STAND. COM. REP. NO. 760

                                   Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 1032
                                        S.D. 1



Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committees on Health and Human Services and Ways and
Means, to which was referred S.B. No. 1032 entitled: 

     "A BILL FOR AN ACT RELATING TO INVOLUNTARY PSYCHIATRIC
     TREATMENT,"

beg leave to report as follows:

     The purpose of this administration measure is to require the
Director of Health to adopt rules to enable interdisciplinary
clinical review panels to authorize the involuntary
administration of psychotropic medication for appropriate
patients at the state hospital at Kaneohe.

     Your Committees received testimony in support of this
measure from the Department of Health (DOH), Hawaii Psychological
Association, Hawaii Psychiatric Medical Association, Mental
Health Association in Hawaii, Hawaii Medical Association, Nami
Oahu, and three private citizens.  Testimony in opposition was
received from the Office of the Public Defender, United Self-
Help, and two private citizens.

     This measure is intended to alleviate mental illness and
restore competency while protecting the rights of patients.  Your
Committees desire that the administrative rules contain adequate
safeguards to ensure that medications are administered in
accordance with proper medical standards.

     Your Committees wish to recommend the following to the DOH:


 
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     (1)  That in the process of adopting administrative rules,
          the DOH collaborate and consult with the Mental Health
          Association of Hawaii, Nami Oahu, United Self-Help,
          Office of the Public Defender, Hawaii Psychiatric
          Medical Association, Mental Health Consumer Sandwich
          Group, Hawaii Psychological Association, Hawaii Medical
          Association, Healthcare Association of Hawaii, and
          individual mental health consumers and advocates; and

     (2)  That the DOH include as members of the
          interdisciplinary clinical review panels the clinical
          director of the facility in which the patient is
          committed, a psychiatrist, an allied mental health
          professional other than a physician, a mental health
          consumer, and a mental health advocate.

     Though not required by this measure, the DOH is strongly
urged to adopt rules for the Hawaii State Hospital and for other
in-patient psychiatric facilities regarding informing patients of
their rights about psychiatric medication and its effects,
including means of handling patients who refuse medication.

     Your Committees note the testimony of the Office of the
Public Defender and wishes to emphasize the comments about the
adverse side effects of prescription medication administered to
psychiatric patients, including the new anti-psychosis drugs.
Your Committee is concerned about the comment, "Thus, these
patients who are committed to the state hospital are faced with a
choice of receiving such medication and endure the side effects
for the benefit of controlling their mental illness."  Your
Committees believe that the right of patients to refuse
medication must be protected as a right to privacy under Hawaii's
Constitution.

     Your Committees have amended this measure by:

     (1)  Clarifying in section 2 of the measure that the new
          section is to be added to part III of chapter 334,
          Hawaii Revised Statutes (HRS), relating to the state
          hospital;

     (2)  Adding "in-patient psychiatric facilities", examination
          for physical or mental disease, disorder, or defect,
          and criminal commitments to the new section 334-   (a),
          HRS, relating to authorization of involuntary
          administration of medication, in section 2 of the
          measure;


 
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     (3)  Clarifying that the appeals process is to a "separate
          panel" instead of a "second body";

     (4)  Combining the new section 334-   (b) and (c), HRS,
          relating to final order and appeals, into one new
          subsection;

     (5)  Clarifying that the administrative process established
          by the rules is not to be construed as a contested case
          under chapter 91;

     (6)  Requiring counsel paid by the State to be provided to
          patients who are subject to involuntary
          hospitalization;

     (7)  Requiring the DOH to report to the Legislature each
          year before the convening of the legislative sessions
          of 2000, 2001, and 2002; 

     (8)  Repealing the Act on June 30, 2002 and reenacting
          current statutory provisions; and

     (9)  Making technical, nonsubstantive amendments for clarity
          and to reflect preferred drafting style.

     As affirmed by the records of votes of the members of your
Committees on Health and Human Services and Ways and Means that
are attached to this report, your Committees are in accord with
the intent and purpose of S.B. No. 1032, as amended herein, and
recommend that it pass Second Reading in the form attached hereto
as S.B. No. 1032, S.D. 1, and be placed on the calendar for Third
Reading.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committees on Health and Human
                                   Services and Ways and Means,



____________________________       ______________________________
CAROL FUKUNAGA, Co-Chair           SUZANNE CHUN OAKLAND, Chair



____________________________
ANDREW LEVIN, Co-Chair

 
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