Legislature(2001 - 2002)

03/20/2001 03:03 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 115-EMERGENCY COMMITMENT ORDERS                                                                                            
                                                                                                                                
CHAIR DYSON announced  that the first order of  business would be                                                               
HOUSE BILL  NO. 115,  "An Act allowing  a physician  assistant or                                                               
advanced  nurse practitioner  to certify  the need  for emergency                                                               
treatment as a result of intoxication."                                                                                         
                                                                                                                                
Number 0160                                                                                                                     
                                                                                                                                
REPRESENTATIVE  MARY  KAPSNER,  Alaska  State  Legislature,  came                                                               
forth as sponsor  of HB 115.  She stated  that this bill proposes                                                               
to change the involuntary commitment  statute, Title 47, to allow                                                               
midlevel practitioners such as  physician assistants and advanced                                                               
nurse  practitioners to  sign medical  certificates of  necessity                                                               
for treatment for individuals with alcohol and drug dependency.                                                                 
                                                                                                                                
Number 0216                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL  made  a  motion to  adopt  the  proposed                                                               
committee substitute (CS) for HB  115, version 22-LS0059\F, Ford,                                                               
2/15/01, as  a work  draft.  There  being no  objection, proposed                                                               
CSHB 115 was before the committee.                                                                                              
                                                                                                                                
REPRESENTATIVE  KAPSNER continued,  stating that  this bill  also                                                               
expands the  definition of mental health  professional to include                                                               
licensed  clinical social  workers, licensed  marital and  family                                                               
therapists, and licensed professional  counselors.  She explained                                                               
to the  committee the  reason she decided  to sponsor  this bill.                                                               
She said:                                                                                                                       
                                                                                                                                
     The requirement  that a physician  involuntarily commit                                                                    
     patients is quite burdensome,  especially in remote and                                                                    
     rural areas  of Alaska where physicians  aren't readily                                                                    
     accessible in many instances.   This results in reduced                                                                    
     access  to  treatment  for those  vulnerable  Alaskans,                                                                    
     many  of whom  move through  both the  criminal justice                                                                    
     system and emergency medical  facilities.  The proposed                                                                    
     change will allow communities  where physicians may not                                                                    
     be  present  to   utilize  physician's  assistants  and                                                                    
     advanced  nurse practitioners  who staff  local clinics                                                                    
     to complete the required  certificates of necessity for                                                                    
     treatment.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  KAPSNER  remarked  that  she  hasn't  met  anyone                                                               
opposed to this legislation.                                                                                                    
                                                                                                                                
Number 0350                                                                                                                     
                                                                                                                                
SENATOR  DONALD OLSON,  Alaska State  Legislature, came  forth as                                                               
cross-sponsor of  HB 115.  He  remarked that he is  privileged to                                                               
be a part of this bill,  having gone to medical school and return                                                               
to practice  health care  amongst the people  that he  was raised                                                               
and grew up  with in the Nome  area.  He said the  reason he came                                                               
back was  because there was  a significant physician  shortage in                                                               
Western Alaska and all of the Bush hospitals.                                                                                   
                                                                                                                                
Number 0464                                                                                                                     
                                                                                                                                
SENATOR OLSON remarked that Nome  recognized [the shortage] early                                                               
on and fairly aggressively recruited  physicians.  He shared that                                                               
[once] during the shortage he had  a lady in the delivery room, a                                                               
gunshot victim in  the emergency room, a knifing going  on in the                                                               
village, and he was  by himself.  He said that  the last thing he                                                               
wanted  to be  doing was  giving the  nod to  an evaluation  by a                                                               
midlevel person saying that he or she wanted to commit a person.                                                                
                                                                                                                                
Number 0555                                                                                                                     
                                                                                                                                
CHAIR DYSON asked  Senator Olson if he sees any  chances of abuse                                                               
[under this bill].                                                                                                              
                                                                                                                                
SENATOR  OLSON  replied that  with  any  type  of bill  there  is                                                               
possible abuse.  He said he  feels that the portion of times that                                                               
it has  happened has  been very  minimal.   He stated  that right                                                               
now,   especially   in   rural   Alaska,   there   are   midlevel                                                               
practitioners who  are doing  almost the  same things  that fully                                                               
licensed physicians are doing, and  they take that responsibility                                                               
with a  fair amount  of weight.   He remarked  that he  had never                                                               
seen it abused.                                                                                                                 
                                                                                                                                
CHAIR  DYSON asked  if someone  in power  commits a  person, what                                                               
rights a person has to appeal.                                                                                                  
                                                                                                                                
Number 0685                                                                                                                     
                                                                                                                                
REPRESENTATIVE STEVENS  asked Senator  Olson what the  process is                                                               
when  somebody  certifies  an  individual  as  needing  emergency                                                               
treatment.                                                                                                                      
                                                                                                                                
SENATOR OLSON  answered that if  somebody comes to  the emergency                                                               
room in  the middle of the  night while the physician  on call is                                                               
there and  a midlevel  practitioner admits  the person,  there is                                                               
usually a  protocol for him  or her to have  emergency treatment.                                                               
Mainly,  someone  from  mental  health or  substance  abuse  gets                                                               
involved.   He stated that  if a patient is  seen out in  a rural                                                               
setting by somebody who thinks he  or she needs to be admitted or                                                               
committed, it  is the  obligation of the  physician in  charge to                                                               
send a  "Medivac" with adequate  personnel to make sure  that the                                                               
health  and welfare  of  [the patient]  is taken  care  of.   The                                                               
person would  then go to a  hospital, where the same  thing would                                                               
occur as if he or she had gone to the emergency room.                                                                           
                                                                                                                                
Number 0830                                                                                                                     
                                                                                                                                
PAM WATTS,  Director, Governor's  Advisory Board on  Alcoholism &                                                               
Drug  Abuse (ABADA),  Office of  the Commissioner,  Department of                                                               
Health & Social Services, came  forth and stated that the [ABADA]                                                               
supports HB 115.  She  said the involuntary commitment statute in                                                               
the state  requires that a  licensed physician in Alaska  be able                                                               
to  sign  a certificate  of  necessity  for treatment  that  must                                                               
accompany  a  petition  for  commitment.   She  stated  that  the                                                               
problem  is  that  in  rural  communities  there  often  are  not                                                               
physicians available.   Although  the physician is  not generally                                                               
the  person who  is  actually applying  for  the commitment,  the                                                               
physical  examination   has  to   be  conducted  by   a  licensed                                                               
physician.  She  remarked that the end result is  that many rural                                                               
residents who  are eligible  for involuntary  alcohol commitments                                                               
keep rotating through  the correctional system and  don't get the                                                               
help they  need because  there is  no one  available to  sign the                                                               
certificates.    She  added that  physicians  are  understandably                                                               
reluctant  to   sign  [following   a  telephone   call],  without                                                               
physically examining the individual.                                                                                            
                                                                                                                                
CHAIR  DYSON asked  what civil  rights  protections the  patients                                                               
have.                                                                                                                           
                                                                                                                                
Number 0990                                                                                                                     
                                                                                                                                
BARBARA CRAVER, Attorney, [speaking on  behalf of herself and Pam                                                               
Watts]  responded   that  there  are  actually   three  different                                                               
procedures  being  dealt  with  by  HB  115.    She  stated  that                                                               
according to the title [of the  bill], the first part of the Act,                                                               
Section 1,  talks about a  mental health  commitment.  This  is a                                                               
special kind of commitment for  people who may harm themselves or                                                               
others  due to  a mental  health  disability or  condition.   She                                                               
stated  that she  believes that  the  ex parte  commitment is  an                                                               
initial  72-hour hold.    If it  is decided  that  the person  is                                                               
suitable for a longer commitment of  30 days, he or she will have                                                               
an  attorney appointed  and  a judge  must  issue the  commitment                                                               
order.                                                                                                                          
                                                                                                                                
Number 1042                                                                                                                     
                                                                                                                                
REPRESENTATIVE  WILSON  asked  who would  [issue  the  commitment                                                               
order] in areas such as Wrangell, where there isn't a judge.                                                                    
                                                                                                                                
MS.  CRAVER answered  that an  ex parte  commitment is  a 72-hour                                                               
hold and  she doesn't believe that  a judge has to  be present in                                                               
granting that.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  WILSON   remarked  that   she  was   involved  in                                                               
something  similar  to this  in  Wrangell  and a  magistrate  was                                                               
involved.                                                                                                                       
                                                                                                                                
MS. CRAVER remarked that there may  be some kind of a preliminary                                                               
judicial  involvement  in  the beginning  of  the  mental  health                                                               
procedures,  but   for  a   short-term  situation   the  judicial                                                               
involvement  is  fairly minimal.    She  continued, stating  that                                                               
Sections 2  and 3 deal  with an emergency commitment  for alcohol                                                               
and drug abuse to public  treatment facilities, which is a fairly                                                               
select group  of facilities.   She stated  that Sections 4  and 5                                                               
apply  to  a long-term  commitment  for  alcohol or  drug  abuse.                                                               
People who  are issued an  alcohol commitment are entitled  to an                                                               
attorney  and a  court-appointed attorney  if they  are indigent.                                                               
They are encouraged within the  48-hour period, in Sections 2 and                                                               
3, to have access to legal counsel.   She stated that if a 30-day                                                               
commitment  is sought  under  [Sections  4 and  5],  a person  is                                                               
entitled to  an attorney and a  trial before a judge.   She added                                                               
that there  are two opportunities  for the petitioner to  go back                                                               
for  180-day  recommitments.   She  noted  that [people  who  are                                                               
involuntarily committed] basically have the  same rights as if in                                                               
a criminal trial.                                                                                                               
                                                                                                                                
Number 1197                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL asked Ms. Craver  to clarify what she said                                                               
about Section 1.                                                                                                                
                                                                                                                                
MS. CRAVER replied that she has  never dealt with a mental health                                                               
commitment, but  she believes that  when a longer hold  is issued                                                               
an attorney must be appointed to the person.                                                                                    
                                                                                                                                
REPRESENTATIVE  STEVENS remarked  that  the title  [of the  bill]                                                               
speaks  just to  intoxication, yet  the body  talks about  mental                                                               
health  and long-term  care.   He  asked if  this  is the  proper                                                               
format and if  the title should reflect all of  the changes being                                                               
requested in the bill.                                                                                                          
                                                                                                                                
CHAIR DYSON  replied that a [semi]  colon on line 2  of the title                                                               
makes   mental   health   proceedings   separate,   in   parallel                                                               
construction to civil proceedings on line 3.                                                                                    
                                                                                                                                
MS. WATTS  stated that  the section  pertaining to  mental health                                                               
professionals doesn't change  who can commit people  for a mental                                                               
health commitment.   The issue  is that a number of mental health                                                               
professionals  currently  do  the   examinations  that  are  then                                                               
reviewed by  a psychiatrist  prior to a  commitment.   She stated                                                               
that this  would amend the  statute to broaden the  definition of                                                               
mental health professional.                                                                                                     
                                                                                                                                
Number 1469                                                                                                                     
                                                                                                                                
ANNE  HENRY, Special  Projects  Coordinator,  Division of  Mental                                                               
Health  &  Developmental  Disabilities, Department  of  Health  &                                                               
Social Services, came forth to testify on HB 115.  She stated:                                                                  
                                                                                                                                
     The   Division  of   Mental   Health  &   Developmental                                                                    
     Disabilities supports  the efforts  to expand  the pool                                                                    
     of mental  health professional  available to  do mental                                                                    
     health  civil commitments  as  an  issue of  increasing                                                                    
     consumer health and safety.                                                                                                
                                                                                                                                
      When a person with a mental health problem seeks an                                                                       
     evaluation for possible admittance to a mental health                                                                      
     hospital facility,  a mental health  professional (MHP)                                                                    
     is called upon to conduct  the evaluation.  The goal of                                                                    
     the  evaluation  is to  determine  whether  or not  the                                                                    
     individual  has  a  mental health  illness  and,  as  a                                                                    
     result, is gravely disabled or  likely to cause serious                                                                    
     harm  to self  or  others.   The  goal  of that  mental                                                                    
     health professional  at the  time that  [he or  she is]                                                                    
     doing  that  evaluation is  actually  to  do the  least                                                                    
     restrictive  thing  for  that  patient.    If  the  MHP                                                                    
     determines that  the individual  fits the  criteria for                                                                    
     civil commitment, and  the individual refuses voluntary                                                                    
     hospitalization,  a  call  is placed  to  a  consulting                                                                    
     psychiatrist or  physician.   And if  that psychiatrist                                                                    
     or physician  concurs with the  evaluation of  the MHP,                                                                    
     then they  contact a judge.  ... The judge  hearing the                                                                    
     results of  the evaluation  and the concurrence  of the                                                                    
     psychiatrist  and  physician  then makes  the  decision                                                                    
     whether or not to involuntarily commit that person.                                                                        
                                                                                                                                
     There  is  currently  very limited  choice  of  who  is                                                                    
     eligible  to do  these commitments.   According  to the                                                                    
     current  statutes  a   mental  health  professional  is                                                                    
     defined as a psychiatrist  or physician who is licensed                                                                    
     to practice  in this state  or employed by  the federal                                                                    
     government;  a clinical  psychologist  licensed by  the                                                                    
     board;  a psychological  associate trained  in clinical                                                                    
     psychology  and   licensed  by   the  state   Board  of                                                                    
     Psychologists  and  Psychological Associate  Examiners;                                                                    
     or  a   trained  nurse  with   a  master's   degree  in                                                                    
     psychiatric  nursing, licensed  by the  State Board  of                                                                    
     Nursing; and a social worker  with a master's degree in                                                                    
     social work  with substantial  experience in  the field                                                                    
     of mental illness.                                                                                                         
                                                                                                                                
MS. HENRY remarked that this statute was written in 1986 and                                                                    
since then the state has licensed social workers, marital and                                                                   
family therapists, and licensed professional counselors.                                                                        
                                                                                                                                
Number 1594                                                                                                                     
                                                                                                                                
MS. HENRY continued, stating:                                                                                                   
                                                                                                                                
     In mental  health agencies across the  state, there are                                                                    
     approximately  140   mental  health   clinicians  doing                                                                    
     emergency service evaluations.   In reality, currently,                                                                    
     about half of  these folks fit the  legal definition of                                                                    
     who's able  to do  this MHP evaluation.   And  in rural                                                                    
     areas this is particularly difficult, to get licensed                                                                      
     folks.                                                                                                                     
                                                                                                                                
MS.  HENRY  remarked  that  the state  recognizes  all  of  these                                                               
different  clinicians as  having  at least  two  years' worth  of                                                               
post-graduate  experience  and   having  passed  examinations  or                                                               
rigorous  scrutiny  from  the  boards that  license  them.    The                                                               
Department   of  Health   &  Social   Services  encourages   this                                                               
definition change,  and the Alaska  Mental Health  Board supports                                                               
the bill.   She remarked  that requiring licensure  and including                                                               
all of  the master's-level mental health  clinicians enlarges the                                                               
pool of MHPs  who must meet the  legislatively mandated standards                                                               
of education, experience, and professionalism.                                                                                  
                                                                                                                                
REPRESENTATIVE STEVENS  stated that  he understands the  logic of                                                               
changing the rules of who  can commit someone for alcohol [abuse]                                                               
in a village or in a  difficult situation in which there needs to                                                               
be  an emergency  decision.   He  asked why  this  would also  be                                                               
needed for a long-term situation,  since there would be more time                                                               
for a physician or psychiatrist to make the decision.                                                                           
                                                                                                                                
REPRESENTATIVE  KAPSNER replied  that she  doesn't know  how much                                                               
[the  bill] is  directly  related to  just emergency  situations.                                                               
Midlevel  practitioners   do  a   lot  of   the  person-to-person                                                               
interaction, and there is a  dearth of doctors statewide, so this                                                               
would eliminate a middleman.                                                                                                    
                                                                                                                                
REPRESENTATIVE  STEVENS   remarked  that  a   30-day  involuntary                                                               
commitment  is such  a serious  issue he  can't imagine  that the                                                               
rules should be changed for that.                                                                                               
                                                                                                                                
Number 1759                                                                                                                     
                                                                                                                                
REPRESENTATIVE  WILSON shared  that  when she  lived  in Tok  and                                                               
worked in  a clinic the  only [medical] people there  were almost                                                               
always  advanced  practitioners  or PAs  (physician  assistants).                                                               
When someone came in who  needed help, there was limited [staff].                                                               
She stated  that sometimes  a 30-day  program is  available right                                                               
away.  If that person can go  right then, when that slot is open,                                                               
the [staff needs to act fast].                                                                                                  
                                                                                                                                
MS.  CRAVER suggested  that in  Section 4,  page 3,  line 4,  the                                                               
words  "physician"  and "of  the  examination"  could be  deleted                                                               
because  if the  section is  passed,  the bill  is expanding  the                                                               
people  who can  make the  examination to  a licensed  physician,                                                               
physician assistant,  or advanced nurse practitioner.   She added                                                               
that the  language could  state,  "The  certificate must  set out                                                               
the medical examiner's findings."                                                                                               
                                                                                                                                
Number 1880                                                                                                                     
                                                                                                                                
CHAIR  DYSON clarified  that the  proposed amendment  on page  3,                                                               
line  4,  deletes  "physician's"  and "of  the  examination"  and                                                               
inserts   the   word   "medical  examiner's"   where   the   word                                                               
"physician's"  had  been.    [No objection  was  stated,  and  he                                                               
announced that Amendment 1 was adopted.]                                                                                        
                                                                                                                                
MS. CRAVER proposed an amendment that  in Section 5, page 3, line                                                               
10, "AS 47.37.180(b)  or" should be deleted because  it refers to                                                               
an emergency commitment  under AS 47.37.180, which  is a distinct                                                               
and  separate  commitment  from  a  30-day  commitment  under  AS                                                               
47.37.190 and AS 47.37.200.                                                                                                     
                                                                                                                                
Number 1922                                                                                                                     
                                                                                                                                
CHAIR DYSON  clarified that Amendment  2 would delete on  page 3,                                                               
line 10, "AS 47.37.180(b) or".   [No objection was stated, and he                                                               
announced that Amendment 2 was adopted.]                                                                                        
                                                                                                                                
MS. CRAVER proposed  an amendment in Section 5, lines  14 and 15,                                                               
that "AS.47.37.180(b) or"  be deleted so that it  would read, "If                                                               
the person has refused to be examined under AS 47.37.190(a)".                                                                   
                                                                                                                                
Number 1962                                                                                                                     
                                                                                                                                
CHAIR  DYSON   clarified  that  Amendment  3   would  delete  "AS                                                               
47.37.180 (b)  or".  [No  objection was stated, and  he announced                                                               
that Amendment 3 was adopted.]                                                                                                  
                                                                                                                                
CHAIR DYSON  stated that he was  going to hold this  bill over in                                                               
order  for  Representative  Kapsner   to  assure  the  committee,                                                               
referring to  Representative Stevens' point, that  during the 30-                                                               
day  commitment  there  is not  a  licensed  physician  generally                                                               
available.  [HB 115 was held over.]                                                                                             
                                                                                                                                

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