ADVOCATES SEEK ASSURANCE OF ADEQUATE PAIN TREATMENT

Compassion in Dying leads a campaign urging a federal agency to ensure
patients are told of their right to request painkillers

Advocacy groups are pushing the federal government to assure that patients
entering hospitals clearly understand their right to request adequate pain
treatment.

Led by the Portland-based Compassion in Dying Federation, the effort
targets the federal Patient Self-Determination Act and the way it is
applied in California. But the groups hope the issue will be addressed
nationwide. A recent national study found that 50 percent of patients who
died in hospitals had suffered moderate to severe pain.

The Patient Self-Determination Act, passed by Congress in 1990, requires
federally financed health care facilities to offer patients the option of
filling out an advance directive when they are admitted. Patients use an
advance directive to describe the care they would want if they became
unable to communicate.

The patient advocacy groups are asserting that the Patient
Self-Determination Act also requires patients to be told of their right to
request pain medication. The groups sent a letter Wednesday to the Health
Care Financing Administration outlining their view.

"Our belief is if patients were better informed about their right to
request pain medication, they would be more likely to make such a request,
and would thereby increase the likelihood that their pain is properly and
adequately treated," said the letter to the federal agency. It was signed
by B. Kirk Robinson, president of the Compassion in Dying Federation, and
Kathryn L. Tucker, the organization's director of legal affairs.

Backing the letter are five national organizations focused on end-of-life
issues, including Americans for Better Care of the Dying and the American
Pain Foundation. The American Bar Association, an early supporter of the
Patient Self-Determination Act, and two California hospice and cancer-pain
groups sent separate letters to the federal agency making the same point.

The groups are making California their test case. Their letter asserts that
the right to know about pain-control options is particularly well defined
in California in that state's Pain Patient's Bill of Rights.

The groups assert that patients in California are not uniformly told of
their options for aggressive pain management.

"It's not as if there's a single facility that is in noncompliance. There
is no facility that is doing what we are urging be done," Tucker said. "I
don't think providers have even thought that this is something they are
obliged to do."

California caregivers see the need for change. "Pain is a common problem,
and it's very prevalent and undertreated. Documents like the Patient
Self-Determination Act should reflect the real, everyday clinical issues,"
said Betty Ferrell, chairman of the Southern California Cancer Pain
Initiative, which sent its own letter.

The groups suggest that the federal government require written information
- -- brochures and posters, for example -- describing patients' rights to
request pain drugs, choose opiate medication and be referred to a pain
specialist.

The Health Care Financing Administration issued a statement Wednesday:
"While we would need to see the letter before being able to comment on it,
we want to make sure Medicare and Medicaid beneficiaries have access to the
highest quality health care and can participate in decision-making about
their care."

Checked-by: Richard Lake