The Southern California Physician, March, 2002 |
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President's
Message AB 487: Mandatory CME for Pain Management and the Treatment of Terminally Ill and Dying Patients The law was enacted because the Legislature believes physicians fail to manage their patients' pain appropriately because of a lack of knowledge. They feel the mandatory continuing education requirement will broaden and update the knowledge base of all physicians. I am convinced that this law is unnecessary and an intrusion upon the way we practice medicine. Pain medicine and end of life care should be included in physicians' training in medical school, internship or residency. I feel the government is legislating without making any provisions for funding. They are handing physicians the burden of having to pay for the classes, taking away precious time from patient care, and adding liability if we do not follow or understand the new rules. Regardless of my personal feelings, it is important that physicians be aware of this new law. I recommend that you refer to several CMA ON-CALL documents that I feel are helpful in understanding what we are now required to do. To access CMA ON-CALL, go to the CMA website, http://www.cmanet.org, on "CMA Physician Members Enter Here," and then link to CMA-ON CALL. You will need Adobe Acrobat to view the documents. Traditionally, pain management has most commonly been associated with end-of-life care. With AB 487 there is an expansion of the concept of pain management to all treatment settings and the creation of a standard of care for pain management for all physicians. To the extent an elder or hospitalized patient is in pain, additional liability issues must be considered. For a discussion on Elder and Dependent Adult Abuse, Reporting Requirements, see CMA ON-CALL document #1510. Per CMA ON-CALL document #0896, "The management of pain is an ongoing process that requires communication between physicians and other disciplines, particularly nurses, who have more frequent patient contact. It is important that nurses chart pain levels just as they chart vital signs and that physicians review the pain assessments done by nurses. Equally important is the development and use of pain assessment and management tools which are understood and applied consistently by all members of the healthcare team. Experts reviewing cases for potential liability will be looking to see if there was an inconsistency in the method of assessment between the nurses and physicians and will be reviewing the level of communication between physicians and other disciplines. There are a variety of available tools for the assessment of pain, particularly in elderly patients. Those tools include: Verbal Descriptor Scale; Pain Thermometer; Numeric Rating Scales; and Faces Pain Scale. Regardless of the tool selected for use by a hospital, defense of a malpractice case will be greatly enhanced when the physician can demonstrate knowledge of the relevant pain assessment tool." CMA has prepared a number of CMA ON-CALL documents that can assist in pain management. Those documents are: #0895 - Elder and Dependent Adult Abuse Liability; #0896 - Pain Management: Risk Management Guidelines; and #0513 - Intractable Pain Management. In addition, CMA has launched a new pain-management project to help physicians
comply with the legislatively mandated CME requirements. They have arranged
tuition discounts for CMA members:
Additional CMA-developed pain-management courses will be available in early summer in various locations in the state. CMA will sponsor CME courses developed by a pain-management work group of CMA Council on Scientific Affairs members, other physicians, and nurses with expertise in pain management. A four-hour seminar preceding CMA's annual Leadership Academy November 22-24 in La Quinta is also planned. We will inform you of additional pain-management educational opportunities available through SBCMS/CMA when they are scheduled. |
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Effective
January 1, 2002, the legislature has mandated that physicians complete
12-hours of continuing medical education in pain management and the treatment
of terminally ill and dying patients by December 31, 2006. Physicians
licensed on or after January 1, 2002 must complete this requirement within
four (4) years of their initial license or by their second renewal date,
whichever occurs first. This requirement does not apply to pathologists
or radiologists, or other categories of physicians exempted by the MBC
because they do not engage in direct patient care, do not provide patient
consultations or do not reside in California. CMA was successful in reducing
the mandatory 20 CME hours down to 12. These hours are included in, not
in addition to, the current requirements of 50 CME hours every two years.
