BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 791|
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THIRD READING
Bill No: AB 791
Author: Thomson (D), et al
Amended: 8/17/99 in Senate
Vote: 21
SENATE BUSINESS & PROFESSIONS COMMITTEE : 6-0, 6/28/99
AYES: Figueroa, Johannessen, Kelley, O'Connell, Polanco,
Speier
NOT VOTING: Murray
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 79-0, 6/4/99 (Passed on Consent) - See
last page for vote
SUBJECT : Healing arts: pain management
SOURCE : Americans for Death with Dignity
DIGEST : This bill adds pain management training,
assessment, and education requirements for health care
practitioners.
ANALYSIS :
Existing law:
1.Regulates the practice of medicine, and sets forth
curriculum requirements for all applicants for a
physician's license.
CONTINUED
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2.Provides for the licensing and regulation of health
facilities by the Department of Health Services
(DHS) and defines health facility.
3.Establishes the Health Insurance Counseling and
Advocacy Program (HICAP) in the Department of Aging
(DOA) to provide Medicare counseling and advocacy
services.
This bill:
1.Requires applicants for licensure as a physician,
who begin medical school on or after June 1, 2000,
to complete coursework in pain management and
end-of-life care.
2.Requires health facilities to include pain as an
item to be assessed at the same time patient vital
signs are taken. Additionally, requires health
facilities to ensure that pain assessment is
performed in a manner that is appropriate to a
patient.
Comments
Measure Intended to Change Attitudes Toward Pain
Management . Sponsored by Americans for Death with Dignity
(ADD), the bill is intended to change the medical
community's approach toward pain management and end-of-life
care. The bill attempts to accomplish this by making pain
management a part of the standard practice of medicine.
Specifically, the bill requires physicians to be trained in
pain management, and requires health facilities, such as
hospitals and special nursing facilities, to include pain
assessment as part of routine vital sign review.
According to the author's office, a number of factors
contribute to poor pain management practices by medical
personnel. The sponsor states that lack of education and
knowledge on the part of physicians regarding appropriate
pain management and lack of understanding by patients
regarding their end of life care are two major factors
motivating this bill.
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This bill attempts to address how medical personnel respond
to patient pain by requiring that pain be assessed as a
vital sign, which allows nurses and physicians to assess a
patient's level of pain for appropriate treatment. The
author's office indicates that the Veterans Administration
has recently initiated a national program on pain
assessment.
Deficiencies in Pain Management and End-of-Life Care Are
Well Documented . According to the author's office, fear of
pain is a common concern among individuals in the final
stages of life. Furthermore, there is common agreement in
the medical profession that one of the major problems
associated with the medical care of terminally ill and
dying patients is the inadequate treatment of pain for
these patients. There have been numerous studies
documenting physician inexperience with end-of-life care,
including physician abandonment of dying patients and late
referrals to hospice care. Additionally, studies indicate
that cancer-related pain management is inadequate and could
be better controlled if medical personnel were aware of the
need for and availability of pain management treatments.
Prior Legislation
Recognizing the need to improve pain management practices,
the Legislature recently enacted a number of related bills.
Three bills chaptered last session dealt with various
aspects of pain management. AB 2693 (Migden and Thomson,
Chapter 789, Statutes of 1998), eased reporting
requirements for the prescription of drugs for terminally
ill patients. SB 1140 (Committee on Health and Human
Services, Chapter 791, Statutes of 1998), among other
things, required the Medical Board to give its highest
priority to considering a course in pain management among
its continuing education requirements for licensees. AB
2305 (Runner, Chapter 984, Statutes of 1998) required
health plan coverage of appropriately prescribed
prescription pain management medications for terminally ill
patients when medically necessary.
The Legislature also adopted ACR 34 (O'Connell, 1993),
which requested that the Medical Board recommend medical
school curriculum changes to ensure that physicians receive
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adequate training in pain management. According to the
author, the Medical Board recommended that instruction in
pain management and palliative care be made a requirement
of physician licensure.
Related Legislation
Another measure this year, AB 1226 (Runner), pending on the
Senate Floor, requires health plan coverage for pain
management medications for patients diagnosed with
intractable pain.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/23/99)
Americans for Death with Dignity (source)
American Cancer Society
California Association of Catholic Hospitals
California Association of Health Facilities
California Association of Homes and Services for the Aging
California Association of Breast Cancer Organizations
California Medical Association
California Nurses Association
California State Hospice Association
Californians for Disability Rights, Inc.
Congress of California Seniors
Medical Board of California
ARGUMENTS IN SUPPORT : The California Nurses Association
supports this bill, stating that physicians should receive
the same type of pain management and end-of-life care needs
education that nurses receive. The California State
Hospice Association states that too many terminally ill
patients and their families are uninformed about the
severity of pain, the types of pain relieving medications
and their side effects, and the alternatives to best manage
or control the pain. According to supporters, this bill
takes a step in educating, assessing and managing pain for
terminally ill patients.
ASSEMBLY FLOOR : 79-0, 6/4/99
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AYES: Aanestad, Ackerman, Alquist, Aroner, Ashburn,
Baldwin, Bates, Battin, Baugh, Bock, Brewer, Briggs,
Calderon, Campbell, Cardenas, Cardoza, Cedillo, Corbett,
Correa, Cox, Cunneen, Davis, Dickerson, Dutra, Firebaugh,
Florez, Floyd, Frusetta, Gallegos, Granlund, Havice,
Hertzberg, Honda, House, Jackson, Kaloogian, Keeley,
Knox, Kuehl, Leach, Lempert, Leonard, Longville,
Lowenthal, Machado, Maddox, Maldonado, Margett, Mazzoni,
McClintock, Migden, Nakano, Olberg, Oller, Robert
Pacheco, Rod Pacheco, Papan, Pescetti, Reyes, Romero,
Runner, Scott, Shelley, Soto, Steinberg, Strickland,
Strom-Martin, Thompson, Thomson, Torlakson, Vincent,
Washington, Wayne, Wesson, Wiggins, Wildman, Wright,
Zettel, Villaraigosa
NOT VOTING: Ducheny
CP:cm 8/23/99 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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