00 HOUSE BILL NO. 318 01 "An Act relating to advance directives for mental health treatment." 02 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 03 * Section 1. AS 47.30 is amended by adding new sections to read: 04 ARTICLE 11. PERSONAL DECLARATION OF PREFERENCES 05 FOR MENTAL HEALTH TREATMENT. 06  Sec. 47.30.950. DECLARATION. (a) An adult of sound mind may make a 07 declaration of preferences or instructions regarding mental health treatment. The 08 preferences or instructions may include consent to or refusal of mental health 09 treatment. 10  (b) A declaration for mental health treatment continues in effect for three years 11 or until revoked, whichever is sooner. The authority of a named attorney-in-fact and 12 an alternative attorney-in-fact named in the declaration continues in effect as long as 13 the declaration appointing the attorney-in-fact is in effect or until the attorney-in-fact 14 has withdrawn. If a declaration for mental health treatment has been invoked and is 01 in effect at the expiration of three years after its execution, the declaration remains 02 effective until the principal is no longer incapable. 03  Sec. 47.30.952. DESIGNATION OF ATTORNEY-IN-FACT. (a) A 04 declaration may designate a competent adult to act as attorney-in-fact to make 05 decisions about mental health treatment. An alternative attorney-in-fact may also be 06 designated to act as attorney-in-fact if the original designee is unable or unwilling to 07 act at any time. An attorney-in-fact who has accepted the appointment in writing may 08 make decisions about mental health treatment on behalf of the principal only when the 09 principal is incapable. The decisions must be consistent with desires the principal has 10 expressed in the declaration. 11  (b) The following may not serve as attorney-in-fact: 12  (1) the attending physician or mental health service provider, or an 13 employee of the physician or provider, if the physician, provider, or employee is 14 unrelated to the principal by blood, marriage, or adoption; 15  (2) an owner, operator, or employee of a health care facility in which 16 the principal is a patient or resident if the owner, operator, or employee is unrelated 17 to the principal by blood, marriage, or adoption. 18  (c) An attorney-in-fact may withdraw by giving notice to the principal. If a 19 principal is incapable, the attorney-in-fact may withdraw by giving notice to the 20 attending physician or provider. The attending physician or provider shall note the 21 withdrawal as part of the principal's medical record. A person who has withdrawn 22 under the provisions of this subsection may rescind the withdrawal by executing an 23 acceptance after the date of the withdrawal. The acceptance must be in the same form 24 as provided by AS 47.30.970 for accepting an appointment. A person who rescinds 25 a withdrawal shall give notice to the principal if the principal is capable or to the 26 principal's health care provider if the principal is incapable. 27  (d) The designation of an attorney-in-fact under this section supersedes a 28 previous or subsequent designation of an attorney-in-fact regarding mental health 29 treatment unless otherwise specifically provided in the declaration executed under 30 AS 47.30.950 - 47.30.980 or in the document that designates the other attorney-in-fact. 31  Sec. 47.30.954. SIGNATURE; WITNESSES. (a) A declaration is effective 01 only if it is signed by the principal and two competent adult witnesses. The witnesses 02 must attest that the principal is known to them, signed the declaration in their presence, 03 appears to be of sound mind, and is not under duress, fraud, or undue influence. 04  (b) The following may not serve as a witness to the signing of a declaration: 05  (1) the attending physician or mental health service provider or a 06 relative of the physician or provider; 07  (2) an owner, operator, or relative of an owner or operator of a health 08 care facility in which the principal is a patient or resident; or 09  (3) a person related to the principal by blood, marriage, or adoption. 10  Sec. 47.30.956. OPERATION OF DECLARATION. (a) A declaration 11 becomes operative when it is delivered to the principal's physician or other mental 12 health treatment provider and remains valid until revoked or expired. The physician 13 or provider shall act in accordance with an operative declaration when the principal has 14 been found to be incapable. The physician or provider shall continue to obtain the 15 principal's informed consent to all mental health treatment decisions if the principal is 16 capable of providing informed consent or refusal. 17  (b) Upon being presented with a declaration, a physician or other provider 18 shall make the declaration a part of the principal's medical record. When acting under 19 authority of a declaration, a physician or provider shall comply with it to the fullest 20 extent possible, consistent with reasonable medical practice, the availability of 21 treatments requested, and applicable law. If the physician or other provider is unwill- 22 ing at any time to comply with the declaration, the physician or provider may withdraw from 23 providing treatment consistent with the exercise of independent medical judgment and shall 24 promptly notify the principal and the attorney-in-fact and document the notification in the 25 principal's medical record. 26  Sec. 47.30.958. POWERS OF ATTORNEY-IN-FACT. (a) The 27 attorney-in-fact does not have authority to make mental health treatment decisions 28 unless the principal is incapable. 29  (b) The attorney-in-fact is not, as a result of acting in that capacity, personally 30 liable for the cost of treatment provided to the principal. 31  (c) Except to the extent the right is limited by the declaration or any federal 01 law, an attorney-in-fact has the same right as the principal to receive information 02 regarding the proposed mental health treatment and to receive, review, and consent to 03 disclosure of medical records relating to that treatment. This right of access does not 04 waive any evidentiary privilege. 05  (d) In exercising authority under the declaration, the attorney-in-fact has a duty 06 to act consistently with the desires of the principal as expressed in the declaration. If 07 the principal's desires are not expressed in the declaration and not otherwise known by 08 the attorney-in-fact, the attorney-in-fact has a duty to act in what the attorney-in-fact 09 in good faith believes to be the best interests of the principal. 10  (e) An attorney-in-fact is not subject to criminal prosecution, civil liability, or 11 professional disciplinary action for an action taken in good faith under a declaration 12 for mental health treatment. 13  Sec. 47.30.960. LIMITATIONS. A person may not be required to execute or 14 to refrain from executing a declaration as a criterion for insurance, as a condition for 15 receiving mental or physical health services, or as a condition of discharge from a 16 health care facility. 17  Sec. 47.30.962. ACTIONS CONTRARY TO DECLARATION. The physician 18 or provider may subject the principal to mental health treatment in a manner contrary 19 to the principal's wishes as expressed in a declaration for mental health treatment only 20  (1) if the principal is committed to a treatment facility under this 21 chapter and treatment is authorized in compliance with AS 47.30.825 - 47.30.865; or 22  (2) in cases of emergency endangering life or health. 23  Sec. 47.30.964. RELATION TO OTHER STATUTES. A declaration does not 24 limit any authority provided in this chapter either to take a person into custody or to 25 admit, retain, or treat a person in a health care facility. 26  Sec. 47.30.966. REVOCATION. A declaration may be revoked in whole or 27 in part at any time by the principal if the principal is not incapable. A revocation is 28 effective when a capable principal communicates the revocation to the attending 29 physician or other provider. The attending physician or other provider shall note the 30 revocation as part of the principal's medical record. 31  Sec. 47.30.968. LIMITED IMMUNITY. A physician or provider who 01 administers or does not administer mental health treatment according to and in good 02 faith reliance upon the validity of a declaration is not subject to criminal prosecution, 03 civil liability, or professional disciplinary action resulting from a subsequent finding 04 of a declaration's invalidity. 05  Sec. 47.30.970. FORM OF DECLARATION. A declaration for mental health 06 treatment shall be in substantially the following form: 07 DECLARATION FOR MENTAL HEALTH TREATMENT 08  I, 09 , being an adult of sound mind, wilfully and voluntarily make this 10 declaration for mental health treatment to be followed if it is determined by a 11 court, two physicians that include a psychiatrist, or one physician and a mental 12 health clinician that my ability to receive and evaluate information effectively 13 or communicate decisions is impaired to such an extent that I lack the capacity 14 to refuse or consent to mental health treatment. "Mental health treatment" 15 means electroconvulsive treatment, treatment of mental illness with 16 psychotropic medication, and admission to and retention in a health care 17 facility for a period up to 17 days. 18  I understand that I may become incapable of giving or withholding 19 informed consent for mental health treatment due to the symptoms of a 20 diagnosed mental disorder. These symptoms may include: 21 _____________________________________________________________________________________________ 22 _________________________________. 23 PSYCHOTROPIC MEDICATIONS 24  If I become incapable of giving or withholding informed consent for 25 mental health treatment, my wishes regarding psychotropic medications are as 26 follows: 27 _____ I consent to the administration of the following medications: ______ 28 _______________________________________________________________ 29 _____ I do not consent to the administration of the following medications: ___ 30 _______________________________________________________________ 31 Conditions or limitations: __________________________________________ 01 _______________________________________________________________. 02 ELECTROCONVULSIVE TREATMENT 03  If I become incapable of giving or withholding informed consent for 04 mental health treatment, my wishes regarding electroconvulsive treatment are 05 as follows: 06 _____ I consent to the administration of electroconvulsive treatment. 07 _____ I do not consent to the administration of electroconvulsive treatment. 08 Conditions or limitations:__________________________________________ 09 _________________________________________________________________. 10 ADMISSION TO AND RETENTION IN FACILITY 11  If I become incapable of giving or withholding informed consent for 12 mental health treatment, my wishes regarding admission to and retention in a 13 health care facility for mental health treatment are as follows: 14 _____ I consent to being admitted to a health care facility for mental health 15 treatment for up to ____ days. 16 _____ I do not consent to being admitted to a health care facility for mental 17 health treatment. 18  This directive cannot, by law, provide consent to retain me in a facility 19 for more than 17 days. 20 Conditions or limitations:____________________________________________ 21 ________________________________________________________________. 22 ADDITIONAL PREFERENCES OR INSTRUCTIONS 23 _____________________________________________________________________________________________ 24 _____________________________________________________________________________________________ 25 Conditions or limitations: _________________________________________ 26 _______________________________________________________________. 27 ATTORNEY-IN-FACT 28 I appoint: 29  NAME ______________________________________________ 30  ADDRESS ___________________________________________ 31  TELEPHONE NO. _____________________________________ 01 to act as my attorney-in-fact to make decisions regarding my mental health 02 treatment if I become incapable of giving or withholding informed consent for 03 that treatment. 04  If the person named above refuses or is unable to act on my behalf, or 05 if I revoke that person's authority to act as my attorney-in-fact, I authorize the 06 following person to act as my attorney-in-fact: 07  NAME _______________________________________________ 08  ADDRESS ____________________________________________ 09  TELEPHONE NO. ______________________________________ 10  My attorney-in-fact is authorized to make decisions that are consistent 11 with the wishes I have expressed in this declaration or, if not expressed, as are 12 otherwise known to my attorney-in-fact. If my wishes are not expressed and are 13 not otherwise known by my attorney-in-fact, my attorney-in-fact is to act in 14 what my attorney-in-fact believes to be my best interests. 15 OTHER DOCUMENTS 16 _____ I have executed a general power-of-attorney or a power-of-attorney 17 under AS 13.26 that includes the power to make decisions regarding health care 18 services for myself. I authorize the attorney-in-fact appointed under this 19 declaration and the attorney-in-fact appointed under a general power-of-attorney 20 under AS 13.26 to serve 21  _____ jointly with consent of each other as to my mental health 22 treatment; 23  _____ separately without each other's consent as to my mental health 24 treatment. 25 _____ I have not executed a general power-of-attorney or a power-of-attorney 26 under AS 13.26 that includes the power to make decisions regarding health care 27 services for myself. 28  ___________________________________ 29 (Signature of Declarant/Date) 30 __________________________________ 31 (Address) 01 _________________________________ 02 (Telephone Number) 03 AFFIRMATION OF WITNESSES 04  We affirm that the principal is personally known to us, that the principal 05 signed or acknowledged the principal's signature on this declaration for mental 06 health treatment in our presence, that the principal appears to be of sound mind 07 and not under duress, fraud, or undue influence, and that neither of us is a 08 person appointed as an attorney-in-fact by this document; the principal's 09 attending physician or mental health service provider or a relative of the 10 physician or provider; the owner, operator, or relative of an owner or operator 11 of a facility in which the principal is a patient or resident; or a person related 12 to the principal by blood, marriage, or adoption. 13 Witnessed By: 14 _____________________________ __________________________________ 15 (Signature of Witness/Date) (Printed Name of Witness) 16 __________________________________ 17 (Address) 18 __________________________________ 19 (Telephone Number) 20 _____________________________ ________________________________ 21  (Signature of Witness/Date) (Printed Name of Witness) 22 __________________________________ 23 (Address) 24 __________________________________ 25 (Telephone Number) 26 ACCEPTANCE OF APPOINTMENT AS ATTORNEY-IN-FACT 27  I accept this appointment and agree to serve as attorney-in-fact to make 28 decisions about mental health treatment for the principal. I understand that I 29 have a duty to act in a manner consistent with the desires of the principal as 30 expressed in this appointment. I understand that this document gives me 31 authority to make decisions about mental health treatment only while the 01 principal is incapable as determined by a court, two physicians that include a 02 psychiatrist, or one physician and a mental health clinician. I understand that 03 the principal may revoke this declaration in whole or in part at any time and 04 in any manner when the principal is not incapable. 05 _______________________________ ______________________________ 06 (Signature of Attorney-in-fact/Date) (Printed name) 07 __________________________________ 08 (Address) 09 __________________________________ 10 (Telephone Number) 11 ____________________________________ ________________________ 12 (Signature of Alternate Attorney-in-fact/Date) (Printed name) 13 __________________________________ 14 (Address) 15 __________________________________ 16 (Telephone Number) 17 NOTICE TO PERSON MAKING A DECLARATION 18 FOR MENTAL HEALTH TREATMENT 19  This is an important legal document. It creates a declaration for mental 20 health treatment. Before signing this document, you should know these 21 important facts: 22  (1) This document allows you to make decisions in advance about three 23 types of mental health treatment: psychotropic medication, electroconvulsive therapy, 24 and short-term (up to 17 days) admission to a treatment facility. The instructions that 25 you include in this declaration will be followed only if a court, two physicians that 26 include a psychiatrist, or a physician and a professional mental health clinician believe 27 that you are incapable of making treatment decisions. Otherwise, you will be 28 considered capable to give or withhold consent for the treatments. 29  (2) You may also appoint a person as your attorney-in-fact to make 30 these treatment decisions for you if you become incapable. The person you appoint 31 has a duty to act consistent with your desires as stated in this document or, if your 01 desires are not stated or otherwise made known to the attorney-in-fact, to act in a 02 manner consistent with what the person in good faith believes to be in your best 03 interest. For the appointment to be effective, the person you appoint must accept the 04 appointment in writing. The person also has the right to withdraw from acting as your 05 attorney-in-fact at any time. 06  (3) This document will continue in effect for a period of three years 07 unless you become incapable of participating in mental health treatment decisions. If 08 this occurs, the directive will continue in effect until you are no longer incapable. 09  (4) You have the right to revoke this document in whole or in part at 10 any time you have not been determined to be incapable. YOU MAY NOT REVOKE 11 THIS DECLARATION WHEN YOU ARE CONSIDERED INCAPABLE BY A 12 COURT, TWO PHYSICIANS THAT INCLUDE A PSYCHIATRIST, OR A 13 PHYSICIAN AND A PROFESSIONAL MENTAL HEALTH CLINICIAN. A 14 revocation is effective when it is communicated to your attending physician or other 15 provider. 16  (5) If there is anything in this document that you do not understand, 17 you should ask a lawyer to explain it to you. This declaration will not be valid unless 18 it is signed by two qualified witnesses who are personally known to you and who are 19 present when you sign or acknowledge your signature. 20  Sec. 47.30.972. PENALTY. It is a class A misdemeanor for a person without 21 authorization of the principal to knowingly alter, forge, conceal, or destroy a 22 declaration executed under AS 47.30.950 - 47.30.980, the reinstatement or revocation 23 of a declaration executed under AS 47.30.950 - 47.30.980, or any other evidence or 24 document reflecting the principal's desires and interests with the intent or effect of 25 affecting a mental health care decision. In this section, "knowingly" has the meaning 26 given in AS 11.81.900(a). 27  Sec. 47.30.980. DEFINITIONS. In AS 47.30.950 - 47.30.980, 28  (1) "attending physician" means the licensed physician who has primary 29 responsibility for the care and treatment of the declarant; 30  (2) "attorney-in-fact" means an adult properly appointed under 31 AS 47.30.950 - 47.30.980 to make mental health treatment decisions for a principal 01 under a declaration for mental health treatment and also means an alternative attorney-in-fact; 02  (3) "facility" means a 03  (A) designated treatment facility, as defined in AS 47.30.915; 04  (B) nursing home; or 05  (C) assisted living home licensed under AS 47.33; 06  (4) "incapable" means that, in the opinion of the court in a guardianship 07 proceeding under AS 13.26, in the opinion of two physicians that include a 08 psychiatrist, or in the opinion of a physician and a professional mental health clinician, 09 a person's ability to receive and evaluate information effectively or communicate 10 decisions is impaired to such an extent that the person currently lacks the capacity to 11 make mental health treatment decisions; 12  (5) "mental health treatment" means electroconvulsive treatment, 13 treatment with psychotropic medication, and admission to and retention in a facility 14 for a period not to exceed 17 days; 15  (6) "professional mental health clinician" means a person having at 16 least a master's degree in psychology, social work, counseling, child guidance, or 17 nursing with specialization or experience in mental health; if employed by a mental 18 health physician clinic, a "professional mental health clinician" must also be licensed 19 to practice in the state in which service is being provided or be a clinical member in 20 good standing of the American Association for Marriage and Family Therapy, and be 21 working in the clinician's field of expertise; in this paragraph, "mental health physician 22 clinic" means a clinic, operated by one or more psychiatrists, that exclusively or 23 primarily provides mental health services furnished by a psychiatrist or by one or more 24 licensed psychologists, licensed psychological associates, licensed clinical social 25 workers, licensed nurse practitioners, licensed psychiatric nursing clinical specialists, 26 or clinical members in good standing of the American Association for Marriage and 27 Family Therapy, who are working in their field of expertise under the direct 28 supervision of a psychiatrist. 29 * Sec. 2. AS 13.26.335 is amended to read: 30  Sec. 13.26.335. ADDITIONAL OPTIONAL PROVISIONS TO STATUTORY 31 FORM POWER OF ATTORNEY. Each of the following provisions may be included 01 in a statutory form power of attorney: 02  (1) IF YOU HAVE GIVEN THE AGENT AUTHORITY REGARDING 03 HEALTH CARE SERVICES UNDER SUBDIVISION (L), COMPLETE THE 04 FOLLOWING: 05  ( ) I have executed a separate declaration under AS 18.12, 06 known as a "Living Will." 07  ( ) I have not executed a "Living Will." 08  ( ) I have executed a separate declaration under 09 AS 47.30.950 - 47.30.980 regarding mental health treatment. 10 If I 11 have appointed an attorney-in-fact under AS 47.30.950 - 12 47.30.980, I authorize that attorney-in-fact and the attorney-in-fact whom I have appointed in this document 13 to serve 14  ( ) jointly with consent of each other as to my 15 mental health treatment 16  ( ) separately without each other's consent as to my 17 mental health treatment. 18  ( ) I have not executed a separate declaration under 19 AS 47.30.950 - 47.30.980. 20  (2) YOU MAY DESIGNATE AN ALTERNATE ATTORNEY-IN-FACT. ANY ALTERNATE YOU 21 DESIGNATE WILL BE ABLE TO EXERCISE 22 THE SAME POWERS AS THE AGENT(S) YOU NAMED AT THE BEGINNING 23 OF THIS DOCUMENT. IF YOU WISH TO DESIGNATE AN ALTERNATE OR 24 ALTERNATES, COMPLETE THE FOLLOWING: 25  If the agent(s) named at the beginning of this document is 26 unable or unwilling to serve or continue to serve, then I appoint the 27 following agent to serve with the same powers: 28  First alternate or successor attorney-in-fact 29 ____________________________________ 30 (Name and address of alternate) 31 ____________________________________ 01 Second alternate or successor attorney-in-fact 02 ____________________________________ 03 (Name and address of alternate) 04  (3) YOU MAY NOMINATE A GUARDIAN OR CONSERVATOR. 05 IF YOU WISH TO NOMINATE A GUARDIAN OR CONSERVATOR, COMPLETE 06 THE FOLLOWING: 07  In the event that a court decides that it is necessary to appoint 08 a guardian or conservator for me, I hereby nominate (Name and 09 address of person nominated)  to be considered by the court for 10 appointment to serve as my guardian or conservator, or in any similar 11 representative capacity. 12 * Sec. 3. AS 13.26.344(l) is amended to read: 13  (l) In the statutory form power of attorney, the language conferring general 14 authority with respect to health care services, shall be construed to mean that, as to the 15 health care of the principal, whether to be provided in the state or elsewhere, the 16 principal authorizes the agent to 17  (1) have access to and disclose to others medical and related 18 information and records; 19  (2) consent or refuse to consent to medical care or relief for the 20 principal from pain, but the agent may not authorize the termination of life-sustaining 21 procedures; 22  (3) take all steps necessary to enforce a properly executed declaration 23 under AS 18.12; 24  (4)  take all steps necessary to enforce a properly executed 25 declaration under AS 47.30.950 - 47.30.980 unless the principal has provided that 26 an attorney-in-fact appointed under AS 47.30.950 - 47.30.980 shall have exclusive 27 authority with regard to mental health treatment and the attorney-in-fact 28 appointed under AS 47.30.950 - 47.30.980 has not withdrawn; 29  (5) consent or refuse to consent to the principal's psychiatric care, but 30 the consent does not authorize a voluntary commitment or placement in a mental 31 health treatment facility, electroconvulsive [CONCLUSIVE] or electric-shock therapy, 01 psychosurgery, sterilization, or an abortion except that, if the principal has properly 02 executed a declaration under AS 47.30.950 - 47.30.980, the agent may consent to 03 voluntary commitment or placement in a mental health treatment facility and 04 electroconvulsive or electric-shock therapy if that consent is consistent with the 05 wishes expressed in the declaration under AS 47.30.950 - 47.30.980 and if the 06 principal has not designated another attorney-in-fact to have exclusive authority 07 to make decisions regarding mental health treatment; 08   (6) [(5)] arrange for care or lodging of the principal in a hospital, 09 nursing home, or hospice; 10   (7) [(6)] grant releases to health care professionals or health care 11 institutions; 12   (8) [(7)] hire, discharge, or compensate an attorney, accountant, expert 13 witness, or assistant when the agent considers the action to be desirable for the proper 14 execution of the powers described in this subsection; and 15   (9) [(8)] do any other act or acts, that the principal can do through an 16 agent, and that the agent considers desirable or necessary to provide for the principal's 17 physical or mental well being. 18 * Sec. 4. AS 47.30.825(b) is amended to read: 19  (b) The patient and the following persons, at the request of the patient, are 20 entitled to participate in formulating the patient's individualized treatment plan and to 21 participate in the evaluation process as much as possible, at minimum to the extent of 22 requesting specific forms of therapy, inquiring why specific therapies are or are not 23 included in the treatment program, and being informed as to the patient's present 24 medical and psychological condition and prognosis: (1) the patient's counsel, (2) the 25 patient's guardian, (3) a mental health professional previously engaged in the patient's 26 care outside of the evaluation facility or designated treatment facility, (4) a 27 representative of the patient's choice, (5) a person designated as the patient's 28 attorney-in-fact with regard to mental health treatment decisions under 29 AS 13.26.332 - 13.26.358, AS 47.30.950 - 47.30.980, or other power-of-attorney, and 30 (6) [(5)] the adult designated under AS 47.30.725. The mental health care professionals 31 may not withhold any of the information described in this subsection from the patient 01 or from others if the patient has signed a waiver of confidentiality or has designated 02 the person who would receive the information as an attorney-in-fact with regard 03 to mental health treatment. 04 * Sec. 5. AS 47.30.825(f) is amended to read: 05  (f) A patient capable of giving informed consent has the absolute right to 06 accept or refuse electroconvulsive [ELECTRO-CONVULSIVE] therapy or aversive 07 conditioning. A patient who lacks substantial capacity to make this decision may not 08 be given this therapy or conditioning without a court order unless the patient 09 expressly authorized that particular form of treatment in a declaration properly 10 executed under AS 47.30.950 - 47.30.980 or has authorized an attorney-in-fact to 11 make this decision and the attorney-in-fact consents to the treatment on behalf of 12 the patient. 13 * Sec. 6. AS 47.30.836 is amended to read: 14  Sec. 47.30.836. PSYCHOTROPIC MEDICATION IN NONEMERGENCIES. 15 An evaluation facility or designated treatment facility may not administer psychotropic 16 medication to a patient in a situation that does not involve a crisis under 17 AS 47.30.838(a)(1) unless the patient 18  (1) [THE PATIENT] has the capacity to give informed consent to the 19 medication, as described in AS 47.30.837, and gives that consent; the facility shall 20 document the consent in the patient's medical chart; [OR] 21  (2)  authorized the use of psychotropic medication in a declaration 22 properly executed under AS 47.30.950 - 47.30.980 or authorized an attorney-in-fact to consent to the use of 23 psychotropic medication for the patient and the 24 attorney-in-fact does consent; or 25  (3) [THE PATIENT] is determined by a court to lack the capacity to 26 give informed consent to the medication and the court approves use of the medication 27 under AS 47.30.839. 28 * Sec. 7. AS 47.30.838(a) is amended to read: 29  (a) Except as provided in (c) and (d) of this section, an evaluation facility or 30 designated treatment facility may administer psychotropic medication to a patient 31 without the patient's informed consent, regardless of whether the patient is capable of 01 giving informed consent, only if 02  (1) there is a crisis situation, or an impending crisis situation, that 03 requires immediate use of the medication to preserve the life of, or prevent significant 04 physical harm to, the patient or another person, as determined by a licensed physician 05 or a registered nurse; the behavior or condition of the patient giving rise to a crisis 06 under this paragraph and the staff's response to the behavior or condition must be 07 documented in the patient's medical record; the documentation must include an 08 explanation of alternative responses to the crisis that were considered or attempted by 09 the staff and why those responses were not sufficient; and 10  (2) the medication is ordered by a licensed physician; the order 11  (A) may be written or oral and may be received by telephone, 12 facsimile machine, or in person; 13  (B) may include an initial dosage and may authorize additional, 14 as needed, doses; if additional, as needed, doses are authorized, the order must 15 specify the medication, the quantity of each authorized dose, the method of 16 administering the medication, the maximum frequency of administration, the 17 specific conditions under which the medication may be given, and the 18 maximum amount of medication that may be administered to the patient in a 19 24-hour period; 20  (C) is valid for only 24 hours and may be renewed by a 21 physician for a total of 72 hours, including the initial 24 hours, only after a 22 personal assessment of the patient's status and a determination that there is still 23 a crisis situation as described in (1) of this subsection; upon renewal of an 24 order under this subparagraph, the facts supporting the renewal shall be written 25 into the patient's medical record. 26 * Sec. 8. AS 47.30.838 is amended by adding a new subsection to read: 27  (d) An evaluation facility or designated treatment facility may administer 28 psychotropic medication to a patient without the patient's informed consent if the 29 patient is unable to give informed consent but has authorized the use of psychotropic 30 medication in a declaration properly executed under AS 47.30.950 - 47.30.980 or has 31 authorized an attorney-in-fact to consent to this form of treatment for the patient and 01 the attorney-in-fact does consent.