Legislature(2019 - 2020)BUTROVICH 205
02/28/2020 01:30 PM Senate HEALTH & SOCIAL SERVICES
Note: the audio ![]()
and video ![]()
recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.
| Audio | Topic |
|---|---|
| Start | |
| SB120 | |
| SB179 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 120 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| *+ | SB 179 | TELECONFERENCED | |
SB 120-ADMINISTRATION OF PSYCHOTROPIC MEDICATION
1:30:45 PM
CHAIR WILSON announced the consideration of SENATE BILL NO. 120,
"An Act relating to administration of psychotropic medication to
a patient without the patient's informed consent; and providing
for an effective date."
He noted that the committee would hear an overview of the bill
and take invited and public testimony.
1:31:35 PM
SENATOR GIESSEL, speaking as sponsor of SB 120, said the bill
addresses the administration of psychotropic drugs. She said
Alaska Psychiatric Institute (API) has gone through some recent
challenges and the bill addresses one of those challenges, the
ongoing psychiatrist shortage in Alaska. Currently, API has one
fulltime year round psychiatrist. Under current statute, a
psychiatrist is the only person who can conduct an initial
assessment of a patient in a behavioral health crisis and decide
whether to prescribe a psychotropic medication.
SENATOR GIESSEL explained that psychotropic medications help
calm patients down to make them safe and to ensure the safety of
the staff and other patients. A psychiatric crisis or emergency
situation is an acute disturbance in a person's behavior,
thought, or mood. If left untreated, it may lead to harm to the
individual or to others. A psychotropic drug includes
olanzapine, chlorpromazine, and haloperidol to treat psychosis,
bipolar disorder, and severe behavioral health disorders and
lorazepam, a valium-type medication used to treat anxiety
reactions.
SENATOR GIESSEL said API's mission is to provide the best
possible care for its patients and the state needs to help so
they can better meet those needs. An Advanced Practice
Registered Nurse (APRN) or Physician Assistant (PA) is present
when the psychiatrist is not available, observing any patient
crisis, breakdown, or the buildup that leads to that crisis
situation. These professionals can make an educated judgment
about the use of one of these psychotropic drugs, but currently
must call the psychiatrist if he is not at the institute.
SB 120 would allow the APRN or PA observing the patient with
escalating behavior to make the assessment, diagnosis, and
decision about whether to prescribe and administer the
medication without any delay. It would remove an obsolete
statute that requires that only a psychiatrist can order the use
of psychotropic medication. The use of de-escalation techniques
and the medications will help keep patients in a safe hospital
setting where these patients can be cared for appropriately
rather than being sent to a jail when their out of control
behavior leads to assault.
SENATOR GIESSEL said these medications are already approved for
APRNs and PA.
1:37:36 PM
JANE CONWAY, Staff, Senator Cathy Giessel, Alaska State
Legislature, Juneau, Alaska, gave the sectional analysis for SB
120. She noted that Amendment 1, in members' packets, would
address an oversight in the drafting of the bill. It adds
physician assistant in Section 1, line 12. Allowing a physician
assistant to assess and prescribe psychotropic medications is a
crucial part of the bill, she said.
1:38:36 PM
At ease
1:38:57 PM
CHAIR WILSON reconvened the meeting.
MS. CONWAY said that after an assessment is made, the patient's
behavior must be documented to explain why other remedies were
not successful and the necessity to prescribe the drug.
Subsection 2 removes the word "licensed" since physicians are
already licensed. It adds Advanced Practice Registered Nurses
and Physician Assistants to the list of those who can prescribe
psychotropic medication and outlines how that must be done.
MS. CONWAY said subsection (c) on page 2, line 15, would outline
the time period, 72 hours, the medication can be prescribed. AS
47.30.839 requires a court order to go beyond prescribing three
days, which is not addressed in this bill. Section 2 also adds
transition language and an immediate effective date.
1:41:08 PM
ALBERT WALL, Deputy Commissioner, Department of Health and
Social Services, Anchorage, Alaska, said SB 120 arose from
discussions with Senator Giessel on ways to improve care and
reduce stress on API's psychiatrists, who are on call 24/7, 365
days a year.
1:42:17 PM
CYNTHIA MONTGOMERY, Psychiatric Nurse Practitioner, Alaska
Psychiatric Institute, Anchorage, Alaska, said SB 120 is in the
best interest of patients. Alaska has many psychiatric
providers, but API is required to use contractors and locum
tenens providers to provide care to the most seriously mentally
ill patients in Alaska. These temporary psychiatrists are often
from the Lower 48 and are not familiar with Alaska's unique laws
surrounding mental health. Even when the patient's primary care
provider is present, if the provider is an APRN or PA, the
registered nurses on duty must call API's psychiatrist to
prescribe any psychotropic medications.
MS. MONTGOMERY said that because the psychiatrist may not be
immediately available, the medication cannot be given to
patients in a timely manner. The psychiatrist may not be
familiar with the patient and may be unwilling to prescribe
crisis medication. She has observed registered nurses call a
locum tenens psychiatrist and the psychiatrist does not
understand the statutory necessity. Often, patients are out of
control and refuse to take the offered medications. Allowing the
patient's own provider to prescribe the medication is in the
best interest of the patients and the facility. Besides
preventing potential harm to themselves or others, the
medication can mitigate damage to the brain during psychotic
agitation and aggression. The Joint Commission Standards require
that a licensed, independent practitioner who is most familiar
with the patient be responsible for that patient's care.
1:45:52 PM
MICHAEL ALEXANDER, M.D., Chief Psychiatrist, Alaska Psychiatric
Institute, Anchorage, Alaska, said SB 120, the crisis medication
bill, is imperative. He is the only psychiatrist at API and is
on call for 20 to 25 days per month. When API began to provide
services, there were only psychiatrists on staff and not
psychiatric nurse practitioners or physician assistants. In the
last 10 years, nurse practitioners and physician assistants were
added to the medical staff. These professionals previously
prescribed psychotropic medications, but about a year ago it was
discovered that only psychiatrists could do so. He said these
professionals are capable of prescribing and administering
psychotropic drugs and should be given the opportunity to care
for their patients.
1:47:49 PM
CHAIR WILSON opened public testimony on SB 120.
1:48:01 PM
MARIEKE HEATWOLE, representing self, Anchorage, Alaska, said she
previously worked as a nurse at Anchorage Psychiatric Institute,
but is currently pursuing a degree as a psychiatrist nurse
practitioner. She echoed the previous testimony in support of SB
120. It resolves a statutory discrepancy and ensures patient-
centered care.
1:49:04 PM
CHAIR WILSON closed public testimony on SB 120 and solicited a
motion.
1:49:17 PM
SENATOR VON IMHOF moved to adopt Amendment 1:
31-LS0866\S.1
Marx
2/25/20
AMENDMENT 1
OFFERED IN THE SENATE
TO: SB 120
Page 1, line 12:
Delete "or a registered"
Insert ", physician assistant, [OR A REGISTERED]"
1:49:25 PM
There being no objection, Amendment 1 was adopted.
CHAIR WILSON held SB 120 in committee.