Legislature(1995 - 1996)
02/14/1996 10:00 AM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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.