Legislature(2001 - 2002)
04/27/2001 01:37 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.