The Health Care Financing Administration has released its opinion that information about pain management must be conveyed to patients under its current rules and interpretive guidelines.
A citizen's petition to HCFA from a Compassion in Dying-led coalition of patient advocacy groups prompted the HCFA letter. In its response to the coalition's petition, HCFA wrote that patients currently have a right to information on all aspects of their medical care, including pain management. The agency further stated that pain management is not only included under medical care, it is a critical aspect of care.
HCFA'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 HCFA 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 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).
Compassion in Dying Federation is supporting legislation in California to improve end-of-life care. The bill, AB 487, instructs the Medical Board of California to order remedial training for physicians who provide inadequate pain care. We are currently soliciting endorsements of this Bill from other health care organizations.
Compassion in Dying is also providing witnesses for a legislative hearing on the problem of under-treated pain in California and the California Medical Board's refusal to take meaningful action.
The Bergman v. Chin trial has been set for May 4. This landmark case is the first to assert that under-treating pain in an elderly patient constitutes elder abuse in California.
The case involves the 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 complaining of intolerable pain. He spent five days in the hospital, where he was treated by Dr. Wing Chin.
Nurses charted pain levels ranging from 7-10 on a 10 point scale, with 10 being the worst pain imaginable, throughout his stay. Mr. Bergman was discharged to die at home, still in agony. His family ultimately got a hospice physician to prescribe pain medication, and Mr. Bergman finally obtained relief. He died the next day.
The family filed a complaint with the Medical Board of California, which investigated and concluded that "the pain care was indeed inadequate," yet declined to take any action. The family then filed suit in California state court asserting medical malpractice and elder abuse. A lower court dismissed the elder abuse claim, but California Superior Court Judge Barbara Miller reinstated it, recognizing that failure to treat pain adequately can constitute elder abuse under California law.
Last year the distinguished law firms of Heller Ehrman White & McAuliffe; Perkins Coie; Arnold & Porter; Brayton Purcell; and Robert Wagstaff honored Compassion in Dying and contributed to our initiatives in pain care and assisted dying with nearly $600,000 in pro bono legal services. This level of commitment from such prestigious organizations is most gratifying. The legal advocacy forged by Compassion in Dying on behalf of the terminally ill would not be possible without this support.
From time to time, we receive inquiries from individuals who are interested in organizing an affiliate in their area. We would like to be able to connect them with other friends of Compassion who are local. How about where you are? If you are interested in affiliate organization and/or are willing to provide names of people who are, we would like to hear from you.
We are currently exploring the possibility of having an affiliate in the Ft. Lauderdale-Miami area of Florida. Please let us know if you would like to be involved in that effort by contacting: Sarah Stebbins, Compassion in Dying director of affiliate development, at email@example.com or 503-221-9556.
Back to the Compassion in Dying Spring 2001 contents page.
This article was provided by Compassion in Dying. It is a part of the publication Compassion in Dying.