California Law Requires Physician Education in Pain Management, End-of-Life Care
In October 2001, California governor Gray Davis signed a law requiring doctors to take courses in pain management and in end-of-life care. The law, drafted by Berkeley, California legislator Dion Aroner, proceeds directly from a verdict rendered by a jury in Alameda County, Calif, in June 2001.
The case, Bergman v Eden, involved care provided to William Bergman, an 85-year-old Californian dying of lung cancer. Mr Bergman was admitted to Eden Medical Center in Northern California on February 16, 1998, complaining of intolerable pain. He spent 5 days in the hospital, where he was treated by Dr Wing Chin, an internal medicine specialist.
Nurses charted pain levels ranging from 7 to 10, with 10 points being the worst pain imaginable. Mr Bergman was discharged to die at home, still in agony. His family ultimately consulted another physician who prescribed proper pain medication and Mr Bergman finally obtained relief. He died in hospice care on February 24, 1998.
The jury in the case found that undertreatment of pain equaled "elder abuse" and awarded the Bergman family $1.5 million in damages, which was subsequently reduced to $250,000.
"This outcome encourages all providers to pay attention to their patients' pain and treat it appropriately. If they don't know, they must become educated," said Barbara Coombs Lee, president of Compassion in Dying. "The verdict empowers patients to insist that physicians treat pain and other symptoms at the end of life."
California law, which often sets the pace for nationwide regulations, now requires physicians to complete courses in pain management and palliative care within 4 years as part of the continuing medical education needed to renew licenses. It also requires the state medical board to track complaints about mishandling of pain treatment, and that the complaints be reviewed by a specialist in pain management.
Compassion in Dying Federation encourages patients to be knowledgeable and assertive consumers of medical services. If appropriate pain management is not provided, patients can and should complain to the nurses and physicians.
In addition, a program known as CHIPS (California Hospital Initiative in Palliative Services) has geared up for its second year of seminars aimed at increasing the number of hospital based palliative care programs in the state with the hope that the program will be emulated nationwide.
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Pain Info Must Be Conveyed to Patients
The Center for Medicare and Medicaid Services (formerly the Health Care Financing Administration) released its opinion in March 2001 that information about pain management must be conveyed to patients under its current rules and interpretive guidelines.
A citizen's petition to CMS from a coalition of patient advocacy groups led by Compassion in Dying prompted the CMS letter. In its response to the coalition's petition, Dr Jeffrey L. Kang, director of the Office for Clinical Standards and Quality at CMS, wrote that patients have a right to be informed of all aspects of their medical care, including pain management. He further wrote that not only is pain management included under medical care, it is a critical aspect of care.
CMS's decision explicitly expresses the agency's position that surveyors, when checking facilities' compliance with state and federal laws, have an obligation to discuss pain management as part of their survey.
"Our petition prompted CMS to give careful and specific consideration to the expectations and demands it places on facilities to inform patients about pain management options," said Kathryn L. Tucker, director of legal affairs for Compassion in Dying Federation. "It is through bold, cooperative efforts such as this petition, and CMS's careful attention and response, that pain management will receive the attention it warrants at the highest levels of government."
Other signatories to the petition are Americans for Better Care of the Dying, American Academy of Pain Management, American Pain Foundation, Medicare Rights Center and Partnership for Caring (formerly Choice in Dying).
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Drug Enforcement Administration, 21 Health Groups Call for Balanced Policy on Prescription Pain Medications to Protect Legitimate Use of Prescription Drugs for Patients in Pain
In an unprecedented collaboration, the US Drug Enforcement Administration has joined 21 of the nation's leading pain and health organizations to call for a balanced policy governing prescription pain medications such as OxyContin. DEA Administrator Asa Hutchinson urged a policy that protects the appropriate use of opioid pain relievers for patients who need them, while also preventing abuse and diversion of the drugs.
Hutchinson stood with groups representing physicians, nurses, pharmacists and patient advocates at a press conference held to release a consensus statement on prescription pain medications such as OxyContin, an opioid that has received wide attention as a new drug of choice by substance abusers. Opioid analgesics are a class of natural and synthetic medication that relieves moderate to severe pain. The joint statement noted that for many patients, these drugs offer the most effective way to treat their pain, and often the only option that provides significant relief.
Because opioids are one of several types of controlled substances that have potential for abuse, they are regulated carefully by the DEA and other state agencies. For example, a physician must be licensed by State medical authorities and registered with the DEA before prescribing a controlled substance.
The issue of use and abuse of prescription pain medications has heated up in Washington, DC, as both Congress and the Food and Drug Administration have scheduled hearings on the subject.
"Both health care professionals, and law enforcement and regulatory personnel, share a responsibility for ensuring that prescription pain medications are available to the patients who need them, and for preventing these drugs from becoming a source of harm or abuse," the joint statement said.
"We don't want to cause patients who have legitimate needs for these medications to be discouraged or afraid to use them. And we don't want to restrict doctors and pharmacists from providing these medications when appropriate," Hutchinson said. "At the same time, we must all take reasonable steps to ensure that these powerful medications don't end up in the wrong hands and lead to abuse. We want a balanced approach that addresses the abuse problem without keeping patients from getting the care they need and deserve."
"The repeated accounts of misuse have skewed peoples' perceptions about drugs like OxyContin. The reality is that the vast majority of people who are given these medications by doctors will not become addicted," said Russell Portenoy, MD, chairman of pain medicine and palliative care at Beth Israel Medical Center in New York City. "Unfortunately, some doctors may now be frightened to prescribe these medications, pharmacists may be reluctant to stock them, and patients may refuse to take them because of fear of addiction and the new social stigma."
The DEA and health groups also called for a renewed focus on educating health professionals, law enforcement, and the public about the appropriate use of opioid pain medications in order to promote both responsible prescribing practices and limit instances of abuse and diversion.
For more information about the press conference and a copy of the consensus statement visit the Last Acts Web site at http://www.lastacts.org.
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Senior Citizen Takes Inventive Approach to Use His Retirement
For his milestone 70th birthday, Ed Blum commissioned a mold for Adapt-A-Lap, a portable device Blum invented to help those with limited use of their arms read easier and for people whose low vision requires reading material to be close to their eyes. The device is useful to readers without disabilities, typists in need of a copy holder, and travelers using a laptop computer.
Adapt-A-Lap was initially sold in medical supply catalogs, and it is now carried by bookstores and department stores such as Marshall Field's. It is also available on the Internet through his Web site, http://www.bookholder.net.
Adapt-A-Lap consists of a light portable desk, 12 by 14 inches, with its own handle molded into it. Attached to the back is an aluminum leg that telescopes like camera tripod legs but with four sections instead of three to allow Adapt-A-Lap to be positioned in a greater variety of places.
The desktop is equipped with adjustable elastic straps for holding a book in place and see-through plastic straps for pinning down the pages. It weighs 22 ounces and folds into a package an inch and a half thick, ready to slip into a briefcase or backpack.
Urbana, Illinois, Free Library Executive Director Fred Schlipf tested Adapt-A-Lap to see if the library wanted to add the device to its array of equipment for disabled library users. Schlipf also found a use for it himself. It was great for holding a book open while he worked with his hands, he said. "A couple of our staff tried it and they thought it was really neat," Schlipf said. "We have one that we're going to put in circulation."
The idea came to Blum when he was temporarily disabled by bursitis and began a search for the ideal book holder. He never found it and decided to design his own, starting with a wooden model produced to his design by Amish craftsmen before designing a pressed plastic version.
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The Bronx VA Medical Center Interdisciplinary Palliative Care Fellowship Program Accepts Applications
The interdisciplinary palliative care fellowship program at the Bronx VA is accepting applications from board certified or board eligible physicians, nurses and social workers in palliative care for a 1-year program beginning July 2002. Clinical component consists of a primary rotation at the Bronx VA with additional rotations at the East Lyons and New Jersey VA, Mount Sinai Medical Center and others. Applications for the fellowship are due March 1, 2002; stipend is commensurate with specialty. FMI, please contact Mary Jo Sweeney, education coordinator VA Medical Center, GRECC, 130 West Kingsbridge Road, Bronx, NY 10468; e-mail: [email protected].
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Blue Cross/Blue Shield of Rochester Promotes Improvement in End-of-Life Care
Blue Cross and Blue Shield of Rochester, New York, have added palliative care consultations to their covered services for Blue Choice and Blue Choice Senior subscribers with life-threatening illnesses as part of an ongoing program to improve quality of care.
Under the new policy, coverage is provided for consultations by physicians who are certified in hospice and palliative medicine in the hospital, physician office, nursing homes, or the patient's home.
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Hospice of the Florida SunCoast Awarded Grant for a Train-the-Trainer Mode Caregiving
The Hospice of the Florida SunCoast has been awarded a US Department of Health and Human Services grant to develop a national program for hospice/palliative care professionals on how to better address caregiver concerns and the entire caregiver experience. National research on family caregiver needs will guide the development of resources and training. The 3-year train-the-trainer model will be offered to hospice and palliative care professionals for duplication in their communities.
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