Approved: January 18, 2006
The meeting was called to order by Chairman Jim Morrison at 1:30 P.M. on January 17, 2006, in Room 526-S of the Capitol.
All members were present except Representatives Landwehr and Kilpatrick.
Committee staff present:
Melissa Calderwood, Kansas Legislative Research Department
Mary Galligan, Kansas Legislative Research Department
Renae Jefferies, Revisor of Statutes’ Office
Gary Deeter, Committee Secretary
Conferees appearing before the committee:
Donna Bales, President and CEO, Life Project
Robert Twillman, Ph.D., LIFE Project Pain Management Task Group, University of Kansas Medical Center
John G. Carney, Vice President, Aging and End-of-Life Center for Practical Bioethics
Others attending:
See attached list.
The Minutes for 1-10-2006 were approved. (Motion, Representative Bethell; second, Representative Kiegerl.
Donna Bales, President and CEO, Life Project, introduced the topic, “Critical Issues in End-of-Life Care,” stating that her organization represents many collaborative organizations across the state (Attachment 1). She said the goal of the Life Project is to assure that Kansans who face the end of life will be able to do so with dignity, comfort and peace. She stated that the following presenters would provide perspective on end-of-life issues.
Robert Twillman, Ph.D., LIFE Project Pain Management Task Group, University of Kansas Medical Center, stated that chronic pain and drug addiction are major public health issues; he outlined the state’s pain policies, noting both positive and negative aspects of these policies and commenting that Kansas was one of only 4 states to receive a high grade on its pain policies (Attachment 2). However, he stated that these policies were not reflected in statute or regulations. He commented that two statutes (Prevention of Assisted Suicide Act and the Medical Practices Act) perpetuate the incorrect belief that opioids hasten death.
Dr. Twillman suggested four ways to improve pain management: develop practice guidelines, monitor quality improvement, educate health-care providers and patients, and adopt better policies and standards. He recommended the standards expressed in the Controlled Substances Act, further recommending that Medicare and Medicaid drug coverage be as unrestricted as possible.
John G. Carney, Vice President, Aging and End-of-Life Center for Practical Bioethics, provided information on advance care planning and artificial nutrition and hydration (Attachment 3). He reviewed the current status of advance health-care directives in Kansas: the living will statute (K.S.A. 65-28, 101, the power of attorney statute (K.S.A. 58.625-632), the pre-hospital Do Not Resuscitate (DNR) statute (K.S.A. 65.4941), and the guardianship provision on withholding and withdrawing hydration and nutrition (K.S.A. 59-3075(e)(7)(C) (HB 2307).
Regarding the living will statute, he said it serves as a record of the patient’s wishes and provides a guide for families, although in practice most Americans do not prepare one, or, when it is needed, it is not available. Also he noted that as dementia becomes more prevalent, what was assumed to be a static decision becomes a drawn-out process.
Mr. Carney said the durable power of attorney for health care (DPOA) is a legal document that appoints a particular person to make medical decisions for someone who is incapacitated, a companion document to a living will, but often ineffective in emergency situations. Mr. Carney said the DNR is valuable to help family members avoid anguishing decisions, but again are difficult to honor in emergency situations, noting that DNR specifically applies only to heart/lung failure. He cited a recent study by the federal Center for Disease Control (2004) that for the first time in American history, chronic illnesses became the leading cause of death
Regarding guardian issues, Mr. Carney said the Kansas statutes were comprehensively updated in 2002, with limits and exceptions clearly spelled out. He commented on recent trends, noting that North Carolina and Vermont allow digital repositories—web sites where advanced directives can be posted. Some states are combining living wills and DPOAs into one document, and others are providing an alternative to DNRs, a document called POLST (physician orders for life-sustaining treatment), which gives more latitude for life-sustaining decisions.
A monograph was also distributed to the committee: “Pain Management: Promising Practices and Frightening Fragmentation,” (Attachment 4).
Conferees responded to members’ questions: Mr. Carney said that to date the Kansas Medical Society has not acted to endorse any of the trends, although the American Medical Society had endorsed POLST. To another question, he said that there are statutory limits on guardianship that are not applicable to a DPOA. Mr. Twillman distinguished between drug dependence and drug addiction, saying the former is solely physical, but the latter includes psychological factors.
The Chair thanked the conferees and opened the floor for bill requests and/or introductions. Representative Goico requested a bill that would allow a person who receives training through an internet course to take a licensure test. The request was approved.
Representative Bethell requested introduction of two bills and one resolution: a pain patient’s bill of rights; a requirement that applications for Medicare or Medicaid include advance directives and living wills; and a resolution that private insurance companies include an advance directive and a living will as a part of an insurance policy presentation. The request was approved.
Representative Kiegerl requested a resolution concerning the dangers of cardiovascular disease for women. The request was approved.
The meeting was adjourned at 2:46 p.m. The next meeting is scheduled for Wednesday, January 18, 2006.