Legislature(1995 - 1996)

03/07/1996 04:12 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
 HB 318 - MENTAL HEALTH TREATMENT DECLARATIONS                                
 CO-CHAIR BUNDE announced that the first order of business would be            
 House Bill 318.  He called on the sponsor, Representative Toohey,             
 to introduce the bill.                                                        
 Number 060                                                                    
 REPRESENTATIVE CYNTHIA TOOHEY stated that HB 318 would allow an               
 individual to make advance directives regarding his or her mental             
 health treatment.  The person would need to be of sound mind when             
 making the declaration, which would designate an attorney-in-fact             
 who would act only when the individual was determined to be                   
 incapable.  The directive would address the use of psychotropic               
 medications, electro-convulsive therapy, and the length of short-             
 term admission, up to 17 days, into a treatment facility.  The                
 declaration would be in effect for three years, unless the                    
 individual became incapable.  In that case, the declaration would             
 continue in effect until the individual was no longer incapable.              
 While an individual is capable, he or she can revoke the                      
 declaration in whole or in part at any time.  This declaration                
 gives the individual the opportunity to make his or her wishes                
 known about treatments--ones that have worked in the past, as well            
 as ones that would be desired in the future, as well as treatments            
 that have not worked in the past and would not be desired in the              
 future.  It provides for a substitute decision-maker with whom the            
 doctor would consult should the declaration not be specific enough,           
 or should the doctor recommend a treatment not specified.  HB 318             
 is similar to an Oregon law.  In Oregon they have found that                  
 individuals who have fought hospitalization and medication in the             
 past, now were more willing to go to the hospital, because they had           
 a declaration in place, and they felt their decisions would be                
 heeded.  HB 318 is supported by Charter North, Alaska State                   
 Hospital & Nursing Home Association, South Central Counseling                 
 Center, the Mental Health Association of Alaska, and the Mental               
 Health Consumers of Alaska, and the Department of Health, Education           
 & Social Services.  There is a zero fiscal note attached.                     
 REPRESENTATIVE TOOHEY stated that there were a number of                      
 individuals present who wished to testify, including Dorothy Peavey           
 of the Mental Health Consumers of Alaska, and Leonard Abel from the           
 Department of Health, Education & Social Services.  Representative            
 Toohey noted that she remembered as a child receiving a very urgent           
 letter from her cousin, who was schizophrenic, asking never to let            
 her doctor use electro-shock therapy.                                         
 CO-CHAIRMAN BUNDE acknowledged the presence of Representatives                
 Robinson and Rokeberg.  He stated that because of the lack of time,           
 and the large number of persons wishing to testify, the committee             
 would first hear all testimony, then address any questions.  He               
 then called on the first witness, Dorothy Peavey.                             
 Number 331                                                                    
 DOROTHY PEAVEY, Executive Director of the Mental Health Consumers             
 of Alaska (MCHA), stated that MCHA is a nonprofit organization                
 composed of individuals who suffer from mental illness.  When her             
 organization became aware of Oregon's law concerning advance                  
 directives for mental health treatment, it seemed like a natural              
 thing for them to support.  This proposed legislation gives a voice           
 to people suffering from mental illness, at a time when their                 
 opinion would not normally be heard.  It empowers consumers to make           
 responsible decisions about their care, and provides a mechanism              
 for those decisions to be carried forward at a time when they are             
 incapable.  She emphasized that the correct term is incapable, not            
 incompetent.  Incompetency is decided by a judge.  To become                  
 incapable under this legislation, a person would have to at one               
 point have filled out a declaration.  Then, in the opinion of two             
 physicians (one of whom is a psychiatrist), or a physician and a              
 professional mental health clinician, the person would be found to            
 be incapable, and the mechanism would take effect.  At that point,            
 upon the advice and council of the attorney-in-fact, the individual           
 could be hospitalized for a period of up to 17 days, without having           
 to go to court to be found incompetent.  Decisions about treatment            
 would also take effect.  If a person had a history with a                     
 medication, then they could make their wishes known, and the doctor           
 would have to pay attention to those wishes.                                  
 MS. PEAVEY stated that she has discussed HB 318 with providers from           
 across the state, and that it has been endorsed by the Mental                 
 Health Providers Association, as well as the groups and individuals           
 named by Representative Toohey.  The bill has support from                    
 families, consumers, and providers.  One question that came up in             
 the Senate hearing was why 17 days was chosen for the time period             
 a person could be hospitalized.  She emphasized that this was a               
 reasoned number.  If a person were to be hospitalized on a Friday             
 afternoon, the 17 days would provide 10 days of evaluation and                
 treatment, if one of the weekends was a three day holiday.  At that           
 point, the doctors could decide if the individual had made a                  
 significant improvement, or whether the individual needed to be               
 held.  Ms. Peavey then invited questions from the committee.                  
 Number 609                                                                    
 CO-CHAIRMAN BUNDE noted for the record that Representative Brice              
 had joined the meeting.  Co-Chairman Bunde then called on the next            
 witness, Leonard Abel.                                                        
 LEONARD ABEL, Ph.D., Community Mental Health Services Program                 
 Administrator, Department of Health, Education & Social Services              
 (State of Alaska), stated he would testify in support of HB 318.              
 Dr. Abel stated that he previously worked for Southcentral                    
 Counseling Center in Anchorage.  About 11 years ago, a client came            
 to him and asked if there was a document she could sign, so that if           
 she became incapable, she would receive the proper treatment.  At             
 the time, there was no such document.  Dr. Abel recognized that the           
 client understood her illness, and knew that if she became                    
 incapable, she might resist treatment, and would have to be                   
 involuntarily committed.  If, on the other hand, she had signed a             
 declaration such as embodied in HB 318, this could be prevented.              
 Persons with mental illnesses, when stabilized on medication, can             
 make reasonable decisions.  When the illness is out of control, the           
 capacity to make such decisions is gone.  Dr. Abel reiterated that            
 he very strongly supports the bill.  It seems to have good                    
 safeguards for the patient, for the attorney-in-fact, and for the             
 mental health professionals.                                                  
 Number 946                                                                    
 CO-CHAIRMAN BUNDE called on the next witness, Jan McGillivary.                
 JAN MCGILLIVARY stated she would speak as President/CEO of the                
 Alaska Mental Health Association (AMHA), and also on behalf of the            
 Building Bridges Campaign, and the Alaska Mental Health Program               
 Director's Association.  As President of AMHA, she represents 600             
 Alaskans.  These kinds of advance directives are very common for              
 persons suffering from HIV and other grave illnesses.  As President           
 of AMHA, she believes the proposed bill is long overdue.  The                 
 Building Bridges Campaign and the Alaska Mental Health Program                
 Director's Association also strongly support the bill.  Ms.                   
 McGillivary noted that she has an allergy to codeine, and therefore           
 she has a personal advance medical directive on file.  She stated             
 that in her 15 years in the mental health field, she has                      
 encountered many consumers who know they are allergic to certain              
 medications.  The proposed legislation would address that problem.            
 She urged the committee to pass the bill.                                     
 Number 1075                                                                   
 CO-CHAIRMAN BUNDE called on the next witness, Bill Cross.                     
 BILL CROSS, a member of the Mental Health Consumers of Alaska,                
 stated that he was once determined to be mentally "incontinent,"              
 but had recovered from the condition.  He further stated that he              
 supports HB 318, because he is aware that there are some treatments           
 he does not respond well to.  By signing such a declaration, he can           
 help his doctors, by letting them know what he has responded well             
 to in the past.                                                               
 Number 1153                                                                   
 KATHERINE A. JOHNSON, a member of the Alaska Mental Health Board,             
 stated that the board supports HB 318.  The board applauds the work           
 of MCHA in developing this legislation.  The Advance Directives               
 bill extends to consumers of mental health services an important              
 control mechanism over their own treatment.  Control of personal              
 destiny is essential to human dignity.  HB 318 provides a means by            
 which difficult situations may be anticipated and addressed, giving           
 consumers a voice they have previously lacked.  The board joins the           
 mental health community in urging the House Health, Education &               
 Social Services Committee to move HB 318, with favorable                      
 Number 1201                                                                   
 STEVEN ESSLEY, an attorney with the Disability Law Center of                  
 Alaska, stated that the center supports HB 318.  He noted that                
 there may actually be a negative fiscal impact from the bill, since           
 it would preclude the need for an involuntary commitment hearing.             
 The Office of Public Advocacy has said that there are about 180               
 involuntary medication hearings each year.  This bill might also              
 eliminate the necessity for a number of those hearings.  He                   
 reiterated that the Disability Law Center of Alaska supports HB
 Number 1294                                                                   
 BERRY JACK, a consumer with Mental Health Consumers of Alaska,                
 stated he does not have a family which is legal defined by law.  He           
 does have a power of attorney.  This bill would allow him to                  
 complete all avenues of his life.  HB 318 would give him a voice              
 and protect his rights.  He asked that the committee support the              
 Number 1350                                                                   
 ROBIN COE, President of the Board of Directors for the Mental                 
 Health Consumers of Alaska, testified that the proposed legislation           
 was vital.                                                                    
 Number 1375                                                                   
 CO-CHAIRMAN BUNDE asked if anyone else wished to testify regarding            
 HB 318.  Seeing there were no further witnesses, Co-Chair Bunde               
 closed the public testimony on HB 318.  He then asked for questions           
 or comments from the committee.                                               
 REPRESENTATIVE TOM BRICE commented that the proposed legislation              
 was long overdue.                                                             
 REPRESENTATIVE NORMAN ROKEBERG moved that the House Health,                   
 Education & Social Services Committee pass HB 318 from committee,             
 with individual recommendations and a zero fiscal note.  There                
 being no objections, HB 318 was passed out of the House HESS                  

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