Legislature(2001 - 2002)

04/27/2001 01:37 PM HES

Audio Topic
* first hearing in first committee of referral
+ 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                                                            
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                                                            
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                                                                  
     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.                                                                                           

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