HOUSE BILL No. 4707 April 29, 1997, Introduced by Reps. Horton, Perricone, Cropsey, Bodem, Gire, Lowe, Walberg, Baird, Voorhees, Law, Green, Rocca, Bobier, Johnson, McManus, Gernaat, Hammerstrom, Jansen, Jellema, Harder, Bankes, Goschka, McBryde, Raczkowski and Ciaramitaro and referred to the Committee on Health Policy. A bill to amend 1978 PA 368, entitled "Public health code," by amending sections 16204, 16204a, 16221, and 16226 (MCL 333.16204, 333.16204a, 333.16221, and 333.16226), section 16204 as added by 1994 PA 234, section 16204a as added by 1994 PA 232, and sections 16221 and 16226 as amended by 1996 PA 594, and by adding sections 17017, 17018, 17517, and 17518. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 16204. (1) Effective for the renewal of licenses or 2 registrations THAT ARE issued under this article andexpiring3 THAT EXPIRE after January 1, 1997, if the completion of continu- 4 ing education is a condition for renewal, the appropriate board 5 shall by rule require an applicant for renewal to complete an 6 appropriate number of hours or courses in pain and symptom 7 management. Rules promulgated by a board under section 16205(2) 02889'97 * CPD 2 1 for continuing education in pain and symptom management shall 2 cover both course length and content and shall take into consid- 3 eration the recommendation for that health care profession by the 4 interdisciplinary advisory committee created in section 16204a. 5 THE RULES SHALL INCLUDE, BUT ARE NOT LIMITED TO, REQUIRED COURSES 6 IN PRE-TERM AND FULL-TERM INFANT AND PEDIATRIC PAIN AND SYMPTOM 7 MANAGEMENT. A board shall submit the notice of public hearing for 8 the rules as required under section 42 of the administrative pro- 9 cedures act of 1969,being section 24.242 of the Michigan10Compiled Laws1969 PA 306, MCL 24.242, not later than 90 days 11 after the first interdisciplinary advisory committee makes its 12 initial recommendations and shall promulgate the rules as expedi- 13 tiously as possible. 14 (2) If a board proposes rules under section 16205(2) to 15 institute a requirement that continuing education be a mandatory 16 condition for the renewal of a license or registration issued 17 under this article, the rules shall require, as part of the con- 18 tinuing education requirements, completion of an appropriate 19 number of hours or courses in pain and symptom management, taking 20 into consideration the recommendation for that health care pro- 21 fession by the interdisciplinary advisory committee created in 22 section 16204a. THE RULES SHALL INCLUDE, BUT ARE NOT LIMITED TO, 23 REQUIRED COURSES IN PRE-TERM AND FULL-TERM INFANT AND PEDIATRIC 24 PAIN AND SYMPTOM MANAGEMENT. 25 (3) This section does not apply to individuals licensed or 26 registered under part 184 or 188 or to an individual licensed to 27 engage in the practice as a dental hygienist under part 166. 02889'97 * 3 1 Sec. 16204a. (1) Subject to subsection (2), an 2 interdisciplinary advisory committee on pain and symptom manage- 3 ment is created in the department. The committee shall consist 4 of the following members: 5 (a) Except as otherwise provided in this subdivision, each 6 board created under this article, not including the Michigan 7 board of sanitarians and the Michigan board of veterinary medi- 8 cine, and the joint task force on physician's assistants created 9 under this article, shall appoint 1 member. The Michigan board 10 of medicine created in part 170 and the Michigan board of osteo- 11 pathic medicine and surgery created in part 175 each shall 12 appoint 2 members, 1 of whom is a physician specializing in pri- 13 mary care and 1 of whom is a physician specializing in the treat- 14 ment of patients with chronic pain or terminal illness, or both. 15 The board of examiners of social workers created under 16 section 1602 ofAct No. 299 of the Public Acts of 1980, being17section 339.1602 of the Michigan Compiled LawsTHE OCCUPATIONAL 18 CODE, 1980 PA 299, MCL 339.1602, shall appoint 1 member. A 19 member appointed under this subdivision need not be a member of a 20 licensing or registration board or task force. 21 (b) The director of the department or his or her designee, 22 who shall serve as chairperson. 23 (c) The director ofpublicTHE DEPARTMENT OF COMMUNITY 24 health or his or her designee. 25 (2) Interdisciplinary advisory committee members appointed 26 under subsection (1)(a) shall receive per diem compensation as 02889'97 * 4 1 established by the legislature and shall be reimbursed for 2 expenses under section 1216. 3 (3) The initial interdisciplinary advisory committee members 4 appointed under subsection (1)(a) shall be appointedwithin 455days after the effective date of the amendatory act that added6this sectionBY AUGUST 15, 1994. The initial interdisciplinary 7 advisory committee shall complete its duties under this section 8within 9 months after completion of the appointment of the ini-9tial members under subsection (1)(a)BY MAY 15, 1995. Beginning 10 in January of the first odd numbered year after the year in which 11 the initial interdisciplinary advisory committee completes its 12 duties under this section, and biennially thereafter until 13 January of 2003, a new interdisciplinary advisory committee shall 14 be created pursuant to subsection (1) to review any changes 15 occurring in pain and symptom management standards and education 16 since the recommendations of the previous interdisciplinary 17 advisory committee. Each biennial interdisciplinary advisory 18 committee shall complete its duties under this section within 180 19 days after completion of the appointment of members under subsec- 20 tion (1)(a). 21 (4) The initial interdisciplinary advisory committee shall 22 do all of the following and each subsequent biennial interdisci- 23 plinary advisory committee shall do all of the following, as 24 necessary: 25 (a) Provide a forum that is open to all human health care 26 professions and to all hospices licensed under article 17 in 02889'97 * 5 1 developing an integrated approach to understanding and applying 2 pain and symptom management techniques. 3 (b) Hold a public hearing in the same manner as provided for 4 a public hearing held under the administrative procedures act of 5 1969, within 90 days after the initial members are appointed6under subsection (1)(a)BY SEPTEMBER 30, 1994 to gather informa- 7 tion from the general public on issues pertaining to pain and 8 symptom management. 9 (c) Develop and encourage the implementation of model core 10 curricula on pain and symptom management. 11 (d) Develop recommendations to the licensing and registra- 12 tion boards and the task force created under this article and to 13 the board of examiners of social workers on integrating pain and 14 symptom management into the customary practice of health care 15 professionals and identifying the role and responsibilities of 16 the various health care professionals in pain and symptom 17 management. 18 (e) Develop written materials explaining pain and symptom 19 management and hospice care for distribution to health care pro- 20 fessionals, health care payment and benefits plans, and the 21 public. 22 (f) Advise the licensing and registration boards and task 23 force created under this article on the duration and content of 24 continuing education requirements for pain and symptom 25 management. 26 (g) Report their activities and recommendations to the 27 standing committees in the senate and the house of 02889'97 * 6 1 representatives with jurisdiction over matters pertaining to 2 public health. Each subsequent biennial interdisciplinary 3 advisory committee shall include in the report information about 4 the impact and effectiveness of the recommendations. 5 (5) In making recommendations and developing written materi- 6 als under subsection (4), each interdisciplinary advisory commit- 7 tee shall review guidelines on pain and symptom management issued 8 by the United States department of health and human services. 9 (6) IN MAKING RECOMMENDATIONS AND DEVELOPING WRITTEN MATERI- 10 ALS UNDER SUBSECTION (4), EACH INTERDISCIPLINARY ADVISORY COMMIT- 11 TEE SHALL INCLUDE IN ITS DELIBERATIONS AND RECOMMENDATIONS INFOR- 12 MATION ABOUT PRE-TERM AND FULL-TERM INFANT AND PEDIATRIC PAIN AND 13 SYMPTOM MANAGEMENT. 14 Sec. 16221. The department may investigate activities 15 related to the practice of a health profession by a licensee, a 16 registrant, or an applicant for licensure or registration. The 17 department may hold hearings, administer oaths, and order rele- 18 vant testimony to be taken and shall report its findings to the 19 appropriate disciplinary subcommittee. The disciplinary subcom- 20 mittee shall proceed under section 16226 if it finds that 1 or 21 more of the following grounds exist: 22 (a) A violation of general duty, consisting of negligence or 23 failure to exercise due care, including negligent delegation to 24 or supervision of employees or other individuals, whether or not 25 injury results, or any conduct, practice, or condition which 26 impairs, or may impair, the ability to safely and skillfully 27 practice the health profession. 02889'97 * 7 1 (b) Personal disqualifications, consisting of 1 or more of 2 the following: 3 (i) Incompetence. 4 (ii) Subject to sections 16165 to 16170a, substance abuse as 5 defined in section 6107. 6 (iii) Mental or physical inability reasonably related to and 7 adversely affecting the licensee's ability to practice in a safe 8 and competent manner. 9 (iv) Declaration of mental incompetence by a court of compe- 10 tent jurisdiction. 11 (v) Conviction of a misdemeanor punishable by imprisonment 12 for a maximum term of 2 years; a misdemeanor involving the ille- 13 gal delivery, possession, or use of a controlled substance; or a 14 felony. A certified copy of the court record is conclusive evi- 15 dence of the conviction. 16 (vi) Lack of good moral character. 17 (vii) Conviction of a criminal offense under sections 520a 18 to 520l of the Michigan penal code,Act No. 328 of the Public19Acts of 1931, being sections 750.520a to 750.520l of the Michigan20Compiled Laws1931 PA 328, MCL 750.520A TO 750.520l. A certi- 21 fied copy of the court record is conclusive evidence of the 22 conviction. 23 (viii) Conviction of a violation of section 492a of the 24 Michigan penal code,Act No. 328 of the Public Acts of 1931,25being section 750.492a of the Michigan Compiled Laws1931 PA 26 328, MCL 750.492A. A certified copy of the court record is 27 conclusive evidence of the conviction. 02889'97 * 8 1 (ix) Conviction of a misdemeanor or felony involving fraud 2 in obtaining or attempting to obtain fees related to the practice 3 of a health profession. A certified copy of the court record is 4 conclusive evidence of the conviction. 5 (x) Final adverse administrative action by a licensure, reg- 6 istration, disciplinary, or certification board involving the 7 holder of, or an applicant for, a license or registration regu- 8 lated by another state or a territory of the United States. A 9 certified copy of the record of the board is conclusive evidence 10 of the final action. 11 (xi) Conviction of a misdemeanor that is reasonably related 12 to or that adversely affects the licensee's ability to practice 13 in a safe and competent manner. A certified copy of the court 14 record is conclusive evidence of the conviction. 15 (c) Prohibited acts, consisting of 1 or more of the 16 following: 17 (i) Fraud or deceit in obtaining or renewing a license or 18 registration. 19 (ii) Permitting the license or registration to be used by an 20 unauthorized person. 21 (iii) Practice outside the scope of a license. 22 (iv) Obtaining, possessing, or attempting to obtain or pos- 23 sess a controlled substance as defined in section 7104 or a drug 24 as defined in section 7105 without lawful authority; or selling, 25 prescribing, giving away, or administering drugs for other than 26 lawful diagnostic or therapeutic purposes. 02889'97 * 9 1 (d) Unethical business practices, consisting of 1 or more of 2 the following: 3 (i) False or misleading advertising. 4 (ii) Dividing fees for referral of patients or accepting 5 kickbacks on medical or surgical services, appliances, or medica- 6 tions purchased by or in behalf of patients. 7 (iii) Fraud or deceit in obtaining or attempting to obtain 8 third party reimbursement. 9 (e) Unprofessional conduct, consisting of 1 or more of the 10 following: 11 (i) Misrepresentation to a consumer or patient or in obtain- 12 ing or attempting to obtain third party reimbursement in the 13 course of professional practice. 14 (ii) Betrayal of a professional confidence. 15 (iii) Promotion for personal gain of an unnecessary drug, 16 device, treatment, procedure, or service. 17 (iv) Directing or requiring an individual to purchase or 18 secure a drug, device, treatment, procedure, or service from 19 another person, place, facility, or business in which the 20 licensee has a financial interest. 21 (f) Failure to report a change of name or mailing address 22 within 30 days after the change occurs. 23 (g) A violation, or aiding or abetting in a violation, of 24 this article or of a rule promulgated under this article. 25 (h) Failure to comply with a subpoena issued pursuant to 26 this part, failure to respond to a complaint issued under this 27 article or article 7, failure to appear at a compliance 02889'97 * 10 1 conference or an administrative hearing, or failure to report 2 under section 16222 or 16223. 3 (i) Failure to pay an installment of an assessment levied 4 pursuant to section 2504 of the insurance code of 1956,Act5No. 218 of the Public Acts of 1956, being section 500.2504 of the6Michigan Compiled Laws1956 PA 218, MCL 500.2504, within 60 days 7 after notice by the appropriate board. 8 (j) A violation of section 17013 or 17513. 9 (k) Failure to meet 1 or more of the requirements for licen- 10 sure or registration under section 16174. 11 (l) A violation of section 17015 or 17515. 12 (m) A violation of section 17016 or 17516. 13 (N) FAILURE TO COMPLY WITH SECTION 9206(3). 14 (O)(n)A violation of section 5654 or 5655. 15 (P) A VIOLATION OF SECTION 17017, 17018, 17517, OR 17518. 16 Sec. 16226. (1) After finding the existence of 1 or more of 17 the grounds for disciplinary subcommittee action listed in sec- 18 tion 16221, a disciplinary subcommittee shall impose 1 or more of 19 the following sanctions for each violation: 20 21 Violations of Section 16221 Sanctions 22 Subdivision (a), (b)(ii), Probation, limitation, denial, 23 (b)(iv), (b)(vi), or suspension, revocation, 24 (b)(vii) restitution, community service, 25 or fine. 26 Subdivision (b)(viii) Revocation or denial. 02889'97 * 11 1 Subdivision (b)(i), Limitation, suspension, 2 (b)(iii), (b)(v), revocation, denial, 3 (b)(ix), probation, restitution, 4 (b)(x), or (b)(xi) community service, or fine. 5 Subdivision (c)(i) Denial, revocation, suspension, 6 probation, limitation, commu- 7 nity service, or fine. 8 Subdivision (c)(ii) Denial, suspension, revocation, 9 restitution, community service, 10 or fine. 11 Subdivision (c)(iii) Probation, denial, suspension, 12 revocation, restitution, commu- 13 nity service, or fine. 14 Subdivision (c)(iv) Fine, probation, denial, 15 or (d)(iii) suspension, revocation, commu- 16 nity service, 17 or restitution. 18 Subdivision (d)(i) Reprimand, fine, probation, 19 or (d)(ii) community service, denial, 20 or restitution. 21 Subdivision (e)(i) Reprimand, fine, probation, 22 limitation, suspension, commu- 23 nity service, denial, or 24 restitution. 25 Subdivision (e)(ii) Reprimand, probation, 02889'97 * 12 1 or (h) suspension, restitution, 2 community service, denial, or 3 fine. 4 Subdivision (e)(iii) Reprimand, fine, probation, 5 or (e)(iv) suspension, revocation, limita- 6 tion, community service, 7 denial, or restitution. 8 Subdivision (f) Reprimand or fine. 9 Subdivision (g) Reprimand, probation, denial, 10 suspension, revocation, limita- 11 tion, restitution, community 12 service, or fine. 13 Subdivision (i) Suspension or fine. 14 Subdivision (j), (O), or 15(n)(P) Reprimand or fine. 16 Subdivision (k) Reprimand, denial, or 17 limitation. 18 Subdivision (l) OR (N) Denial, revocation, restitution, 19 probation, suspension, limita- 20 tion, reprimand, or fine. 21 Subdivision (m) Revocation or denial. 22 (2) Determination of sanctions for violations under this 23 section shall be made by a disciplinary subcommittee. If, during 24 judicial review, the court of appeals determines that a final 25 decision or order of a disciplinary subcommittee prejudices sub- 26 stantial rights of the petitioner for 1 or more of the grounds 27 listed in section 106 of the administrative procedures act of 02889'97 * 13 1 1969,being section 24.306 of Michigan Compiled Laws1969 PA 2 306, MCL 24.306, and holds that the final decision or order is 3 unlawful and is to be set aside, the court shall state on the 4 record the reasons for the holding and may remand the case to the 5 disciplinary subcommittee for further consideration. 6 (3) A disciplinary subcommittee may impose a fine of up to, 7 but not exceeding, $250,000.00 for a violation of 8 section 16221(a) or (b). 9 (4) A disciplinary subcommittee may require a licensee or 10 registrant or an applicant for licensure or registration who has 11 violated this article or article 7 or a rule promulgated under 12 this article or article 7 to satisfactorily complete an educa- 13 tional program, a training program, or a treatment program, a 14 mental, physical, or professional competence examination, or a 15 combination of those programs and examinations. 16 SEC. 17017. (1) IT IS THE INTENT OF THE LEGISLATURE IN 17 ENACTING THIS SECTION AND SECTION 17018 TO ENSURE THAT PATIENTS 18 WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADO- 19 LESCENTS IN THIS STATE ARE GIVEN APPROPRIATE AND ADEQUATE PAIN 20 MANAGEMENT INCLUDING, BUT NOT LIMITED TO, ADEQUATE SEDATION, 21 ANALGESIA, AND ANAESTHESIA WHEN RECEIVING MEDICAL TREATMENT OR 22 UNDERGOING SURGICAL PROCEDURES. THE LEGISLATURE RECOGNIZES ALL 23 OF THE FOLLOWING: 24 (A) THAT PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM 25 INFANTS, CHILDREN, AND ADOLESCENTS IN THIS STATE OFTEN ARE NOT 26 GIVEN APPROPRIATE AND ADEQUATE PAIN MANAGEMENT WHEN RECEIVING 27 MEDICAL TREATMENT OR UNDERGOING SURGICAL PROCEDURES. 02889'97 * 14 1 (B) THAT PARENTS AND GUARDIANS IN THIS STATE NEED MORE AND 2 BETTER INFORMATION FROM HEALTH PROFESSIONALS AND HEALTH FACILI- 3 TIES BEFORE CONSENTING TO MEDICAL TREATMENT OR SURGICAL PROCE- 4 DURES FOR THEIR CHILDREN. 5 (C) THAT PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM 6 INFANTS, CHILDREN, AND ADOLESCENTS IN THIS STATE NEED AND DESERVE 7 THE SAME PAIN MANAGEMENT TECHNIQUES AS ADULT PATIENTS. 8 (D) THAT THERE ARE EXISTING PROFESSIONAL STANDARDS OF PRAC- 9 TICE FOR THE MANAGEMENT OF PEDIATRIC PAIN, AND THAT HEALTH PRO- 10 FESSIONALS AND HEALTH FACILITIES IN THIS STATE OFTEN DO NOT CON- 11 FORM TO THOSE STANDARDS WHEN PROVIDING MEDICAL TREATMENT OR PER- 12 FORMING SURGICAL PROCEDURES ON PATIENTS WHO ARE PRE-TERM INFANTS, 13 FULL-TERM INFANTS, CHILDREN, AND ADOLESCENTS. 14 (E) THAT IT HAS BEEN SCIENTIFICALLY PROVEN THAT A HUMAN 15 FETUS FEELS PAIN AND THAT PRE-TERM INFANTS AND FULL-TERM INFANTS 16 RESPOND TO PAIN AND HAVE MEMORY OF PAIN. 17 (F) THAT THE ETHICAL RESPONSIBILITY OF HEALTH PROFESSIONALS 18 AND HEALTH FACILITIES IS TO PROVIDE FULL TREATMENT OF PAIN IN 19 PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, 20 AND ADOLESCENTS UNLESS OTHERWISE JUSTIFIED BY DEFINED THERAPEUTIC 21 BENEFITS. 22 (G) THAT THE ASSESSMENT AND TREATMENT OF PAIN IN PATIENTS 23 WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADO- 24 LESCENTS ARE IMPORTANT PARTS OF PEDIATRIC PRACTICE, AND FAILURE 25 TO PROVIDE APPROPRIATE AND ADEQUATE CONTROL OF PAIN IN THOSE 26 PATIENTS AMOUNTS TO SUBSTANDARD AND UNETHICAL MEDICAL PRACTICE. 02889'97 * 15 1 (2) BEGINNING 120 DAYS AFTER THE EFFECTIVE DATE OF THE 2 AMENDATORY ACT THAT ADDED THIS SECTION, A PHYSICIAN WHO ADVISES 3 THE PARENT OR GUARDIAN OF A PATIENT WHO IS A PRE-TERM INFANT, 4 FULL-TERM INFANT, CHILD, OR ADOLESCENT THAT THE PATIENT NEEDS 5 MEDICAL TREATMENT FOR A PAINFUL DISEASE OR CONDITION OR SHOULD 6 UNDERGO A SURGICAL PROCEDURE OR OTHER PAINFUL PROCEDURE, INCLUD- 7 ING, BUT NOT LIMITED TO, CIRCUMCISION, SHALL INFORM THE PARENT OR 8 GUARDIAN, ORALLY AND IN WRITING, ABOUT ALTERNATIVE METHODS OF 9 PAIN AND SYMPTOM MANAGEMENT FOR THE PATIENT. THE PHYSICIAN ALSO 10 SHALL INFORM THE PARENT OR GUARDIAN ABOUT THE ADVANTAGES, DISAD- 11 VANTAGES, AND RISKS OF EACH METHOD OF PAIN AND SYMPTOM MANAGE- 12 MENT, AND ABOUT THE PARENT'S OR GUARDIAN'S RIGHT TO BE INFORMED 13 ABOUT AND TO SELECT 1 OR MORE PAIN AND SYMPTOM MANAGEMENT PROCE- 14 DURES FOR THE PATIENT, AND ABOUT THE PROCEDURES INVOLVED IN EACH 15 METHOD OF PAIN AND SYMPTOM MANAGEMENT. 16 (3) IF A PARENT OR GUARDIAN RECEIVES A STANDARDIZED WRITTEN 17 SUMMARY OR BROCHURE, AS DESCRIBED IN THIS SUBSECTION OR SUBSEC- 18 TION (4), THE PHYSICIAN DESCRIBED IN SUBSECTION (2) IS IN FULL 19 COMPLIANCE WITH SUBSECTION (2), INCLUDING BOTH THE WRITTEN AND 20 ORAL REQUIREMENTS. WITHIN 60 DAYS AFTER THE EFFECTIVE DATE OF 21 THE AMENDATORY ACT THAT ADDED THIS SECTION, THE DEPARTMENT OF 22 COMMUNITY HEALTH SHALL DO ALL OF THE FOLLOWING: 23 (A) IN COOPERATION WITH THE CHRONIC DISEASE ADVISORY COMMIT- 24 TEE, DEVELOP A STANDARDIZED WRITTEN SUMMARY THAT DESCRIBES THE 25 ALTERNATIVE METHODS OF PAIN AND SYMPTOM MANAGEMENT FOR PATIENTS 26 WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND 27 ADOLESCENTS AND WHO NEED MEDICAL TREATMENT FOR A PAINFUL DISEASE 02889'97 * 16 1 OR CONDITION OR WHO UNDERGO A SURGICAL PROCEDURE OR OTHER PAINFUL 2 PROCEDURE INCLUDING, BUT NOT LIMITED TO, CIRCUMCISION. 3 (B) DRAFT THE STANDARDIZED WRITTEN SUMMARY IN NONTECHNICAL 4 TERMS THAT ARE EASILY UNDERSTOOD BY INDIVIDUALS WHO ARE NOT 5 HEALTH PROFESSIONALS. 6 (C) INCLUDE IN THE STANDARDIZED WRITTEN SUMMARY INFORMATION 7 ABOUT THE ADVANTAGES, DISADVANTAGES, AND RISKS OF EACH METHOD OF 8 PAIN AND SYMPTOM MANAGEMENT APPROPRIATE FOR AS MANY PAINFUL PEDI- 9 ATRIC DISEASES OR CONDITIONS AS PRACTICABLE AND FOR EACH SURGICAL 10 PROCEDURE OR OTHER PAINFUL PROCEDURE, INCLUDING, BUT NOT LIMITED 11 TO, CIRCUMCISION, COMMONLY PERFORMED ON PATIENTS WHO ARE PRE-TERM 12 INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADOLESCENTS AND ABOUT 13 THE PROCEDURES INVOLVED IN EACH METHOD OF PAIN AND SYMPTOM 14 MANAGEMENT. 15 (4) FOR PURPOSES OF SUBSECTION (3), A PHYSICIAN MAY USE A 16 BROCHURE THAT CONTAINS INFORMATION THAT IS SUBSTANTIALLY SIMILAR 17 TO THE INFORMATION CONTAINED IN THE STANDARDIZED WRITTEN SUMMARY 18 DEVELOPED BY THE DEPARTMENT OF COMMUNITY HEALTH UNDER SUBSECTION 19 (3) AND THAT IS APPROVED BY THE DEPARTMENT OF COMMUNITY HEALTH. 20 (5) THE MICHIGAN BOARD OF MEDICINE AND THE MICHIGAN BOARD OF 21 OSTEOPATHIC MEDICINE AND SURGERY SHALL MAKE THE STANDARDIZED 22 WRITTEN SUMMARY DEVELOPED UNDER SUBSECTION (3) OR A BROCHURE 23 DESCRIBED IN SUBSECTION (4), OR BOTH, AVAILABLE TO PHYSICIANS. 24 THE MICHIGAN BOARD OF MEDICINE AND THE MICHIGAN BOARD OF OSTEO- 25 PATHIC MEDICINE AND SURGERY SHALL NOTIFY IN WRITING EACH PHYSI- 26 CIAN SUBJECT TO THIS SECTION OF THE REQUIREMENTS OF THIS SECTION 27 AND THE AVAILABILITY OF THE STANDARDIZED WRITTEN SUMMARY WITHIN 02889'97 * 17 1 90 DAYS AFTER THE EFFECTIVE DATE OF THE AMENDATORY ACT THAT ADDED 2 THIS SECTION. 3 (6) AFTER A PHYSICIAN INFORMS A PARENT OR GUARDIAN IN COM- 4 PLIANCE WITH SUBSECTION (2), THE PHYSICIAN MAY REQUEST THAT THE 5 PARENT OR GUARDIAN SIGN A FORM INDICATING THAT THE PARENT OR 6 GUARDIAN HAS BEEN GIVEN A COPY OF THE STANDARDIZED WRITTEN SUM- 7 MARY DESCRIBED IN SUBSECTION (3) OR OF A BROCHURE APPROVED UNDER 8 SUBSECTION (4). THE PHYSICIAN SHALL INCLUDE THE SIGNED FORM IN 9 THE PATIENT'S MEDICAL RECORD AND SHALL GIVE THE PARENT OR GUARD- 10 IAN A TRUE COPY OF THE SIGNED FORM. 11 (7) A PHYSICIAN'S DUTY TO INFORM A PARENT OR GUARDIAN UNDER 12 THIS SECTION DOES NOT REQUIRE DISCLOSURE OF INFORMATION BEYOND 13 WHAT A REASONABLY WELL-QUALIFIED PHYSICIAN WHO REGULARLY TREATS 14 PATIENT'S WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, 15 OR ADOLESCENTS AND WHO IS LICENSED UNDER THIS ARTICLE WOULD 16 KNOW. 17 (8) A PARENT OR GUARDIAN WHO SIGNS A FORM PURSUANT TO SUB- 18 SECTION (6) IS BARRED FROM SUBSEQUENTLY BRINGING A CIVIL ACTION 19 AGAINST THE PHYSICIAN PROVIDING THE STANDARDIZED WRITTEN SUMMARY 20 DESCRIBED IN SUBSECTION (3) OR THE BROCHURE APPROVED UNDER SUB- 21 SECTION (4) BASED ON FAILURE TO OBTAIN INFORMED CONSENT, BUT ONLY 22 IN REGARD TO INFORMATION CONTAINED IN THE STANDARDIZED WRITTEN 23 SUMMARY OR BROCHURE AND PERTAINING TO ALTERNATIVE METHODS OF PAIN 24 AND SYMPTOM MANAGEMENT FOR PATIENTS WHO ARE PRE-TERM INFANTS, 25 FULL-TERM INFANTS, CHILDREN, AND ADOLESCENTS AND WHO REQUIRE MED- 26 ICAL TREATMENT FOR A PAINFUL DISEASE OR CONDITION OR WHO UNDERGO 27 SURGICAL PROCEDURES OR OTHER PAINFUL PROCEDURES, INCLUDING, BUT 02889'97 * 18 1 NOT LIMITED TO, CIRCUMCISION, AND THE ADVANTAGES, DISADVANTAGES, 2 AND RISKS OF EACH METHOD. 3 SEC. 17018. (1) A PHYSICIAN SHALL NOT PERFORM A SURGICAL 4 PROCEDURE OR OTHER PAINFUL PROCEDURE, INCLUDING, BUT NOT LIMITED 5 TO, CIRCUMCISION, ON A PATIENT WHO IS A PRE-TERM INFANT, 6 FULL-TERM INFANT, CHILD, OR ADOLESCENT WITHOUT SEDATION, ANALGE- 7 SIA, OR ANESTHESIA THAT IS APPROPRIATE AND ADEQUATE IN THE PRO- 8 FESSIONAL MEDICAL JUDGMENT OF THE PHYSICIAN. 9 (2) A PHYSICIAN SHALL NOT PERFORM A SURGICAL PROCEDURE OR 10 OTHER PAINFUL PROCEDURE, INCLUDING, BUT NOT LIMITED TO, CIRCUMCI- 11 SION, ON A PATIENT WHO IS A PRE-TERM INFANT, FULL-TERM INFANT, 12 CHILD, OR ADOLESCENT AND WHO IS PARALYZED BY A CHEMICAL AGENT OR 13 IS PHYSICALLY RESTRAINED, UNLESS THE PATIENT IS ANESTHETIZED. 14 SEC. 17517. (1) IT IS THE INTENT OF THE LEGISLATURE IN 15 ENACTING THIS SECTION AND SECTION 17518 TO ENSURE THAT PATIENTS 16 WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADO- 17 LESCENTS IN THIS STATE ARE GIVEN APPROPRIATE AND ADEQUATE PAIN 18 MANAGEMENT INCLUDING, BUT NOT LIMITED TO, ADEQUATE SEDATION, 19 ANALGESIA, AND ANESTHESIA WHEN RECEIVING MEDICAL TREATMENT OR 20 UNDERGOING SURGICAL PROCEDURES. THE LEGISLATURE RECOGNIZES ALL 21 OF THE FOLLOWING: 22 (A) THAT PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM 23 INFANTS, CHILDREN, AND ADOLESCENTS IN THIS STATE OFTEN ARE NOT 24 GIVEN APPROPRIATE AND ADEQUATE PAIN MANAGEMENT WHEN RECEIVING 25 MEDICAL TREATMENT OR UNDERGOING SURGICAL PROCEDURES. 26 (B) THAT PARENTS AND GUARDIANS IN THIS STATE NEED MORE AND 27 BETTER INFORMATION FROM HEALTH PROFESSIONALS AND HEALTH 02889'97 * 19 1 FACILITIES BEFORE CONSENTING TO MEDICAL TREATMENT OR SURGICAL 2 PROCEDURES FOR THEIR CHILDREN. 3 (C) THAT PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM 4 INFANTS, CHILDREN, AND ADOLESCENTS IN THIS STATE NEED AND DESERVE 5 THE SAME PAIN MANAGEMENT TECHNIQUES AS ADULT PATIENTS. 6 (D) THAT THERE ARE EXISTING PROFESSIONAL STANDARDS OF PRAC- 7 TICE FOR THE MANAGEMENT OF PEDIATRIC PAIN, AND THAT HEALTH PRO- 8 FESSIONALS AND HEALTH FACILITIES IN THIS STATE OFTEN DO NOT CON- 9 FORM TO THOSE STANDARDS WHEN PROVIDING MEDICAL TREATMENT OR PER- 10 FORMING SURGICAL PROCEDURES ON PATIENTS WHO ARE PRE-TERM INFANTS, 11 FULL-TERM INFANTS, CHILDREN, OR ADOLESCENTS. 12 (E) THAT IT HAS BEEN SCIENTIFICALLY PROVEN THAT A HUMAN 13 FETUS FEELS PAIN AND THAT PRE-TERM INFANTS AND FULL-TERM INFANTS 14 RESPOND TO PAIN AND HAVE MEMORY OF PAIN. 15 (F) THAT THE ETHICAL RESPONSIBILITY OF HEALTH PROFESSIONALS 16 AND HEALTH FACILITIES IS TO PROVIDE FULL TREATMENT OF PAIN IN 17 PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADOLESCENTS 18 UNLESS OTHERWISE JUSTIFIED BY DEFINED THERAPEUTIC BENEFITS. 19 (G) THAT THE ASSESSMENT AND TREATMENT OF PAIN IN PATIENTS 20 WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, AND ADO- 21 LESCENTS ARE IMPORTANT PARTS OF PEDIATRIC PRACTICE, AND FAILURE 22 TO PROVIDE APPROPRIATE AND ADEQUATE CONTROL OF PAIN IN THOSE 23 PATIENTS AMOUNTS TO SUBSTANDARD AND UNETHICAL MEDICAL PRACTICE. 24 (2) BEGINNING 120 DAYS AFTER THE EFFECTIVE DATE OF THE AMEN- 25 DATORY ACT THAT ADDED THIS SECTION, A PHYSICIAN WHO ADVISES THE 26 PARENT OR GUARDIAN OF A PATIENT WHO IS A PRE-TERM INFANT, 27 FULL-TERM INFANT, CHILD, OR ADOLESCENT THAT THE PATIENT NEEDS 02889'97 * 20 1 MEDICAL TREATMENT FOR A PAINFUL DISEASE OR CONDITION OR SHOULD 2 UNDERGO A SURGICAL PROCEDURE OR OTHER PAINFUL PROCEDURE, INCLUD- 3 ING, BUT NOT LIMITED TO, CIRCUMCISION, SHALL INFORM THE PARENT OR 4 GUARDIAN, BOTH ORALLY AND IN WRITING, ABOUT ALTERNATIVE METHODS 5 OF PAIN AND SYMPTOM MANAGEMENT FOR THE PATIENT. THE PHYSICIAN 6 ALSO SHALL INFORM THE PARENT OR GUARDIAN ABOUT THE ADVANTAGES, 7 DISADVANTAGES, AND RISKS OF EACH METHOD OF PAIN AND SYMPTOM MAN- 8 AGEMENT, AND ABOUT THE PARENT'S OR GUARDIAN'S RIGHT TO BE 9 INFORMED ABOUT AND TO SELECT 1 OR MORE PAIN AND SYMPTOM MANAGE- 10 MENT PROCEDURES FOR THE PATIENT, AND ABOUT THE PROCEDURES 11 INVOLVED IN EACH METHOD OF PAIN AND SYMPTOM MANAGEMENT. 12 (3) IF A PARENT OR GUARDIAN RECEIVES A STANDARDIZED WRITTEN 13 SUMMARY OR BROCHURE, AS DESCRIBED IN SECTION 17016(3) OR (4), THE 14 PHYSICIAN DESCRIBED IN SUBSECTION (2) IS IN FULL COMPLIANCE WITH 15 SUBSECTION (2), INCLUDING BOTH THE WRITTEN AND ORAL 16 REQUIREMENTS. 17 (4) AFTER A PHYSICIAN INFORMS A PARENT OR GUARDIAN ABOUT 18 ALTERNATIVE METHODS OF PAIN AND SYMPTOM MANAGEMENT IN COMPLIANCE 19 WITH SUBSECTION (2), THE PHYSICIAN MAY REQUEST THAT THE PARENT OR 20 GUARDIAN SIGN A FORM INDICATING THAT THE PARENT OR GUARDIAN HAS 21 BEEN GIVEN A COPY OF THE STANDARDIZED WRITTEN SUMMARY DEVELOPED 22 UNDER SECTION 17016(3) OR A BROCHURE APPROVED UNDER SECTION 23 17016(4). IF THE PARENT OR GUARDIAN SIGNS THE FORM, THE PHYSI- 24 CIAN SHALL INCLUDE THE SIGNED FORM IN THE PRE-TERM, FULL-TERM, 25 NEONATAL, OR ADOLESCENT PATIENT'S PERMANENT MEDICAL RECORD, AND 26 SHALL GIVE THE PARENT OR GUARDIAN A TRUE COPY OF THE SIGNED 27 FORM. 02889'97 * 21 1 (5) A PHYSICIAN'S DUTY TO INFORM A PARENT OR GUARDIAN UNDER 2 THIS SECTION DOES NOT REQUIRE DISCLOSURE OF INFORMATION BEYOND 3 WHAT A REASONABLY WELL-QUALIFIED PHYSICIAN WHO REGULARLY TREATS 4 PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, 5 OR ADOLESCENTS AND WHO IS LICENSED UNDER THIS ARTICLE WOULD 6 KNOW. 7 (6) A PARENT OR GUARDIAN WHO SIGNS A FORM PURSUANT TO SUB- 8 SECTION (4) IS BARRED FROM SUBSEQUENTLY BRINGING A CIVIL ACTION 9 AGAINST THE PHYSICIAN PROVIDING THE STANDARDIZED WRITTEN SUMMARY 10 OR THE BROCHURE DESCRIBED IN SUBSECTION (4) BASED ON FAILURE TO 11 OBTAIN INFORMED CONSENT, BUT ONLY IN REGARD TO INFORMATION CON- 12 TAINED IN THE STANDARDIZED WRITTEN SUMMARY OR BROCHURE AND PER- 13 TAINING TO ALTERNATIVE METHODS OF PAIN AND SYMPTOM MANAGEMENT FOR 14 PATIENTS WHO ARE PRE-TERM INFANTS, FULL-TERM INFANTS, CHILDREN, 15 AND ADOLESCENTS AND WHO REQUIRE MEDICAL TREATMENT FOR A PAINFUL 16 DISEASE OR CONDITION OR WHO UNDERGO SURGICAL PROCEDURES OR OTHER 17 PAINFUL PROCEDURES, INCLUDING, BUT NOT LIMITED TO, CIRCUMCISION, 18 AND THE ADVANTAGES, DISADVANTAGES, AND RISKS OF EACH METHOD. 19 SEC. 17518. (1) A PHYSICIAN SHALL NOT PERFORM A SURGICAL 20 PROCEDURE OR OTHER PAINFUL PROCEDURE, INCLUDING, BUT NOT LIMITED 21 TO, CIRCUMCISION, ON A PATIENT WHO IS A PRE-TERM INFANT, 22 FULL-TERM INFANT, CHILD, OR ADOLESCENT WITHOUT SEDATION, ANALGE- 23 SIA, OR ANESTHESIA THAT IS APPROPRIATE AND ADEQUATE IN THE PRO- 24 FESSIONAL MEDICAL JUDGMENT OF THE PHYSICIAN. 25 (2) A PHYSICIAN SHALL NOT PERFORM A SURGICAL PROCEDURE OR 26 OTHER PAINFUL PROCEDURE, INCLUDING, BUT NOT LIMITED TO, 27 CIRCUMCISION, ON A PATIENT WHO IS A PRE-TERM INFANT, FULL-TERM 02889'97 * 22 1 INFANT, CHILD, OR ADOLESCENT AND WHO IS PARALYZED BY A CHEMICAL 2 AGENT OR IS PHYSICALLY RESTRAINED, UNLESS THE PATIENT IS 3 ANESTHETIZED. 02889'97 * Final page. CPD