Bill Summary for Bill Number SB09-007

Date: 03/02/2009

Final
BILL SUMMARY for SB09-007

HOUSE COMMITTEE ON JUDICIARY

Votes: View-->	Action Taken:
Adopt prepared amendment L.003 (Attachment C). Th Postpone Senate Bill 09-007 indefinitely. The mot Refer Senate Bill 09-007 to the Committee of the W	FAIL PASS FAIL

03:04 PM -- Senate Bill 09-007

Representative Riesberg, sponsor, presented Senate Bill 09-007 concerning making certain duties related to the involuntary commitment process for substance abusers solely the authority of a licensed physician. The bill preempts the implementation of advanced practice nurses certifying or conducting examinations for involuntary commitment of persons who abuse alcohol or drugs. Only licensed physicians have this authority. Last year, the General Assembly passed House Bill 08-1061, which granted advanced practice nurses the authority to sign or accept certain medical documents. The Governor signed the bill into law on March 20, 2008, and provisions go into effect on July 1, 2009. Senate Bill 09-007 would prevent advanced practice nurses from certifying or conducting examinations for the involuntary commitment of persons who abuse alcohol or drugs as authorized by House Bill 08-1061, but other portions of House Bill 08-1061 would go into effect on July 1, 2009. Representative Riesberg discussed prepared amendment L.003 (Attachment C) and stated his belief that the amendment addresses most of the objections that different groups have expressed about the bill.

03:16 PM

The committee conducted a lengthy discussion of the potential problems caused by House Bill 08-1061 that are addressed by Senate Bill 09-007. Representative Riesberg indicated that the bill clears up two areas of confusion with regard to House Bill 08-1061 and the effective date. He responded to questions from the committee about the qualifications of advanced practice nurses to conduct mental health assessments.

03:23 PM -- Mary Ciambelli, Colorado Nurses Association, spoke in opposition to the bill. Dr. Ciambelli provided information of her credentials. She discussed the confusion that can occur in Colorado because statutes separate mental health issues and substance abuse issues. Dr. Ciambelli talked about her experience doing psychiatric evaluations and involuntary commitments. She stated her opinion and that of her colleagues regarding the qualifications of advanced practice nurses to make such a recommendation to a judge regarding involuntary commitment. She responded to extensive questions from the committee. Dr. Ciambelli discussed the level of education required for different levels of nursing. Committee discussion continued.

03:52 PM -- Mary Weber, Colorado Nurses Association, spoke in opposition to the bill. Dr. Weber discussed national educational standards that are accepted by all state boards for advanced practice nurses. Part of the curriculum in these standards include minimum competencies for psychiatric nursing. She indicated that involuntary commitment is a difficult decision to make and no medical personnel makes it lightly. The committee discussed the scope of practice for advanced practice nurses and professional responsibility standards. Dr. Weber responded to questions from the committee about the process of involuntarily committing an individual.

04:08 PM -- Vickers Myers, representing herself, spoke in opposition to the bill. Ms. Myers expressed concern for her juvenile patients if the bill passes. She stated her belief that the bill could decrease her ability to get help for her patients.

04:11 PM -- Fran Ricker, Colorado Nurses Association, spoke in opposition to the bill. Ms. Ricker clarified the position of the Colorado Nurses Association on the bill and on L.003. She stated that the important thing at issue is identifying individuals in critical need of commitment and treatment, as well as protecting public safety. The association feels that advanced practice nurses are qualified and should be allowed to provide medical testimonials at hearings where an individual's civil liberties are at stake. Ms. Ricker talked about discussions about this bill with representatives from the Department of Human Services, Division of Behavioral Health. She expressed support for the review, which is required by L.003.

04:19 PM -- Bill Hanna and Yolanda Gray, Department of Human Services, spoke in support of the bill. Mr. Hanna distributed a fact sheet to the committee (Attachment D) and discussed background issues. He talked about the process of amending House Bill 08-1061 and how it created problems that are addressed by this bill. He responded to questions from the committee about L.003. The committee discussed potential quality of care issues with advanced practice nurses providing services in lieu of a physician doing so. Ms. Gray is the Involuntary Commitment Coordinator for the department. She explained the process and reasons for involuntary commitment. She discussed the licensing of detoxification centers in the state, which do not always employ advanced practice nurse. The detox centers are set up in a non-medical social model. Ms. Gray explained that the Division of Behavioral Health is required to prove by clear and convincing evidence that an individual should be committed. The committee discussed rural access to care issues.

04:53 PM -- Virginia Byrnes Horton, Arapahoe County Attorney's Office, spoke in support of the bill. Ms. Byrnes Horton discussed her background as an attorney. She talked about the process of passing House Bill 08-1061 and problems with existing law. She responded to questions from the committee about the quality of care provided by advanced practice nurses. Ms. Byrnes Horton discussed her preference that a licensed physician recommend involuntary commitment. The committee discussed potential legal issues in other states that allow advanced practice nurses to recommend involuntary commitment.

05:13 PM -- Michael Stafford, Denver City Attorney's Office, spoke in support of the bill. Mr. Stafford discussed his background and qualifications. He stated that he has two concerns. First, some patients will ask for an independent medical evaluation if an advanced practice nurse recommends commitment. If the two medical opinions conflict, he foresees public safety issues. He responded to questions from the committee about the weight of evidence provided by different types of medical professionals. His second concern is the issue of a non-physician taking away an individual's civil liberties without the commission of a crime. He talked about similarities and differences between language in Titles 25 and 27 of the Colorado Revised Statutes, which address the involuntary commitment for alcohol and drug use and mental illness, respectively. The two are essentially the same, although this bill only seeks to amend Title 25. Mr. Stafford is concerned about constitutional problems if one group of people (the mentally ill) may only have their civil liberties restricted by a licensed physician, but another group (those with substance abuse problems) can be committed by an advanced practice nurse.

05:22 PM -- Michael Allen, Colorado Psychiatric Society, spoke in support of the bill. Dr. Allen discussed his background and qualifications. He is not convinced that the system is broken and is concerned that House Bill 08-1061 is an awkward solution. He differentiated between the processes for committing adults and children. He stated that advanced practice nurses are currently involved in the process and the question is whether they can be counted on as expert witnesses. He wants to see evidence that the system is not working for attempts are made to fix it. Also, Dr. Allen does not agree that lower cost is the same as cost effective. He responded to questions from the committee.

05:32 PM -- Jonathan Ritvo, representing himself, spoke in support of the bill. Dr. Ritvo discussed his background and qualifications. He stated his opinion that this is not an access to care issue and stressed that this bill represents a minuscule amount of the total mental health care in the state. He stated that the role of the physician in this process is not to provide care, but rather to induce an individual to seek treatment. Dr. Ritvo supports the notion of advanced practice nurses providing medical opinions about the addiction of a patient to drugs or alcohol, but feels that a physician should make the final call when commitment is involved. The process is very complicated and requires a great deal of medical expertise. He stated that House Bill 09-1061 was a quick solution to a very complicated problem, but it is not the right solution.


BILL:	SB09-007
TIME:	05:40:49 PM
MOVED:	McCann
MOTION:	Adopt prepared amendment L.003 (Attachment C). The motion failed on a vote of 5-6.
SECONDED:	Court
		VOTE
	Apuan	No
	Court	Yes
	Gardner B.	No
	King	Yes
	Miklosi	No
	Pace	No
	Roberts	No
	Ryden	No
	Waller	Yes
	McCann	Yes
	Levy	Yes

Not Final YES: 5 NO: 6 EXC: 0 ABS: 0 FINAL ACTION: FAIL

05:41 PM

Representative Riesberg wrapped up his presentation of the bill. He explained his commitment to continue working on this issue, evidenced by L.003, and asked for a favorable recommendation. Committee members commented extensively about their positions on the bill.


BILL:	SB09-007
TIME:	06:02:32 PM
MOVED:	McCann
MOTION:	Refer Senate Bill 09-007 to the Committee of the Whole with a favorable recommendation. The motion failed on a vote of 4-7.
SECONDED:	Levy
		VOTE
	Apuan	Yes
	Court	No
	Gardner B.	No
	King	Yes
	Miklosi	No
	Pace	No
	Roberts	No
	Ryden	No
	Waller	No
	McCann	Yes
	Levy	Yes

Not Final YES: 4 NO: 7 EXC: 0 ABS: 0 FINAL ACTION: FAIL


BILL:	SB09-007
TIME:	06:03:32 PM
MOVED:	Roberts
MOTION:	Postpone Senate Bill 09-007 indefinitely. The motion passed on a vote of 10-1.
SECONDED:	Waller
		VOTE
	Apuan	Yes
	Court	Yes
	Gardner B.	Yes
	King	Yes
	Miklosi	Yes
	Pace	Yes
	Roberts	Yes
	Ryden	Yes
	Waller	Yes
	McCann	Yes
	Levy	No

Final YES: 10 NO: 1 EXC: 0 ABS: 0 FINAL ACTION: PASS