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HCFA Rules California Patients Must Receive Notice on Pain Care

August 1999

A huge step forward in fighting the under-treatment of pain and further asserting the rights of patients was announced by Compassion in Dying Federation.

A letter from the Health Care Financing Administration (HCFA) has ruled that the Patient Self Determination Act (PSDA) requires "Medicare and Medicaid providers in California to inform patients of their right under California State law to request or reject the use of effective pain treatment." Compassion in Dying Federation requested the federal ruling on behalf of several national patient advocacy organizations.

"Compliance with this requirement will have a huge impact on what patients expect and receive in the way of pain care," said Barbara Coombs Lee, Executive Director of Compassion in Dying Federation.

Kathryn Tucker, Compassion in Dying's Director of Legal Affairs, added, "Inadequate pain care is a widespread problem. Increasing patients' awareness that pain should be addressed, and that they have a right to receive any and all modalities to relieve pain, is an important piece of the puzzle to improve the situation. HCFA's determination that health care providers must inform patients about pain care rights and options will raise patient awareness. Fewer patients will suffer needlessly as a result."

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If patients are aware of their rights to receive pain medication, they are more likely to insist that caregivers pay attention to their pain in ways that many doctors today are not, due to excessive federal and state regulation. This ruling will result in fewer patients suffering needlessly."

In a December 1998 letter to HCFA, concerns were raised that healthcare providers throughout the country were not fulfilling their obligations under the PSDA and state law to inform patients of their rights to make decisions concerning medical care, specifically regarding adequate pain treatment. The signers of the letter believe that patients who are informed about their right to request pain medication will be more likely to make such a request, and will therefore have their pain properly and adequately treated.

The ruling hinged on the definition of "medical care." Though medical care is not defined in the PSDA, said HCFA in its response, its common definition in other Federal statutes includes the "mitigation, treatment, or prevention of disease," and the "...provision of pain medication is part of the mitigation and treatment of disease."

HCFA said that since the term "medical care" includes pain treatment, "...patients must be informed of any rights they have under state law to make decisions concerning pain treatment." HFCA concluded that in California, under its 1997 Pain Patient's Bill of Rights, patients "must be informed of their rights under state law to request or reject specific pain medication."

"Inadequate pain treatment is a growing concern nationwide," said Coombs Lee, "but some legislators want to make it more difficult for physicians to treat pain. The so-called 'Pain Relief Promotion Act of 1999' would chill adequate pain treatment by second guessing physicians' intentions when prescribing pain medication, and subjecting physicians and other health care workers to stiff legal penalties, including a possible life term in prison, if law enforcement officials decide a physician's intent in prescribing medication was improper. This ruling by HCFA proves that pain care issues can be properly addressed without creating a chilling impact on physicians."

"This effort will raise both patient and physician awareness of the importance of treating pain and further strengthen patients' participation in the decision making process about their medical care," said Tucker.

National organizations joining the letter to HCFA included Americans for Better Care of the Dying, American Academy of Pain Management, American Pain Foundation, Medicare Rights Center and Choice in Dying. Other groups who sent separate letters supporting the inquiry were California Hospice, the American Bar Association, Pain and Policy Studies Group at the University of Wisconsin and Southern California Cancer Pain Initiative.





  
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This article was provided by Compassion in Dying. It is a part of the publication Compassion in Dying.
 

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