MCC Testimony on H. 3071, a bill directing the state board of medicine to create pain relief standards, and directing the state department of public health to appoint an ombudsperson on end-of-life care, submitted to the Joint Committee on Health Care, Massachusetts General Court, Tuesday, May 11, 1999

The Massachusetts Catholic Conference recommends that the Joint Committee on Health Care refer H. 3071 to the Special Sub-Committee on End of Life Care, Joint Committee on the Judiciary, so that the issues the bill raises may be carefully considered as part of a comprehensive package of initiatives and incentives.

The December 30, 1998 Report of the Special Subcommittee mentioned that many medical professionals involved in the prescription and administration of pain medication "fear retribution by the Board of Registration, the State Police and the Federal Drug Enforcement Administration." Report at 20. The Report also found that seminars by the Drug Diversion Unit of the State Police, which "translate what transgressions the State Police enforce as opposed to what health professionals believe is enforced", are poorly attended. Report at 22. A careful look must be given to the effect on unfounded fears that any legislation might have that focuses on regulatory mechanisms to define appropriate behavior.

In addition, the support and cooperation of groups representing the health professions will be a key component in determining state policy in this area. In 1998, congressional legislation intended to incorporate pain relief standards into the federal law governing Schedule II drugs met with stiff resistance from the medical community. There was widespread concern that such a change would increase, rather than decrease, fears of unnecessary prosecution among doctors for providing adequate pain care. This year, a coalition of medical groups, including the Catholic Health Association, is supporting revised legislation that takes a different, incentives-based approach called the Conquering Pain Act, S. 941, available at http://thomas.loc.gov/, the congressional website.

According to medical professionals within Catholic medical institutions that I have consulted, clear standards for excellent and ethical pain relief are readily found in any good palliative care textbook. The problem to be addressed may have less to do with any lack of regulatory clarity and more to do with the creative encouragement of medical professionals to avail themselves of the educational and clinical resources already available.

The Joint Commission on Accreditation of Health Care Organizations has already employed institutional standards for the management of pain for dying persons, and is working on new standards "to expand the patient’s right to adequate pain assessment and treatment across the continuum of care." JCAHCO website, accessed May 12, 1999 –www.jcaho.org/pubedmul/pulicat/pat/dearcol.htm. These comprehensive standards "would require organizations not only to recognize each patient’s right to assessment and treatment of pain, but monitor and manage the pain and to educate staff and patients regarding the importance of effective pain management." Id.

In addition, the Massachusetts Department of Public Health, Division of Health Care Quality has formally adopted the Quality Improvement Guidelines for the Treatment of Acute and Cancer Pain developed by the American Pain Society. DPH has begun to urge all licensed health facilities in Massachusetts to adopt and implement these guidelines. Circular letter from Paul Dreyer, Director, Division of Health Care Quality, to All Licensed Health Care Facilities, Mar. 13, 1998.

Many medical institutions are not waiting to be told what to do; they are already providing good pain management and education. For example, the Catholic Memorial Home in Fall River became in 1998 the first extended care facility in the country to be accredited by the American Academy of Pain Management. Catholic Memorial Home has made the commitment to provide comprehensive pain management for all of its residents and to provide continuous education for residents, family and staff. Other Catholic medical institutions are taking the lead as well. Caritas Christi Health Systems, in a joint effort with the Fall River Diocesan Health Facilities network, will be hosting a series of comprehensive physician training sessions on care for the dying beginning in October 1999.