HOUSE BILL REPORT
HB 1197
BYRepresentatives Brekke, Winsley, Brooks, Appelwick, Kremen, Leonard, Phillips, P. King, Braddock, H. Sommers, Ferguson, Moyer, Bristow, Inslee and Raiter
Regulating the administration of antipsychotic medications.
House Committe on Human Services
Majority Report: The substitute bill be substituted therefor and the substitute bill do pass. (10)
Signed by Representatives Bristow, Chair; Scott, Vice Chair; Moyer, Ranking Republican Member, Anderson, Brekke, Leonard, Padden, Raiter, Tate and Winsley.
Minority Report: Do not pass. (1)
Signed by Representative Hargrove.
House Staff:John B. Welsh, Jr. (786-7133)
Rereferred House Committee on Appropriations
Majority Report: The substitute bill by Committee on Human Services be substituted therefor and the substitute bill do pass. (26)
Signed by Representatives Locke, Chair; Grant, Vice Chair; H. Sommers, Vice Chair; Silver, Ranking Republican Member; Youngsman, Belcher, Bowman, Braddock, Brekke, Bristow, Dorn, Ebersole, Hine, Holland, May, McLean, Nealey, Padden, Peery, Rust, Sayan, Spanel, Sprenkle, Valle, Wang and Wineberry.
House Staff: Maureen Morris (786-7136)
AS REPORTED BY COMMITTEE ON APPROPRIATIONS FEBRUARY 17, 1989
BACKGROUND:
Currently there is no statutory process defining the rights of mental health patients who are in state custody regarding the involuntary administration of antipsychotic medication.
The State Supreme Court in Harper vs. State issued an unanimous decision on July 7, 1988 which recognized the fundamental right of mental patients in state custody to refuse antipsychotic medication. This right is encompassed in the right of individuals to refuse medical treatment and the fundamental liberty interest in ensuring that an individual's bodily integrity is not invaded without consent.
However, the court further held that this right could be over ridden by a compelling state interest in the preservation of life. In this regard, a judicial hearing is required, and the court must decide by clear, cogent and convincing evidence whether a compelling state interest to administer antipsychotic medication exists, and whether the administration of this medication is both necessary and effective.
The Court ruling overturned a state policy which provided for an informal administrative hearing before a committee of state hospital officials whenever a patient refused to take a prescribed medication.
SUMMARY:
SUBSTITUTE BILL: Antipsychotic medication is defined to include a class of drugs used to treat serious mental illness associated with thought disorders.
A person in state custody is accorded a right to refuse the administration of antipsychotic medication, including shock treatment, unless ordered by a court upon a showing by clear, cogent and convincing evidence that there exists a compelling state interest that justifies it. The medication must be both necessary and effective, absent other less intrusive medical treatment which is likely to be effective.
If the patient is unable to make a rational informed decision, the court shall make a substituted judgment.
The person is required to be present at the hearing, and has the right to be represented by an attorney, to present evidence, cross-examine witnesses, proceed by the rules of evidence, remain silent, inspect all papers, and receive reasonable notice of any hearing.
The court is authorized to appoint a psychiatrist, psychologist or physician to testify on behalf of the person. Antipsychotic medication may be administered before the court hearing in an emergency where the person presents an imminent likelihood of serious harm and medically acceptable alternative treatment is not available or effective.
Administration of these medications on an emergency basis falls within the qualified immunity from legal liability granted to public and private officials pursuant to law.
The person must have a medical evaluation within 24 hours of admitting to an evaluation and treatment facility done by either a physician who may be assisted by a physician assistant, and a mental health professional, but the physician -patient privilege shall be waived on the issue of antipsychotic medication.
Gender specific terminology is deleted.
SUBSTITUTE BILL COMPARED TO ORIGINAL: Initial medical evaluations of mental patients may be done by physician assistants assisting the physician; and the court may appoint a psychologist practicing within the scope of practice to evaluate a patient to determine the appropriateness of antipsychotic medication. A court order for the administration of antipsychotic medication is effective from the hearing through any subsequent ninety day treatment period, but the court may review, upon request, the appropriateness of the medication order. These provisions are made applicable equally to minors. An emergency clause is added.
CHANGES PROPOSED BY COMMITTEE ON APPROPRIATIONS: None.
Fiscal Note: Available.
Effective Date:The bill contains an emergency clause and takes effect immediately.
House Committee ‑ Testified For: (Human Services) Robert Stier, Washington Association of Prosecuting Attorneys; Josephine Moore, Fairfax Hospital; Cliff Webster, Washington State Medical Association; Chris Dagadakis, Washington Psychiatric Association and Harborview Medical Center; Pat Thibaudeau, Washington Community Mental Health Council; William Salen, King County Public Defenders Association Civil Commitment Division; Greg Vigdor, Washington State Hospital Association; Annabelle Fisher, Department of Social and Health Services (with reservations) and Eleanor Owen, Washington Alliance for the Mentally Ill (with reservations).
(Appropriations) Pat Thibaudeau, Washington Community Mental Health Council.
House Committee - Testified Against: (Human Services) None Presented.
(Appropriations) None Presented.
House Committee - Testimony For: (Human Services) This legislation is necessary in light of the Supreme Court decision in order to implement new procedures for the administration of antipsychotic medication upon the refusal of a patient in state custody to consent. The emergency administration of these medications is also appropriate where there is an imminent likelihood of serious harm. However, the emergency administration of antipsychotic medication prior to hearing may violate the holding of the Supreme Court. In such circumstance the harm should be at least physically life-threatening. Judges should not make any substitute judgment on behalf of a patient who has evidenced a decision not to consent, however rational or informed.
(Appropriations) This bill is necessary for humane treatment of the mentally ill.
House Committee - Testimony Against: (Human Services) None Presented.
(Appropriations) None Presented.