AHLA's Speaking of Health Law
AHLA's Speaking of Health Law
Medical Marijuana: Legal and Practical Considerations for Long Term Care Providers
Ashlee Gray, General Counsel, Transforming Age, and Aleah Schutze, Of Counsel, Steptoe & Johnson PLLC, discuss how long term care providers can navigate the legal and practical considerations of medical marijuana. They cover the current legal and regulatory landscape, legal and compliance risks for providers, and best practices for providers regarding the storage and administration of medical marijuana. Ashlee and Aleah spoke about this topic at AHLA’s 2024 Long Term and Post-Acute Care Law and Compliance in San Diego, CA.
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Speaker 2:This episode of A HLA speaking of health law is brought to you by A HLA members and donors like you. For more information, visit American health law.org.
Speaker 3:Hello and welcome. My name is Ashley Gray. I am General Counsel of Transforming Age. I, along with my co-presenter today, Aliyah , we'll be talking about medical marijuana, the legal and practical considerations for long-term care providers. Um, Aliyah and I presented on this topic at this year's 2024 long-term and post-acute care long compliance conference in February , which is an awesome conference, if I must say so myself, and would encourage everyone to attend , um, not only a good chance to network with individuals, but just a breadth of knowledge. And also , please submit , um, a submission or , or a proposal for a session as well. At this time, I'll turn it over to Aaliyah to introduce herself. And I'll also ask Aaliyah , Aaliyah , can you tell us, myself and our audience a little bit about the history of medical marijuana?
Speaker 4:Yeah, abso absolutely. Thanks Ashley. And thanks to the listeners out there for joining us today. Um, my name is Aliyah Chui . I am an attorney at Steptoe and Johnson, PLLC. Um, I'm currently located in Louisville, Kentucky, although I have a national regulatory and compliance practice and speak frequently and work frequently in the medical cannabis and recreational cannabis space for that matter, too. So, like Ashley said, I'm just gonna briefly , um, talk about the history of medical cannabis. Um, so as everyone probably knows, there's 38 states that have legalized medical marijuana, and then there's 24 states that have fully legalized recreational marijuana. So, you know , uh, medical cannabis, cannabis is out across the country and easily accessible to people and easily accessible to residents of long-term care facilities. Um, as probably everyone knows as well, despite the fact that the states , um, the majority of the states allow medical marijuana, it is still illegal , um, under federal law . So , um, at this time, marijuana is still, sched is still classified as a schedule one illegal sub substance, excuse me, under the Controlled Substances Act , um, that, you know, is, is possibly changing. There's been a recommendation just in the last, gosh, what is it, Ashley ,
Speaker 3:Six months ? Yeah . Like mid May . Yeah ,
Speaker 4:Mid May , um, to move marijuana from a Schedule one controlled substance to a Schedule three controlled substance. And obviously that would, you know, be impactful because as other well-known Schedule one substances are drugs such as heroin and LSD, and as Schedule three drugs are, you know, steroids and, you know, other much lesser drugs. So it would be significant. However, marijuana would still stay on the Controlled Substances Act. So, we'll, we'll be talking about that a little bit more later, but just really briefly, until very recently until the last year or so, regulatory agencies have taken a very dim view of cannabis. Um, so the, you know, the Department of Justice has been back and forth over the last, what , dozen years or so , uh, regarding whether or not they will enforce , uh, marijuana laws or whether they would leave enforcement to the states. And that's kind of changed with the administrations. Um, in add , in addition , uh, the , uh, department of Housing and Urban Development , um, you know, has come out and said that federal non-discrimination laws don't require, or , uh, the allowing the use of medical marijuana as a reasonable accommodation. And prior, previously , uh, the Food and Drug Administration had , uh, been, had only approved one cannabis derived drug for the treatment of seizures and three synthetic cannabis related drugs. Um, because they felt that it was, you know, important to protect the public health. And they were , um, I guess not comfortable with , uh, cannabis or a lot of the cannabis derived drugs. And then until, again, very recently, the Department of Health and Human Services and CMS just basically hadn't said anything. And finally, the Drug Enforcement Agency had come out and said that the weight of the evidence did not support the classification of marijuana as anything besides a Schedule one controlled substance. So, with that said, Ashley , um, you know, a lot of mixed messages and therefore, providers and as general counsel of a long-term care provider, I mean, how are, how , what are, how are providers supposed to, to understand the laws and to wade into this area?
Speaker 3:Yeah. Providers are definitely in a conundrum. I mean, we are in between a rock and a hard place. Um, whether it's a skilled nursing facility, an assisted living memory care , um, it's, it's hard. It's hard, you know, trying to decide between residents rights versus federal and state law, right? I mean, the residents rights includes self-determination, freedom of choice, right ? Have their needs reasonably met, you know, quality of care is always a big issue. On the other hand, you know, if there's any long-term or post-acute care provider out there, which most of us do except any type of federal funding, Medicare, Medicaid, we have to certify every year that we're in compliance with all state and federal law. Um, now, you know, the , it is , the DOJ has been pretty silent of it about it, or I shouldn't say silent. I mean, in terms of like, not trying to actively prosecute, knock on wood, <laugh>, any long-term care provider up to this point. Um, but you, you do have to weigh those two considerations. I mean, there , uh, could also be liability issues, licensing issues, you know, and I said federal funding , funding , things like that. One of the other things we're always taking into consideration is clinically, like, clinically, how is this going to impact our residents? Is it, is there gonna be a contraindication between medical marijuana and another medication they're taking? So do we wanna know, do we not wanna know , um, is it gonna be not just the medication, is it, you know, hey, if Mrs. Jane Doe is taking some type of medical marijuana, we also may need a care plan around that. Her escort for meals may need to be more cognizant that she may have had medical marijuana and may have trouble ambulating. Um, or do we need to adjust her meal time ? So there are lots of considerations around that. Um, do we, I think some providers may know, but they don't put it on the mar for the residents. Um, so there are a loss of considerations, and I think in a skilled nursing facility, if a , if a provider chooses to regulate, it's a little bit better. Um, but if you have an assisted living , um, and independent living is independent, you know, I don't, I don't think providers in an independent living setting, it's, it's independent for a reason. Right? But when you come to an assisted living setting in some residents are asking for assistance with medication administration, is that gonna be your staff? Is it, is that resident gonna have a designated family member, friend or caregiver come in? Um, and again, do you wanna know? Do you not wanna know? Right. Ultimately, you, your concerned about the health, safety and wellbeing of the resident. Um, again, you don't want any other contraindications with medications. You don't want ambulation issues or, you know, meal service issues or, you know, just a myriad of things that can spiral when you have a resident that's taken medical marijuana just because of the marijuana, other effects . Um , so it, it is, you know, there are several policy options. We can, I guess providers can go that okay , absolutely not route , which I think is what a lot of providers were doing up until maybe two, three years ago, like, no, you know what , we don't wanna take the chance and look , I'm not gonna tell anyone that willfully break the law , right? Um , but a lot of providers were like, no, it's a schedule one . This is ban contraband. Not at all. But a lot of the state laws are, I think, just more progressive and Right. They can move quicker than DC does in the laws that they've developed regarding medical marijuana. You know, Minnesota's been on the forefront some of the other states as well. And a lot of these states now do allow long-term care providers and hospitals to , um, administer in store , excuse me, in store medical marijuana. I mean, that's another consideration too, right? Is , is the administration storage of it , um, which are considerations for providers. I are you , you as a provider, are you gonna allow this resident to store it in their apartment? Are you gonna store it in the med cart or locked cabin? I mean, that's also a hell nother host of liability that is being opened up to, you know , the provider as well as the resident depending on the storage issue.
Speaker 4:Let's, let's drill down on some of those particular points a little bit. I think so. I mean, so like , I think you said earlier, and this is, this is my understanding too. So we don't know of any particular enforcement action that's ever been taken against providers. Correct. You don't know of anything? I don't. Right. I
Speaker 3:Dunno of anything to date. Right.
Speaker 4:Okay. So the only thing I've ever heard of is of a facility in San Francisco where a regulator came in. I can't remember what the type of facility was. I feel like it wasn't a sniff , but , um, they came in and asked, like asked about the policy of the facility and whether or not they allowed residents to use, you know, medical cannabis. But that's the only time I've even heard of a regulator bringing it up at all. Um, and I don't know if you know, CMS ever, ever, you know, taking any enforcement action, we mentioned the DOJ of course, earlier, going back and forth, but, so we, you know, it feels relatively safe, right? As far as, we don't know of any enforcement actions . But let's talk a little bit more about kind of, I guess aside from the practical considerations that we can talk about, you know, I guess what would happen if CMS did decide to take action? I mean, what are providers really looking at as far as as, as, as what the stakes are, I guess, or what they could lose?
Speaker 3:I mean, I think ultimately you're concerned about, as a provider is losing that funding and that payer source , um, right. If , if CMS were to come down and say, oh , no, you know, a you've sworn to them that you have been in compliance with federal and state law. Well, okay, maybe CMS saying , well , that's not entirely true. Um, so we're gonna take away our funding. Are they gonna try to call back some of the payments that they provided? Maybe? Um , I don't think we know. I think it's very just unchartered territory. So providers are like, okay, how risk tolerant are, are we willing to be? And I think years ago it was an absolutely not. And now it's like, okay, well maybe we'll allow patients to self-direct use of medical marijuana , um, and we'll just kind of ignore it , uh, as long as it doesn't conflict with treatment plans or other policies. Or are we , um, going to possibly create a policy where we're bringing in other experts , um, to help us create a policy, whether that's a pharmacist or other professional associations, drug diversion experts, things like that. Mm-Hmm, <affirmative> , um, so did I answer your question?
Speaker 4:I think so. Yeah. I mean, I think you're right. It's about the money, right? I mean, that's the main issue is , um, even if you had, let's say that surveyors started surveying, asking, let's say that surveyor in San Francisco took it a step further and said, oh, you're restricting access to medical cannabis. You know, we're , what if , I mean, is then that's a citation, I guess, or, you know, you have to <crosstalk> ,
Speaker 3:But then I would, I mean, that's a citation. If I were a community, like I would definitely appeal like , uh, yes , on the one hand I can maybe understand the surveyor's point, but not really, because it's like, now you're citing me for being in compliance with federal law, which is the law you're here to enforce , right?
Speaker 4:Right. So you'd put that in your corrective action plan.
Speaker 3:Yeah. <laugh> .
Speaker 4:Um , no, that makes sense. So , um, well, what's interesting I think, too, is so, okay, that's, you know, from a federal perspective, that's the real conundrum, like you said, for providers. But then in some states, you know, the state laws in some of them , um, I mean they, they kind of generally have all, all state programs kind of generally have the same , uh, I guess common themes , so to speak. So there's, you know, protection from criminal penalties, you can typically, you know, do home grow or you access , uh, marijuana or cannabis from a dispensary. You know, there's a variety of products that are allowed. But, you know, in one state it might be, you know, actual physical, pardon me, physical buds versus, you know, in another state you can't get the, but for example, in Kentucky, I'm in Louisville, Kentucky. Kentucky is currently , um, you know, putting out the regulations as they are implementing the medical cannabis program here. And you're not gonna be able to buy buds. It's only gonna be tinctures and oils and , um, you know, smoking it , smoking and vapor vaporization are not allowed. So that kind of stuff varies by state. Um, but you know, it's prohibited in certain uses. There's typically some , um, discrimination protections for, you know, for unemployment and housing. Um, and then they generally follow that kind of, you know, a provider can't prescribe medical marijuana, they don't dispense medical marijuana. Um , they make recommendations, that kind of thing anyway. But the whole point in bringing up all of that background stuff is that in some states, they actually allow long-term care facilities to act on behalf of their residents in regards to obtaining marijuana and even potentially administering marijuana. So then a provider potentially could be going against what's allowed under state law . I mean , does that kind of give you any pause? I guess
Speaker 3:It does . Gimme pause . I just , because it's allowed , I probably would not feel comfortable at this point making our policy such that, you know, our staff or provider staff would have to do those things. Um, yeah , the state can allow it all at once. Doesn't mean we have to do it. Right. Doesn't they shall, yeah , it's allowed, doesn't we have to? Um, so yeah, I would not feel comfortable telling staff that they have to administer it or different things at this point, I guess, I mean, I guess it also depends on the state, right? Like , is there special training that goes along ? Do you know, is it , um, any type of special training that would have to go along with that in those days ? And with that training, does there come some identification language from the state or, or what? Right. Um,
Speaker 4:Well, and I think that's part of it. I think you're right. It doesn't, there's no state that has requires a provider. It's not an affirmative obligation to provide or, you know, to obtain or dispense medical marijuana. That is not the case in any state, obviously. But, but there are laws that protect in , in these states that have it, which to be clear listeners is not every state and is frankly, not even the majority of states. But in some states, there are. So for example, in Massachusetts , um, the Department of Public Health, which oversees the Massachusetts medical marijuana program, they do permit staff members at long-term care facilities to act as personal caregivers. And those personal caregivers , uh, in all states, if you're a caregiver, you register with the state's registry and you say, okay, I, you know, Aaliyah Chui am a caregiver for Ashley, and therefore I can go and obtain this marijuana for her and, you know, bring it to her and obtain it on her behalf. Um, and so for example, in Massachusetts, if a long-term care facility staff member acts as a personal caregiver, then you know, there is some protection , uh, written into the law. So that then kind of, I guess, makes it, you know, more like, maybe I think about allowing it, because there are some protections in place under state law, even though the federal law , um, you know, it's still kind of an unknown at this time, but there's, you know, there's , uh, you know, Missouri has , uh, Florida has laws that allow , um, so for example, in Florida, a hospice employee can be a caregiver. Um, in, in Maine, the, the law permits the use of medical marijuana by hospitalized patients and provides immunity to the hospital. Um, also allows hospice and nursing home employees to register as caregivers. So there, you know, there's definitely some state law out there that does provide that immunity, but then there's a number of states that, you know, are just silent on , um, you know, anything to do with healthcare providers.
Speaker 3:Yeah, that's very interesting. I mean, I think it is interesting, you just touched on the point about the caregivers. So looking at it from a provider employer perspective, so now my staff is , would be asked to go out, procure the medical marijuana, transport it back to the community for the residents. Um, that's a big risk, right? For my employee, I think, to be that transporter. Like, yes, I get the state law , but practically speaking , if someone happens to get wind that, you know, nurse Jane Doe goes out every Tuesday morning to the dispensary to get the medical marijuana. I mean, how are we securing that employee's safety as well? Um,
Speaker 4:I think you make a really good there , because that's something that I always come back to and I think we do as attorneys, because it's like, okay, well, despite what the state law says, do I want nurse Jane Doe driving because she's on my company time? Right? Right. What happens if there's a MVA, you know, <laugh>, right ? And what she's doing is going offsite in order to obtain medical marijuana for a resident, right ? And then, you know, and like you said too, I mean, there's other safety considerations too. Obviously she'd be carrying , um, cash, you know, since you have to utilize cash at dispensaries and she's transporting resident funds. And yeah, I mean, I think that there are other , and, and then frankly, there's also the issue of what if she goes and gets this cannabis for , uh, you know, a resident and then the resident has a bad, a has an adverse , uh, what do I wanna say? I mean, it's not gonna be like a, but what if she has, if it makes her really sick, let's say, or something, or she has a fall because the cannabis is stronger than you know, what she anticipated and she gets out of bed and she falls, and then, you know, she breaks her hip or something, God forbid then what? You know, and does the fact that the , that the nurse attained the cannabis for her make that lawsuit worse if the family pursues a lawsuit?
Speaker 3:Yeah .
Speaker 4:I don't know if you've ever heard of any of those kind of cases. I haven't. But you, you know , being general counsel, you may have heard some war stories that I haven't
Speaker 3:No, I, I haven't heard any, luckily. Um, but it's a consideration, right? I mean, I, I am concerned about, I'm also concerned for my employee safety. If someone knows Nurse Jane Doe is going out to make these runs , I mean, are they, is she a potential target for robbery? Um, right. She has cash. She either has cash or drugs right in her car or in this vehicle. Um, right. At some point.
Speaker 4:Yeah, no, I think that's a good point . Point. I ,
Speaker 3:I think there's lots, right? I think it comes down to the provider's level of risk tolerance and just taking into all the, the risk management issues into consideration. Um,
Speaker 4:You know , yeah , that makes sense .
Speaker 3:Where is it ? You know, again, how's it gonna be transported? Where's it gonna be stored? Who knows what the schedules are? Are we care planning for this resident? Um,
Speaker 4:So let's talk about that a little bit. Um, you know, let's, let's talk a little bit more about, you mentioned earlier, we kind of think, you know, we've talked about this lots of times , um, in the past, you know, there's the , the three approaches that you could take. The option one is blanket restriction on the possession or use of medical marijuana or recreational marijuana for that matter in a facility. You treat it like contraband, it's just not allowed, you know, on facility property. Um, or you take the option number two, which is to allow that self-directed use. So it's basically maybe just kind of ignoring whether or not legal marijuana is being used , um, in a facility, and
Speaker 3:Patient has to obtain their own responsible for storing it on their own, or patient or residents responsible for administering it as well.
Speaker 4:Yep . Yeah. Or option three is, and I think you had , you had started talking about this, is just allowing it and being like, okay, fine, I accept that, you know, we're in a state where medical marijuana or recreational marijuana is allowed, you know, how are we gonna integrate this into our system? You know? And , and , and also there are, if you do choose to go that route, there's also the requirement of having to verify that a patient is on the state registry for purposes of medical marijuana and that it remains medically necessary, right? Because that's part of that sort of overarching scheme for these medical cannabis programs in the individual states. Although they vary in every state, a physician certifies a patient as having a qualifying condition, and those, you know, you have to re-certify. So in some states it's only annually, but in some states it's every 60 days. Yeah . So, you know, that requires you to really kind of keep up on it in addition to figuring out how you're gonna put it, you know, in your EMR and you know, how you're gonna balance it with , um, you know, the other , uh, with a , with a patient's treatment plan. So let's talk a little bit more. Let's kind of assume, I, I still think the majority of long-term care facilities take that option. One of restricting use on their campuses,
Speaker 3:I think , right? But we are seeing more communities like hearing about more that are allowed, right? Like in New York, some communities are saying, okay, let me contract with a physician that has experience with it. The resident can keep it in a locked box . The resident is responsible for procuring it and administrating or administering it to themselves, right? Um, but there's not gonna be any smoking, right? No. Vaping, it can only be a capsule or a tincture, right? Um, you know, some in the Washington state area, you know, Washington had recreational cannabis has been legalized for several years , um, do allow medical cannabis, but , but again, no smoking, no vaping, edibles are okay and a physician must approve use for these residents. So yeah , I think the tide seems to be turning, although very slowly on what the risk tolerance level is for long term and post acute care providers on medical marijuana. But yes , I do think most still have the blanket restriction, but it seems to be more and more saying, okay, this is legal in our state, and I think the residents are asking for it. They're , I mean, they're , they're wanting this form of whether it's pain control or for dementia or Alzheimer's residents or their families or their power of attorneys are asking for this type of therapy, treatment, medication to be provided , um,
Speaker 4:To, yeah, I think, I think you make a great point there, Ashley. And the other thing is public opinion on cannabis has changed considerably, particularly in the last 10 years.
Speaker 3:Yes , absolutely. Absolutely. I mean, in Washington, the , um, you know, Washington Healthcare Association has sampled medical marijuana policies on its website. Um, right. I mean, so, but yeah, like you said , uh, I think if the tide is shifting, public opinion has shifted. So, yeah.
Speaker 4:Do you think that having cannabis be moved from schedule one of the Controlled Substances Act as Schedule three will encourage more providers to allow its use on their campuses?
Speaker 3:Um, possibly. I mean, I think if that's the route we're going, it's a step in the right direction. But if it is a Schedule three , right, it is still controlled by the DEA , there still has to be, you know, FDA approvals for certain things. Um, I think yes, it's a positive step in the right direction, and maybe more providers will start to allow on their campuses if it becomes a Schedule three . Yeah, I could see that happening.
Speaker 4:Okay. Yeah. So let's, let's talk about that. Let's assume that that is in fact what's happening. And for what it's worth, I think that you are right. Um, and I know that I've had several providers in Kentucky because it's, you know, we're, we're in the process right now of setting up our medical cannabis program and I've had several providers reach out asking me, you know, what does that look like? And tell us exactly what our risk is because, you know, we wanna allow this for our patients. So let's talk a little bit about , um, I guess kind of policy considerations, best kind of best practices. So I know what ,
Speaker 3:So what are you telling folks in terms of like policy considerations, like smoking, storage, all the things?
Speaker 4:Yes . So, well first, I mean, you know, I always talk about the, the kind of, I mean, really one of the things is the risk tolerance and the attitude of the board of directors , um, and the administrators, because I want people to, you know, go in eyes wide open. But what I typically say is, you know, make sure to involve people from all your various departments, review your insurance carrier policies , um, you know, and then you really have to draft thorough policies because you have to address what you're gonna do with the residents as well as your employees, right ? Um, and, and one of the big things, I know I already said this, but I'll say it again, is how are you going to obtain and maintain the medical marijuana program registrations? 'cause that's really a big deal. You know, that's one of those liability issues. But then also, like you said, think about restrictions on use. So both, you know what's allowed in the state, of course, but then all, you know, you're not gonna allow smoking on a, you know, a healthcare campus, but you know, are you gonna restrict it to certain times of the day? You know, you don't have your physical therapist typically working with patients at 7:00 PM at night, you know , because the shift is over. And so, are we wanting this to be more something of a end of day thing, or are we really gonna try to integrate it throughout the day and, you know, what are you gonna tell those therapists as far as, well, if Mr. Jones just, you know , used an edible, just ate a gummy an hour ago, then you are gonna have to circle back to him later because you don't probably wanna get him up and doing his physical therapy right now. Or, or maybe he's fine, I don't, you know , but that's something that you have to think about. You need to make sure that, that you really have procedures in place to guide and to educate your staff so that they know what's allowed and they're not worried about getting in trouble or that they're not, you know, that they're just, or that it's kind of like just a , you know, totally a free for all . You don't want that either. Um, you know, you're gonna probably, well, not probably, you'll need to look at your resident admission agreements and you know, integrate , uh, or consider whether you're gonna integrate information about medical cannabis into those admission agreements. And then you need to obviously make sure to update those policies, you know, periodically. Um, but you know, the other things that you need to think about again, and , and you mentioned some of these things. How is the resident going to obtain the medical marijuana? We've already talked about probably not allowing your facility staff, even if the state law would allow it, not allowing your staff member to go and obtain it. I mean, just for the record, if I didn't say it , I'm in agreement with you on that. I think there's too many other liability issues. Um, how are you gonna store it? I mean, is the facility gonna be responsible for storage? Can you even store it? You know , um, that's a real question for hospitals obviously. And then if you are storing it and you remove it , um, are you then dispensing it? You know, I don't know what's the definition of dispensing in your state? Um, you know, so that's kind of a fact specific question, but
Speaker 3:I think, and then to piggyback on that, as the facility stores it, where are they going to store it? Are they gonna store it in the onsite pharmacy if they have one? Are they gonna store it in the resident's room? Is it , um,
Speaker 4:Yes . And who has access if they do store it in the resident's room? But honestly, you can't necessarily store it. Again, depending on what type of facility it is, you can't store it in an onsite , right . You know , uh, pharmacy. So that is a really big question. And then, so I would say arguably you're gonna do patient storage in patient room, right? That's probably gonna be the default, is what I would recommend. Since you asked what I'd recommend, that's what I'd recommend. Um , but then, you know, who has access to it and what do you, what does that look like? Are you , there's ,
Speaker 3:Could another option be if there's like a designated caregiver, okay, then that caregiver brings it with them, administers it , and then if there's anything left over , they take it back with them , right?
Speaker 4:Um , yeah, you could definitely do that policy too, if you decide that you're not going to store it on site , which yeah , you , that's the first consideration then. Yes, I agree. Then you know, you could have your facility policy say , uh, you know, the caregiver has to bring it in for use and take it out with 'em . And I, that's very legitimate too, you know, it just depends on which route you decide to go. Yeah . And then I think, go ahead . I was just gonna say, I think one of the big things is in addition to the, you know, thinking about the dosage and the dosing schedules, what about the administration? What would you do as far as administration goes?
Speaker 3:Um, my preference would be to have either the re resident self administer , or they have their designated caregiver, right? Whether that's a family member or friend or someone they ated administer it to them, not our staff .
Speaker 4:Yeah, I think that's right. I think that's a smart way to approach it. And then, you know ,
Speaker 3:I guess on the other hand, I mean, if our staff administered, you have that control, okay, it should be getting done at this time, at this day. Um, but I think at this time I'm probably leaning towards , you know, the resident arranging that either self-directing it or having a family member or their designated outside caregiver do that, do those responsibilities.
Speaker 4:I think you're right, because I think if you did have, if you allowed your employee to administer it, then also depending on state law, whether you can do that. But also then you're kind of in inputting yourself more into the process and then that creates potentially those liability issues. What if they administer too much or, you know, it just, it gives more control, but then it makes you more a part of it. But, you know, some, some places do do that because they wanna have the control and the understanding of, you know, when patients are, are using medical cannabis. So I, I mean, I definitely can see it from both perspectives. Um, I think too, it depends on the comfort the providers have around the laws in their state. You know, because you need to know what it is that you're administering also. Um, you know, so you wanna make sure that it's coming from a dispensary, that it has the label affixed that you know, you know, the, the amount of THC , you know, you wanna know what you're administering if you are gonna allow your employees to administer.
Speaker 3:Right . Well I think, you know, this is an evolving topic, loss of consideration to think about.
Speaker 4:Yeah, absolutely. I do wanna just mention one more thing that kind of popped into my mind, but another thing is if you do have caregivers come into the facility and bring medical cannabis, that's another thing that the facility would need to track is who's actually a registered caregiver. 'cause you know, that's an issue to consider as well. Yeah . Um, and one thing that I think we don't talk about enough, but I think it's also a consideration is first of all, thinking about documenting clinical documentation of medical marijuana. But, but this is really the main thing is how do other residents feel about it? Because if you are in a, in a shared room, you know, maybe one resident would be adamantly opposed to it and another resident, you know, fully embraces it. So does it create any kind of social or interpersonal issues too? Which, I mean, that's not a legal issue, but that's still something to consider because, you know, you wanna, you need to respect the rights of all of your residents and you want people to get along and you know, have a harmonious living situation. So I dunno if you have any thoughts about that.
Speaker 3:I mean, I guess that leads to if somebody had a roommate, how are we being HIPAA compliant, right? With their medication administration and things like that? Would the roommate necessarily know that the person is being administered men marijuana? Um, just another consideration. Yeah . But I think we're just about out of time and need to wrap up on this intriguing and evolving topic.
Speaker 4:Yes , absolutely. I feel like you and I could talk about this for hours and in fact, we have <laugh>
Speaker 3:<laugh> , so I guess we'll just thank everyone for tuning in , listening , reach out for any questions and the next long and postacute care law and compliance conference .
Speaker 4:Thanks everyone.
Speaker 2:Thank you for listening. If you enjoyed this episode, be sure to subscribe to a HLA speaking of health law wherever you get your podcasts. To learn more about AHLA and the educational resources available to the health law community, visit American health law.org.