Honolulu, Hawaii
                                                   , 1999

                                 RE: H.R. No. 16
                                     H.D. 1

Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Health, to which was referred H.R. No. 16


begs leave to report as follows:

     The purpose of this resolution is to require all healthcare
institutions to implement effective pain management programs by
urging that:

     (1)  The Agency for Healthcare Policy and Research (AHCPR)
          guidelines for the treatment of pain be accepted as the
          community standard of care for all healthcare

     (2)  The Department of Health to establish the right to
          skilled pain management in a "Patients Bill of Rights"
          for all certified and/or licensed facilities;

     (3)  Pain management programs and the AHCPR guidelines be
          accepted as practice standards and instituted in each
          of those facilities;

     (4)  Pain management be part of the required curriculum of
          all medical, nursing, and other healthcare professional
          schools in the State; and

                                 STAND. COM. REP. NO. 1119
                                 Page 2

     (5)  Professional organizations be challenged to formally
          adopt AHCPR standards and incorporate them in their
          peer review and continuing education programs.

     The Commission of Persons with Disabilities, Hawaii Family
Forum, and the American Association of Retired Persons submitted
testimony in support of this measure.  The Executive Office on
Aging, the Hawaii Medical Association (HMA), Hawaii Catholic
Conference, and the Hawaii Nurses' Association (HNA) submitted
testimony in support of the intent of this measure.  The
University of Hawaii School of Nursing submitted comments.

     Your Committee believes that pain management is a necessary
component of health care to ensure comfort, relief, and dignity
during a person's final days.

     Your Committee has learned that HMA has committed itself
through a two-year project to train both physicians and nurses to
better diagnose and treat pain through its American Medical
Association/HMA Education for Physician's on End-of-Life Care
program (Program).  As such, your Committee has requested HMA and
HNA to evaluate the pain management component of the Program to
determine, among other things, the effectiveness of having all
physicians and nurses skilled in pain management for their

     Your Committee has also amended this measure by:

     (1)  Authorizing that the ACHPR guidelines be used as a
          guide for all healthcare providers;

     (2)  Urging pain management programs and guidelines be
          instituted in all certified or licensed healthcare

     (3)  Encouraging all medical, nursing, and other healthcare
          professional schools in the State to incorporate pain
          management courses into their curricula instead of
          mandating school curriculum;

     (4)  Requesting HMA and HNA to submit to the Legislature its
          preliminary findings of the Program prior to the
          Regular Session of 2000 and a final report prior to the
          Regular Session of 2001; and

     (5)  Making technical, nonsubstantive amendments for
          purposes of clarity and style.

                                 STAND. COM. REP. NO. 1119
                                 Page 3

     As affirmed by the record of votes of the members of your
Committee on Health that is attached to this report, your
Committee concurs with the intent and purpose of H.R. No. 16, as
amended herein, and recommends that it be referred to the
Committees on Higher Education and Consumer Protection and
Commerce in the form attached hereto as H.R. No. 16, H.D. 1.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health,

                                   ALEXANDER C. SANTIAGO, Chair