STAND. COM. REP. NO. 523

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 851
                                        S.D. 1




Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Health and Human Services, to which was
referred S.B. No. 851 entitled: 

     "A BILL FOR AN ACT RELATING TO HEALTH CARE,"

begs leave to report as follows:

     The purpose of this measure is to require the Department of
Health (DOH) to adopt rules relating to patient self-
determination for medical care and pain management during end of
life care.

     Your Committee received testimony in support of this measure
from the DOH, Executive Office on Aging, Hawaii Catholic
Conference, and American Association of Retired Persons.
Testimony in opposition was received from the Hawaii Nurses
Association.

     This measure is intended to facilitate a patient's wishes
for pain treatment at end of life care.   Your Committee
recognizes that this is a very personal and sensitive subject and
believes that dying patients should have a certain amount of
freedom to choose a course of pain management.  This measure
requires the DOH to adopt rules for industry standards for the
treatment of pain based on the guidelines issued by the Agency
for Healthcare Policy and Research of the United States
Department of Health.

     Your Committee also received testimony in support of a
related measure, S.B. No. 847, relating to hospice care

 
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reimbursement, from the Insurance Commissioner, Executive Office
on Aging, Hawaii Catholic Conference, Commission on Persons with
Disabilities, American Association of Retired Persons, and Hawaii
Nurses Association.

     Your Committee finds that hospice care can be a very
appropriate method of end of life care and that Hawaii needs more
hospice homes.  S.B. No. 847 requires health insurers to cover
expenses for hospice care and removes county zoning barriers to
the location of hospice homes in residentially designated zones.  

     Your Committee has amended this measure by:

     (1)  Inserting the provisions of S.B. No. 847 into this
          measure;

     (2)  Adding a new section to chapter 46, Hawaii Revised
          Statutes (HRS), relating to counties, permitting a
          hospice home in a residential area;

     (3)  Deleting the new section to chapter 432D, HRS, and
          inserting an amendment to section 432D-23, HRS, as the
          appropriate revision;

     (4)  Deleting the amendment to section 321-13, HRS, relating
          to insertion of the word "services" into the
          permissible subjects of occupation regulation of DOH;

     (5)  Making changes to language that reflect proper
          statutory language for revising insurance statutes;

     (6)  Making other changes to language for purposes of
          clarity and style; and

     (7)  Reformatting and renumbering sections.

     As affirmed by the record of votes of the members of your
Committee on Health and Human Services that is attached to this
report, your Committee is in accord with the intent and purpose
of S.B. No. 851, as amended herein, and recommends that it pass
Second Reading in the form attached hereto as S.B. No. 851,
S.D. 1, and be referred to the Committee on Judiciary.


 
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                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health and Human
                                   Services,



                                   ______________________________
                                   SUZANNE CHUN OAKLAND, Chair

 
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