Legislature(1995 - 1996)

02/14/1996 10:00 AM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                       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                      
 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                                                                
 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             
 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               
 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                  
 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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