Legislature(2001 - 2002)
05/06/2001 01:45 PM JUD
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 115-EMERGENCY COMMITMENT ORDERS AND TREATMENT SENATOR DONNY OLSON, cross sponsor for HB 115, testified that the problems associated with alcohol abuse in Alaska are well documented and this bill would make it possible for mid-level practitioners, advanced nurse practitioners and physician assistants (PA) in particular, to have the opportunity to commit those who chronically abuse the use of alcohol to a treatment facility. When an intoxicated individual must be transported great distances to reach a hospital for examination by a physician before they can be admitted to a treatment program, enough time may have passed that the alcohol in their blood stream may have metabolized to the point that they do not look or act drunk and their blood alcohol level may be within acceptable limits. When this happens, individuals who may be in need of treatment might be turned away. HB 115 allows the first responders to admit intoxicated individuals to treatment programs. CHAIRMAN TAYLOR said he had received some criticism of the bill stemming from the concern that mid level practitioners may not have the training, experience and background to make the necessary diagnosis for commitment. Number 304 SENATOR OLSON responded that the concern is valid for those just out of training but he personally knows of many mid lever practitioners, both physician assistants and nurse practitioners, who are as capable as and show better judgment than rookie medical doctors. Because physician assistants have collaborative agreements with medical doctors and any questionable decisions reflect on that doctor, such agreements would not be formed if the doctor did not have confidence in that health care provider. CHAIRMAN TAYLOR then asked whether the bill had been modified in other committees. SENATOR OLSON responded that the original bill allowed additional types of health care providers to make commitment decisions. CHAIRMAN TAYLOR asked whether emergency medical technicians (EMT) were included originally. SENATOR OLSON acknowledged that EMTs and marriage counselors were originally included and now the bill is limited to physician assistants and nurse practitioners. SENATOR THERRIAULT asked if a judge makes the final decision after the written application for admission is made. SENATOR OLSON said that was correct. Even a physician needs judicial agreement in cases of involuntary commitment. As a past member of the medical board, he knows that physician assistants who have recently finished school are not sent to rural Alaska immediately. Physician assistants are better trained than in previous years and are well controlled. Number 609 ANGELA TILLERY testified via teleconference from Anchorage that she is opposed to involuntary commitment for any reason. Her beliefs are based on two separate cases that she went on to explain. CHAIRMAN TAYLOR told the witness this bill is for involuntary commitment for intoxicated individuals and her case models were not applicable to the legislation. MS. TILLERY said she understood that but she is opposed to involuntary commitment for any reason. The court or family should make the decision. CHAIRMAN TAYLOR reminded her that the courts make the final decision in any case. KATHLEEN WEDERMEYER, first stated that there should be more opportunity for public testimony. She thought the bill was still worded too generally. It allows PAs and nurse practitioners to sign off on commitment forms in urban areas where there is no shortage of medical doctors who could make the decision. Although supposedly intended for use in rural areas, this is stated nowhere in the bill. Next she questioned whether there would be a judge available in a village that didn't even have a doctor. In her opinion, an advanced nurse practitioner or physician assistant should never have the authority to sign 30 day commitment forms. CHAIRMAN TAYLOR replied that commitments are not made without a court hearing. MS. WEDERMEYER responded that that is only for 30 day commitments. For 48 hour to 10 day commitments there is no hearing. Short term commitment papers are "rubber stamped"; a judge's signature is obtained via fax or over the telephone. TOM SWANSON testified against HB 115 for the same reasons as those stated above. He wanted the steps for involuntary commitment outlined and asked whether the individual had any rights at all once they were committed. CHAIRMAN TAYLOR said his concerns are addressed in current Alaska law. The conditions for commitment are carefully thought out and have met constitutional challenge. This legislation simply changes who may sign the initial application. SENATOR THERRIAULT asked whether the court is involved in any commitment. CHAIRMAN TAYLOR explained that the court is not involved on an emergency basis. SENATOR OLSON disagreed with the accuracy of some of the previous testimony. He said that there are 72 hour holds that may be placed but a judge must agree. In his rural medical experience, there was not enough time to deal with intoxicated individuals when they were in an intoxicated state in addition to other emergencies. CHAIRMAN TAYLOR called for further testimony and received no response. He asked for the pleasure of the committee. SENATOR COWDERY moved SCS CSHB 115 (HES) from committee with individual recommendations. There being no objection, SCS CSHB 115 (HES) moved from committee with individual recommendations.