BILL ANALYSIS                                                                                                                                                                                                    



                                                             


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|SENATE RULES COMMITTEE            |                   AB 791|
|Office of Senate Floor Analyses   |                         |
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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.

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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.








                                                      AB 791
                                                       Page  
3

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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