California's governor, Gray Davis, last month signed the first law in the United States requiring doctors to take courses in pain management and in care of people at the end of life. The measure was drafted by assembly woman Dion Aroner, a Berkeley Democrat.
The new law resulted from the case of William Bergman, an 85 year old man admitted in February 1998 to Eden Medical Center in Castro Valley, northern California. Mr Bergman was an inpatient for five days, with probable advanced lung cancer and bone fractures. Dr Wing Chin, an internist, gave him too little medication, despite the fact that nurses rated his pain as being between 7 and 10 on a scale of 1 to 10, with 10 being the worst pain imaginable.
Mr Bergman was still in agony when he was sent home. His family consulted another doctor, who prescribed analgesics that provided relief. He died in a hospice on 24 February 1998.
His daughter contacted Compassion in Dying, a non-profit making organisation dedicated to improving care and expanding people's choices at the end of their life. She sued Eden Medical Center and Dr Chin for "elder abuse." Last June an Alameda county jury awarded Mr Bergman's family $1.5m (£1m), which a judge subsequently reduced to $250 000.
The plaintiff's lawyer, James Geagen, said, "Medical experts testified that there were numerous serious deviations from standards of care. They called Dr Chin's conduct ‘amazingly reckless' and ‘inexcusable.' "
The new law requires doctors to complete courses in pain management and palliative care within four years, as part of the continuing medical education needed to renew their licences. It also requires the state medical board to track complaints of doctors mishandling treatment of pain and to ensure that these complaints are reviewed by a pain specialist.
"Hospitals, universities, and professional medical societies will develop new courses," said Linda Whitney, chief of legislation for the state medical board.
Dr Russell Portenoy, past president of the American Pain Society and head of the department of palliative care at Beth Israel Hospital in New York, said that the law represents a "very extraordinary step . . . to address what is clearly an enormous problem."
Kathryn Tucker, director of legal affairs for Compassion in Dying, said, "This is the first law among the 50 states designed to foster physician education in pain management and end of life care. It is a model for the other states to follow."