Legislation

1999 Hospice Legislation

This crucial legislation required:

• Health plan’s offering hospice care to reimburse at a set level
• Health plan coverage of residential hospice care
• Allowance of hospice home facilities in residentially zoned neighborhood

1999 Uniform Health Care Decisions Act

This comprehensive legislation set forth standards for advanced directives and for surrogate health care decision-making.

2002 Cancer Pain Initiative/Narcotic Enforcement Proposal

The Hawaii Cancer Pain Initiative worked with the Narcotic Enforcement Division to pass Act 165. This important legislation removed previously existing barriers to the provision of effective pain management. It removed the requirement for duplicate prescriptions and allowed for partial dispensing of vital pain medication, allowing for more effective and aggressive treatment of patient pain.

In a recent national report on end-of-life care, Hawaii ranked 1st in the nation for good pain management in hospitals. (www.lastacts.org - 2002)

Non-Legislative Improvements*

National Pain Standards

1999-2001 The Joint Commission for the Accreditation of Healthcare Organizations requires all facilities to have adequate systems in place to assess and address patient pain needs. Throughout facilities, system-wide, JACHO looks for evidence that the facility is paying adequate attention to patient pain and appropriate pain management. Every hospital in Hawaii is JACHO accredited.

Hawaii Cancer Pain Initiative

The Hawaii Cancer Pain Initiative (HCPI) brings together our community’s leaders in the area of cancer pain. HCPI is involved in professional education to give health health providers the very practical tools they need to know how best to assess and address their patients’ pain.

Kokua Mau (Continuous Care)

This is a public/private partnership to improve end-of-life care between Hawaii’s Executive Office on Aging and the Robert Wood Johnson Foundation. Kokua Mau has done extensive community education on advance directives and end-of-life care. They have sponsored public service announcements, done seminars and training and encouraged the community to ‘start the conversation’ about end-of-life care. (www.kokuamau.org)

Palliative Care Improvements

Palliative care involves more than just great pain management. It also focuses on the relief of distressing symptoms, including physical, psycho-social, emotional, and existential.

Community Innovations in Palliative Care Currently Underway

Community Leaders Regular Meetings. On October 25, 2002, Hawaii’s clinical leaders and invested professionals met for the first of several time to address two crucial questions.

1. What is your organization doing in the palliative care area?
2. What should we, as a health care community, aim for in establishing community standards in palliative care?

Medical/Nursing School Curriculum

Key health care leaders are meeting to ask and answer the question “How do we integrate issues surrounding end of life care all throughout our curriculum?” A focus on these issues at the medical/nursing school level will help provide greater education, therefore improving end-of-life care in Hawaii.

HMA Professional Training-Since 1999, the Hawaii Medical Association has been offering the AMA physicians’ training course on end-of-life care. This professional education has been provided to non-physician clinicians as well and continues to this day.

Kona Community Hospital

Under the leadership of Dr. Robin Seto, this health care entity has been working to comprehensively integrate the concepts of palliative care into all appropriate health care services.

*HPACC highlights these health care improvements to demonstrate the innovative programs underway in Hawaii’s health care community. Inclusion of these projects in no way implies a physician assisted suicide position on the part of the entities named in this paper.

HPACC members are:

• Hawaii Medical Association
• Hawaii Nurses Association
• Healthcare Association of Hawaii
• Hawaii Cancer Pain Initiative
• Not Dead Yet (Disability Rights Organization)
• Disability Rights Hawaii
• Hawaii Centers for Independent Living
• Hawaii Family Forum
• Hawaii Catholic Conference
• Hawaii Right to Life

6301 Pali Highway
Kaneohe, HI 96744-5224
Phone: (808) 203-6704
Fax: (808) 261-7022
hpacc@hpacc.org