Academy Testifies Before State Assembly on Pain Management Bill

NEW YORK CITY, Nov. 5???As state lawmakers are considering legislative initiatives in the area of pain management for patients, The New York Academy of Medicine is urging them to take into account significant progress that has been made on this important subject rather than create new rules that start from scratch.

David Keepnews, Ph.D., J.D., R.N., Director of the Academy Office of Policy Development, testified today at a hearing of the Health Committee of the New York State Assembly on Assembly Bill 10407. This bill proposes mandatory medical school curriculum on pain management, mandatory coursework on this subject every four years for health professionals, and changes in health professional disciplinary procedures. The main proponent of the bill is the Compassion in Dying Federation.

Noting that the medical schools have already demonstrated their willingness and ability to undertake voluntary change in this area, Keepnews suggested that further efforts to enhance medical education on pain management should build on the considerable progress that has been made, rather than creating new state requirements for the schools to do what they are already doing. The Academy and the state???s medical schools launched an initiative in 1998 to develop and integrate curriculum content on palliative care and pain management throughout the four years of medical education. That initiative, the Palliative Education Assessment Tool (PEAT), funded by the Robert Wood Johnson Foundation, has led to significant progress in improving medical education on pain management and has established New York as a national leader in this area, Keepnews said.

Inadequate treatment of pain is an ongoing concern for patients who are at the end of life, suffering with chronic pain, or experiencing shorter-term pain from acute medical problems or following surgery, Keepnews explained. Lack of education in this area among physicians and other providers has been cited as a major barrier to adequate pain management. Providers also hesitate to prescribe, dispense or administer opioid medications for managing pain out of concerns that they may face license revocation, suspension or even criminal penalties.

Keepnews noted that there has been progress in state regulatory practices on prescribing of pain medications. He cited current Board of Professional Medical Conduct (BPMC) policy recognizing that pain should be assessed and treated promptly, and that pain management, including prescribing controlled substances, will be evaluated by taking into account the patient???s individual needs. He suggested that initiatives in this area should also build upon current progress.

Keepnews also told the Health Committee that ???an effective approach to improving pain management must go beyond a focus on health professionals, and should address health systems??? support for adequate pain assessment and treatment..???

Proponents and critics of the proposed bill each had opportunities to comment at the hearing. Joseph J. Fins, M.D., Chief of the Division of Medical Ethics at Weill Medical College of Cornell University and Director of Medical Ethics for New York Presbyterian Hospital-Weill Cornell Center, expressed concerns about the ???unintended consequences??? of creating state mandates for content of medical school curricula, particularly in areas like end-of-life care that have sometimes proved controversial. Fins played a leading role in designing and implementing the PEAT, as did Alan Fleischman, M.D., Senior Advisor to the Academy.

Witnesses who testified in favor of the legislation include Sylvia Law, J.D., of New York University???s School of Law and Steven A. King, M.D., of the New York University School of Medicine and the Hospital for Joint Diseases. Law, King and other witnesses emphasized the need for strong state policy to improve pain management for New York residents.

State Assembly Health Committee Chair Richard Gottfried (D-NY), chief sponsor of the bill, said that he intends to promote further discussion of the proposed legislation with the ultimate goal of improving pain management.

Read Keepnews???s written statement before the Health Committee by clicking here.

The New York Academy of Medicine, one of the country???s premier urban health policy and intervention centers, focuses on enhancing the health of people living in cities through research, education, advocacy, and prevention.

Posted on November 5, 2004

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Andrew J. Martin
Director of Communications
The New York Academy of Medicine
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New York, New York 10029
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amartin@nyam.org

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