Legislature(1995 - 1996)
02/14/1996 10:00 AM Senate HES
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES COMMITTEE
February 14, 1996
10:00 a.m.
MEMBERS PRESENT
Senator Lyda Green, Chairman
Senator Loren Leman, Vice-Chairman
Senator Mike Miller
Senator Johnny Ellis
Senator Judy Salo
MEMBERS ABSENT
All members present.
COMMITTEE CALENDAR
SENATE BILL NO. 159
"An Act relating to advance directives for mental health
treatment."
SENATE BILL NO. 185
"An Act relating to immunization records for children under the age
of seven." was scheduled, but not heard this date.
PREVIOUS SENATE COMMITTEE ACTION
SB 159 - No previous action to record.
SB 185 - See Senate Health, Education & Social Services minutes
dated 2/12/96.
WITNESS REGISTER
Senator Steve Rieger, Prime Sponsor
State Capitol
Juneau, Alaska 99801-1182
POSITION STATEMENT: Discussed the intent of SB 159.
Leonard Abel, Program Administrator
Mental Health Services Program
Division of Mental Health & Developmental Disabilities
Department of Health & Social Services
326 4th Street #1002
Juneau, Alaska 99801
POSITION STATEMENT: Supported SB 159.
Dorothy Peavey
Mental Health Consumers of Alaska
430 W. 7th, #220
Anchorage, Alaska 99501
POSITION STATEMENT: Answered questions and related the positive
response she received regarding SB 159.
Sharon Macklin
Bridges
315 5th Street
Juneau, Alaska 99801
POSITION STATEMENT: Supported SB 159.
Pat Clasby
Alaska Hospital and Nursing Home Association
319 Seward Street, Suite 10
Juneau, Alaska 99801
POSITION STATEMENT: Supported SB 159.
ACTION NARRATIVE
TAPE 96-10, SIDE A
SHESS - 2/14/96
SB 159 MENTAL HEALTH TREATMENT DECLARATIONS
Number 001
CHAIRMAN GREEN called the Senate Health, Education and Social
Services (HESS) Committee to order at 10:00 a.m. and introduced
SB 159 as the only order of business before the committee.
SENATOR RIEGER, Prime Sponsor of SB 159, explained that SB 159
would allow an individual to employ some self determination over
the treatment and medication he/she receives which is normally in
the patient's control. When a patient is determined to be in a
state of incompetence which often occurs with people who have a
mental illness, that control is no longer afforded to the
individual. He informed that committee of an example where an
individual received a psychotropic medication that the individual
did not want due to the after effects. That individual wanted to
be able to say in advance not to use that treatment. SB 159 would
allow an individual to put an advance directive in writing and
allow the individual to appoint an attorney-in-fact to make
decisions beyond those in writing. Senator Rieger mentioned that
there are number of letters of support which are in the committee
packets.
Number 048
SENATOR ELLIS supported SB 159. He informed the committee that he
had declined to sponsor the bill because he did not want to inhibit
its chance of passage. He referred to page 4, lines 16-20 when
noting that the time described in those lines would be the time
when the advance directive would be most important.
CHAIRMAN GREEN asked if Senator Ellis was concerned about the time
when an individual is hospitalized or admitted to a treatment
facility. SENATOR ELLIS clarified that at that time, the advance
directive would not apply although, that is when the patient would
most be concerned.
SENATOR RIEGER explained that this clause was requested by the
mental health consumers. He indicated that the provision was
present in order to deal with the facility's liability. AS
47.30.825 is the Patient Medical Rights section of law which also
refers to the capability to give informed consent. He agreed with
Chairman Green that the advance directive could specify that the
individual did not want to go into a facility.
CHAIRMAN GREEN seemed to think that this could be a requirement for
admittance into a facility. Perhaps, a mental health provider
could answer this question.
Number 127
LEONARD ABEL, Mental Health Services Program for the Division of
Mental Health & Developmental Disabilities in DHSS, posed a
situation in which a patient stated in an advanced declaration that
he/she did not want any medications. The patient is admitted into
API. Mr. Abel understood current law to mean that if conditions
warrant, the provider can go to court to have a judge rule that
medications must be taken whether the patient wants to or not. He
believed that this section of the statute says that an advanced
declaration refuting medication could only be violated through the
current statute, AS 47.30.825, to which the bill refers.
SENATOR RIEGER said that the Declaration of Rights does, in some
instances, refer to a true medical emergency and an absolute right
regarding some strong treatments. The question of medication is
still loose as written in the bill.
LEONARD ABEL supported SB 159 on behalf of the department. He
informed the committee that he first became interested in this
issue when working as a clinician at the South Central Counseling
Center. One of his clients had schizophrenia, but generally the
person was able to remain stable with only one or two psychotic
breaks. This patient asked Mr. Abel if she could sign something in
order to receive treatment in the case of another psychotic break.
She realized that a psychotic break would leave her unable to think
rationally and logically; her ability to make decisions regarding
treatment, hospitalization, medication, and counseling would be
gone.
Mr. Abel said that a number of patients would benefit from this
bill. He applauded the work on this bill. He pointed out that the
provider and the attorney-in-fact are covered under this bill. The
bill does not have any financial impact, therefore, the fiscal note
is zero. He explained that there is a direct appropriation for the
Alaska Psychiatric Institute (API) as well as for community and
mental health grants; whether this bill passes or not will
determine which part of the system would be affected. The money
would be structured the same.
Number 204
CHAIRMAN GREEN asked if Senator Ellis' concern would be a problem.
LEONARD ABEL believed that the section was needed in order to
address situations in which a patient accepts hospitalization and
a certain type of medication while the doctor feels that another
medication would be more appropriate. Under the existing law, the
patient could refuse the medication. This section in the bill
verifies that a declaration cannot be avoided unless current law to
force the medication is followed.
SENATOR SALO inquired as to the procedure of the existing law.
LEONARD ABEL explained that in a case where a patient refuses
medication which places the patient and/or others in danger, a
court order must be obtained in order to administer the medication.
Therefore, the section in SB 159 would mean that a court order is
necessary to override a declaration.
Number 237
CHAIRMAN GREEN asked if there was a reason the bill only refers to
three types of mental health treatment - psychotropic medication,
electroconvulsive therapy, and short-term admission. Is the
definition of "mental health treatment" on page 11 an established
definition? LEONARD ABEL believed that it was for purposes of this
statute. The three types of treatment are specifically listed
because they would be cases in which people would most likely
object to the treatment.
CHAIRMAN GREEN asked if this bill was too narrow. LEONARD ABEL
reiterated that the three mental health treatments listed are the
most likely to be controversial. Mr. Abel guessed that the 17 day
limit was possibly an average length of stay. SENATOR RIEGER
seemed to think that there was some clinical reason for that limit.
Regarding Senator Ellis' concern about the admission to a facility,
SENATOR RIEGER pointed out that SB 159 adds an attorney-in-fact to
have standing to be consulted on questions.
Number 290
In response to Senator Salo, LEONARD ABEL replied that electric
shock treatments are still used, however not to the extent that
they once were. Electroconvulsive treatment is effective for
persons with severe levels of depression; this treatment is
worthless as a broad cure all. Mr. Abel was not aware of any use
of insulin shock treatment anywhere.
DOROTHY PEAVEY, testifying from Anchorage, stated that SB 159 is
patterned after a piece of legislation which was passed in Oregon
over two years ago. Oregon has experienced a decrease in anxiety
and resistance from the patients since the passage of the
declaration. These patients seem to feel as if their voices are
being heard regarding their treatment. There is much validity to
utilizing the advanced declaration, written when the person is
competent, because a person in a state of psychosis or mental
health crisis may not make the best decisions.
Number 333
With regards to the concern on page 4, Section 47.30.962, the
patient with an advanced declaration would be admitted as a
voluntary patient. If the patient has declared a treatment which
the doctor does not view as necessary, the doctor would have to go
to court in order to move beyond the voluntary status to commit the
patient. There would also be a medication hearing. This provides
an additional safeguard. Ms. Peavey pointed out that the 17 day
limit was used in order to account for the worst scenario: a
patient is admitted on a Friday afternoon which would give the
patient two working weeks of treatment if there happened to be a
three day weekend during that time. That would give the patient
three weekends with 10 days of treatment. Ms. Peavey said that the
17 day limit is optional, but that is the maximum amount of time
one can be placed in a hospital. She directed the committee to
page 6, lines 12-13 which allows the patient to fill in the amount
of time they could be treated.
Ms. Peavey reported that she had talked with many consumers across
the state regarding SB 159 and they have responded positively. She
related the story of a patient who stopped taking her medication at
one point and had to go to the hospital. The doctors placed her on
medication that she said she did not want to take. The patient
responded fairly well to the medication, at least from an outward
perspective. When asked about her experience, the patient did not
have a good internal experience on this medication that she did not
want. More than seven months later, the patient convinced the
doctors that her internal experience was not good and she should be
placed back on her original medication. Ms. Peavey believed that
an internal experience regarding a medication is important when
determining a course of treatment.
Number 395
SB 159 would give a patient a voice in their treatment as well as
appointing an attorney-in-fact which would determine the best
interest of the patient before going to court. During a forced
medication hearing, the court merely decides that an institute or
a hospital can utilize the appropriate venues; the court does not
choose between medications. Ms. Peavey agreed with Leonard Abel
regarding the three specified treatments in the bill; those
treatments are specified because they are the most controversial.
She explained that psychotherapy was not included because most
patients do not receive 50 minute session, in most cases treatment
is done in groups. Ms. Peavey did not object to adding
psychotherapy to the definition of mental health treatment.
CHAIRMAN GREEN expressed concern with the definition of mental
health treatment and that the language may limit the declaration to
only those treatments listed.
SENATOR SALO suggested that the word "means" on page 11, line 7
could be deleted and replaced with "may include" in order to
alleviate the concerns with the definition of mental health
treatment. DOROTHY PEAVEY pointed out that the change would also
be required on page 5, line 13.
CHAIRMAN GREEN pondered if an attorney should review that change or
could it be done in Judiciary which is the next committee of
referral.
Number 443
SHARON MACKLIN, representing the Bridges campaign, explained that
Bridges encompasses all the community based mental health programs
across Alaska. Bridges supported SB 159.
CHAIRMAN GREEN asked if there had been any comments from providers,
physicians, or treatment specialists. SHARON MACKLIN clarified
that everyone she represents is a provider.
PAT CLASBY, Alaska Hospital and Nursing Home Association, supported
SB 159.
SENATOR MILLER moved that SB 159 be moved out of committee with
individual recommendations and the accompanying fiscal notes.
SENATOR RIEGER interjected that there is an amendment in the
committee packet.
SENATOR MILLER withdrew his motion. Senator Miller moved Amendment
1, Lauterbach 1/30/96, be adopted.
SENATOR ELLIS objected for purposes of discussion.
SENATOR RIEGER explained that Amendment 1 would broaden the class
of people who could participate in the declaration of incompetence.
This would ensure that there is a medical side and a counseling
side as well.
SENATOR ELLIS asked if that was because of the content of the
decision or the distribution of health care providers across the
state. SENATOR RIEGER did not know, this was requested by the
proponents of the bill. SENATOR ELLIS removed his objection.
SENATOR SALO objected for purposes of discussion.
SENATOR SALO believed that the changes the amendment would make on
page 5, line 10 of the bill does not read correctly. SENATOR
RIEGER said that the drafter could clean it up. SENATOR SALO
removed her objection.
Hearing no objection to Amendment 1, Amendment 1 was adopted.
Number 491
SENATOR MILLER moved that CSSB 159(HES) be moved out of committee
with individual recommendations and accompanying fiscal notes.
Hearing no objection, it was so ordered.
There being no further business before the committee, the meeting
was adjourned at 10:29 a.m.
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