END-OF-LIFE: HCFA Says California Hospitals Must Counsel on Pain Relief
The federal government has issued a new interpretation of the 1990 federal Patient Self-Determination Act that will require California hospitals to inform dying patients of their right to pain medication, the Portland Oregonian reports. The 1990 law mandates that "federally financed health care facilities ... offer patients the option of filling out an advance directive" to clarify their wishes concerning end-of-life treatment. Kathryn Tucker, director of legal affairs for the Oregon-based Compassion in Dying Federation, drafted a letter to HCFA outlining her analysis of the 1990 act and garnered support from five groups (Barnett, 7/13). The letter convinced the agency. In a letter to the Compassion in Dying Federation dated June 25, 1999, HCFA Administrator Nancy-Ann Min DeParle agreed, saying, "We have concluded that the Patient Self-Determination Act may be interpreted to require Medicare and Medicaid providers in California to inform patients of their right under California state law to request or reject the use of effective pain treatment" (Fox, Reuters/Nando Times, 7/13). Compassion in Dying Executive Director Barbara Coombs Lee, said, "We're ecstatic." She noted that the California law has been underused "because so few patients are aware of its provisions" (Rovner, CongressDaily AM, 7/14). The San Francisco Chronicle reports that "California's Patient Self- Determination Act already gives patients the right to make their own decisions about their medical care," but Compassion in Dying "has been pushing regulators to take stronger measures to improve access to narcotics and other pain medications often denied to people with terminal disease." Dr. Robert Brody, head of pain consultation at San Francisco General Hospital, said, "Patients will be informed of their rights," and predicted "an entirely different dynamic" in doctor-patient relationships (Hall, 7/14). Richard Chambers, acting deputy regional administrator for HCFA's San Francisco office, said he expects California patients to feel the effects of the interpretation in the coming months (Oregonian, 7/13).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.