Legislature(1995 - 1996)
03/07/1996 04:12 PM House HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HB 318 - MENTAL HEALTH TREATMENT DECLARATIONS CO-CHAIR BUNDE announced that the first order of business would be House Bill 318. He called on the sponsor, Representative Toohey, to introduce the bill. Number 060 REPRESENTATIVE CYNTHIA TOOHEY stated that HB 318 would allow an individual to make advance directives regarding his or her mental health treatment. The person would need to be of sound mind when making the declaration, which would designate an attorney-in-fact who would act only when the individual was determined to be incapable. The directive would address the use of psychotropic medications, electro-convulsive therapy, and the length of short- term admission, up to 17 days, into a treatment facility. The declaration would be in effect for three years, unless the individual became incapable. In that case, the declaration would continue in effect until the individual was no longer incapable. While an individual is capable, he or she can revoke the declaration in whole or in part at any time. This declaration gives the individual the opportunity to make his or her wishes known about treatments--ones that have worked in the past, as well as ones that would be desired in the future, as well as treatments that have not worked in the past and would not be desired in the future. It provides for a substitute decision-maker with whom the doctor would consult should the declaration not be specific enough, or should the doctor recommend a treatment not specified. HB 318 is similar to an Oregon law. In Oregon they have found that individuals who have fought hospitalization and medication in the past, now were more willing to go to the hospital, because they had a declaration in place, and they felt their decisions would be heeded. HB 318 is supported by Charter North, Alaska State Hospital & Nursing Home Association, South Central Counseling Center, the Mental Health Association of Alaska, and the Mental Health Consumers of Alaska, and the Department of Health, Education & Social Services. There is a zero fiscal note attached. REPRESENTATIVE TOOHEY stated that there were a number of individuals present who wished to testify, including Dorothy Peavey of the Mental Health Consumers of Alaska, and Leonard Abel from the Department of Health, Education & Social Services. Representative Toohey noted that she remembered as a child receiving a very urgent letter from her cousin, who was schizophrenic, asking never to let her doctor use electro-shock therapy. CO-CHAIRMAN BUNDE acknowledged the presence of Representatives Robinson and Rokeberg. He stated that because of the lack of time, and the large number of persons wishing to testify, the committee would first hear all testimony, then address any questions. He then called on the first witness, Dorothy Peavey. Number 331 DOROTHY PEAVEY, Executive Director of the Mental Health Consumers of Alaska (MCHA), stated that MCHA is a nonprofit organization composed of individuals who suffer from mental illness. When her organization became aware of Oregon's law concerning advance directives for mental health treatment, it seemed like a natural thing for them to support. This proposed legislation gives a voice to people suffering from mental illness, at a time when their opinion would not normally be heard. It empowers consumers to make responsible decisions about their care, and provides a mechanism for those decisions to be carried forward at a time when they are incapable. She emphasized that the correct term is incapable, not incompetent. Incompetency is decided by a judge. To become incapable under this legislation, a person would have to at one point have filled out a declaration. Then, in the opinion of two physicians (one of whom is a psychiatrist), or a physician and a professional mental health clinician, the person would be found to be incapable, and the mechanism would take effect. At that point, upon the advice and council of the attorney-in-fact, the individual could be hospitalized for a period of up to 17 days, without having to go to court to be found incompetent. Decisions about treatment would also take effect. If a person had a history with a medication, then they could make their wishes known, and the doctor would have to pay attention to those wishes. MS. PEAVEY stated that she has discussed HB 318 with providers from across the state, and that it has been endorsed by the Mental Health Providers Association, as well as the groups and individuals named by Representative Toohey. The bill has support from families, consumers, and providers. One question that came up in the Senate hearing was why 17 days was chosen for the time period a person could be hospitalized. She emphasized that this was a reasoned number. If a person were to be hospitalized on a Friday afternoon, the 17 days would provide 10 days of evaluation and treatment, if one of the weekends was a three day holiday. At that point, the doctors could decide if the individual had made a significant improvement, or whether the individual needed to be held. Ms. Peavey then invited questions from the committee. Number 609 CO-CHAIRMAN BUNDE noted for the record that Representative Brice had joined the meeting. Co-Chairman Bunde then called on the next witness, Leonard Abel. LEONARD ABEL, Ph.D., Community Mental Health Services Program Administrator, Department of Health, Education & Social Services (State of Alaska), stated he would testify in support of HB 318. Dr. Abel stated that he previously worked for Southcentral Counseling Center in Anchorage. About 11 years ago, a client came to him and asked if there was a document she could sign, so that if she became incapable, she would receive the proper treatment. At the time, there was no such document. Dr. Abel recognized that the client understood her illness, and knew that if she became incapable, she might resist treatment, and would have to be involuntarily committed. If, on the other hand, she had signed a declaration such as embodied in HB 318, this could be prevented. Persons with mental illnesses, when stabilized on medication, can make reasonable decisions. When the illness is out of control, the capacity to make such decisions is gone. Dr. Abel reiterated that he very strongly supports the bill. It seems to have good safeguards for the patient, for the attorney-in-fact, and for the mental health professionals. Number 946 CO-CHAIRMAN BUNDE called on the next witness, Jan McGillivary. JAN MCGILLIVARY stated she would speak as President/CEO of the Alaska Mental Health Association (AMHA), and also on behalf of the Building Bridges Campaign, and the Alaska Mental Health Program Director's Association. As President of AMHA, she represents 600 Alaskans. These kinds of advance directives are very common for persons suffering from HIV and other grave illnesses. As President of AMHA, she believes the proposed bill is long overdue. The Building Bridges Campaign and the Alaska Mental Health Program Director's Association also strongly support the bill. Ms. McGillivary noted that she has an allergy to codeine, and therefore she has a personal advance medical directive on file. She stated that in her 15 years in the mental health field, she has encountered many consumers who know they are allergic to certain medications. The proposed legislation would address that problem. She urged the committee to pass the bill. Number 1075 CO-CHAIRMAN BUNDE called on the next witness, Bill Cross. BILL CROSS, a member of the Mental Health Consumers of Alaska, stated that he was once determined to be mentally "incontinent," but had recovered from the condition. He further stated that he supports HB 318, because he is aware that there are some treatments he does not respond well to. By signing such a declaration, he can help his doctors, by letting them know what he has responded well to in the past. Number 1153 KATHERINE A. JOHNSON, a member of the Alaska Mental Health Board, stated that the board supports HB 318. The board applauds the work of MCHA in developing this legislation. The Advance Directives bill extends to consumers of mental health services an important control mechanism over their own treatment. Control of personal destiny is essential to human dignity. HB 318 provides a means by which difficult situations may be anticipated and addressed, giving consumers a voice they have previously lacked. The board joins the mental health community in urging the House Health, Education & Social Services Committee to move HB 318, with favorable recommendations. Number 1201 STEVEN ESSLEY, an attorney with the Disability Law Center of Alaska, stated that the center supports HB 318. He noted that there may actually be a negative fiscal impact from the bill, since it would preclude the need for an involuntary commitment hearing. The Office of Public Advocacy has said that there are about 180 involuntary medication hearings each year. This bill might also eliminate the necessity for a number of those hearings. He reiterated that the Disability Law Center of Alaska supports HB 318. Number 1294 BERRY JACK, a consumer with Mental Health Consumers of Alaska, stated he does not have a family which is legal defined by law. He does have a power of attorney. This bill would allow him to complete all avenues of his life. HB 318 would give him a voice and protect his rights. He asked that the committee support the bill. Number 1350 ROBIN COE, President of the Board of Directors for the Mental Health Consumers of Alaska, testified that the proposed legislation was vital. Number 1375 CO-CHAIRMAN BUNDE asked if anyone else wished to testify regarding HB 318. Seeing there were no further witnesses, Co-Chair Bunde closed the public testimony on HB 318. He then asked for questions or comments from the committee. REPRESENTATIVE TOM BRICE commented that the proposed legislation was long overdue. REPRESENTATIVE NORMAN ROKEBERG moved that the House Health, Education & Social Services Committee pass HB 318 from committee, with individual recommendations and a zero fiscal note. There being no objections, HB 318 was passed out of the House HESS Committee.
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