Legislature(2001 - 2002)

05/06/2001 01:45 PM JUD

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

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