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Most health care institutions will seek accreditation from a private health care organization. Although theoretically voluntary, as a practical matter accreditation may be required in order for the institution to meet Medicare certification requirements or to satisfy state licensure requirements. Accreditation standards are developed by medical professionals and institutions are subject to compliance programs. Although voluntary and private evidence of compliance or noncompliance with accreditation standards may have an effect on a medical malpractice action. Several accreditation organizations now address the issue of pain management. In particular, the Joint Commission (JCAHO), the leading accreditation organization, has added pain management issues to many of its Standards. [HTML] Joint Commission on Accreditation of Healthcare Organizations (JCAHO) [HTML]

JCAHO Practice Guidelines - Pain Management Standards for 2001 [HTML]

• Specific requirements include:
  
• Patients have the right to appropriate assessment and management of pain (RI.1.2.8)
• Pain is assessed in all patients (PE.1.4)
• Patients are educated about pain and managing pain as part of treatment, as appropriate (PF.3.4)
• Background on the Development of the Joint Commission Standards on Pain Management [HTML]

American Academy of Pain Management (AAPM) [HTML]
Non-Clinical Standards [PDF]
General Clinical Standards [PDF]
Classification Specific Clinical Standards [PDF]

Accreditation-Related Legislation
California Assembly Bill 791. [PDF]

• Summary: This Bill, approved by California’s Governor in 1999, amended the California Health and Safety Code to include pain as “an item to be assed at the same time as vital signs are taken.” Under the bill, charting a patient’s pain becomes a condition of licensure for hospitals. This bill also mandates that pain management be included in medical school curriculums for those entering medical school after June 1, 2000.

California assembly Bill 791 was codified in the following two sections of the California Code:

• CAL. HEALTH & SAFETY CODE § 1254.7 [Findlaw] $[Lexis] $[Westlaw]
  • Summary: This provision conditions health facility licensure on the recording of a patient’s pain as the fifth vital sign. The statute notes that pain assessment should be “performed in a consistent manner that is appropriate to the patient.”

• CAL. BUS. & PROF. CODE § 2089 [Findlaw] $[Lexis] $[Westlaw]
• Summary: This provision requires that physicians who apply for medical licensure in the state of California who entered medical school after June 1, 2000 must complete a medical school curriculum that includes training in pain management and end-of-life care.