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 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 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.
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 firstname.lastname@example.org or 503-221-9556.
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This article was provided by Compassion in Dying. It is a part of the publication Compassion in Dying.