Angela Hospice physician advocates on behalf of hospice patients
Angela Hospice's chief medical officer, Dr. James Boal, appeared before the Senate Health Policy and Human Services Committee in Lansing to advocate for a hospice exemption to new laws restricting the use of controlled substances. His argument revolved around the need for hospice patients to access these medications for pain control at the end of life.
"We are grateful to Dr. Boal, both for his expertise in caring for patients in advanced stages of illness, and his dedication to providing the best possible care for these individuals," said Marti Coplai, Angela Hospice President and CEO. "Despite any challenges that may arise from policy changes or any other arena, Dr. Boal is committed to serving the best interest of his patients."
Dr. Boal's testimony seemed to make a positive impact on the committee, as no opposition was registered. You can read more about this legislation in the bulletin below.
MIRS NEWS SERVICE – March 7
Panel Hears Arguments For Hospice MAPS Exemption
The Senate Health Policy and Human
Services Committee took testimony today on SB 0127, which would amend Michigan’s
Mandated Automated Prescription (MAPS) law, which was just passed and enacted
in 2017, to provide exemptions for hospices.
Committee Chair, Sen. Curt Vanderwall (R-Ludington) is the sponsor of SB 0127, which would exempt a patient who was under the care of a hospice from requirements related to the prescription of Schedule 2 to 5 controlled substances. Sen. Curtis Hertel Jr. (D-East Lansing) is the sponsor of SB 0128, which would amend the Public Health Code to revise the definition of "bona fide prescriber-patient relationship."
The testimony of Jim Boal, a physician with Angela Hospice of Michigan, summed up the argument in favor of the legislation from the hospice viewpoint.
"In the last stages of life, pain can become intolerable," Boal told the committee. "Controlled substances are often needed immediately to be added or adjusted for the patient to be comfortable."
"In 2017, PA 246 through 249 were enacted in order to prevent deaths from the opioid crisis," Boal continued. "I've taken care of people at hospice who were victims of the opioid crisis. I think these laws are good laws. However, they hamper access to good pain management while in hospice care."
According to Boal, in other states that adopted MAPS types of laws, they exempted hospices. Without such an exemption, he said, laws like Michigan’s new law makes almost no sense whatsoever regarding hospice care.
"A prescriber who wishes to provide more than a three-day prescription of Level 2 to 5 controlled substances must ask the patient about their background of controlled substance use, has to check the electric MAPS record to see what their history of controlled substances is, and have a bona fide patient-physician relationship with the patient," Boal said. "Under the law, a bona fide relationship between patient and prescriber is described as -- the physician has reviewed relevant records and completed a full assessment of the patient’s medical history, current medical condition -- including an evaluation of the patient's medical condition conducted in person or via telehealth.
"This doesn't work in hospice, because at the end of life almost all hospice care is provided in the patient's home or residence," Boal asserted. "It's usually done by nurses and similar practitioners. Hospice was actually invented as a nursing mode of health care. Physicians kind of got added on later to fulfill legal requirements."
Boal said that with hospice schedule 2 to 5 medications are used to prevent pain and suffering and prescribers are usually contacted by phone or during inter-disciplinary team meetings.
Committee Chair, Sen. Curt Vanderwall (R-Ludington) is the sponsor of SB 0127, which would exempt a patient who was under the care of a hospice from requirements related to the prescription of Schedule 2 to 5 controlled substances. Sen. Curtis Hertel Jr. (D-East Lansing) is the sponsor of SB 0128, which would amend the Public Health Code to revise the definition of "bona fide prescriber-patient relationship."
The testimony of Jim Boal, a physician with Angela Hospice of Michigan, summed up the argument in favor of the legislation from the hospice viewpoint.
"In the last stages of life, pain can become intolerable," Boal told the committee. "Controlled substances are often needed immediately to be added or adjusted for the patient to be comfortable."
"In 2017, PA 246 through 249 were enacted in order to prevent deaths from the opioid crisis," Boal continued. "I've taken care of people at hospice who were victims of the opioid crisis. I think these laws are good laws. However, they hamper access to good pain management while in hospice care."
According to Boal, in other states that adopted MAPS types of laws, they exempted hospices. Without such an exemption, he said, laws like Michigan’s new law makes almost no sense whatsoever regarding hospice care.
"A prescriber who wishes to provide more than a three-day prescription of Level 2 to 5 controlled substances must ask the patient about their background of controlled substance use, has to check the electric MAPS record to see what their history of controlled substances is, and have a bona fide patient-physician relationship with the patient," Boal said. "Under the law, a bona fide relationship between patient and prescriber is described as -- the physician has reviewed relevant records and completed a full assessment of the patient’s medical history, current medical condition -- including an evaluation of the patient's medical condition conducted in person or via telehealth.
"This doesn't work in hospice, because at the end of life almost all hospice care is provided in the patient's home or residence," Boal asserted. "It's usually done by nurses and similar practitioners. Hospice was actually invented as a nursing mode of health care. Physicians kind of got added on later to fulfill legal requirements."
Boal said that with hospice schedule 2 to 5 medications are used to prevent pain and suffering and prescribers are usually contacted by phone or during inter-disciplinary team meetings.
"The patients themselves are usually too sick to travel to a doctor’s office," Boal said. "Under the new law, doctors are going to have to travel to that patient every single time we need to change medication."
At the end of testimony at the 43-minute hearing, a number of cards in support of the legislation were noted. There were apparently no cards in opposition turned in. It's expected that a vote on the bills will take place at the next hearing.
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