Legislature(2019 - 2020)ADAMS 519
03/19/2020 09:00 AM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB120 | |
| SB137 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 120 | TELECONFERENCED | |
| + | SB 137 | TELECONFERENCED | |
| + | HB 23 | TELECONFERENCED | |
| += | HB 187 | TELECONFERENCED | |
| + | TELECONFERENCED |
CS FOR SENATE BILL NO. 120(HSS)
"An Act relating to administration of psychotropic
medication to a patient without the patient's informed
consent; and providing for an effective date."
9:04:06 AM
Vice-Chair Ortiz invited the sponsor and her staff to the
table.
SENATOR CATHY GIESSEL, SPONSOR, explained that SB 120
related to the administration of psychotropic medications.
She emphasized that the legislation was an emergency
response bill requested by the Alaska Psychiatric Institute
(API). The state had a shortage of psychiatrists which was
impacting API. Presently, they had one psychiatrist on
staff. The provider was on call 24/7 working long hours.
The bill proposed to improve patient safety during those
times when the psychiatrist was not present at the hospital
and unable to be reached by cell phone at a time when a
patient crisis was occurring.
Senator Giessel continued that psychotropic drugs were
medications prescribed or administered in a psychiatric
crisis. The individuals that were hospitalized had very
serious psychiatric issues. When a patient had a
psychiatric crisis, it was an emergency. The goal was to
protect the patient, people around the patient, and staff.
Psychotropic medications were administered to help a
patient calm down. She listed several of the medications
used. Only one of the drugs was a controlled substance. The
rest of them were medications that physician assistants
(PA) and advanced practice registered nurses (APRN) could
prescribe and administer. However, there was a rule in
place requiring that the psychiatrist be consulted before
the medication was administered. Senate Bill 120 would
authorize the PA or APRN who was with the patient to
administer the medication, thereby, calming the patient and
protecting the patient and others nearby. Currently, the
psychiatrist was the only person that could conduct an
initial assessment on a patient and prescribe medication in
a crisis. By allowing the APRN or the AP the opportunity to
administer needed medication, it would keep everyone much
safer. She added that because of API's issues, patients
with behavioral health issues often times assault people
and end up in jail. The more that could be done to help
patients get immediate care to ramp down a crisis
situation, the more patients would be protected from a
worse environment.
Vice-Chair Ortiz relayed the names of available testifiers.
9:09:36 AM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, explained there
were only 2 sections in the bill. She was happy to review
them if it was the will of the committee.
Vice-Chair Ortiz indicated the committee would move on to
questions.
9:09:56 AM
Representative LeBon asked if additional training would be
necessary for a PA or APRN to administer the medications.
Senator Giessel deferred to the representative from API who
could better answer the question. She noted that the
medications fell within the scope of practice for a PA and
APRN. She also pointed out that the practitioners working
in the environment at API understood the treatment of the
patients with specialized needs.
Representative LeBon restated his question about additional
training. He wondered if PAs and APRNs would be able to act
immediately. Senator Giessel believed so but would to defer
to the APRN online.
CYNTHIA MONTGOMERY, ADVANCED PRACTICE REGISTERED NURSE,
ANCHORAGE, responded that APRNs and PAs that practiced at
API were very familiar with the medications that were used
in crisis periods. They were often the same medications
already prescribed on a daily basis to patients. No
additional training would be necessary.
9:12:20 AM
Representative Knopp had a question for Dr. Alexander if he
was available. He referred to the fifth paragraph in the
sponsor statement which read: "The psychiatrist being
unfamiliar with the case may decline to prescribe needed
medication." He wondered if there was any reason a
psychiatrist would not want to have a drug administered.
MICHAEL ALEXANDER, DOCTOR, CHIEF OF PSYCHIATRY, ALASKA
PSYCHIATRIC INSTITUTE, ANCHORAGE, replied that all of the
mid-level practitioners including PAs and APRNs had
previously been in a position of prescribing crisis
medications. About a year prior it was discovered that the
law did not include mid-level practitioners. He continued
that when the laws were originally established, mid-level
practitioners were not working at API. In 2007, when he was
working at API, it was unheard of to have a mid-level
provider working at the facility. Mid-level practitioners
started working at API in 2010 or 2011. Currently, API had
four mid-level providers who had been administering
psychotropic drugs for the previous several years until it
was discovered that the law prevented them from doing so.
Representative Knopp was wondering if there was any
scenario in which a patient should not receive the
medication. However, it sounded like it was a matter of
updating statutes with changing times. Dr. Alexander
responded, "That is correct."
9:15:09 AM
Representative Josephson asked Dr. Alexander if he thought
the bill should read that the mid-level practitioners
should be able to provide medication via teleconference.
Dr. Alexander responded that traditionally in the past
mid-level practitioners had been able to via
teleconference. The Alaska Psychiatric Institute was not a
24-hour manned facility. Mid-level practitioners provided
on-call services just like physicians. They worked their
regular day then took calls from home through the call
system. In the night there was an on-call provider to
direct services, but no one was physically in the building.
Representative Josephson asked the protocol. Dr. Alexander
responded that providers received calls from nurses working
on the floors who would evaluate the patient. If the
patient went into a psychotic state and became extremely
violent, a nurse on duty would call the on-call
psychiatrist or mid-level practitioner. They would discuss
the case and start a crisis period providing medications
over objection. The following morning, the provider would
interview the patient and decide if the crisis period
should continue or end. The process was done over the
phone.
Representative Josephson asked the credential for the
person administering medication. Dr. Alexander replied that
a registered nurse would be giving the medication.
Vice-Chair Ortiz recognized that Representative Carpenter
had joined the meeting.
Representative Sullivan-Leonard asked if there had been
increased situations with patients which had necessitated
the legislation. Dr. Alexander responded that there had
been a number of incidents in which staff or patients had
been assaulted. He wanted to ensure that the institute was
a safe place equipped with all of the right tools.
Representative Sullivan-Leonard confirmed that the need for
the legislation was based on the need to be able to
immediately control a situation that could become dangerous
when it occurred at API. She wondered if her assessment was
accurate. Dr. Alexander responded that API needed immediate
help to control a situation whether a patient was trying to
hurt themselves or others.
Representative Wool asked if there were limitations to what
an APRN or a PA could prescribe. Senator Giessel responded
that presently an APRN had the privilege of independent
practice in Alaska, and full prescriptive authority. The
Advanced Practice Nurse could prescribe controlled
substances if they had applied and received a DEA number.
The same was true for a PA except that they practiced in a
collaborative agreement with a physician. Typically, PAs
were rather independent and with a DEA number could
prescribe and administer controlled substances.
9:20:55 AM
Representative Wool assumed that if an APRN or a PA already
had DEA approval to write prescriptions for controlled
substances they could already do what was being proposed in
the bill. He asked if he was correct.
Senator Giessel replied that there was a law in place that
prior to 2010 there were no PAs and APRNs in API. There was
also a rule in place that only a psychiatrist could
authorize the administration of medications which the bill
was trying to change. She pointed to page 1, line 11 of the
bill. She read directly from the bill: "Harm to the patient
or another person as determined by the licensed physician."
She was adding: "or physician assistant or advanced
practice registered nurse." She was reading from a
committee substitute. Next, she referred to page 2, line 4
which read: "The medication is ordered by a licensed
physician, physician assistant, or advanced practice
registered nurse." The same was repeated on line 16. It was
an update to get rid of the restrictive law currently in
place.
Representative Wool thought the law already allowed PAs and
APRNs to prescribe controlled substances with a DEA
endorsement. He asked for additional clarity. Ms. Conway
responded that it was a section of law (AS.47.30.838) that
governed Psychotropic medications in crisis situations.
Currently, the only person that could determine that a
person was in a crisis situation was a physician. The bill
added PAs and APRNs to the list of those that could
prescribe medications immediately. Rather than having to
call the psychiatrist, they would be able to make an
assessment on the scene.
Representative Wool brought up the issue of a patient's
consent. He relayed he had experience working in a
psychiatric hospital in Boston that had about the same
number of patients as API. He relayed that anytime someone
had to administer drugs a doctor had to be called first.
The process could be done over the phone. He suggested that
the law would allow a PA or an APRN to be called avoiding a
conversation with a doctor entirely. He remarked that there
should be more than one physician at API, a matter that he
thought should be dealt with as soon as possible. He
wondered why a doctor could not be contacted within 72
hours. He understood the immediacy of an acute situation
and the need for someone to be medicated quickly. However,
he thought a physician could be reached within 3 days. He
asked for clarification.
9:26:14 AM
Senator Giessel thought Representative Wool was referring
to the section on page 2, beginning with line 15 in
Section C. She explained that it was referring to line 4.
She read from the bill: "The medication is ordered and
valid for only 24 and may be renewed for a total of 72
hours." The restriction was in current law and related to
the renewal of the medication previously administered. If
the person was requiring the medication for 72 hours,
further intervention might be necessary. She deferred to
Dr. Alexander.
Dr. Alexander responded that in order for API to prescribe
medications with patients who did not want to take any
medications the institute had to either appeal to a judge
for permission or enter a crisis period. Judges were not
available for 72 hours considering weekends. Court occurred
at the institute 3 days per week. Often times, the time
between court days was significant. It allowed API to
administer medications over 72 hours. The client was seen
immediately the following day with necessary adjustments
being made. Being able to prescribe medication for the
period allowed API to get control. Otherwise, the patient
might receive a medication, but reoffend once the
medication wore off. He added that for every day a person
was psychotic, it became more difficult to control and
maintain safety. The length of time a person was on
medication was limited because a decision by the court
would be necessary for any length of time.
9:30:37 AM
Representative Sullivan-Leonard wondered why the bill was
referred to the House Finance Committee rather than the
House Health and Social Services Committee, as the fiscal
notes were zero-impact notes. She wondered if the bill
would be heard in the House Health and Social Services
Committee. Senator Giessel did not know.
Representative Sullivan-Leonard commented that it struck
her curiosity because of a zero-impact fiscal note. She
wondered if the bill would be heard in the House Health and
Social Services Committee or the House Labor and Commerce
Committee.
Vice-Chair Ortiz offered that the deputy commissioner from
DHSS was available for questions.
Representative Sullivan-Leonard questioned the route of the
bill. She asked if the Medical Board had taken a position
on the bill. Senator Giessel responded that she had several
letters of support. She noted the authors of the support
letters. She mentioned that the bill was heard in the
Senate Health and Social Services Committee with no
objections to the legislation.
Representative Josephson asked Ms. Conway for clarification
about mid-level practitioners being on the seen at the time
of an incident versus on the phone. Ms. Conway responded
that the representative was correct. A mid-level
practitioner might not be on the scene. Senator Giessel
added that clarity was critical. The practitioners were not
new healthcare providers. She relayed that the APRNs and
PAs had been practicing at API for 10 years. Nurse
practitioners practiced independently in Alaska since 1984
with prescriptive authority. She could not confirm the same
longevity for PAs, but they were not new clinicians.
9:34:41 AM
Representative Wool thought it was astonishing that the
patients would be jailed for their behavior. He asked if
calling the police was a recent phenomenon. He asked if it
happened elsewhere. Senator Giessel deferred to Dr.
Alexander. Dr. Alexander responded that it was not a recent
phenomenon or limited to API. The Alaska Psychiatric
Institute tried diligently to keep patients at the
facility. However, the institute also tried to keep its
staff safe. In the prior year, there had been over 100
assaults on staff by patients. He clarified that not all of
the patients that did the assaulting were sent to jail.
However, the staff had the right to file charges against a
patient.
Representative Tilton wanted to know whether a guardian
could give permission to administer drugs rather than
having to get permission from a court. Senator Giessel
deferred to Dr. Alexander. Dr. Alexander replied that the
statute specified that once a patient arrived at API, no
guardian or any other representative of the patient could
mandate any kind of medication other than by going through
a crisis period or going to court. He thought API's
attorney could cite the statute.
9:38:48 AM
Representative Josephson thanked the sponsor for the
legislation. He clarified his previous statement. His
intended point was to make them a new group that would be
dually authorized to expressly administer or deputize
others to administer psychotropic drugs. Senator Giessel
appreciated Representative Josephson's remarks. She
reminded members that until recently, when the law was
noted by someone else, the PA and APRN were actually
functioning in the role.
Vice-Chair Ortiz announced that amendments were due by the
end of the day at 5:00 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 120 Comparison Flowchart 2-26-2020.pdf |
HFIN 3/19/2020 9:00:00 AM SHSS 2/28/2020 1:30:00 PM |
SB 120 |
| SB 120 Sponsor Statement 1.30.2020.pdf |
HFIN 3/19/2020 9:00:00 AM SHSS 2/28/2020 1:30:00 PM |
SB 120 |
| SB 137 Parole-Board Sunset Audit 20-20116-19.pdf |
HFIN 3/19/2020 9:00:00 AM SFIN 3/11/2020 9:00:00 AM SSTA 2/18/2020 3:30:00 PM |
SB 137 |
| SB 137 Sponsor Statement v.M 031720.pdf |
HFIN 3/19/2020 9:00:00 AM |
SB 137 |
| HB 187 Public Testimony Rec'd by 031820 (2).pdf |
HFIN 3/19/2020 9:00:00 AM |
HB 187 |