BILL ANALYSIS Ó
SB 500
Page 1
Date of Hearing: June 10, 2014
ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER
PROTECTION
Susan A. Bonilla, Chair
SB 500 (Lieu) - As Amended: May 29, 2014
SENATE VOTE : 33-0
SUBJECT : Medical practice: pain management.
SUMMARY : Requires the Medical Board of California (MBC) to
update pain management case review standards by July 1, 2015,
and every five years thereafter, as specified. Specifically,
this bill :
1)Requires MBC to update pain management case review standards
on or before July 1, 2015, and every five years thereafter.
2)Authorizes MBC to consult with the Osteopathic Medical Board
of California in developing pain management case review
standards.
3)Requires MBC to convene a task force to develop and recommend
the updated standards to the board.
4)Authorizes the task force to consult with entities such as the
American Pain Society, the American Academy of Pain Medicine,
the California Society of Anesthesiologists, the California
Chapter of the American College of Emergency Physicians, the
Osteopathic Medical Board of California, any other medical
entity specializing in pain control therapies, the American
Cancer Society, a physician who treats or evaluates patients
as part of the workers' compensation system, an osteopathic
physician, a physician assistant, and specialists in
pharmacology and addiction medicine.
5)Makes other technical or nonsubstantive changes.
EXISTING LAW :
1) Licenses and regulates physicians and surgeons under the
Medical Practice Act (Act) by the MBC. (Business and
Professions Code (BPC) Sections 2000, et seq.)
SB 500
Page 2
2) Authorizes a physician and surgeon to prescribe, dispense, or
administer prescription drugs, including prescription
controlled substances, to an addict under his or her
treatment for a purpose other than maintenance on, or
detoxification from, prescription drugs or controlled
substances. Authorizes a physician and surgeon to prescribe,
dispense, or administer prescription drugs or prescription
controlled substances to an addict for purposes of
maintenance on, or detoxification from, prescription drugs
under certain circumstances. Provides that a physician and
surgeon may not prescribe, dispense, or administer dangerous
drugs or controlled substances to a person he or she knows or
reasonably believes is using or will use the drugs or
substances for a nonmedical purpose. (BPC 2241)
3) Authorizes a physician and surgeon to prescribe for, or
dispense or administer to, a person under his or her
treatment for a medical condition dangerous drugs or
prescription controlled substances for the treatment of pain
or a condition causing pain, including, but not limited to,
intractable pain. Provides that a physician and surgeon
shall not be subject to disciplinary action for prescribing,
dispensing, or administering dangerous drugs or prescription
controlled substances according to certain requirements.
Authorizes MBC to take any action against a physician and
surgeon who violates laws related to inappropriate
prescribing. Provides that a physician and surgeon shall
exercise reasonable care in determining whether a particular
patient or condition, or the complexity of a patient's
treatment, including, but not limited to, a current or recent
pattern of drug abuse, requires consultation with, or
referral to, a more qualified specialist. (BPC 2241.5)
4) Requires MBC to develop to ensure competent review in cases
concerning the management, including, but not limited to, the
undertreatment, undermedication, and overmedication of a
patient's pain. (BPC 2241.6)
FISCAL EFFECT : Unknown
COMMENTS :
1)Purpose of this bill . This bill requires MBC to convene a
task force to update MBC's 2007 pain management case review
standards to ensure the competent review of such cases by July
SB 500
Page 3
1, 2015, and every five years thereafter. This bill is author
sponsored.
2)Author's statement . According to the author's office, "It is
important for [MBC's] prescriber guidelines to strike the
right balance so that patients in pain are treated
appropriately, timely and in a consistent and safe manner by
their doctor. Similarly, it is critical for [MBC] to have
appropriate, current guidelines that take into account the
realities faced by patients, physicians and regulators in the
Board's efforts managing the important issue of prescribing
controlled substances."
3)Current MBC standards for pain management . MBC publishes
guidelines for physician's management of patient pain to
educate those physicians who lack knowledge about appropriate
treatment and for those who may fail to treat pain properly
due to fear of discipline by MBC. MBC's Web site states,
"These Guidelines are intended to improve effective pain
management in California, by avoiding under treatment, over
treatment, or other inappropriate treatment of a patient's
pain and by clarifying the principles of professional practice
that are endorsed by the Medical Board so that physicians have
a higher level of comfort in using controlled substances,
including opioids, in the treatment of pain. These Guidelines
are intended to promote improved pain management for all forms
of pain and for all patients in pain."
The guidelines were first adopted in 1994, when MBC outlined
its approach to improving appropriate prescribing for
effective pain management in California in a policy statement.
The statement was the product of one year of research,
hearings and discussions.
The statement was expanded in May 2002 as a result of AB 487
(Aroner), Chapter 518, Statutes of 2001, which called for a
task force to review the 1994 Guidelines and to assist MBC in
"develop[ing] standards to assure the competent review in
cases concerning the management, including, but not limited
to, the under treatment, under medication, and over medication
of a patient's pain." The task force expanded the scope of the
Guidelines from intractable pain patients to all patients with
pain.
4)Evolving standards of pain control . Pain prescribing
SB 500
Page 4
guidelines have evolved over the years. For example, previous
law declared it to be unprofessional conduct for a
practitioner to prescribe pain medications to an addict.
However, the standard of care has evolved, and current law now
permits a physician to prescribe, dispense, or administer
prescription drugs, including prescription controlled
substances, to an addict under his or her treatment for a
purpose other than maintenance on, or detoxification from,
prescription drugs or controlled substances.
Standards of care change due to new information, practices,
and medication. MBC last revised its guidelines for
prescribing controlled substances in 2007. This bill will
ensure that MBC revisits its guidelines every five years to
reflect changing practices.
5)MBC's Prescribing Task Force . MBC established a Prescribing
Task Force in 2013 in response to a board member's suggestion
that MBC further define best practices as it relates to
prescribing controlled substances to aid pain management and
reduce prescription drug overdoses. The Task Force will
revisit the pain management guidelines and continue to meet,
although it does not have a deadline for approving changes.
6)Arguments in support . MBC writes, "This bill would codify the
work that [MBC] has started to address related to the
important consumer protection issue of inappropriate
prescribing and pain management. This bill will ensure that
the pain management guidelines are revised, and then reviewed
in a consistent, ongoing manner to provide appropriate
guidance to physicians who are prescribing pain medication.
[MBC] is pleased to support this important measure."
7)Arguments in opposition . The California Right to Life
Committee, Inc. writes, "We don't know what ethics or what
organizations will be represented on any outside advisory
boards. How many people will represent the death and dying
lobbies versus the traditional respect for human life in all
its strengths and frailties?
"We are observing, currently, in California and across the
country, an aggressive promotion and advertising campaign by
agencies and facilities promoting comfort care only for those
patients judged to be within a year or so of death from
disease or illness, and removing all curative care.
SB 500
Page 5
"Many Hospices start a patient off with a mix of curative and
palliative care and then slowly withdraw the curative portion
of care until it is palliative or comfort only - no
nutrition/hydration, no curative medications."
8)Previous legislation . AB 487 (Aroner), Chapter 518, Statutes
of 2001, required all physicians to complete a mandatory
continuing education course in the subjects of pain management
and the treatment of terminally ill and dying patients, and
requires MBC to develop standards assuring competent review in
cases concerning the under-treatment and under-medication of a
patient's pain.
AB 2198 (Houston), Chapter 350, Statutes of 2006, updated the
laws governing the use of drugs to treat pain for purposes of
clarifying that health care professionals that have a medical
basis, including the treatment of pain, for prescribing,
furnishing, dispensing, or administering dangerous drugs or
prescription controlled substances, may do so without
being subject to disciplinary action or prosecution.
REGISTERED SUPPORT / OPPOSITION :
Support
Medical Board of California
Opposition
California Right to Life Committee, Inc.
Analysis Prepared by : Sarah Huchel / B.,P. & C.P. / (916)
319-3301