03/31/2007 12:30 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB113 | |
| HB173 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | SJR 1 | TELECONFERENCED | |
| *+ | HB 173 | TELECONFERENCED | |
| += | HB 113 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 31, 2007
12:35 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Mark Neuman
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Representative William "Bill" Thomas
Representative Ralph Samuels
Representative Scott Kawasaki
COMMITTEE CALENDAR
HOUSE BILL NO. 113
"An Act relating to the prescription and use of pharmaceutical
agents, including controlled substances, by optometrists."
- MOVED CSHB 113(HES) OUT OF COMMITTEE
HOUSE BILL NO. 173
"An Act relating to court approval of involuntary administration
of psychotropic medication; and providing for an effective
date."
- HEARD AND HELD
SENATE JOINT RESOLUTION NO. 1
Relating to reauthorization of federal funding for children's
health insurance; and encouraging the Governor to support
additional funding for and access to children's health
insurance.
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
BILL: HB 113
SHORT TITLE: OPTOMETRISTS' USE OF PHARMACEUTICALS
SPONSOR(s): REPRESENTATIVE(s) SAMUELS
01/30/07 (H) READ THE FIRST TIME - REFERRALS
01/30/07 (H) HES, L&C
03/20/07 (H) HES AT 3:00 PM CAPITOL 106
03/20/07 (H) Heard & Held
03/20/07 (H) MINUTE(HES)
03/31/07 (H) HES AT 12:30 AM CAPITOL 106
BILL: HB 173
SHORT TITLE: INVOLUNTARY PSYCHOTROPIC DRUG TREATMENT
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
03/05/07 (H) READ THE FIRST TIME - REFERRALS
03/05/07 (H) HES, JUD
03/20/07 (H) HES AT 3:00 PM CAPITOL 106
03/20/07 (H) <Bill Hearing Canceled>
03/31/07 (H) HES AT 12:30 AM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE WILLIAM "BILL" THOMAS, Member
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented CSHB 173, as the co-sponsor.
MICHAEL BENNETT, O. D.; President
Alaska Optometric Association
Juneau, Alaska
POSITION STATEMENT: Testified in support of CSHB 173.
AARON WEINGEIST, M. D.; Member
American Academy of Ophthalmology
West Seattle, Washington
POSITION STATEMENT: Testified in opposition of CSHB 173.
PAUL BARNEY, O. D.; Center Director
Pacific Cataract and Laser Institute
Anchorage, Alaska
POSITION STATEMENT: Testified in support of CSHB 113.
ROBERT BREFFEILH, M.D.; Member
Alaska State Medical Board
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB [113].
REPRESENTATIVE RALPH SAMUELS, Member
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on CSHB 113,
as the sponsor.
REBECCA ROONEY, Staff
to Representative Peggy Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented HB 173 on behalf of
Representative Peggy Wilson, sponsor.
STACIE KRALY, Chief Assistant Attorney General
Statewide Section Supervisor
Human Services Section
Civil Division
Department of Law (DOL)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
173.
TIM FARRELL
Fairbanks, Alaska
POSITION STATEMENT: Testified during the hearing on HB 173.
FRANK TURNEY
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 173.
JIM GOTTSTEIN, Attorney-at-Law
Law Project for Psychiatric Rights
Anchorage, Alaska
POSITION STATEMENT: Testified during the hearing on HB 173.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 12:35:28 PM.
Representatives Wilson, Fairclough, Seaton, Neuman, Gardner, and
Roses were present at the call to order. Representative Cissna
arrived as the meeting was in progress.
HB 113-OPTOMETRISTS' USE OF PHARMACEUTICALS
12:36:02 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 113, "An Act relating to the prescription and use
of pharmaceutical agents, including controlled substances, by
optometrists." [Before the committee was CSHB 113, 25-LS0411\K,
Bullard, 3/5/07.]
12:36:49 PM
REPRESENTATIVE WILLIAM "BILL" THOMAS, Alaska State Legislature,
presented HB 113 as the co-sponsor. He informed the committee
that he represents 37 rural communities and this bill will
provide optometric assistance in the rural areas. He expressed
his concern that SouthEast Alaska Regional Health Consortium
(SEARHC) bears the burden of the high cost of providing eye care
that optometrists in rural areas could provide if authorized by
the passage of this bill.
12:38:50 PM
CHAIR WILSON opened public testimony on CSHB 113, Version K.
12:38:59 PM
MICHAEL BENNETT, O.D., President, Alaska Optometric Association,
stated his support for [Version K], paraphrasing from a written
statement, which read as follows [original punctuation
provided]:
I am Dr. Michael Bennett, a private practice
optometrist here in Juneau and current president of
the Alaska Optometric Assoc. Thank you Madame Chair
and all committee members for taking the time on a
beautiful Saturday afternoon to hear this committee
substitute on HB 113, an issue of importance to
Alaska's eye care patients. I would also like to
thank Chair Wilson and her staff for their efforts in
crafting this substitute bill. This bill will allow
licensed optometrists to prescribe medications by
additional routes of administration for treatment of
conditions of the eye and immediately surrounding
tissues, as well as pain medications for very brief
periods of time. It also provides for the treatment
of anaphylactic shock which can occur under very rare
circumstances, following the administration of
dilating eye drops in the office. This is a treatment
which patients with bee sting allergies self-
administer. This bill is narrow in scope; it does
not allow prescription of the most abused controlled
substances; it specifically prohibits injections
inside the eye; it in no way grants surgical
privileges, and it mandates continuing education and
competency testing.
Optometry has long been well qualified for these
prescriptive rights. We are a doctoral level
profession, meaning four vigorous years beyond a
bachelor's degree. Optometry school provides over 200
hours in pharmacology course work and greater than
2,000 hours of supervised patient contact. Entrance
requirements and health science curriculum are the
equal of medical and dental school. I have heard
opposition say that this is a very recent development,
but that is the case only if you consider 35 years to
be very recent.
In the years this bill has been before this
committee we have heard several eye surgeons testify
on the length and depth of their education and
specialties. I applaud them for their efforts as I
frequently trust my patient's vision to their surgical
skills and I think it's appropriate they spend a few
extra years learning the intricacy of ocular surgery.
But their surgical education has nothing to do with
this bill. That is like a heart surgeon saying your
primary care doctor should not treat your high blood
pressure. It's much more informative to look at
professions with less training and education.
Advanced nurse practitioners are able to prescribe
medications for the entire body, including the eye,
with a master's degree level of education as
determined and licensed by their board. They do a
terrific job in Alaska. They do it through hard work,
dedication and training and a common sense approach to
referrals to specialists. I don't believe you have
seen an outcry against Alaska's nurses from eye
surgeons across the country in their quest to protect
the public. Optometry is singled out for competitive
reasons not safety concerns. We have been proving
that for 30 years in 45 states.
In the 16 years the National Practitioner Data Bank
has been in existence medical doctors have paid more
than 229,000 malpractice claims. Optometrists have
paid 514 nationwide. That is a ratio of 446:1. A
million dollars of malpractice insurance costs an
Alaskan optometrist $511 per year, less than many
people's monthly car payments. That is the same rate
as in North Carolina which has oral prescriptive
authority for 30 years. An Alaskan eye surgeon, by
comparison, pays 38 times that much for the same one
million dollar coverage. Malpractice rates are based
on experience plus a profit for the carrier.
Malpractice rates set so unbelievably low reflect a
low rate of actual occurrence of malpractice.
Optometrists are a conservative bunch. Our track
record bears out that we are not wildly seeking scope
expansion beyond our training. Rather we want to
practice primary eye care to the full extent of our
training and to the betterment of our patient's eye
health. They deserve no less. As an integral part of
the medical community, to not advance and grow with
new technologies would be to shirk our responsibility
to the public. In the interest of being brief, I have
not addressed in depth every aspect of this
legislation. If it pleases the chair I would be happy
to answer any questions raised by the committee.
Thank you for your time and attention.
12:44:45 PM
REPRESENTATIVE SEATON asked for a description of the injections
that are allowed by HB 113.
DR. BENNETT explained that injections into the area surrounding
the eye, primarily the eyelids, are allowed. In addition, there
is approval for an epinephrine injection into the body for a
patient suffering anaphylactic shock. Currently, optometrists
have prescriptive rights to use therapeutic and diagnostic drops
that can produce anaphylactic shock, but not the legal authority
to treat it.
12:46:15 PM
CHAIR WILSON asked whether Dr. Bennett can have an epinephrine
shot in his office for administration to a patient.
DR. BENNETT answered no. He added that legally, board authority
could provide that, but permission must come from the
legislature.
12:46:53 PM
REPRESENTATIVE FAIRCLOUGH asked for further specifics on what
type of injections are made into the eyelid.
DR. BENNETT replied that injections are needed for unusual
infections such as for chronic sties.
REPRESENTATIVE FAIRCLOUGH noted that, currently, a rural
resident would need to fly to a hub community for this
treatment.
DR. BENNETT responded that there is possibility that a primary
care physician could treat this condition.
REPRESENTATIVE FAIRCLOUGH remarked:
I'm just wondering what the risk factor associated to
... we've already excluded the ocular globe itself and
so we need to weigh, as a committee, the benefit of
the eyelid, and the ability to expand that scope to an
optometrist versus someone needing additional care
from more of a medical perspective, and a actual
ophthalmologist. Can you tell this committee
specifically why you think an optometrist should be
allowed to inject into the eyelid.
DR. BENNETT said:
The training and scope have been ... a part of
optometric curriculum for a long long time. ...
There's a certain nervousness that seems to pervade
the use of a needle. The medications are widely in
use, it's just a different route of administering it.
We're not talking about doing intravenous injections
... [or] injecting behind the globe. And there are
certainly situations involving eyelids that you would
want that patient to see a surgeon for. A great
example is, primary care physicians could do brain
surgery or ... deliver babies ... they tend not to do
that because there are people who specialize in that.
... We rely on every profession to make quality
judgments ... on when it is appropriate to refer and
when it's not necessary. ... North Carolina has had
similar ... for 30 years now. And their malpractice
rates are not any higher than ours and they've not had
a single instance of any inappropriate actions
reported to their board. ... No optometrist had any
inclination to be injecting into the globe, in states
where it's not specifically prohibited, they're not
doing it. It's a, that is a very highly specialized
retinal ... practitioner's prerogative and just
because it's something that they're licensed to do
doesn't mean that people are doing it if there is
somebody better qualified.
12:51:25 PM
REPRESENTATIVE FAIRCLOUGH further asked whether there are more
than one state that allows injections into the eyelid.
DR. BENNETT estimated 11 states.
12:51:55 PM
REPRESENTATIVE ROSES asked for the number of patients who
require treatment by injection.
DR. BENNETT responded that it would be several patients a year.
REPRESENTATIVE ROSES requested clarification of "ocular adnexal
disease or conditions."
DR. BENNETT replied that it is a disease of the surrounding
structure of the eye.
12:52:44 PM
REPRESENTATIVE GARDNER informed the committee that information
in the committee packet is supplied by the Alaska Optometric
Association and indicates that 29 states have injectable drug
authority.
12:53:21 PM
DR. BENNETT, in answer to a question, explained that the
information provided further describes the differences between
the authority rights for optometrists state by state.
12:53:53 PM
AARON WEINGEIST, M.D., informed the committee that he represents
the American Academy of Ophthalmology. Dr. Weingeist stated his
organization's opposition to CSHB 113 [Version K] due to the
fact that the bill allows procedures exceeding the median
optometric scope across the country. He suggested that the bill
has been put forth by the practice of optometry and that there
is no patient outcry for these services to be provided. He
noted that, as an ophthalmologist, he rarely uses systemic
medications, and that the currently allowed topical medications
are adequate for the management of pain and infection. In fact,
only about .5 percent of routine eye patient visits result in an
oral prescription. He stated that studies on rural access of
care reveal that most prescriptions are written in urban areas
even though authorized optometrists are available locally. Dr.
Weingeist said that CSHB 113 [Version K] allows all injections,
other than those into the eye, and that there are many
structures around the eye that are injected with Botox,
steroids, and anesthetics. He pointed out that optometric
education in pharmacology is didactic, and happens mostly in
classrooms. Students do not see patients with multiple issues
and medications. Ophthalmologists and medical doctors are
trained for four years beyond optometric training, caring for
hospitalized patients. In addition, optometry does not have a
national board certification. Dr. Weingeist noted that the
major difference between nurse practitioner's, podiatrist's,
physician assistant's and nurse anesthetist's training versus
optometrist's training, is the mandated time working in a
hospital environment.
1:00:15 PM
DR. WEINGEIST referred to optometrist's prescriptive authority
in other states and territories. He pointed out that state law
varies greatly on what is allowed by optometrists; in fact, in
Puerto Rico, optometrists can not prescribe therapeutic
medications at all. Furthermore, in Oregon, a professional
committee decides which medications are on the formulary; in
Pennsylvania, drugs must be approved by the secretary of health;
in Texas, a professional committee decides which medications are
acceptable for optometric prescribing, and some are prohibited
around surgery. In other states, many drugs are restricted to
at-risk patients. He opined that the language in CSHB 113
[Version K] is extremely broad and vague; in fact, it would be
one of the most permissive optometric scope laws in the country.
He told the committee that the interpretation of "non-topical"
could be to include all future medications applied by all
routes, and with the only restriction being a maximum of four
days for narcotics. The need to inject steroids around the eyes
are uncommon; in fact, during ten years of practice he has only
done this procedure once. Dr. Weingeist relayed that the bill
also advocates all the remaining prescriptive authority to the
board of optometry and reduces legislative oversight. He
concluded by saying that CSHB 113 [Version K] is a precursor to
surgery.
1:02:41 PM
REPRESENTATIVE GARDNER asked Dr. Weingeist to explain how CSHB
113 [Version K] is a precursor to surgery.
DR. WEINGEIST answered that the bill removes most of the
barriers that restrict optometrists from doing surgery. The
next expansion in the scope of their practice would be laser
surgery.
REPRESENTATIVE GARDNER affirmed that then, by default, the next
step is surgery.
DR. WEINGEIST clarified that there are other procedures that
optometrists see in training and some states allow removing
foreign bodies from the surface of the eye or the eyelid.
1:04:45 PM
REPRESENTATIVE GARDNER questioned whether what was described
would qualify as surgery.
DR. WEINGEIST said that it would depend on how surgery is
defined. The terms "surgery" and "surgical procedures" can be
argued.
1:05:29 PM
REPRESENTATIVE ROSES asked how ophthalmologists define these
procedures.
DR. WEINGEIST expressed his belief that current procedural
terminology (CPT) codes recognize that surgery is an invasive
procedure that has inherent risks.
REPRESENTATIVE ROSES re-stated his question as to how Dr.
Weingeist personally qualifies the procedures that the
optometrists have characterized as treatment.
DR. WEINGEIST responded that the removal of a corneal foreign
body has the potential to not be surgical; however, an incision
to release fluid or removal of tissue is surgical.
1:07:47 PM
REPRESENTATIVE CISSNA observed that there are many people in
rural Alaska who do not have easy access to flights, much less
medical help. In addition, health care costs are so high that
rural communities are trying to practice preventative care.
CSHB 113 [Version K] will allow some prescriptive authority in
rural communities that is currently not possible. She asked
that Dr. Weingeist address the statistics for malpractice suits
that indicate a low incidence of malpractice by optometrists.
1:10:55 PM
DR. WEINGEIST advised that the profession of optometry has a
single insurance carrier that covers all states. Therefore,
optometrists pay an average cost across the country, regardless
of the scope of their practices. In addition, unlike medical
doctors and ophthalmologists, there is no mandatory requirement
for optometrists to report malpractice claims or claims that are
settled out of court.
1:12:25 PM
REPRESENTATIVE CISSNA expressed her belief that insurance
companies would monitor claims settled out of court.
DR. WEINGEIST disagreed, and stated that the malpractice risk
factor of ophthalmologists versus optometrists is an unfair
comparison.
1:13:42 PM
REPRESENTATIVE SEATON clarified that Dr. Weingeist is not
testifying that this bill allows surgery, but that surgery may
be the next step.
DR. WEINGEIST answered yes.
1:14:07 PM
REPRESENTATIVE ROSES commented that rural care in other states
is not comparable to the economic regions of Alaska which are:
urban, rural, and remote. He then asked whether the bill would
be less objectionable if all injections were restricted.
DR. WEINGEIST agreed that restricting injections would improve
patient safety; however, his organization would still object
because the remaining language includes prescribing oral
medications and leaves the determination of appropriate medicine
up to the board of optometry.
DR. WEINGEIST, in response to questions, explained that, in most
states, ophthalmologists are governed by the medical board and
optometrists are governed by the board of optometry.
REPRESENTATIVE ROSES questioned whether the practices are
governed by different boards because of the different procedures
allowed.
DR. WEINGEIST opined that the practices have been viewed as
different professions over the last 35 years.
1:17:46 PM
REPRESENTATIVE ROSES asked whether the restriction of injections
will limit this bill to only allowing optometrists to provide
oral medication.
DR. WEINGEIST concurred.
REPRESENTATIVE ROSES further asked whether there are
classifications of oral medications in the bill.
DR. WEINGEIST responded that the only restriction is the
limitation on some narcotics, and the term of the prescription.
REPRESENTATIVE ROSES quoted the definition from the Committee
Substitute which stated "the pharmaceutical agent is not a
schedule IA, IIA or VIA controlled substance; and is prescribed
in a quantity that does not exceed four days of prescribed use
if it is a controlled substance;" and asked which drugs fall
into these categories.
DR. WEINGEIST answered that these are all in the categories of
controlled substances in Alaska and have potentially addictive
qualities. He added that the 29 states that allow injections
may just be referring to the epinephrine to treat anaphylactic
shock. He opined that only three states allow other forms of
injections.
1:20:59 PM
CHAIR WILSON asked whether Dr. Weingeist was aware of any
general practicing M. D. who performs brain surgery.
DR. WEINGEIST said that he was not.
1:21:15 PM
PAUL BARNEY, O. D., Center Director, Pacific Cataract and Laser
Institute, Anchorage, informed the committee that he has been
practicing optometry for 22 years and is speaking in favor of
CSHB 113 [Version K]. Dr. Barney explained how this bill will
impact rural Alaska by eliminating the need for a referral to a
specialist or primary care physician. He is licensed in Alaska
and Washington and can prescribe oral medication to patients in
Washington, but not in Alaska. This is a burden on the patient
in rural Alaska due to potential travel cost and loss of time.
He warned that Alaska may be on the verge of a health care
crisis due to the decline in the number of health care providers
practicing in the state. For new doctors of optometry looking
for a place to practice, Alaska is not a top choice, as they
will not be able to practice to the full level of their
training. He opined that this bill will safely provide patients
with care and will help attract new doctors of optometry to the
state. He then referred to previous testimony that stated that
there is not a national certification board for optometry; in
fact, there is a national board examination required to qualify
for the state licensing examination. On the issue of the bill
removing the barriers towards performing surgery, Dr. Barney
emphasized that there are surgeries that can be performed with
the application of topical medications, such as laser vision
correction. Lasix is done with topical anesthesia; therefore,
if the only barrier to optometrists performing surgery is a lack
of prescriptive authority, that barrier does not exist. He
concluded by saying that the intent of this bill is not to
remove barriers to surgery, the intent is to allow Alaskans
better access to eye care without undue costs.
1:27:48 PM
REPRESENTATIVE ROSES repeated his question about whether CSHB
113 [Version K] would be less acceptable to optometrists if the
committee removed the ability to perform injections of
pharmaceuticals.
DR. BARNEY opined that the bill would still provide some
improved access to care.
REPRESENTATIVE ROSES inquired as to the necessity of performing
injections at the witness's Washington practice.
DR. BARNEY answered that he performs injections into eyelids
approximately once a month.
1:29:26 PM
DR. BARNEY, in answer to a question, said that his practice in
Alaska is licensed by the Board of Optometry. However, in
Washington State, the Board of Optometry and the State Medical
Board are grouped in the same licensing department. He agreed
with the statement of a previous witness that the two
professions developed at different times and the boards were
created separately.
1:31:04 PM
REPRESENTATIVE ROSES suggested that optometrists, if given
further authority for writing prescriptions and injections, may
then be governed by the medical board.
DR. BARNEY advised that the change would be objectionable
because there is a certain amount of friction between the two
professions. He opined that, if the optometrists were governed
by ophthalmologists, optometrists would not receive fair
treatment, and the converse would also be true.
1:32:45 PM
ROBERT BREFFEILH, M. D. informed the committee that he is an
ophthalmologist, has practiced in Southeast Alaska for 18 years,
and is a member of the State Medical Board of Alaska. He stated
his opposition to HB [113], and described his practice route in
rural Alaska that includes Skagway, Haines, Sitka, Petersburg,
Wrangell, Ketchikan, and Annette Island. Dr. Breffeilh relayed
his education and experience, and noted that during his
residency at Walter Reed Army Medical Center he worked without
animosity with optometrists in triage and mass casualty
situations. He said that his testimony is not as a
representative of the State Medical Board. He read from a
prepared statement [original punctuation provided]:
I will not reiterate the difference in training
between ophthalmologists and our optometric
colleagues. But I will, from my experience with the
medical board, state that poorly or non-trained health
care professionals who have not passed through a
proper vetting process will constitute a danger to our
citizens.
We must not allow an ill advised legislative action to
proceed further for the sake of our ... patients,
fellow citizens, friends, and families. I would like
to make a mention of one statement that was made in
previous testimony about injections in the State of
Washington. It is state law that injections are
allowed by optometrists for anaphylaxis, which is an
injection usually subcutaneous in the arm, or
elsewhere, nowhere near the eye. But it specifically
prohibits all other injections by optometrists. So, I
question the previous testimony as to what's being
done and the fact that it's legal. Now this has been
a issue that comes back over and over every year. The
optometric lobby is quite active, we try to avoid the
issue of turf battles and the like, and try to keep it
on the level of patient care. It's been a difficult
process. I don't really know what the future holds,
but I would like to make one observation, which is a
bit tongue in cheek, but I would pray that those in
the legislative process who are eager to see this bill
pass, and if it's successful, will show equal alacrity
and be the first in line for our optometric colleagues
to practice their new-found surgical and medical
skills on.
REPRESENTATIVE SEATON asked, "You said surgical?"
DR. BREFFEILH said, "Surgical and medical, because that's
coming. ... As you well recognize, this is a step-wise process,
this is going to go on."
1:37:26 PM
REPRESENTATIVE GARDNER asked for the source of the "Prohibitions
and Restrictions on the Practice of Optometry" checklist and
asked whether it is current and above question.
DR. WEINGEIST replied that the information is up to date.
1:38:59 PM
REPRESENTATIVE GARDNER compared laws in Alaska and Washington.
She read the restriction for Washington and said:
[Washington] requires pharmacy board to be consulted
and to approve specific guidelines for the
prescription and administration of drugs by
optometrists.
REPRESENTATIVE GARDNER concluded that Washington prohibits
optometrists to prescribe all schedule I and II controlled
drugs; schedule IV analgesics for more than seven days; schedule
V analgesics for more than seven days; anti metabolites; and
topicals, unless the prescriber has further education. In
addition, the State of Washington requires oversight
consultation with a treating eye M. D. for 90 days following
surgery, when an oral is used; prohibits prescription of oral
drugs unless the prescriber has further education; and prohibits
infusions. She noted the difficulties of evaluating medical
information for those who are not in the medical field.
1:42:09 PM
REPRESENTATIVE GARDNER then asked Dr. Breffeilh questions about
the Alaska State Medical Board.
DR. BREFFEILH, responding to questions, said that he was on the
medical board, but was not representing it. He added that the
State Medical Board governs physicians, physician's assistants,
and Emergency Medical Technicians (EMT).
REPRESENTATIVE GARDNER asked whether the State Medical Board has
issued an opinion on HB 113.
DR. BREFFEILH explained that the medical board has not been
formally requested to issue an opinion. He then said that the
current chair is reluctant to become involved; however, the
board will be meeting next week and the bill may be an agenda
item.
1:43:23 PM
REPRESENTATIVE ROSES asked whether physician's assistants are
allowed to prescribe medications and injections.
DR. BREFFEILH said yes.
REPRESENTATIVE ROSES asked Dr. Breffeilh to compare the training
of physician's assistants and optometrists.
DR. BREFFEILH estimated that physician's assistants have two
years of didactic training and one thousand four hundred hours
of work in a clinic, under direct supervision of a physician.
REPRESENTATIVE ROSES asked whether nurse practitioners are
allowed to prescribe or inject.
DR. BREFFEILH said yes. He also said that nurse practitioners
are not governed by the medical board.
1:44:53 PM
REPRESENTATIVE ROSES asked:
... being a member of the medical board when somebody
comes before you for a review, and there's a state law
that dictates what they can and can not do. How do
you handle that situation, if you even don't
particularly like it, but it falls under the
guidelines of the law?
DR. BREFFEILH said:
Pretty straight forwards. We have to censor them. ...
And, as aside, the Alaska State Medical Board has been
noted by the National Federation of Medical Boards to
be one of the most active of the state medical boards
nationwide, and most effective.
1:46:15 PM
DR. BREFFEILH then pointed out that injections for chalazia are
not the standard of care. Moreover, when there is a problem
with oral medications in a community the optometrist can always
go to the nurse practitioner, physician's assistant, or primary
care physician to consult on a prescription.
1:47:10 PM
REPRESENTATIVE SEATON asked:
... is it your testimony then, that for the specialty
of eyes, that people are better off going to a nurse
practitioner or a physician's assistant than they are
to an optometrist that specializes in ...
1:47:41 PM
DR. BREFFEILH said:
That's not what I said. I think ... that the
diagnostic process can be done by the optometrist.
These other professions already have the privilege of
providing medications and in most cases those people
that are concerned at that time are already patients
of theirs and they know them intimately, and so if
there's any problems with any medication interactions
they would be the ones to know about it. And they
could prescribe it; it would be a simple process of
having a consulting relationship.
1:48:20 PM
CHAIR WILSON closed public testimony.
1:48:31 PM
REPRESENTATIVE GARDNER commented that this bill is confusing and
has been intensely lobbied. She noted that, along with good and
compelling testimony, there appears to be red-herrings and false
claims or exaggerations on both sides of this bill. It appears
to be a "turf war" and the important question is whether this is
good for Alaskan health care or a real danger. She emphasized
that in all this testimony, the committee has only heard from
one patient; all of the testimony has been from practitioners,
not patients, or the rural or Native health clinics.
Representative Gardner stated that she has not been persuaded
that the changes brought by the bill are necessary or
unambiguously safe.
1:51:16 PM
REPRESENTATIVE ROSES relayed that the testimony about
malpractice insurance claims may not be relevant in this
discussion. In addition, the cost savings for urban and remote
health care may not be a compelling argument, either, due to
insurance coverage. He recalled that there was an individual
who testified in opposition, and he has received a letter from
one individual supporting the bill.
1:53:26 PM
REPRESENTATIVE ROSES offered Conceptual Amendment 1, which would
eliminate the ability of an optometrist to inject. He suggested
that the language would read:
That a doctor of optometry shall not administer any
pharmaceutical agent by injection except for emergency
anaphylactic.
1:53:57 PM
REPRESENTATIVE NEUMAN objected. He said that the bill has gone
through many changes, and that an injection is just another way
to administer medication. The practical impact of the bill, in
Alaska, is whether an optometrist is going to put his/her
practice in jeopardy by performing unsafe procedures.
Representative Neuman stated that he would not support the
amendment and felt that the optometrists' integrity and the
participation of the pharmacist will provide checks and balances
to prevent drug interactions.
1:56:23 PM
CHAIR WILSON commented that, in her experience as a nurse, as in
other professions, there is a wide spectrum of quality and
responsibility in health care.
1:57:16 PM
REPRESENTATIVE GARDNER, speaking to the amendment, opined that a
pharmacist would not be involved if an injection were given in
the optometrist's office. She stated her objection to the
amendment and pointed out that medications, whether oral or
injected, are systemic.
1:58:15 PM
REPRESENTATIVE ROSES told the committee that the amendment is
meant to address the safety concerns for injections and to
prevent the injection of Botox. He continued to say that
intervention by pharmacists or insurance companies may not be
timely enough to prevent drug interaction.
1:59:43 PM
REPRESENTATIVE SEATON relayed that this amendment changes the
bill somewhat, and stated that he may support it. The quality
of service to residents of rural and remote Alaska may be
enhanced by the use of other drugs. He stressed the importance
of authorizing optometrists to use an injection to treat
anaphylactic shock. Representative Seaton asked the sponsor for
more information on the other injectable drugs.
2:00:59 PM
CHAIR WILSON informed the committee that an injection,
incorrectly administered, will deliver medication directly to
the heart.
2:01:32 PM
REPRESENTATIVE FAIRCLOUGH stated her opposition to the
conceptual amendment. She recalled that only six communities in
the state have ophthalmologists and that eye health care is
extremely limited to remote and rural Alaska. She opined that
the need for an optometrist to inject medication is rare.
Representative Fairclough acknowledged that there have been
exaggerations in testimony and expressed her concern that both
sides have brought fears into the discussion in order to protect
their "turf."
REPRESENTATIVE ROSES indicated that without passage of the
Conceptual Amendment 1 he will not support the bill.
2:03:47 PM
REPRESENTATIVE RALPH SAMUELS, Alaska State Legislature, sponsor
of HB 113, stated that the intent of this bill is to provide
medical access to Alaskans. He spoke of the changes that have
limited some of the scope of the original bill, and commented
that with Conceptual Amendment 1 the bill will still improve
rural and remote access to care. He encouraged the committee to
keep its focus on the question of optometrists and eye care, not
on nurse practitioners or governing boards. Representative
Samuels stressed that HB 113 is about access to health care for
rural residents.
2:06:11 PM
REPRESENTATIVE SEATON expressed his belief that providing access
to health care to remote Alaska is critical.
2:06:45 PM
REPRESENTATIVE ROSES agreed that the testimony supports the
infrequent need of injections and removal of the authority does
not change the quality of care the bill seeks to provide. The
amendment provides a higher level of safety, and the person who
testified here was concerned about injections by optometrists.
He reviewed the testimony surrounding the injection aspect of HB
113.
2:08:21 PM
REPRESENTATIVE FAIRCLOUGH referred to the report stating that 11
states give injectable drug authority to optometrists. Taking
into consideration that the malpractice insurance has not
increased in those states does support the safety factor of this
authority.
2:10:26 PM
REPRESENTATIVE NEUMAN spoke of the unavailability of medical
care in rural Alaska. He noted that new techniques are needed,
along with important medical tools, for professionals to
utilize. He stated his opposition to the amendment.
2:11:58 PM
REPRESENTATIVE ROSES stated that ophthalmologists and
optometrists were open to the changes made by his amendment.
2:12:41 PM
A roll call vote was taken. Representatives Seaton, Roses, and
Wilson voted in favor of Conceptual Amendment 1.
Representatives Neuman, Cissna, Gardner, and Fairclough voted
against it. Therefore, Conceptual Amendment 1 failed by a vote
of 3-4.
2:13:46 PM
REPRESENTATIVE CISSNA provided a personal story. Speaking as a
member of this committee for seven years, she emphasized the
need for committee members to travel to remote and rural Alaska.
She stated her support for the bill.
2:16:02 PM
REPRESENTATIVE NEUMAN restated his concern for residents living
in a remote area. He stated his support for the bill.
2:17:00 PM
REPRESENTATIVE SEATON expressed his concern about the care for
residents in rural areas, and stated his support for the bill.
2:17:31 PM
REPRESENTATIVE ROSES stated his opposition to the bill.
2:17:54 PM
REPRESENTATIVE GARDNER stated that that she would like know
whether there is support for this bill from health care
providers, community health centers, and consortiums that are
not connected with optometry or ophthalmology.
2:18:43 PM
REPRESENTATIVE FAIRCLOUGH reviewed health care cost statistics
for Alaska. She noted that fears and concerns about expansion
of authority beyond this bill are not relevant. In addition,
she cited state statute that the removal of foreign bodies from
the eye is not surgery. Representative Fairclough opined that
support for this bill has been from optometrists because they
have to refer patients to subsequent doctors for treatment that
they feel trained to do. Representative Fairclough quoted
testimony from a previous witness and noted that the language in
HB 113 outlines specific practices and training that
optometrists must complete to protect the safety of Alaskans.
She expressed her support for the bill.
2:21:46 PM
CHAIR WILSON opined that the statute cannot govern the
disposition of a foreign object in an eye. As an advocate for
health access to rural areas, she stated that this bill has
evolved in a positive way. Nevertheless, she stated her
opposition to the bill.
2:22:53 PM
REPRESENTATIVE SAMUELS stated that he will solicit impartial
witnesses to provide testimony to the next committee of referral
regarding the remaining concerns about the bill.
2:23:44 PM
REPRESENTATIVE SEATON moved to report CSHB 113, Version 25-
LS0411\K, Bullard, 3/5/07, out of committee with individual
recommendations and the accompanying fiscal notes.
2:23:57 PM
REPRESENTATIVE ROSES objected.
2:24:09 PM
A roll call vote was taken. Representatives Seaton, Cissna,
Gardner, Fairclough, and Neuman voted in favor of CSHB 113,
Version 25-LS0411\K, Bullard, 3/5/07. Representatives Roses and
Wilson voted against it. Therefore, CSHB 113(HES) was reported
out of the House Health, Education and Social Services Standing
Committee by a vote of 5-2.
The committee took an at ease from 2:25 p.m. to 2:32 p.m.
HB 173-INVOLUNTARY PSYCHOTROPIC DRUG TREATMENT
2:33:09 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 173, "An Act relating to court approval of
involuntary administration of psychotropic medication; and
providing for an effective date."
2:33:56 PM
REBECCA ROONEY, staff to Representative Peggy Wilson, Alaska
State Legislature, introduced HB 173, on behalf of the sponsor.
She paraphrased from the following written statement [original
punctuation provided]:
The purpose of HB 173 is to bring Alaska statutes into
conformance with the Alaska Supreme Court decision in
Meyers v. API, which was decided by the court in June
of 2006. The court's decision provides additional
patient protection when authorizing involuntary
administration of psychotropic medications. These
additional protections have already been put into
practice.
Current statutes provide that when a designated
evaluation or treatment facility wanted to medicate an
involuntarily committed patient (in a non-emergency
situation) the hospital had to prove to a court only
that the patient (1) was presently incapable of giving
or withholding informed consent, and (2) had not in
the past, while competent, reliably indicated a wish
not to be treated with such medication in the future.
Once those showings were made the court was required
to approve the hospital's request to administer the
medication.
This past year, the Alaska Supreme Court decided in
Myers v. API, the current statute was unconstitutional
as written. The court based its decision on the
Alaska Constitutional guarantees of liberty and
privacy to Alaska's citizens, and on the fact that
psychotropic medication, which is intended to alter a
recipient's mind, is both very intrusive into the
recipient's life, and may cause potentially
devastating side effects.
In Myers vs. API the court ruled that in addition to
the criteria in current statute the court must be
convinced that the recommended psychotropic medication
treatment is in the best interest of the patient and
also be convinced that there is no less intrusive
alternative available for the recommended course of
treatment.
This court decision has provided additional
protections for patient's rights. HB 173 will put
those protections into statute. Please pass HB 173
out of committee.
2:36:22 PM
REPRESENTATIVE SEATON asked whether the proposed use must be a
pre-authorization, not a post justification for the
administration of psychotropic drugs.
MS. ROONEY clarified that this is to satisfy a court order to
approve the administration of psychotropic drugs.
2:37:08 PM
REPRESENTATIVE SEATON referred to the bill on page 2, sub-
subparagraph (j), and noted that for a person who has had
several episodes the court would require the court order for
each episode, unless the commitment period is extended.
MS. ROONEY deferred to the Department of Law (DOL).
2:37:49 PM
STACIE KRALY, Chief Assistant Attorney General, Statewide
Section Supervisor, Human Services Section, Civil Division,
Department of Law (DOL), advised the committee that when an
individual is involuntarily committed they are committed for 30
days and the court order for medication is for 30 days; for
subsequent commitments, the court order for forced medication
would be concurrent with the period of the commitments.
REPRESENTATIVE SEATON re-stated his question. He asked for
confirmation that when someone is committed at one time, and is
administered drugs, and then is admitted with the same condition
six months or a year later, the court would need to make another
finding for use of the drugs.
MS. KRALY concurred.
2:40:02 PM
REPRESENTATIVE NEUMAN relayed a story of an individual who was
unable to function, despite the assistance that was offered to
him, and concluded that this bill would be helpful in a similar
case.
2:41:04 PM
CHAIR WILSON opened public testimony.
2:41:21 PM
TIM FARRELL informed the committee that he is a resident of
Fairbanks, and directed the committee's attention to his written
testimony included in the committee packet. Mr. Farrell stated
his opposition to HB 173 and said that the use of psychotropic
drugs is very dangerous for the patient. He opined that these
drugs are mind-altering and can cause violent and suicidal
effects.
CHAIR WILSON observed that this bill makes the court finding
more rigorous, prior to the administration of these drugs.
MR. FARRELL asked the committee to review his suggested
amendments.
REPRESENTATIVE CISSNA asked for a copy of Mr. Farrell's
amendments.
2:44:13 PM
CHAIR WILSON provided copies of Mr. Farrell's email for the
committee members, which read [italics designate deletions]:
*Section 1. AS 47.30.839(g) is repealed and reenacted
to read:
(g) the court shall may approve the proposed use by a
facility of a psychotropic medication if the court
determines, by clear and convincing evidence, that
(1) it does not go against the person's health care
choices previously determined and documented in a
mental health advance directive, as described in AS
13.52;
(2) it does not run contrary to the patient's history
of health care decisions so that a person being
considered by a psychiatric facility for forced
drugging is not prevented from actively seeking
alternative and recognized (licensed or certified)
health care practitioners to diagnose and treat
medical/physical ailments;
(1) (3) the patient does not have the capacity to give
or withhold informed consent (not just disagreeing
with recommended psychiatric treatment) regarding the
patient's treatment s described under AS 47.30.837 and
did not have the capacity at the time of previously
expressed wishes under (g)(2) of the Section;
(2) (4) the facility must document their efforts to
achieve informed consent as informed consent; and
The proposed use of the psychotropic medication is in
the patient's best interest; and
(3) (5) the facility/psychiatrists must actively allow
alternative approaches to helping someone who is in an
emotional crisis of lesser or greater degree and
actively allow complementary treatment to occur on
premises by state licensed/certified health care
practitioners.
There is no less intrusive alternative treatment
available.
End of revisions.
2:44:28 PM
FRANK TURNEY stated that he is a resident of Fairbanks, and
stated his support for HB 173. He said that the bill will
protect the rights of patients by the increased restrictions
against involuntary drugging by the court system. Mr. Turney
expressed his support for the amendments suggested by Mr.
Farrell and relayed a personal story regarding the drug
Prolyxin. He noted his support for the court action regarding
Faith J. Myers v. Alaska Psychiatric Institute; however, the
Supreme Court failed to rule on incarcerated mental health
patients in jails and prisons. Another area of his concern is
about how often recommendations for the treatment of illicit
drug use are more drugs versus an alternative treatment. He
concluded by asking the committee to consider that the bill does
not apply to the administration of medication to prisoners
confined in correctional institutions.
2:48:17 PM
CHAIR WILSON responded that the committee has not looked at that
point. She asked for his opinion of medications in general.
2:48:39 PM
MR. TURNEY replied that, as a former twenty-year mental health
client from Oregon, he survived his treatment only with the
intervention of his family. He gave personal examples of the
long and short term effects of psychotropic drugs. Mr. Turney
encouraged the consideration of holistic treatment alternatives
instead of forced medication. He urged the committee to adopt
Mr. Farrell's amendments to HB 173.
2:51:37 PM
REPRESENTATIVE NEUMAN opined that the change suggested by Mr.
Farrell for Sec. 1, subsection (g), from "the court shall" to
"the court may" appears to make the language stronger.
2:52:11 PM
CHAIR WILSON informed the committee that guidelines were set out
during the lawsuit. She asked her aide to provide the criteria
required prior to approval of the order for the use of the
drugs.
2:53:02 PM
MS. ROONEY explained that, under AS 47.30.837(d)(2), guidelines
were developed regarding how the court is to determine what is
in the patient's best interest. The guidelines are:
An explanation of the patient's diagnosis and
prognosis or their predominant symptoms with and
without the medication; information about the proposed
medication, its purpose, the method of administration,
the recommended ranges of dosages, possible side
effects and benefits; ways to treat side effects and
risks of other conditions such as tartive disconesia
... ; a review of the patient's history including
medication history and previous side effects from
medications; an explanation of interactions with other
drugs, including over-the-counter drugs, street drugs
and alcohol; and information about alternative
treatments and their risks; side effects and benefits,
including the risks of non-treatment; also the extend
and duration of changes in behavior patterns and
mental activity effected by the treatment; the risks
of adverse side effect; the experimental nature of the
treatment; its acceptance by the medical community of
the state; and the extent of intrusion into the
patient's body and the pain connected with that
treatment.
2:54:30 PM
REPRESENTATIVE GARDNER expressed her understanding that
Representative Neuman is asking whether the judge is required to
approve the order, if all of the conditions are met.
2:55:13 PM
CHAIR WILSON directed the question to the DOL.
2:55:21 PM
MS. KRALY speaking from a drafting standpoint, advised that the
use of the word "shall" is a mandatory action, and "may" is more
permissive. She opined that in this context, meeting the
criteria as read by Ms. Rooney, and meeting a clear and
convincing evidentiary standard, will require the issuance of
the order by the court.
2:56:29 PM
REPRESENTATIVE GARDNER expressed her belief that all
psychotropic drugs are somewhat experimental and it appears that
under the current language, a judge will be required to approve
the order after conditions in paragraphs (1), (2), and (3) are
met.
MS. KRALY answered no. She added that all four of the standards
would have to be met, and she reviewed the four criteria.
2:57:53 PM
CHAIR WILSON said that under subsection (g) there are only three
criteria listed and she read:
(1) the patient does not have the capacity to give or
withhold informed consent regarding the patient's
treatment as described under AS 47.30.837 and did not
have the capacity at the time of previously expressed
wishes under (d)(2) of this section;
MS. KRALY explained that those are two distinct findings that
the court would have to make in addition to the two findings by
the Alaska Supreme Court in the Myers decision. She opined that
there are four evidentiary burdens that the state must meet
before forced medication can be administered.
2:58:42 PM
REPRESENTATIVE GARDNER remarked:
... if the court makes those four findings, does not
[sub]section (g) say the court shall approve the
proposed use, if these findings are true?
MS. KRALY answered:
If all four of them have been met by clear and
convincing evidence, the standard is the "shall", that
means the court shall order the administration ... of
drugs .... So, the answer to your question is yes.
2:59:23 PM
CHAIR WILSON said:
In the past they only had to do the first two ... So
we've added two more safeguards for the patient so
that there's a lot more criteria that has to be met.
Is that correct?
3:00:02 PM
MS. KRALY agreed.
[Temporarily lost reception]
3:00:09 PM
CHAIR WILSON asked:
... I just want to make sure that, that with the
ruling of the court these four now, meet that
requirement that the court upheld.
3:00:13 PM
MS. KRALY said yes.
3:00:16 PM
REPRESENTATIVE GARDNER remarked:
So, I understand that if we change the word from
"shall" to "may", in [sub]section (g) it's a sea
change in terms of how we do treatment. Because it
would give the court the discretion to say, even if
all those findings are met, the court could choose not
to. What would you think about doing that?
MS. KRALY answered:
Personally, ... I don't think ... I could comment on
that particular question, but I would agree that if
you changed the word "shall" to "may" it would give
the court discretion in those instances even when all
four have been met, or the standards have been met to
still not grant the petition for forced medication.
3:01:30 PM
REPRESENTATIVE NEUMAN questioned whether, with the four
criteria, does the court have the discretion to say ... yes or
no with that word "shall" ....
MS. KRALY answered:
Well, under traditional statutory construction the
word "shall" would be a mandatory requirement. I do
believe that the courts have inherent discretionary
authority to make decisions and now with this Myers
decision, the best interest requirement gives the
court a lot of discretion to decide what is in the
individual's best interest, irrespective of the other
three criteria that are required. So, the "shall"
although, under general statutory construction, would
require a mandatory action by the court system the
court system, in these instances, have in many
instances, have broad discretionary authority to make
appropriate decisions on a case by case basis.
3:03:00 PM
REPRESENTATIVE CISSNA referred to one of Mr. Ferrell's
suggestions that complementary medicine is beginning to be
licensed and certified in Alaska. However, institutions of last
resort are often focused on the medical model. She expressed
her concern that, even with the Myers decision by the court,
Sec. 1 paragraph (3) states "there is no less intrusive
alternative treatment available." Representative Cissna
observed that if the medical staff at the institution does not
like complementary treatment, it would not be available. She
urged use of the word "may" or the elimination of paragraph (3).
CHAIR WILSON asked whether changing "shall" to "may" would
satisfy the lawsuit.
3:05:46 PM
MS. KRALY replied that the change would give a broader
protection in the administration of the drug, and she restated
that the court could decide to not grant a petition for use of
the drug, even if all four criteria were clearly established.
3:06:21 PM
REPRESENTATIVE FAIRCLOUGH remarked:
... truly, it feels like we're debating a word that
already has permissive language in there. And I
appreciate the person who's offered the amendment, but
"shall" is already a "may" in this particular context,
if you go down to line 2, ... a judge, in his
discrimination, not line 2, but number 2, [HB 173,
Sec. 1, (g)(2)] all he has to do so he doesn't have
to administer the drug, if he ... make a finding that
is not in the patient's best interest. ... So, I think
we can change it ... to "may" easily, because it's
already there, or we could leave it .... The judge can
look to that, not modify the language that we have
before us, and still could ... make a determination
that it's not in the best interest and then the
"shall" goes away.
3:07:42 PM
REPRESENTATIVE SEATON recalled testimony regarding the side
effects of drugs. He questioned whether the judge ever hears
discussion about which particular medication is being proposed
or if the specific choice of medication is left to the facility.
MS. KRALY explained that the statewide practice for hearings is
that when a petition for forced medication is filed the
questions are directed towards the specific medication being
proposed for that individual. The judge hears testimony about
the specific drug and its side affects, interactions and
benefits. The approval of the petition is not a blanket
approval for any medication.
3:10:21 PM
REPRESENTATIVE SEATON noted that the language in the bill is not
specific in that regard.
3:10:41 PM
[3:10:28 to 3:11:30 testimony obscured by outside noise]
REPRESENTATIVE GARDNER asked Mr. Farrell whether he, personally,
could conceive of a situation for the endorsement of a
psychotropic medication being administered to an unwilling
patient.
3:11:40 PM
MR. FARRELL responded that it goes against human rights to force
medication.
MR. TURNEY agreed and added that the involuntary use of
psychotropic drugs would not be appropriate even in extreme
cases.
3:12:22 PM
REPRESENTATIVE CISSNA reiterated her concern that there are
other alternatives that will not be made available because it is
not the method that the professionals in that setting are
approving. She suggested expanding the rights of the individual
by changing paragraph (3) to read:
And a chosen less intrusive alternative treatment has
been utilized and proven ineffective.
MS. KRALY advised that the language for the legislation was
taken from the Alaska Supreme Court decision and placed in the
bill. She stressed that the question of alternative medications
is brought before the judge at the time of the petition, and
that all of the alternatives available are discussed in order to
meet the clear and convincing burden of the petition.
3:15:23 PM
CHAIR WILSON observed that HB 173 will be reviewed by the House
Judiciary Standing Committee.
3:16:03 PM
REPRESENTATIVE CISSNA noted that having the implied or inferred
standard may be insufficient. She pointed out that science is
changing every day. In addition, a judge may not recognize the
legislature's intention when acting on legislation. She stated
her concern for the rights of patients who may see the world in
a different perspective.
3:17:29 PM
JIM GOTTSTEIN, attorney-at-law, Law Project for Psychiatric
Rights, informed the committee that he was the attorney who won
the Myers v API lawsuit. Mr. Gottstein suggested an addition to
the bill in order to comply with the court ruling in Myers v
API. He read:
When making the best interest determination under (g)
of this section, the court shall, at a minimum,
consider the same factors as set forth in AS
47.30.837(d)(2)
MR. GOTTSTEIN explained that the Alaska Supreme Court
specifically indicated that those factors should be considered.
In answer to a question, he noted that the factors he referred
to have been read into the record and suggested that they be a
part of the statute, and not only a part of the court decision.
In addition, he informed the committee that the court petition
hearings are often "a sham". Mr. Gottstein reiterated that the
court ruled that those factors should be considered at a
minimum. He continued to explain that, in Anchorage, testimony
by physicians is not challenged by the public defenders and the
elements of discovery are not discussed. He opined that
patient's rights are not honored, but dishonored, as a matter of
course.
CHAIR WILSON asked whether strengthening the language about what
information is provided to the judge will make a difference.
MR. GOTTSTEIN answered that to solve the problem, patients need
to be given real legal representation. Otherwise, their rights
will be ignored. However, he opined that the problem of legal
representation was beyond the scope of this committee. Mr.
Gottstein then turned to the issue of "shall" versus "may".
[Due to technical difficulties Mr. Gottstein's testimony was
interrupted, and the meeting was subsequently adjourned.]
[HB 173 was held over.]
3:30:39 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 3:42 p.m.
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