BILL ANALYSIS C.S.H.B. 2288 By: Hirschi 04-04-95 Committee Report (Substituted) BACKGROUND A statewide survey by the Texas Cancer Pain Initiative and the Texas Pain Society concluded that over half of the physicians surveyed say the greatest barrier to optimal pain treatment is physician reluctance to prescribe pain medication. Almost three quarters of the physicians surveyed consider all patients who take pain medication to be chronic addicts. These numbers point to the need for an effort to educate physicians to distinguish between tolerance or physical dependence, and addiction or psychological dependence on a drug. Physicians armed with the latest information in pain management and treatment are more likely to treat patients based on an understanding of this, rather than undertreat, which is often due to fear of patient addiction, and a lack of proper assessment of the pain. The Texas State Board of Medical Examiners recently adopted Title 22, Texas Administration Code, Sections 170.1-170.3 (Texas Civil Statutes, Article 4485b), establishing regulations to clarify the standards of care and specifying guidelines with respect to proper prescribing for the treatment of pain. With the regulations in place, the next step would be education to address the existing reluctance to adequately prescribe for pain. PURPOSE H.B. 2288, as substituted, encourages physicians who treat patients for pain to include among their hours of continuing medical education course work in pain treatment, requires the Texas Cancer Council to maintain a list of accredited continuing education courses in pain treatment for the physicians, and requires each medical school to determine the extent to which pain treatment medical education course work is offered to the medical students. RULEMAKING AUTHORITY It is the committee's opinion that this bill expressly grants additional rulemaking authority to the Texas State Board of Medical Examiners in Section 4(b). SECTION BY SECTION ANALYSIS SECTION 1. Adds Article 4495d, entitled "CONTINUING MEDICAL EDUCATION IN PAIN TREATMENT," to Chapter 6, Title 71, of the Revised Statutes, by encouraging a physician who submits an application for renewal of a license that designates a direct patient care practice and who treats patients for pain to include continuing medical education in pain treatment among the hours needed to comply with Section 3.025(a)(2) of the Medical Practice Act. SECTION 2. Adds Subsection (c) to Chapter 102, Section 102.009, Health and Safety Code, requiring the Texas Cancer Council and/or its contracted projects to maintain for physicians a list of available continuing medical education courses in patient treatment offered by accredited schools, hospitals, health care facilities, professional societies or associations for physicians. SECTION 3. Adds Sec. 61.785, entitled "PAIN TREATMENT MEDICAL EDUCATION COURSE WORK," to Chapter 61, Education Code, as follows: (a) Requires each medical school to determine the extent to which pain treatment medical education course work meeting the instructional elements prescribed by Subsection (b) of this Section is offered to all students enrolled in medical schools. (b) States that pain treatment education course work should include instruction in the areas specified in this subsection. SECTION 4. (a) Effective date: September 1, 1995. (b) Allows the Texas State Board of Medical Examiners to adopt rules under this Act by December 1, 1995. (c) Requires each medical school to report the analysis of pain treatment medical education coursework to the Texas Higher Education Coordinating Board by March 1, 1996. SECTION 5. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE The original bill, in Section 1, mandates that physicians take a specified number of hours related to pain management as part of their continuing medical education (CME) requirement. The substitute bill merely encourages physicians to take pain education courses as part of their CME. In Section 2, the substitute directs the Texas Cancer Council to maintain a listing of available pain management CME courses. Section 3 of the original bill directed the Higher Education Coordinating Board to require that pain management courses are offered to all medical students enrolled in the state's medical schools. The original also specifies the content of the coursework to be offered. The substitute only establishes suggested guidelines for pain management curricula and directs the state's medical schools to determine the extent to which their curricula fulfill the guidelines. SUMMARY OF COMMITTEE ACTION H.B. 2288 was considered by the Public Health Committee in a public hearing in April 4, 1995. The committee considered a complete substitute for the bill. The substitute was adopted without objection. The following persons testified for the bill: C. Stratton Hill, Jr., representing self and Texas Cancer Pain Initiative. David Ralston, representing self and Texas Cancer Pain Initiative. John Lindell, representing self and Austin Memorial Society. The bill was reported favorably as substituted, with the recommendation that it do pass and be printed by a record vote of 6 AYES, 0 NAYS, 0 PNV, and 3 ABSENT.