Legislature(2001 - 2002)
04/27/2001 01:37 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 115-EMERGENCY COMMITMENT ORDERS AND TREATMENT
CHAIRWOMAN GREEN announced HB 115 to be up for consideration.
REPRESENTATIVE MARY KAPSNER, sponsor, said she wanted someone to
offer an amendment on page 3, line 4 following "physician's" to
insert, "physician assistants or advanced nurse practitioner".
SENATOR LEMAN moved amendment #1. There were no objections and it
was so ordered.
REPRESENTATIVE KAPSNER explained that HB 115 does two things: it
expands the definition of mental health professional to include
three people, a licensed clinical social worker, a licensed marital
and family therapist and a licensed professional counselor. It adds
these people to the pool of clinicians who are able to perform
mental health evaluations.
Second, HB 115 allows physician assistants and advanced nurse
practitioners to sign medical certificates of necessity for
treatment of individuals for alcohol and drug dependency under
Title 47.
SENATOR LEMAN said he received a number of messages opposed to this
bill because it expands into areas that it shouldn't go. He asked
if there was some kind of turf battle.
REPRESENTATIVE KAPSNER said she only received one e-mail in that
regard. The reason for this legislation is that right now when one
person feels that another person needs to get alcohol or drug
treatment, only a doctor can sign the petition that is presented to
a judge to make the final decision. In some areas, there are very
few or no physicians.
She said that a lot of doctors are wary of prescribing that
treatment without seeing the patient.
TAPE 01-40, SIDE A
REPRESENTATIVE KAPSNER said she didn't know where the resistance
was coming from.
SENATOR LEMAN said his messages weren't well documented or
supported from what he remembers.
REPRESENTATIVE KAPSNER said she thought some people might be
confused, because they are afraid that someone could involuntarily
commit someone. She said that all the cases have to be presented to
a judge and he makes the final decision regardless of who signs the
petition for the certificate of necessity for treatment. To her
knowledge, no physicians have been opposed to this and no one in
the mid-level practitioner field has opposed the bill.
MS. PAM WATTS, Director, Advisory Board on Alcoholism and Drug
Abuse, said that any opposition has been primarily due to
misinformation and inaccurate views about what this bill would do.
She was testifying regarding only the alcohol section.
She said the legislation addresses two different kinds of
commitments. One is an emergency commitment for up to 48 hours. The
involuntary commitment in sections 4 and 5 is up to 30 days.
MS. WATTS explained that an emergency under current statute is when
a physician examines the individual and determines that they are in
need of emergency medical care and monitoring. There is a provision
for an extension up to five days if it's determined they need to be
monitored longer.
The involuntary commitment is for up to 30 days with an extension
provision for up to 180 days, if they go back to court for another
examination. The only thing this bill asks is when the medical
examination is done, it need not be done by a physician. Physician
assistants or advanced nurse practitioners who currently do
physical examinations around the state, would legally be able to
examine a patient. She didn't think there was any difference
between a physician assistant, a nurse practitioner, or a medical
doctor's ability to make that determination, although it might
require some training. The physician's certificate is a small part
of what is required for a 30 day involuntary commitment.
Number 513
CHAIRWOMAN GREEN said that some people from one area of the state
came in with concerns. In one case, a woman was in the process of
adopting and she went to local medical provider because she had a
lot of headaches because of stress from taking care of the children
she already had. That health care provider went to the adoption
agency and told them that she was way too stressed and to stop the
adoption. The woman was devastated. This was in an area where there
weren't enough health care providers and an abuse of
confidentiality. She asked if there are any assurances of
confidentiality.
MS. ANNE HENRY, Division of Mental Health and Developmental
Disabilities, said one thing they think will be helpful about this
bill is that people who are licensed are required to follow a code
of ethics. If they violate someone's confidentiality, they can be
sanctioned.
CHAIRWOMAN GREEN said she appreciated that and the woman she was
talking about didn't have anyone in her community to talk to about
her situation.
REPRESENTATIVE KAPSNER said that they couldn't prevent people from
talking, but this bill would provide more people who can sign for
the petition to go to the judge.
SENATOR WARD asked if a physician's assistant can practice
currently without a contract with a physician.
MS. HENRY answered yes.
SENATOR WARD asked if a person could practice as a nurse
practitioner without being contracted with a physician.
MS. HENRY answered yes.
SENATOR DAVIS said she thought 30 days was much too long for a
nurse practitioner to be able to have someone not receive medical
attention. She thought 48 hours to five days was fine.
MS. HENRY said there is confusion about the alcohol commitment and
the mental health commitment.
CHAIRWOMAN GREEN announced a recess to move to another room.
CHAIRWOMAN GREEN called the meeting back to order at 3:35 pm.
CHAIRWOMAN GREEN announced HB 115 to be back before the committee.
MS. KATHLEEN WEDEMEYER, Fairbanks resident, said she didn't think
an individual needed to work in a particular field in order to have
a balanced opinion and make an informed decision about these
situations. She thought provisions in this bill would ultimately
cause more harm than good. She felt it would take away a person's
individual freedom, which is a weighty decision, whether that
person has alcohol problems or not. She thought taking the decision
out of highly trained professional hands increased the potential
for abuses of individual rights and lawsuits.
SENATOR WARD said he understands that it's a small segment of the
population and that taking away someone's rights and locking them
up for no good reason is a concern, but some people have lost the
ability to take care of themselves. He asked if we didn't have a
responsibility to take care of them and there simply aren't enough
physicians to get these people into some type of program.
MS. WEDEMEYER said that some doctors are concerned that there could
be an underlying physical reason for a person's action and she
thought there needed to be every account taken to make sure it's
not one of those cases. She also thought the bill was too general.
CHAIRWOMAN GREEN thanked her for her testimony.
MS. BARBARA CRAVER, Alaska Bar Association, said she used to work
for the City and Borough of Juneau for 10 years. She represented
the Juneau Recovery Hospital in involuntary commitments and
emergency procedures for that time. She thought that sections 4 and
5 were the more important sections, because they have to do with
when a court can order a 30 day involuntary commitment. Those same
standards would apply if a person were to petition for a
recommitment of up to 180 days. These are significant periods of
time. She thought it would be helpful to think about it from a
lawyer's point of view. She pointed out that these are the
standards that allow a court to accept certain kinds of testimony
to prove incapacity.
Section 4 deals with the type of evidence that the Superior Court
can use for ordering an involuntary commitment. She said that it's
easy to misunderstand that the person who makes the decision about
whether there's sufficient evidence to commit a person is a judge.
The standards of the statute currently restrict evidence that's
provided for a medical evaluation to that of a physician.
Language in HB 115 would expand that to a physician assistant's or
an advanced nurse practitioner's evidence being allowed by the
judge. None of the proposed sections touch the fact that the court
must clearly find that the grounds for an involuntary commitment
have been established. Communities have found it very difficult to
get the medical evidence because of the lack of physicians. She
emphasized that other kinds of evidence have nothing to do with
this, like what kind of drinking habits that person has, what kind
of care they can give themselves. This kind of evidence can be
given by a whole lot of other people, because it's not medical.
MS. CRAVER emphasized:
I want to try and reassure you that the protections of
the court, the protections of a jury trial, the
protections of a court appointed lawyer continue to be
there for the person who is considered the respondent in
these actions. The only thing these two sections would
change would be that the court could even consider and
accept as evidence the examination of a person who is a
physician assistant or an advanced nurse practitioner.
Right now the court would not be able to consider those.
Nothing says that there can't be more medical
professionals there to give an opinion. For example, a
defense attorney for the respondent might say, "I just
don't think that this person who gave the initial
petition certificate had enough information. I'm going to
have the respondent examined by my own physician at the
court's expense." You can do that. You can have as much
evidence as you need if you think there's a genuine
dispute.
In my experience, in 10 years of doing involuntary
commitment procedures, there has never been a competing
physician. Usually the examination by the physician is
not in controversy. The bare medical fact about whether
or not that person is a chronic alcoholic is usually not
the issue. A lot of times the arguments come down to what
kind of treatment is appropriate and where that treatment
should be given. Often, the respondent, themselves, are
having a very difficult time with accepting the fact that
they need to be forced to do this. That's sort of the
crux of the problem, too.
If you can look at the larger process of the court making
the decision and all the provisions and protections that
are already in the statute and the court procedure, it
might allow you to consider that this broadening of
evidence is all that's involved in sections 4 and 5. Not
that this would be an insignificant help. It would allow
even more cases to be brought to a judge, but the judge
would still have to make the decision as to whether or
not the grounds had been clearly established. I think
judges are great advocates of civil rights, themselves,
and reluctant to see anybody railroaded and subjected to
the court's power without legitimate reason.
SENATOR WARD asked what the definition of an advanced nurse
practitioner is.
MS. HENRY replied that the Division of Occupational Licensing would
have it.
SENATOR WARD asked for the language to be brought to the committee.
MS. HENRY said that advanced nurse practitioners are qualified to
administer all kinds of drugs and narcotics.
SENATOR DAVIS asked what kind of training and guidelines these
people would have to get.
MS. CRAVER replied that she didn't think they needed training, but
guidance. Typically, they will not be the ones initiating the
situation. She explained that the certificate is very simple. "Is
this person an alcoholic in your opinion as a medical professional
and are they incapacitated? Do they lack the judgment to make a
rational decision?"
She thought the general definition of an alcoholic that all the
professionals use is based on the DSM IV.
CHAIRWOMAN GREEN thanked everyone for their testimony and said she
would hold the bill for further work.
| Document Name | Date/Time | Subjects |
|---|