[Congressional Record Volume 147, Number 82 (Wednesday, June 13, 2001)]
[Senate]
[Pages S6213-S6217]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. WYDEN (for himself, Mr. Smith of Oregon, Mr. Rockefeller,
and Mr. Breaux):
S. 1024. A bill to amend the Public Health Service Act to provide for
a public response to the public health crisis of pain, and for other
purposes; to the Committee on Health, Education, Labor, and Pensions.
Mr. WYDEN. Mr. President, pain is our Nation's silent public health
crisis. Pain is often left untreated or under-treated, especially among
older patients, minorities and children. Forty to 50 percent of dying
patients experience moderate to severe pain at least half of the time
in the last days of their lives. A Brown University study published in
last month's Journal of the American Medical Association found that 40
percent of nursing home patients nationwide with acute or chronic pain
are not getting treatment that brings them relief. Thousand of
Americans die in pain every year, and thousands live in chronic pain.
What is truly tragic for these patients is that the medical
technology and know-now exist to make them more comfortable. What does
not exist is a medical system that supports clinicians trying to
address these issues or a system to support patients and families as
they try to find help for pain.
[[Page S6214]]
The primary goal of the Conquering Pain Act, a bipartisan bill that I
am introducing today with Senators Smith, Rockefeller, and Breaux is to
create a public health framework with on which effective pain
management policies can be developed. Providing help to patients in
pain, to their health care providers, and to others caring for those
patients will ensure their access to pain management 24 hours a day,
seven days a week, 365 days a year.
The widespread crisis of failing to adequately address patients in
pain is made crystal clear by the fact that only one State in the
Nation has ever has sanctioned a physician for the under-treatment of
pain. That State is my home State of Oregon, which is now also
considering the creation of a commission on pain management with the
State health department.
The Conquering Pain Act does not seek to tell clinicians how to
practice medicine. It does not override State regulation and oversight
of medicine. it does provide information to physicians and families in
an effort to support them. It also seeks to find answers to the complex
problems created by the interplay between State and Federal regulation
of pain medications.
Most importantly, the bill would create six regional Family Support
Networks linking patients, families and providers to information and
services to assist patients in pain. These networks would also assist
clinicians who need additional information, mentoring or support to
deal with the medically complex cases that patients in pain often
present.
It would be cruel and callous for this Congress to continue to ignore
the overwhelming number of scientific studies that show patient after
patient failing to get relief from pain. This legislation, which enjoys
broad support with the medical and patient community, would start us
down the road toward addressing in a bipartisan, positive way one of
our Nation's most serious and continued health problems.
I ask unanimous consent that the text of the bill be printed in the
Record.
There being no objection, the bill was ordered to be printed in the
Record, as follows:
S. 1024
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the``Conquering
Pain Act of 2001''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title.
Sec. 2. Findings.
Sec. 3. Definitions.
TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN
Sec. 101. Guidelines for the treatment of pain.
Sec. 102. Patient expectations to have pain and symptom management.
Sec. 103. Quality improvement projects.
Sec. 104. Pain coverage quality evaluation and information.
Sec. 105. Surgeon General's report.
TITLE II--DEVELOPING COMMUNITY RESOURCES
Sec. 201. Family support networks in pain and symptom management.
TITLE III--REIMBURSEMENT BARRIERS
Sec. 301. Reimbursement barriers report.
Sec. 302. Insurance coverage of pain and symptom management.
TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND
INFORMATION
Sec. 401. Advisory Committee on Pain and Symptom Management.
Sec. 402. Institutes of Medicine report on controlled substance
regulation and the use of pain medications.
Sec. 403. Conference on pain research and care.
TITLE V--DEMONSTRATION PROJECTS
Sec. 501. Provider performance standards for improvement in pain and
symptom management.
Sec. 502. End of life care demonstration projects.
SEC. 2. FINDINGS.
Congress finds that--
(1) pain is often left untreated or under-treated
especially among older patients, African Americans, Hispanics
and other minorities, and children;
(2) chronic pain is a public health problem affecting at
least 50,000,000 Americans through some form of persisting or
recurring symptom;
(3) 40 to 50 percent of patients experience moderate to
severe pain at least half the time in their last days of
life;
(4) 70 to 80 percent of cancer patients experience
significant pain during their illness;
(5) one in 7 nursing home residents experience persistent
pain that may diminish their quality of life;
(6) despite the best intentions of physicians, nurses,
pharmacists, and other health care professionals, pain is
often under-treated because of the inadequate training of
clinicians in pain management;
(7) despite the best intentions of physicians, nurses,
pharmacists, mental health professionals, and other health
care professionals, pain and symptom management is often
suboptimal because the health care system has focused on cure
of disease rather than the management of a patient's pain and
other symptoms;
(8) the technology and scientific basis to adequately
manage most pain is known;
(9) pain should be considered the fifth vital sign; and
(10) coordination of Federal efforts is needed to improve
access to high quality effective pain and symptom management
in order to assure the needs of chronic pain patients and
those who are terminally ill are met.
SEC. 3. DEFINITIONS.
In this Act:
(1) Chronic pain.--The term ``chronic pain'' means a pain
state that is persistent and in which the cause of the pain
cannot be removed or otherwise alleviated. Such term includes
pain that may be associated with long-term incurable or
intractable medical conditions or disease.
(2) End of life care.--The term ``end of life care'' means
a range of services, including hospice care, provided to a
patient, in the final stages of his or her life, who is
suffering from 1 or more conditions for which treatment
toward a cure or reasonable improvement is not possible, and
whose focus of care is palliative rather than curative.
(3) Family support network.--The term ``family support
network'' means an association of 2 or more individuals or
entities in a collaborative effort to develop multi-
disciplinary integrated patient care approaches that involve
medical staff and ancillary services to provide support to
chronic pain patients and patients at the end of life and
their caregivers across a broad range of settings in which
pain management might be delivered.
(4) Hospice.--The term ``hospice care'' has the meaning
given such term in section 1861(dd)(1) of the Social Security
Act (42 U.S.C. 1395x(dd)(1)).
(5) Medication therapy management services.--The term
``medication therapy management services'' means
consultations with a physician or other health care
professional (including a pharmacist) who is practicing
within the scope of the professional's license, concerning a
patient which results in--
(A) a change in the drug regimen of the patient to avoid an
adverse drug interaction with another drug or disease state;
(B) a change in inappropriate drug dosage or dosage form
with respect to the patient;
(C) discontinuing an unnecessary or harmful medication with
respect to the patient;
(D) an initiation of medication therapy for a medical
condition of the patient;
(E) consultation with the patient or a caregiver in a
manner that results in a significant improvement in drug
regimen compliance; or
(F) patient and caregiver understanding of the appropriate
use and adherence to medication therapy.
(6) Pain and symptom management.--The term ``pain and
symptom management'' means services provided to relieve
physical or psychological pain or suffering, including any 1
or more of the following physical complaints--
(A) weakness and fatigue;
(B) shortness of breath;
(C) nausea and vomiting;
(D) diminished appetite;
(E) wasting of muscle mass;
(F) difficulty in swallowing;
(G) bowel problems;
(H) dry mouth;
(I) failure of lymph drainage resulting in tissue swelling;
(J) confusion;
(K) dementia;
(L) delirium;
(M) anxiety;
(N) depression; and
(O) and other related symptoms
(7) Palliative care.--The term ``palliative care'' means
the total care of patients whose disease is not responsive to
curative treatment, the goal of which is to provide the best
quality of life for such patients and their families. Such
care--
(A) may include the control of pain and of other symptoms,
including psychological, social and spiritual problems;
(B) affirms life and regards dying as a normal process;
(C) provides relief from pain and other distressing
symptoms;
(D) integrates the psychological and spiritual aspects of
patient care;
(E) offers a support system to help patients live as
actively as possible until death; and
(F) offers a support system to help the family cope during
the patient's illness and in their own bereavement.
(8) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
TITLE I--EMERGENCY RESPONSE TO THE PUBLIC HEALTH CRISIS OF PAIN
SEC. 101. GUIDELINES FOR THE TREATMENT OF PAIN.
(a) Development of Website.--Not later than 2 months after
the date of enactment of
[[Page S6215]]
this Act, the Secretary, acting through the Agency for
Healthcare Research and Quality, shall develop and maintain
an Internet website to provide information to individuals,
health care practitioners, and health facilities concerning
evidence-based practice guidelines developed for the
treatment of physical and psychological pain. Websites in
existence on such date may be used if such websites meet the
requirements of this section.
(b) Requirements.--The website established under subsection
(a) shall--
(1) be designed to be quickly referenced by health care
practitioners; and
(2) provide for the updating of guidelines as scientific
data warrants.
(c) Provider Access to Guidelines.--
(1) In general.--In establishing the website under
subsection (a), the Secretary shall ensure that health care
facilities have made the website known to health care
practitioners and that the website is easily available to all
health care personnel providing care or services at a health
care facility.
(2) Use of certain equipment.--In making the information
described in paragraph (1) available to health care
personnel, the facility involved shall--
(A) ensure that such personnel have access to the website
through the computer equipment of the facility;
(B) carry out efforts to inform personnel at the facility
of the location of such equipment; and
(C) ensure that patients, caregivers, and support groups
are provided with access to the website.
(3) Rural areas.--
(A) In general.--A health care facility, particularly a
facility located in a rural or underserved area, without
access to the Internet shall provide an alternative means of
providing practice guideline information to all health care
personnel.
(B) Alternative means.--The Secretary shall determine
appropriate alternative means by which a health care facility
may make available practice guideline information on a 24-
hour basis, 7 days a week if the facility does not have
Internet access. The criteria for adopting such alternative
means should be clear in permitting facilities to develop
alternative means without placing a significant financial
burden on the facility and in permitting flexibility for
facilities to develop alternative means of making guidelines
available. Such criteria shall be published in the Federal
Register.
SEC. 102. PATIENT EXPECTATIONS TO HAVE PAIN AND SYMPTOM
MANAGEMENT.
(a) In General.--The administrator of each of the programs
described in subsection (b) shall ensure that, as part of any
informational materials provided to individuals under such
programs, such materials shall include information, where
relevant, to inform such individuals that they should expect
to have their pain assessed and should expect to be provided
with effective pain and symptom relief, when receiving
benefits under such program.
(b) Programs.--The programs described in this subsection
shall include--
(1) the medicare and medicaid programs under titles XIX and
XXI of the Social Security Act (42 U.S.C. 1935 et seq., 1936
et seq.);
(2) programs carried out through the Public Health Service;
(3) programs carried out through the Indian Health Service;
(4) programs carried out through health centers under
section 330 of the Public Health Service Act (42 U.S.C.
254b);
(4) the Federal Employee Health Benefits Program under
title 5, United States Code;
(5) the Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) as defined in section 1073(4) of
title 10, United States Code; and
(6) other programs administered by the Secretary.
SEC. 103. QUALITY IMPROVEMENT EDUCATION PROJECTS.
The Secretary shall provide funds for the implementation of
special education projects, in as many States as is
practicable, to be carried out by peer review organizations
of the type described in section 1152 of the Social Security
Act (42 U.S.C. 1320c-1) to improve the quality of pain and
symptom management. Such projects shall place an emphasis on
improving pain and symptom management at the end of life, and
may also include efforts to increase the quality of services
delivered to chronic pain patients and the chronically ill
for whom pain may be a significant symptom.
SEC. 104. PAIN COVERAGE QUALITY EVALUATION AND INFORMATION.
(a) In General.--Section 1851(d)(4) of the Social Security
Act (42 U.S.C. 42 U.S.C. 1395w-21(d)(4)) is amended--
(1) in subparagraph (A), by adding at the end the
following:
``(ix) The organization's coverage of pain and symptom
management.''; and
(2) in subparagraph (D)--
(A) in clause (iii), by striking ``and'' at the end;
(B) in clause (iv), by striking the period and inserting
``, and''; and
(C) by adding at the end the following:
``(v) not later than 2 years after the date of enactment of
this clause, an evaluation (which may be made part of any
other relevant report of quality evaluation that the plan is
required to prepare) for the plan (updated annually) that
indicates the performance of the plan with respect to access
to, and quality of, pain and symptom management, including
such management as part of end of life care. Data shall be
posted in a comparable manner for consumer use on
www.medicare.gov.''.
(b) Effective Date.--The amendments made by paragraph (1)
apply to information provided with respect to annual,
coordinated election periods (as defined in section
1851(e)(3)(B) of the Social Security Act (42 U.S.C. 1395-
21(e)(3)(B)) beginning after the date of enactment of this
Act.
SEC. 105. SURGEON GENERAL'S REPORT.
Not later than October 1, 2002, the Surgeon General shall
prepare and submit to the appropriate committees of Congress
and the public, a report concerning the state of pain and
symptom management in the United States. The report shall
include--
(1) a description of the legal and regulatory barriers that
may exist at the Federal and State levels to providing
adequate pain and symptom management;
(2) an evaluation of provider competency in providing pain
and symptom management;
(3) an identification of vulnerable populations, including
children, advanced elderly, non-English speakers, and
minorities, who may be likely to be underserved or may face
barriers to access to pain management and recommendations to
improve access to pain management for these populations;
(4) an identification of barriers that may exist in
providing pain and symptom management in health care
settings, including assisted living facilities;
(5) an identification of patient and family attitudes that
may exist which pose barriers in accessing pain and symptom
management or in the proper use of pain medications;
(6) an evaluation of medical, nursing, and pharmacy school
training and residency training for pain and symptom
management;
(7) a review of continuing medical education programs in
pain and symptom management; and
(8) a description of the use of and access to mental health
services for patients in pain and patients at the end of
life.
TITLE II--DEVELOPING COMMUNITY RESOURCES
SEC. 201. FAMILY SUPPORT NETWORKS IN PAIN AND SYMPTOM
MANAGEMENT.
(a) Establishment.--The Secretary, acting through the
Public Health Service, shall award grants for the
establishment of 6 National Family Support Networks in Pain
and Symptom Management (in this section referred to as the
``Networks'') to serve as national models for improving the
access and quality of pain and symptom management to chronic
pain patients (including chronically ill patients for whom
pain is a significant symptom) and those individuals in need
of pain and symptom management at the end of life and to
provide assistance to family members and caregivers.
(b) Eligibility and Distribution.--
(1) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity shall--
(A) be an academic facility or other entity that has
demonstrated an effective approach to training health care
providers including mental health professionals concerning
pain and symptom management and palliative care services; and
(B) prepare and submit to the Secretary an application (to
be peer reviewed by a committee established by the
Secretary), at such time, in such manner, and containing such
information as the Secretary may require.
(2) Distribution.--In providing for the establishment of
Networks under subsection (a), the Secretary shall ensure
that--
(A) the geographic distribution of such Networks reflects a
balance between rural and urban needs; and
(B) at least 3 Networks are established at academic
facilities.
(c) Activities of Networks.--A Network that is established
under this section--
(1) shall provide for an integrated interdisciplinary
approach, that includes psychological and counseling
services, to the delivery of pain and symptom management;
(2) shall provide community leadership in establishing and
expanding public access to appropriate pain care, including
pain care at the end of life;
(3) shall provide assistance, through caregiver supportive
services, that include counseling and education services;
(4) shall develop a research agenda to promote effective
pain and symptom management for the broad spectrum of
patients in need of access to such care that can be
implemented by the Network;
(5) shall provide for coordination and linkages between
clinical services in academic centers and surrounding
communities to assist in the widespread dissemination of
provider and patient information concerning how to access
options for pain management;
(6) shall establish telemedicine links to provide education
and for the delivery of services in pain and symptom
management;
(7) shall develop effective means of providing assistance
to providers and families for the management of a patient's
pain 24 hours a day, 7 days a week; and
(8) may include complimentary medicine provided in
conjunction with traditional medical services.
(d) Provider Pain and Symptom Management Communications
Projects.--
(1) In general.--Each Network shall establish a process to
provide health care personnel with information 24 hours a
day, 7 days a week, concerning pain and symptom management.
Such process shall be designed to test the effectiveness of
specific forms of communications with health care personnel
so that such personnel may obtain information to ensure that
all appropriate patients
[[Page S6216]]
are provided with pain and symptom management.
(2) Termination.--The requirement of paragraph (1) shall
terminate with respect to a Network on the day that is 2
years after the date on which the Network has established the
communications method.
(3) Evaluation.--Not later than 60 days after the
expiration of the 2-year period referred to in paragraph (2),
a Network shall conduct an evaluation and prepare and submit
to the Secretary a report concerning the costs of operation
and whether the form of communication can be shown to have
had a positive impact on the care of patients in chronic pain
or on patients with pain at the end of life.
(4) Rule of construction.--Nothing in this subsection shall
be construed as limiting a Network from developing other ways
in which to provide support to families and providers, 24
hours a day, 7 days a week.
(e) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $18,000,000 for
fiscal years 2002 through 2004.
TITLE III--REIMBURSEMENT BARRIERS
SEC. 301. REIMBURSEMENT BARRIERS REPORT.
The Medicare Payment Advisory Commission (MedPac)
established under section 1805 of the Social Security Act (42
U.S.C. 1396b-6) shall conduct a study, and prepare and submit
to the appropriate committees of Congress a report,
concerning--
(1) the manner in which medicare policies may pose barriers
in providing pain and symptom management and palliative care
services in different settings, including a focus on payment
for nursing home and home health services;
(2) the identification of any financial barriers that may
exist within the medicare and medicaid programs under titles
XVIII and XIX of the Social Security Act (42 U.S.C. 1395 et
seq., 1396 et seq.) that interfere with continuity of care
and interdisciplinary care or supportive care for the broad
range of chronic pain patients (including patients who are
chronically ill for whom pain is a significant symptom), and
for those who are terminally ill, and include the
recommendations of the Commission on ways to eliminate those
barriers that the Commission may identify;
(3) the reimbursement barriers that exist, if any, in
providing pain and symptom management through hospice care,
particularly in rural areas, and if barriers exist,
recommendations concerning adjustments that would assist in
assuring patient access to pain and symptom management
through hospice care in rural areas;
(4) whether the medicare reimbursement system provides
incentives to providers to delay informing terminally ill
patients of the availability of hospice and palliative care;
and
(5) the impact of providing payments for medication therapy
management services in pain and symptom management and
palliative care services.
SEC. 302. INSURANCE COVERAGE OF PAIN AND SYMPTOM MANAGEMENT.
(a) In General.--The General Accounting Office shall
conduct a survey of public and private health insurance
providers, including managed care entities, to determine
whether the reimbursement policies of such insurers inhibit
the access of chronic pain patients to pain and symptom
management and pain and symptom management for those in need
of end-of-life care (including patients who are chronically
ill for whom pain is a significant symptom). The survey shall
include a review of formularies for pain medication and the
effect of such formularies on pain and symptom management.
(b) Report.--Not later than 1 year after the date of
enactment of this Act, the General Accounting Office shall
prepare and submit to the appropriate committees of Congress
a report concerning the survey conducted under subsection
(a).
TITLE IV--IMPROVING FEDERAL COORDINATION OF POLICY, RESEARCH, AND
INFORMATION
SEC. 401. ADVISORY COMMITTEE ON PAIN AND SYMPTOM MANAGEMENT.
(a) Establishment.--The Secretary shall establish an
advisory committee, to be known as the Advisory Committee on
Pain and Symptom Management, to make recommendations to the
Secretary concerning a coordinated Federal agenda on pain and
symptom management.
(b) Membership.--The Advisory Committee established under
subsection (a) shall be comprised of 11 individuals to be
appointed by the Secretary, of which at least 1 member shall
be a representative of--
(1) physicians (medical doctors or doctors of osteopathy)
who treat chronic pain patients or the terminally ill;
(2) nurses who treat chronic pain patients or the
terminally ill;
(3) pharmacists;
(4) hospice;
(5) pain researchers;
(6) patient advocates;
(7) caregivers; and
(8) mental health providers.
The members of the Committee shall designate 1 member to
serve as the chairperson of the Committee.
(c) Meetings.--The Advisory Committee shall meet at the
call of the chairperson of the Committee.
(d) Agenda.--The agenda of the Advisory Committee
established under subsection (a) shall include--
(1) the development of recommendations to create a
coordinated Federal agenda on pain and symptom management;
(2) the development of proposals to ensure that pain is
considered as the fifth vital sign for all patients;
(3) the identification of research needs in pain and
symptom management, including gaps in pain and symptom
management guidelines;
(4) the identification and dissemination of pain and
symptom management practice guidelines, research information,
and best practices;
(5) proposals for patient education concerning how to
access pain and symptom management across health care
settings;
(6) the manner in which to measure improvement in access to
pain and symptom management and improvement in the delivery
of care;
(7) the development of ongoing strategies to assure the
aggressive use of pain medications, including opiods,
regardless of health care setting; and
(8) the development of an ongoing mechanism to identify
barriers or potential barriers to pain and symptom management
created by Federal policies.
(e) Recommendation.--Not later than 2 years after the date
of enactment of this Act, the Advisory Committee established
under subsection (a) shall prepare and submit to the
Secretary recommendations concerning a prioritization of the
need for a Federal agenda on pain and symptom management, and
ways in which to better coordinate the activities of entities
within the Department of Health and Human Services, and other
Federal entities charged with the responsibility for the
delivery of health care services or research on pain and
symptom management with respect to pain management.
(f) Consultation.--In carrying out this section, the
Advisory Committee shall consult with all Federal agencies
that are responsible for providing health care services or
access to health services to determine the best means to
ensure that all Federal activities are coordinated with
respect to research and access to pain and symptom
management.
(g) Administrative Support; Terms of Service; Other
Provisions.--The following shall apply with respect to the
Advisory Committee:
(1) The Committee shall receive necessary and appropriate
administrative support, including appropriate funding, from
the Department of Health and Human Services.
(2) The Committee shall hold open meetings and meet not
less than 4 times per year.
(3) Members of the Committee shall not receive additional
compensation for their service. Such members may receive
reimbursement for appropriate and additional expenses that
are incurred through service on the Committee which would not
have incurred had they not been a member of the Committee.
(4) The requirements of Appendix 2 of title 5, United
States Code.
SEC. 402. INSTITUTES OF MEDICINE REPORT ON CONTROLLED
SUBSTANCE REGULATION AND THE USE OF PAIN
MEDICATIONS.
(a) In General.--The Secretary, acting through a contract
entered into with the Institute of Medicine, shall review
findings that have been developed through research conducted
concerning--
(1) the effects of controlled substance regulation on
patient access to effective care;
(2) factors, if any, that may contribute to the underuse of
pain medications, including opiods;
(3) the identification of State legal and regulatory
barriers, if any, that may impact patient access to
medications used for pain and symptom management; and
(4) strategies to assure the aggressive use of pain
medications, including opiods, regardless of health care
setting.
(b) Report.--Not later than 18 months after the date of
enactment of this Act, the Secretary shall prepare and submit
to the appropriate committees of Congress a report concerning
the findings described in subsection (a).
SEC. 403. CONFERENCE ON PAIN RESEARCH AND CARE.
Not later than December 31, 2005, the Secretary, acting
through the National Institutes of Health, shall convene a
national conference to discuss the translation of pain
research into the delivery of health services including
mental health services to chronic pain patients and those
needing end-of-life care. The Secretary shall use unobligated
amounts appropriated for the Department of Health and Human
Services to carry out this section.
TITLE V--DEMONSTRATION PROJECTS
SEC. 501. PROVIDER PERFORMANCE STANDARDS FOR IMPROVEMENT IN
PAIN AND SYMPTOM MANAGEMENT.
(a) In General.--The Secretary, acting through the Health
Resources Services Administration, shall award grants for the
establishment of not less than 5 demonstration projects to
determine effective methods to measure improvement in the
skills, knowledge, and attitudes and beliefs of health care
personnel in pain and symptom management as such skill,
knowledge, and attitudes and beliefs apply to providing
services to chronic pain patients and those patients
requiring pain and symptom management at the end of life.
(b) Evaluation.--Projects established under subsection (a)
shall be evaluated to determine patient and caregiver
knowledge
[[Page S6217]]
and attitudes toward pain and symptom management.
(c) Application.--To be eligible to receive a grant under
subsection (a), an entity shall prepare and submit to the
Secretary an application at such time, in such manner and
containing such information as the Secretary may require.
(d) Termination.--A project established under subsection
(a) shall terminate after the expiration of the 2-year period
beginning on the date on which such project was established.
(e) Authorization of Appropriations.--There is authorized
to be appropriated such sums as may be necessary to carry out
this section.
SEC. 502. END OF LIFE CARE DEMONSTRATION PROJECTS.
The Secretary, acting through the Health Resources and
Services Administration, shall--
(1) not later than January 1, 2004, carry out not less than
5 demonstration and evaluation projects that implement care
models for individuals at the end of life, at least one of
which shall be developed to assist those individuals who are
terminally ill and have no family or extended support, and
each of which may be carried out in collaboration with
domestic and international entities to gain and share
knowledge and experience on end of life care;
(2) conduct 3 demonstration and evaluation activities
concerning the education and training of clinicians in end of
life care, and assist in the development and distribution of
accurate educational materials on both pain and symptom
management and end of life care;
(3) in awarding grants for the training of health
professionals, give priority to awarding grant to entities
that will provide training for health professionals in pain
and symptom management and in end-of-life care at the
undergraduate level;
(4) shall evaluate demonstration projects carried out under
this section within the 5-year period beginning on the
commencement of each such project; and
(5) develop a strategy and make recommendations to Congress
to ensure that the United States health care system--
(A) has a meaningful, comprehensive, and effective approach
to meet the needs of individuals and their caregivers as the
patient approaches death; and
(B) integrates broader supportive services.
Mr. SMITH of Oregon. Mr. President, I rise today to join my friend
and colleague from Oregon in reintroducing the Conquering Pain Act. He
and I have worked long and hard together to expand access to effective
pain and symptom management for chronic pain and terminally ill
patients, and I believe that this legislation is an important step
toward accomplishing that goal. This is an issue of great importance to
my home state of Oregon, and a matter of personal significance to me.
Prior to my service in elected office, I served as a volunteer for my
church. In this capacity, I found my professional work as a food
processor in a constant, but blessed, state of interruption. On a
weekly basis and at the oddest of hours, I found myself making
continual rounds at St. Anthony's Hospital in Pendleton, Oregon. On
many occasions I shared with parents the unspeakable joy of welcoming
newborn babies into this world. On others, I suffered in heartbreaking
sorrow as I tried to comfort the critically ill, or hold the hands of
those who lay at the brink of eternity.
On too many of these occasions, patients suffered intense pain and
discomfort during their final hours; sometimes as a result of
inadequate pain management techniques, and sometimes as a result of our
medical focus on curing illness and prolonging life at any cost. I have
seen many beloved friends suffer unnecessarily and I believe that all
Americans have been touched at some point by a friend or family member
struggling to cope with chronic or acute pain. We all deserve a health
care system committed to adequately addressing the comfort of ailing
patients.
The legislation we reintroduce today, the Conquering Pain Act, is
consistent with my belief that the practice of medicine must place
greater emphasis on helping people who are experiencing chronic and
acute pain.
The Conquering Pain Act of 2001 will take a number of steps to ensure
that patients have greater access to effective pain management. This
legislation will commission studies by the Surgeon General's office,
the General Accounting Office, the Institute of Medicine, and MedPac to
examine the state of pain and symptom management in the United States,
and to review regulatory obstacles that stifle effective pain
management in our health care system. The Act will establish
demonstration projects at the Department of Health and Human Services
and other institutions to provide advanced pain management care and to
research effective methods to measure improvement in the skills,
knowledge, and attitudes of health care personnel in pain and symptom
management. In addition, this bill will make important and timely
information related to pain management available to patients and health
care professionals over the Internet.
The Conquering Pain Act of 2001 will do something that should have
been done many years ago; it will finally establish a coordinated
Federal agenda regarding pain and symptom management. For better or for
worse, our health care system has focused intensely on curing disease
but has never adequately addressed the need to provide effective pain
management. Americans should expect their health care providers to
attend to their comfort as well as their health, and I believe that
this legislation will go a long way toward addressing this long-
standing deficiency.
______