CSSB 159(HES): "An Act relating to advance directives for mental health treatment."
00CS FOR SENATE BILL NO. 159(HES) 01 "An Act relating to advance directives for mental health treatment." 02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 03 * Section 1. AS 47.30 is amended by adding new sections to read: 04 ARTICLE 11. PERSONAL DECLARATION OF PREFERENCES 05 FOR MENTAL HEALTH TREATMENT. 06 Sec. 47.30.950. DECLARATION. (a) An adult of sound mind may make a 07 declaration of preferences or instructions regarding mental health treatment. The 08 preferences or instructions may include consent to or refusal of mental health 09 treatment. 10 (b) A declaration for mental health treatment continues in effect for three years 11 or until revoked, whichever is sooner. The authority of a named attorney-in-fact and 12 an alternative attorney-in-fact named in the declaration continues in effect as long as 13 the declaration appointing the attorney-in-fact is in effect or until the attorney-in-fact 14 has withdrawn. If a declaration for mental health treatment has been invoked and is
01 in effect at the expiration of three years after its execution, the declaration remains 02 effective until the principal is no longer incapable. 03 Sec. 47.30.952. DESIGNATION OF ATTORNEY-IN-FACT. (a) A 04 declaration may designate a competent adult to act as attorney-in-fact to make 05 decisions about mental health treatment. An alternative attorney-in-fact may also be 06 designated to act as attorney-in-fact if the original designee is unable or unwilling to 07 act at any time. An attorney-in-fact who has accepted the appointment in writing may 08 make decisions about mental health treatment on behalf of the principal only when the 09 principal is incapable. The decisions must be consistent with desires the principal has 10 expressed in the declaration. 11 (b) The following may not serve as attorney-in-fact: 12 (1) the attending physician or mental health service provider, or an 13 employee of the physician or provider, if the physician, provider, or employee is 14 unrelated to the principal by blood, marriage, or adoption; 15 (2) an owner, operator, or employee of a health care facility in which 16 the principal is a patient or resident if the owner, operator, or employee is unrelated 17 to the principal by blood, marriage, or adoption. 18 (c) An attorney-in-fact may withdraw by giving notice to the principal. If a 19 principal is incapable, the attorney-in-fact may withdraw by giving notice to the 20 attending physician or provider. The attending physician or provider shall note the 21 withdrawal as part of the principal's medical record. A person who has withdrawn 22 under the provisions of this subsection may rescind the withdrawal by executing an 23 acceptance after the date of the withdrawal. The acceptance must be in the same form 24 as provided by AS 47.30.970 for accepting an appointment. A person who rescinds 25 a withdrawal shall give notice to the principal if the principal is capable or to the 26 principal's health care provider if the principal is incapable. 27 (d) The designation of an attorney-in-fact under this section supersedes a 28 previous or subsequent designation of an attorney-in-fact regarding mental health 29 treatment unless otherwise specifically provided in the declaration executed under 30 AS 47.30.950 - 47.30.980 or in the document that designates the other attorney-in-fact. 31 Sec. 47.30.954. SIGNATURE; WITNESSES. (a) A declaration is effective
01 only if it is signed by the principal and two competent adult witnesses. The witnesses 02 must attest that the principal is known to them, signed the declaration in their presence, 03 appears to be of sound mind, and is not under duress, fraud, or undue influence. 04 (b) The following may not serve as a witness to the signing of a declaration: 05 (1) the attending physician or mental health service provider or a 06 relative of the physician or provider; 07 (2) an owner, operator, or relative of an owner or operator of a health 08 care facility in which the principal is a patient or resident; or 09 (3) a person related to the principal by blood, marriage, or adoption. 10 Sec. 47.30.956. OPERATION OF DECLARATION. (a) A declaration 11 becomes operative when it is delivered to the principal's physician or other mental 12 health treatment provider and remains valid until revoked or expired. The physician 13 or provider shall act in accordance with an operative declaration when the principal has 14 been found to be incapable. The physician or provider shall continue to obtain the 15 principal's informed consent to all mental health treatment decisions if the principal 16 is capable of providing informed consent or refusal. 17 (b) Upon being presented with a declaration, a physician or other provider 18 shall make the declaration a part of the principal's medical record. When acting under 19 authority of a declaration, a physician or provider shall comply with it to the fullest 20 extent possible, consistent with reasonable medical practice, the availability of 21 treatments requested, and applicable law. If the physician or other provider is unwilling at any time to comply with 22 the declaration, the physician or provider may 23 withdraw from providing treatment consistent with the exercise of independent medical 24 judgment and shall promptly notify the principal and the attorney-in-fact and document 25 the notification in the principal's medical record. 26 Sec. 47.30.958. POWERS OF ATTORNEY-IN-FACT. (a) The 27 attorney-in-fact does not have authority to make mental health treatment decisions 28 unless the principal is incapable. 29 (b) The attorney-in-fact is not, as a result of acting in that capacity, personally 30 liable for the cost of treatment provided to the principal. 31 (c) Except to the extent the right is limited by the declaration or any federal
01 law, an attorney-in-fact has the same right as the principal to receive information 02 regarding the proposed mental health treatment and to receive, review, and consent to 03 disclosure of medical records relating to that treatment. This right of access does not 04 waive any evidentiary privilege. 05 (d) In exercising authority under the declaration, the attorney-in-fact has a duty 06 to act consistently with the desires of the principal as expressed in the declaration. If 07 the principal's desires are not expressed in the declaration and not otherwise known 08 by the attorney-in-fact, the attorney-in-fact has a duty to act in what the 09 attorney-in-fact in good faith believes to be the best interests of the principal. 10 (e) An attorney-in-fact is not subject to criminal prosecution, civil liability, or 11 professional disciplinary action for an action taken in good faith under a declaration 12 for mental health treatment. 13 Sec. 47.30.960. LIMITATIONS. A person may not be required to execute or 14 to refrain from executing a declaration as a criterion for insurance, as a condition for 15 receiving mental or physical health services, or as a condition of discharge from a 16 health care facility. 17 Sec. 47.30.962. ACTIONS CONTRARY TO DECLARATION. The physician 18 or provider may subject the principal to mental health treatment in a manner contrary 19 to the principal's wishes as expressed in a declaration for mental health treatment only 20 (1) if the principal is committed to a treatment facility under this 21 chapter and treatment is authorized in compliance with AS 47.30.825 - 47.30.865; or 22 (2) in cases of emergency endangering life or health. 23 Sec. 47.30.964. RELATION TO OTHER STATUTES. A declaration does not 24 limit any authority provided in this chapter either to take a person into custody or to 25 admit, retain, or treat a person in a health care facility. 26 Sec. 47.30.966. REVOCATION. A declaration may be revoked in whole or 27 in part at any time by the principal if the principal is not incapable. A revocation is 28 effective when a capable principal communicates the revocation to the attending 29 physician or other provider. The attending physician or other provider shall note the 30 revocation as part of the principal's medical record. 31 Sec. 47.30.968. LIMITED IMMUNITY. A physician or provider who
01 administers or does not administer mental health treatment according to and in good 02 faith reliance upon the validity of a declaration is not subject to criminal prosecution, 03 civil liability, or professional disciplinary action resulting from a subsequent finding 04 of a declaration's invalidity. 05 Sec. 47.30.970. FORM OF DECLARATION. A declaration for mental health 06 treatment shall be in substantially the following form: 07 DECLARATION FOR MENTAL HEALTH TREATMENT 08 I, 09 , being an adult of sound mind, wilfully and voluntarily make this 10 declaration for mental health treatment to be followed if it is determined by a 11 court, two physicians that include a psychiatrist, or one physician and a 12 professional mental health clinician, that my ability to receive and evaluate 13 information effectively or communicate decisions is impaired to such an extent 14 that I lack the capacity to refuse or consent to mental health treatment. "Mental 15 health treatment" means electroconvulsive treatment, treatment of mental illness 16 with psychotropic medication, and admission to and retention in a health care 17 facility for a period up to 17 days. 18 I understand that I may become incapable of giving or withholding 19 informed consent for mental health treatment due to the symptoms of a 20 diagnosed mental disorder. These symptoms may include: 21 ______________________________________________________________________________________________________________________ 22 PSYCHOTROPIC MEDICATIONS 23 If I become incapable of giving or withholding informed consent for 24 mental health treatment, my wishes regarding psychotropic medications are as 25 follows: 26 _____ I consent to the administration of the following medications: ______ 27 _______________________________________________________________ 28 _____ I do not consent to the administration of the following medications: ___ 29 _______________________________________________________________ 30 Conditions or limitations: __________________________________________ 31 _______________________________________________________________.
01 ELECTROCONVULSIVE TREATMENT 02 If I become incapable of giving or withholding informed consent for 03 mental health treatment, my wishes regarding electroconvulsive treatment are 04 as follows: 05 _____ I consent to the administration of electroconvulsive treatment. 06 _____ I do not consent to the administration of electroconvulsive treatment. 07 Conditions or limitations:__________________________________________ 08 _________________________________________________________________. 09 ADMISSION TO AND RETENTION IN FACILITY 10 If I become incapable of giving or withholding informed consent for 11 mental health treatment, my wishes regarding admission to and retention in a 12 health care facility for mental health treatment are as follows: 13 _____ I consent to being admitted to a health care facility for mental health 14 treatment for up to ____ days. 15 _____ I do not consent to being admitted to a health care facility for mental 16 health treatment. 17 This directive cannot, by law, provide consent to retain me in a facility 18 for more than 17 days. 19 Conditions or limitations:____________________________________________ 20 ________________________________________________________________. 21 ADDITIONAL PREFERENCES OR INSTRUCTIONS 22 ______________________________________________________________________________________________________________________ 23 Conditions or limitations: _________________________________________ 24 _______________________________________________________________. 25 ATTORNEY-IN-FACT 26 I appoint: 27 NAME ______________________________________________ 28 ADDRESS ___________________________________________ 29 TELEPHONE NO. _____________________________________ 30 to act as my attorney-in-fact to make decisions regarding my mental health 31 treatment if I become incapable of giving or withholding informed consent for
01 that treatment. 02 If the person named above refuses or is unable to act on my behalf, or 03 if I revoke that person's authority to act as my attorney-in-fact, I authorize the 04 following person to act as my attorney-in-fact: 05 NAME _______________________________________________ 06 ADDRESS ____________________________________________ 07 TELEPHONE NO. ______________________________________ 08 My attorney-in-fact is authorized to make decisions that are consistent 09 with the wishes I have expressed in this declaration or, if not expressed, as are 10 otherwise known to my attorney-in-fact. If my wishes are not expressed and are 11 not otherwise known by my attorney-in-fact, my attorney-in-fact is to act in 12 what my attorney-in-fact believes to be my best interests. 13 OTHER DOCUMENTS 14 _____ I have executed a general power-of-attorney or a power-of-attorney 15 under AS 13.26 that includes the power to make decisions regarding health care 16 services for myself. I authorize the attorney-in-fact appointed under this 17 declaration and the attorney-in-fact appointed under a general power-of-attorney 18 under AS 13.26 to serve 19 _____ jointly with consent of each other as to my mental health 20 treatment; 21 _____ separately without each other's consent as to my mental health 22 treatment. 23 _____ I have not executed a general power-of-attorney or a power-of-attorney 24 under AS 13.26 that includes the power to make decisions regarding health care 25 services for myself. 26 ___________________________________ 27 (Signature of Declarant/Date) 28 _________________________________ 29 (Address) 30 ________________________________ 31 (Telephone Number)
01 AFFIRMATION OF WITNESSES 02 We affirm that the principal is personally known to us, that the principal 03 signed or acknowledged the principal's signature on this declaration for mental 04 health treatment in our presence, that the principal appears to be of sound mind 05 and not under duress, fraud, or undue influence, and that neither of us is a 06 person appointed as an attorney-in-fact by this document; the principal's 07 attending physician or mental health service provider or a relative of the 08 physician or provider; the owner, operator, or relative of an owner or operator 09 of a facility in which the principal is a patient or resident; or a person related 10 to the principal by blood, marriage, or adoption. 11 Witnessed By: 12 _____________________________ __________________________________ 13 (Signature of Witness/Date) (Printed Name of Witness) 14 __________________________________ 15 (Address) 16 __________________________________ 17 (Telephone Number) 18 _____________________________ ________________________________ 19 (Signature of Witness/Date) (Printed Name of Witness) 20 __________________________________ 21 (Address) 22 __________________________________ 23 (Telephone Number) 24 ACCEPTANCE OF APPOINTMENT AS ATTORNEY-IN-FACT 25 I accept this appointment and agree to serve as attorney-in-fact to make 26 decisions about mental health treatment for the principal. I understand that I 27 have a duty to act in a manner consistent with the desires of the principal as 28 expressed in this appointment. I understand that this document gives me 29 authority to make decisions about mental health treatment only while the 30 principal is incapable as determined by a court, two physicians that include a 31 psychiatrist, or one physician and a professional mental health clinician. I
01 understand that the principal may revoke this declaration in whole or in part at 02 any time and in any manner when the principal is not incapable. 03 _______________________________ ______________________________ 04 (Signature of Attorney-in-fact/Date) (Printed name) 05 __________________________________ 06 (Address) 07 __________________________________ 08 (Telephone Number) 09 ____________________________________ ________________________ 10 (Signature of Alternate Attorney-in-fact/Date) (Printed name) 11 __________________________________ 12 (Address) 13 __________________________________ 14 (Telephone Number) 15 NOTICE TO PERSON MAKING A DECLARATION 16 FOR MENTAL HEALTH TREATMENT 17 This is an important legal document. It creates a declaration for mental 18 health treatment. Before signing this document, you should know these 19 important facts: 20 (1) This document allows you to make decisions in advance about three 21 types of mental health treatment: psychotropic medication, electroconvulsive therapy, 22 and short-term (up to 17 days) admission to a treatment facility. The instructions that 23 you include in this declaration will be followed only if a court, two physicians that 24 include a psychiatrist, or a physician and a professional mental health clinician believe 25 that you are incapable of making treatment decisions. Otherwise, you will be 26 considered capable to give or withhold consent for the treatments. 27 (2) You may also appoint a person as your attorney-in-fact to make 28 these treatment decisions for you if you become incapable. The person you appoint 29 has a duty to act consistent with your desires as stated in this document or, if your 30 desires are not stated or otherwise made known to the attorney-in-fact, to act in a 31 manner consistent with what the person in good faith believes to be in your best
01 interest. For the appointment to be effective, the person you appoint must accept the 02 appointment in writing. The person also has the right to withdraw from acting as your 03 attorney-in-fact at any time. 04 (3) This document will continue in effect for a period of three years 05 unless you become incapable of participating in mental health treatment decisions. If 06 this occurs, the directive will continue in effect until you are no longer incapable. 07 (4) You have the right to revoke this document in whole or in part at 08 any time you have not been determined to be incapable. YOU MAY NOT REVOKE 09 THIS DECLARATION WHEN YOU ARE CONSIDERED INCAPABLE BY A 10 COURT, TWO PHYSICIANS THAT INCLUDE A PSYCHIATRIST, OR A 11 PHYSICIAN AND A PROFESSIONAL MENTAL HEALTH CLINICIAN. A 12 revocation is effective when it is communicated to your attending physician or other 13 provider. 14 (5) If there is anything in this document that you do not understand, 15 you should ask a lawyer to explain it to you. This declaration will not be valid unless 16 it is signed by two qualified witnesses who are personally known to you and who are 17 present when you sign or acknowledge your signature. 18 Sec. 47.30.972. PENALTY. It is a class A misdemeanor for a person without 19 authorization of the principal to knowingly alter, forge, conceal, or destroy a 20 declaration executed under AS 47.30.950 - 47.30.980, the reinstatement or revocation 21 of a declaration executed under AS 47.30.950 - 47.30.980, or any other evidence or 22 document reflecting the principal's desires and interests with the intent or effect of 23 affecting a mental health care decision. In this section, "knowingly" has the meaning 24 given in AS 11.81.900(a). 25 Sec. 47.30.980. DEFINITIONS. In AS 47.30.950 - 47.30.980, 26 (1) "attending physician" means the licensed physician who has primary 27 responsibility for the care and treatment of the declarant; 28 (2) "attorney-in-fact" means an adult properly appointed under 29 AS 47.30.950 - 47.30.980 to make mental health treatment decisions for a principal 30 under a declaration for mental health treatment and also means an alternative attorney- 31 in-fact;
01 (3) "facility" means a 02 (A) designated treatment facility, as defined in AS 47.30.915; 03 (B) nursing home; or 04 (C) assisted living home licensed under AS 47.33; 05 (4) "incapable" means that, in the opinion of the court in a guardianship 06 proceeding under AS 13.26, in the opinion of two physicians that include a 07 psychiatrist, or in the opinion of a physician and a professional mental health clinician, 08 a person's ability to receive and evaluate information effectively or communicate 09 decisions is impaired to such an extent that the person currently lacks the capacity to 10 make mental health treatment decisions; 11 (5) "mental health treatment" means electroconvulsive treatment, 12 treatment with psychotropic medication, and admission to and retention in a facility 13 for a period not to exceed 17 days; 14 (6) "professional mental health clinician" means a person having at 15 least a master's degree in psychology, social work, counseling, child guidance, or 16 nursing with specialization or experience in mental health; if employed by a mental 17 health physician clinic, a "professional mental health clinician" must also be licensed 18 to practice in the state in which service is being provided or be a clinical member in 19 good standing of the American Association for Marriage and Family Therapy, and be 20 working in the clinician's field of expertise; in this paragraph, "mental health physician 21 clinic" means a clinic, operated by one or more psychiatrists, that exclusively or 22 primarily provides mental health services furnished by a psychiatrist or by one or more 23 licensed psychologists, licensed psychological associates, licensed clinical social 24 workers, licensed nurse practitioners, licensed psychiatric nursing clinical specialists, 25 or clinical members in good standing of the American Association for Marriage and 26 Family Therapy, who are working in their field of expertise under the direct 27 supervision of a psychiatrist. 28 * Sec. 2. AS 13.26.335 is amended to read: 29 Sec. 13.26.335. ADDITIONAL OPTIONAL PROVISIONS TO STATUTORY 30 FORM POWER OF ATTORNEY. Each of the following provisions may be included 31 in a statutory form power of attorney:
01 (1) IF YOU HAVE GIVEN THE AGENT AUTHORITY REGARDING 02 HEALTH CARE SERVICES UNDER SUBDIVISION (L), COMPLETE THE 03 FOLLOWING: 04 ( ) I have executed a separate declaration under AS 18.12, 05 known as a "Living Will." 06 ( ) I have not executed a "Living Will." 07 ( ) I have executed a separate declaration under 08 AS 47.30.950 - 47.30.980 regarding mental health treatment. If I 09 have appointed an attorney-in-fact under AS 47.30.950 - 47.30.980, 10 I authorize that attorney-in-fact and the attorney-in-fact whom I 11 have appointed in this document to serve 12 ( ) jointly with consent of each other as to my 13 mental health treatment 14 ( ) separately without each other's consent as to my 15 mental health treatment. 16 ( ) I have not executed a separate declaration under 17 AS 47.30.950 - 47.30.980. 18 (2) YOU MAY DESIGNATE AN ALTERNATE ATTORNEY-IN- 19 FACT. ANY ALTERNATE YOU DESIGNATE WILL BE ABLE TO EXERCISE THE 20 SAME POWERS AS THE AGENT(S) YOU NAMED AT THE BEGINNING OF THIS 21 DOCUMENT. IF YOU WISH TO DESIGNATE AN ALTERNATE OR ALTERNATES, 22 COMPLETE THE FOLLOWING: 23 If the agent(s) named at the beginning of this document is 24 unable or unwilling to serve or continue to serve, then I appoint the 25 following agent to serve with the same powers: 26 First alternate or successor attorney-in-fact 27 ____________________________________ 28 (Name and address of alternate) 29 ____________________________________ 30 Second alternate or successor attorney-in-fact 31 ____________________________________
01 (Name and address of alternate) 02 (3) YOU MAY NOMINATE A GUARDIAN OR CONSERVATOR. 03 IF YOU WISH TO NOMINATE A GUARDIAN OR CONSERVATOR, COMPLETE 04 THE FOLLOWING: 05 In the event that a court decides that it is necessary to appoint 06 a guardian or conservator for me, I hereby nominate (Name and 07 address of person nominated) to be considered by the court for 08 appointment to serve as my guardian or conservator, or in any similar 09 representative capacity. 10 * Sec. 3. AS 13.26.344(l) is amended to read: 11 (l) In the statutory form power of attorney, the language conferring general 12 authority with respect to health care services shall be construed to mean that, as to the 13 health care of the principal, whether to be provided in the state or elsewhere, the 14 principal authorizes the agent to 15 (1) have access to and disclose to others medical and related 16 information and records; 17 (2) consent or refuse to consent to medical care or relief for the 18 principal from pain, but the agent may not authorize the termination of life-sustaining 19 procedures; 20 (3) take all steps necessary to enforce a properly executed declaration 21 under AS 18.12; 22 (4) take all steps necessary to enforce a properly executed 23 declaration under AS 47.30.950 - 47.30.980 unless the principal has provided that 24 an attorney-in-fact appointed under AS 47.30.950 - 47.30.980 shall have exclusive 25 authority with regard to mental health treatment and the attorney-in-fact 26 appointed under AS 47.30.950 - 47.30.980 has not withdrawn; 27 (5) consent or refuse to consent to the principal's psychiatric care, but 28 the consent does not authorize a voluntary commitment or placement in a mental 29 health treatment facility, electroconvulsive [CONVULSIVE] or electric-shock therapy, 30 psychosurgery, sterilization, or an abortion except that, if the principal has properly 31 executed a declaration under AS 47.30.950 - 47.30.980, the agent may consent to
01 voluntary commitment or placement in a mental health treatment facility and 02 electroconvulsive or electric-shock therapy if that consent is consistent with the 03 wishes expressed in the declaration under AS 47.30.950 - 47.30.980 and if the 04 principal has not designated another attorney-in-fact to have exclusive authority 05 to make decisions regarding mental health treatment; 06 (6) [(5)] arrange for care or lodging of the principal in a hospital, 07 nursing home, or hospice; 08 (7) [(6)] grant releases to health care professionals or health care 09 institutions; 10 (8) [(7)] hire, discharge, or compensate an attorney, accountant, expert 11 witness, or assistant when the agent considers the action to be desirable for the proper 12 execution of the powers described in this subsection; and 13 (9) [(8)] do any other act or acts that the principal can do through an 14 agent and that the agent considers desirable or necessary to provide for the principal's 15 physical or mental well-being. 16 * Sec. 4. AS 47.30.825(b) is amended to read: 17 (b) The patient and the following persons, at the request of the patient, are 18 entitled to participate in formulating the patient's individualized treatment plan and to 19 participate in the evaluation process as much as possible, at minimum to the extent of 20 requesting specific forms of therapy, inquiring why specific therapies are or are not 21 included in the treatment program, and being informed as to the patient's present 22 medical and psychological condition and prognosis: (1) the patient's counsel, (2) the 23 patient's guardian, (3) a mental health professional previously engaged in the patient's 24 care outside of the evaluation facility or designated treatment facility, (4) a 25 representative of the patient's choice, (5) a person designated as the patient's 26 attorney-in-fact with regard to mental health treatment decisions under 27 AS 13.26.332 - 13.26.358, AS 47.30.950 - 47.30.980, or other power-of-attorney, and 28 (6) [(5)] the adult designated under AS 47.30.725. The mental health care professionals 29 may not withhold any of the information described in this subsection from the patient 30 or from others if the patient has signed a waiver of confidentiality or has designated 31 the person who would receive the information as an attorney-in-fact with regard
01 to mental health treatment. 02 * Sec. 5. AS 47.30.825(f) is amended to read: 03 (f) A patient capable of giving informed consent has the absolute right to 04 accept or refuse electroconvulsive [ELECTRO-CONVULSIVE] therapy or aversive 05 conditioning. A patient who lacks substantial capacity to make this decision may not 06 be given this therapy or conditioning without a court order unless the patient 07 expressly authorized that particular form of treatment in a declaration properly 08 executed under AS 47.30.950 - 47.30.980 or has authorized an attorney-in-fact to 09 make this decision and the attorney-in-fact consents to the treatment on behalf of 10 the patient. 11 * Sec. 6. AS 47.30.836 is amended to read: 12 Sec. 47.30.836. PSYCHOTROPIC MEDICATION IN NONEMERGENCIES. 13 An evaluation facility or designated treatment facility may not administer psychotropic 14 medication to a patient in a situation that does not involve a crisis under 15 AS 47.30.838(a)(1) unless the patient 16 (1) [THE PATIENT] has the capacity to give informed consent to the 17 medication, as described in AS 47.30.837, and gives that consent; the facility shall 18 document the consent in the patient's medical chart; [OR] 19 (2) authorized the use of psychotropic medication in a declaration 20 properly executed under AS 47.30.950 - 47.30.980 or authorized an attorney-in- 21 fact to consent to the use of psychotropic medication for the patient and the attorney-in-fact does consent; or 22 (3) [THE PATIENT] is determined by a court to lack the capacity to 23 give informed consent to the medication and the court approves use of the medication 24 under AS 47.30.839. 25 * Sec. 7. AS 47.30.838(a) is amended to read: 26 (a) Except as provided in (c) and (d) of this section, an evaluation facility or 27 designated treatment facility may administer psychotropic medication to a patient 28 without the patient's informed consent, regardless of whether the patient is capable of 29 giving informed consent, only if 30 (1) there is a crisis situation, or an impending crisis situation, that 31 requires immediate use of the medication to preserve the life of, or prevent significant
01 physical harm to, the patient or another person, as determined by a licensed physician 02 or a registered nurse; the behavior or condition of the patient giving rise to a crisis 03 under this paragraph and the staff's response to the behavior or condition must be 04 documented in the patient's medical record; the documentation must include an 05 explanation of alternative responses to the crisis that were considered or attempted by 06 the staff and why those responses were not sufficient; and 07 (2) the medication is ordered by a licensed physician; the order 08 (A) may be written or oral and may be received by telephone, 09 facsimile machine, or in person; 10 (B) may include an initial dosage and may authorize additional, 11 as needed, doses; if additional, as needed, doses are authorized, the order must 12 specify the medication, the quantity of each authorized dose, the method of 13 administering the medication, the maximum frequency of administration, the 14 specific conditions under which the medication may be given, and the 15 maximum amount of medication that may be administered to the patient in a 16 24-hour period; 17 (C) is valid for only 24 hours and may be renewed by a 18 physician for a total of 72 hours, including the initial 24 hours, only after a 19 personal assessment of the patient's status and a determination that there is still 20 a crisis situation as described in (1) of this subsection; upon renewal of an 21 order under this subparagraph, the facts supporting the renewal shall be written 22 into the patient's medical record. 23 * Sec. 8. AS 47.30.838 is amended by adding a new subsection to read: 24 (d) An evaluation facility or designated treatment facility may administer 25 psychotropic medication to a patient without the patient's informed consent if the 26 patient is unable to give informed consent but has authorized the use of psychotropic 27 medication in a declaration properly executed under AS 47.30.950 - 47.30.980 or has 28 authorized an attorney-in-fact to consent to this form of treatment for the patient and 29 the attorney-in-fact does consent.