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.