Legislature(2001 - 2002)
03/20/2001 03:03 PM House HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 115-EMERGENCY COMMITMENT ORDERS CHAIR DYSON announced that the first order of business would be HOUSE BILL NO. 115, "An Act allowing a physician assistant or advanced nurse practitioner to certify the need for emergency treatment as a result of intoxication." Number 0160 REPRESENTATIVE MARY KAPSNER, Alaska State Legislature, came forth as sponsor of HB 115. She stated that this bill proposes to change the involuntary commitment statute, Title 47, to allow midlevel practitioners such as physician assistants and advanced nurse practitioners to sign medical certificates of necessity for treatment for individuals with alcohol and drug dependency. Number 0216 REPRESENTATIVE COGHILL made a motion to adopt the proposed committee substitute (CS) for HB 115, version 22-LS0059\F, Ford, 2/15/01, as a work draft. There being no objection, proposed CSHB 115 was before the committee. REPRESENTATIVE KAPSNER continued, stating that this bill also expands the definition of mental health professional to include licensed clinical social workers, licensed marital and family therapists, and licensed professional counselors. She explained to the committee the reason she decided to sponsor this bill. She said: The requirement that a physician involuntarily commit patients is quite burdensome, especially in remote and rural areas of Alaska where physicians aren't readily accessible in many instances. This results in reduced access to treatment for those vulnerable Alaskans, many of whom move through both the criminal justice system and emergency medical facilities. The proposed change will allow communities where physicians may not be present to utilize physician's assistants and advanced nurse practitioners who staff local clinics to complete the required certificates of necessity for treatment. REPRESENTATIVE KAPSNER remarked that she hasn't met anyone opposed to this legislation. Number 0350 SENATOR DONALD OLSON, Alaska State Legislature, came forth as cross-sponsor of HB 115. He remarked that he is privileged to be a part of this bill, having gone to medical school and return to practice health care amongst the people that he was raised and grew up with in the Nome area. He said the reason he came back was because there was a significant physician shortage in Western Alaska and all of the Bush hospitals. Number 0464 SENATOR OLSON remarked that Nome recognized [the shortage] early on and fairly aggressively recruited physicians. He shared that [once] during the shortage he had a lady in the delivery room, a gunshot victim in the emergency room, a knifing going on in the village, and he was by himself. He said that the last thing he wanted to be doing was giving the nod to an evaluation by a midlevel person saying that he or she wanted to commit a person. Number 0555 CHAIR DYSON asked Senator Olson if he sees any chances of abuse [under this bill]. SENATOR OLSON replied that with any type of bill there is possible abuse. He said he feels that the portion of times that it has happened has been very minimal. He stated that right now, especially in rural Alaska, there are midlevel practitioners who are doing almost the same things that fully licensed physicians are doing, and they take that responsibility with a fair amount of weight. He remarked that he had never seen it abused. CHAIR DYSON asked if someone in power commits a person, what rights a person has to appeal. Number 0685 REPRESENTATIVE STEVENS asked Senator Olson what the process is when somebody certifies an individual as needing emergency treatment. SENATOR OLSON answered that if somebody comes to the emergency room in the middle of the night while the physician on call is there and a midlevel practitioner admits the person, there is usually a protocol for him or her to have emergency treatment. Mainly, someone from mental health or substance abuse gets involved. He stated that if a patient is seen out in a rural setting by somebody who thinks he or she needs to be admitted or committed, it is the obligation of the physician in charge to send a "Medivac" with adequate personnel to make sure that the health and welfare of [the patient] is taken care of. The person would then go to a hospital, where the same thing would occur as if he or she had gone to the emergency room. Number 0830 PAM WATTS, Director, Governor's Advisory Board on Alcoholism & Drug Abuse (ABADA), Office of the Commissioner, Department of Health & Social Services, came forth and stated that the [ABADA] supports HB 115. She said the involuntary commitment statute in the state requires that a licensed physician in Alaska be able to sign a certificate of necessity for treatment that must accompany a petition for commitment. She stated that the problem is that in rural communities there often are not physicians available. Although the physician is not generally the person who is actually applying for the commitment, the physical examination has to be conducted by a licensed physician. She remarked that the end result is that many rural residents who are eligible for involuntary alcohol commitments keep rotating through the correctional system and don't get the help they need because there is no one available to sign the certificates. She added that physicians are understandably reluctant to sign [following a telephone call], without physically examining the individual. CHAIR DYSON asked what civil rights protections the patients have. Number 0990 BARBARA CRAVER, Attorney, [speaking on behalf of herself and Pam Watts] responded that there are actually three different procedures being dealt with by HB 115. She stated that according to the title [of the bill], the first part of the Act, Section 1, talks about a mental health commitment. This is a special kind of commitment for people who may harm themselves or others due to a mental health disability or condition. She stated that she believes that the ex parte commitment is an initial 72-hour hold. If it is decided that the person is suitable for a longer commitment of 30 days, he or she will have an attorney appointed and a judge must issue the commitment order. Number 1042 REPRESENTATIVE WILSON asked who would [issue the commitment order] in areas such as Wrangell, where there isn't a judge. MS. CRAVER answered that an ex parte commitment is a 72-hour hold and she doesn't believe that a judge has to be present in granting that. REPRESENTATIVE WILSON remarked that she was involved in something similar to this in Wrangell and a magistrate was involved. MS. CRAVER remarked that there may be some kind of a preliminary judicial involvement in the beginning of the mental health procedures, but for a short-term situation the judicial involvement is fairly minimal. She continued, stating that Sections 2 and 3 deal with an emergency commitment for alcohol and drug abuse to public treatment facilities, which is a fairly select group of facilities. She stated that Sections 4 and 5 apply to a long-term commitment for alcohol or drug abuse. People who are issued an alcohol commitment are entitled to an attorney and a court-appointed attorney if they are indigent. They are encouraged within the 48-hour period, in Sections 2 and 3, to have access to legal counsel. She stated that if a 30-day commitment is sought under [Sections 4 and 5], a person is entitled to an attorney and a trial before a judge. She added that there are two opportunities for the petitioner to go back for 180-day recommitments. She noted that [people who are involuntarily committed] basically have the same rights as if in a criminal trial. Number 1197 REPRESENTATIVE COGHILL asked Ms. Craver to clarify what she said about Section 1. MS. CRAVER replied that she has never dealt with a mental health commitment, but she believes that when a longer hold is issued an attorney must be appointed to the person. REPRESENTATIVE STEVENS remarked that the title [of the bill] speaks just to intoxication, yet the body talks about mental health and long-term care. He asked if this is the proper format and if the title should reflect all of the changes being requested in the bill. CHAIR DYSON replied that a [semi] colon on line 2 of the title makes mental health proceedings separate, in parallel construction to civil proceedings on line 3. MS. WATTS stated that the section pertaining to mental health professionals doesn't change who can commit people for a mental health commitment. The issue is that a number of mental health professionals currently do the examinations that are then reviewed by a psychiatrist prior to a commitment. She stated that this would amend the statute to broaden the definition of mental health professional. Number 1469 ANNE HENRY, Special Projects Coordinator, Division of Mental Health & Developmental Disabilities, Department of Health & Social Services, came forth to testify on HB 115. She stated: The Division of Mental Health & Developmental Disabilities supports the efforts to expand the pool of mental health professional available to do mental health civil commitments as an issue of increasing consumer health and safety. When a person with a mental health problem seeks an evaluation for possible admittance to a mental health hospital facility, a mental health professional (MHP) is called upon to conduct the evaluation. The goal of the evaluation is to determine whether or not the individual has a mental health illness and, as a result, is gravely disabled or likely to cause serious harm to self or others. The goal of that mental health professional at the time that [he or she is] doing that evaluation is actually to do the least restrictive thing for that patient. If the MHP determines that the individual fits the criteria for civil commitment, and the individual refuses voluntary hospitalization, a call is placed to a consulting psychiatrist or physician. And if that psychiatrist or physician concurs with the evaluation of the MHP, then they contact a judge. ... The judge hearing the results of the evaluation and the concurrence of the psychiatrist and physician then makes the decision whether or not to involuntarily commit that person. There is currently very limited choice of who is eligible to do these commitments. According to the current statutes a mental health professional is defined as a psychiatrist or physician who is licensed to practice in this state or employed by the federal government; a clinical psychologist licensed by the board; a psychological associate trained in clinical psychology and licensed by the state Board of Psychologists and Psychological Associate Examiners; or a trained nurse with a master's degree in psychiatric nursing, licensed by the State Board of Nursing; and a social worker with a master's degree in social work with substantial experience in the field of mental illness. MS. HENRY remarked that this statute was written in 1986 and since then the state has licensed social workers, marital and family therapists, and licensed professional counselors. Number 1594 MS. HENRY continued, stating: In mental health agencies across the state, there are approximately 140 mental health clinicians doing emergency service evaluations. In reality, currently, about half of these folks fit the legal definition of who's able to do this MHP evaluation. And in rural areas this is particularly difficult, to get licensed folks. MS. HENRY remarked that the state recognizes all of these different clinicians as having at least two years' worth of post-graduate experience and having passed examinations or rigorous scrutiny from the boards that license them. The Department of Health & Social Services encourages this definition change, and the Alaska Mental Health Board supports the bill. She remarked that requiring licensure and including all of the master's-level mental health clinicians enlarges the pool of MHPs who must meet the legislatively mandated standards of education, experience, and professionalism. REPRESENTATIVE STEVENS stated that he understands the logic of changing the rules of who can commit someone for alcohol [abuse] in a village or in a difficult situation in which there needs to be an emergency decision. He asked why this would also be needed for a long-term situation, since there would be more time for a physician or psychiatrist to make the decision. REPRESENTATIVE KAPSNER replied that she doesn't know how much [the bill] is directly related to just emergency situations. Midlevel practitioners do a lot of the person-to-person interaction, and there is a dearth of doctors statewide, so this would eliminate a middleman. REPRESENTATIVE STEVENS remarked that a 30-day involuntary commitment is such a serious issue he can't imagine that the rules should be changed for that. Number 1759 REPRESENTATIVE WILSON shared that when she lived in Tok and worked in a clinic the only [medical] people there were almost always advanced practitioners or PAs (physician assistants). When someone came in who needed help, there was limited [staff]. She stated that sometimes a 30-day program is available right away. If that person can go right then, when that slot is open, the [staff needs to act fast]. MS. CRAVER suggested that in Section 4, page 3, line 4, the words "physician" and "of the examination" could be deleted because if the section is passed, the bill is expanding the people who can make the examination to a licensed physician, physician assistant, or advanced nurse practitioner. She added that the language could state, "The certificate must set out the medical examiner's findings." Number 1880 CHAIR DYSON clarified that the proposed amendment on page 3, line 4, deletes "physician's" and "of the examination" and inserts the word "medical examiner's" where the word "physician's" had been. [No objection was stated, and he announced that Amendment 1 was adopted.] MS. CRAVER proposed an amendment that in Section 5, page 3, line 10, "AS 47.37.180(b) or" should be deleted because it refers to an emergency commitment under AS 47.37.180, which is a distinct and separate commitment from a 30-day commitment under AS 47.37.190 and AS 47.37.200. Number 1922 CHAIR DYSON clarified that Amendment 2 would delete on page 3, line 10, "AS 47.37.180(b) or". [No objection was stated, and he announced that Amendment 2 was adopted.] MS. CRAVER proposed an amendment in Section 5, lines 14 and 15, that "AS.47.37.180(b) or" be deleted so that it would read, "If the person has refused to be examined under AS 47.37.190(a)". Number 1962 CHAIR DYSON clarified that Amendment 3 would delete "AS 47.37.180 (b) or". [No objection was stated, and he announced that Amendment 3 was adopted.] CHAIR DYSON stated that he was going to hold this bill over in order for Representative Kapsner to assure the committee, referring to Representative Stevens' point, that during the 30- day commitment there is not a licensed physician generally available. [HB 115 was held over.]
| Document Name | Date/Time | Subjects |
|---|