Colorado at the Boulder Street campus after a wide-ranging state and federal investigation into the two hospital systems.

In short: Will Memorial Hospital, which had no previous policy on the oils, allow parents to administer them during hospital stays?

On Monday, Memorial Hospital's board of directors will discuss the issue, said Dan Weaver, a spokesman for University of Colorado Health, which leases the hospital.

He said until a decision is made, the hospital will work with families and doctors on whether to allow the oil "on a case-by-base basis," he said.

"We're working on that new policy, and we'll have it in place very soon," Weaver said.

Children's Hospital Colorado allows parents of children with medical marijuana cards to administer such oils inside hospitals and at patients' bedsides across the state, said Elizabeth Whitehead, a Children's Hospital spokeswoman.

In an email, she added that "patients need to be really sick," such as with terminal, chronic or debilitating diseases, and attending physicians or providers could prohibit the oils at any time.

That was the case at the Children's Hospital ward inside Memorial Hospital Central before June 4, when massive changes were made at the facility, she said.

Children's Hospital Colorado gave up its license at Memorial after state and federal investigators found inappropriate patient transfers between the two separately licensed hospitals, which were co-located in the same building. The lines between the hospitals became dangerously blurred - including how staff members were shared, and in the processes for admitting patients and in handling complaints, the investigation found.

Memorial Hospital gave up a Level I pediatric trauma waiver that had allowed it to treat the most seriously ill or injured children. Those children now must be transferred to hospitals in the Denver area.

In announcing the investigation's findings and the ensuing changes last month, executives for Memorial Hospital and Children's Hospital said patients would see little - if any - difference or disruption in care.

Children's Hospital doctors and nurses were expected to remain at the facility, albeit as contract employees for Memorial Hospital, the executives said. And care would be streamlined, with simplified admissions procedures, and with only one electronic health record per patient.

But the possibility of banning cannabis-based oils at the facility caught some parents off-guard.

As recently as December, Stier said she brought Charlotte's Web to Memorial Hospital Central's campus while Cora underwent surgery in the Children's Hospital ward. The cannabis-based oil was on Cora's list of medications for doctors to review, and Stier said she administered it in her daughter's room.

Her seizures come from an extremely rare condition called macrocephaly-capillary malformation. Doctors removed the right side of her brain in a bid to end the seizures - only to watch them roar back a few months later.

So far, the oil has helped Cora begin to transition off of a highly specialized diet that doctors recommend children use for no more than a year or two.

The diet helped reduce seizures, but Cora has been on it for five years - making her bones more brittle, and causing other health concerns. She's suffered three bone fractures in the last year - making Charlotte's Web a far more palatable option for the family.

On Thursday, Stier said a nurse told her that the oils could no longer be brought on Memorial Hospital Central's campus, including during a surgery scheduled for Wednesday.

Doctors plan to remove Cora's tonsils and adenoids, while also removing a vascular hemangioma from her tongue. The outpatient procedure is only expected to require a 23-hour hospital stay, Stier said, though she feared that complications would mean more time in a hospital bed - and more time without access to the oil.

"It's 'do no harm' first," said Stier, of Monument. "And for a hospital to have a policy that is putting kids in danger is ridiculous."

Friday afternoon, one hospital official changed course - telling her that a final decision would be made by 5 p.m. Monday, Stier said.

Then, one of her doctors called to ask whether she could postpone the surgery a week and a half, to allow Memorial Hospital's board time to finalize its cannabis policy.

Stier refused, fearing that Cora would get sick in that time. The surgery has been delayed once because Cora caught a cold.

"It's frustrating because we shouldn't even have to be discussing this," Stier said. "They should have looked at policies. I don't know how they could have not known this was coming."

Other facilities appear to have allowed the oils, though the issue remains mired in nuance due to conflicting state and federal laws.

Alhough Colorado voters legalized it in 2012, cannabis remains illegal at the federal level as a schedule I substance, the nation's highest classification for drugs.

Most therapeutic oils are considered hemp because they have no more than .3 percent tetrahydrocannabinol, or THC, which is the substance that gives marijuana users a high. Marijuana, by contrast, has more THC.

While low on THC, oils such as Charlotte's Web are high in CBD, or cannabidiol, which appears to provide relief for such medical conditions as epilepsy.

Cindy Colwell of Colorado Springs said she administered oils to her son, Wyatt, 12, during a recent hospital stay at Rocky Mountain Hospital for Children in Denver, which is part of the Health One system.

She used Charlotte's Web to treat seizures and another oil - this one higher in THC - to reduce debilitating pain caused by spastic quadriplegic cerebral palsy, she said. She said Wyatt has been treated at Memorial Hospital, and she might seek care elsewhere if the oils are banned.

"My main concern with Memorial is that they didn't tell parents," Colwell said. "There was no communication with parents about a policy change. We all heard about it word of mouth."

In Colorado Springs, Penrose-St. Francis Health Services' policy is to not allow cannabis-based oils on its campuses, except in life-saving situations where no other options are available, said Gil Porat, the system's chief medical officer. The reason: Penrose-St. Francis must abide by federal laws to receive federal Medicare payments - the lifeblood of hospital budgets.

Still, there are gray areas, and decisions to allow the oils are made on a case-by-case basis, he said.

"We would look at that situation and certainly would have to do what's best for the patient," Porat said.

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