Pubdate: Thu, 17 Dec 1998 Source: Oregonian, The (OR) Contact: 503-294-4193 Mail: 1320 SW Broadway, Portland, OR 97201 Website: http://www.oregonlive.com/ Forum: http://forums.oregonlive.com/ Copyright: 1998 The Oregonian Author: Erin Hoover Barnett, The Oregonian staff 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