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.