CALIFORNIA HOSPITALS TO BE REQUIRED TO TELL PATIENTS ABOUT PAIN RELIEF

Advocates for better pain control for patients in California have enlisted
a powerful new ally: the folks who write the checks for federal health
insurance.

Under a newly adopted policy, the federal Health Care Financing
Administration, which administers the Medicare program, plans to require
hospitals and other health care providers to start formally advising
patients about their pain-relief options.

The policy was outlined in a June 25 letter from agency Administrator
Nancy-Ann Min DeParle to Kathryn Tucker, director of legal affairs for
Compassion in Dying, an Oregon-based group active in that state's battle
over physician-assisted suicide.

In California, the group has been pushing regulators to take stronger
measures to improve access to narcotics and other pain medications often
denied to people with terminal disease.

California's Patient Self-Determination Act already gives patients the
right to make their own decisions about their medical care. Providers are
responsible for giving people access to information needed for informed
consent.

The law does not specifically cover pain treatment, a controversial area of
medicine because many of the drugs are prone to misuse and can be
addictive. Physicians have sometimes lost their licenses or faced criminal
prosecution for overprescribing pain drugs.

Under the June 25 Health Care Financing Administration pronouncement, pain
medication is considered "part of the mitigation and treatment of disease.''

In California, this means that "patients must be informed of their rights
under state law to request or reject specific pain medication,'' DeParle wrote.

The Health Care Financing Administration has authority to enforce that
reading of the law through periodic audits and financial penalties.
Managers in the agency's San Francisco office have been directed to take
the necessary steps to ensure compliance.

Pain-control advocates, who held a news conference at San Francisco General
Hospital yesterday to trumpet the Health Care Financing Administration
pronouncement, conceded that little will change right away.

Even after the agency gets the word out, they said, the result could be
little more tangible than a slightly reworded hospital brochure or some new
fine print among the many documents patients must sign when checking into a
health care facility.

But the financing administration's decision could help to generate more
demands on providers if patients and their families begin to realize that
pain can nearly always be relieved through proper treatment.

"Patients will have to be informed of their rights,'' said Dr. Robert
Brody, head of pain consultation at San Francisco General, predicting "an
entirely different dynamic'' in the doctor-patient relationship.