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Minutes for HB2704 - Committee on Children and Seniors
Short Title
Requiring written informed consent before administering an antipsychotic medication to an adult care home resident.
Minutes Content for Tue, Mar 20, 2018
The Chair opened the hearing on HB 2704.
Staff Kyle Hamilton briefed the committee by giving detailed information surrounding the use of anti-psychotic drugs for patients in adult care homes. He noted specific definitions, policies pertaining to a patient's rights to deny receiving medication, verbal and written consent issues, and requirements of a guardian caring for a resident.
Representative Gallagher, District 23, introduced HB 2704 out of concern for the safety and well-being of persons with dementia residing in care homes who are being given anti-psychotic medication inappropriately. She noted that in seventeen double-blind studies, usage of these medications has identified a nearly double increase in mortality in older adults; many other maladies contribute to the diminished quality of life. Representative Gallagher concluded her remarks saying passage of this bill could result in informed consent becoming a best practice in the care of many elder Kansans (Attachment 4).
Steve Gieber, who has worked in direct field service with people having a mental illness, reported the current practice in nursing and adult care homes appears to disregard many of the safeguards available to patients. He reported finding alternatives such as drug holidays to help minimize the strong impact on a person's health. Mr. Gieber advocated for people to be aware of possible side effects and to sign written consent in the use of chemical restraint (Attachment 5).
Barbara Hickert, the Kansas State Long-Term Care Ombudsman, spoke as a proponent of HB 2704. She agreed that the bill includes a person's right to be fully informed and to be free to refuse treatment with undesired drugs. Ms. Hickert also addressed the issue of retaliation and threats of discharge from a care home in the event of refusal of anti-psychotic medication (Attachment 6).
Mitzi McFatrich addressed the committee by stating what the bill does and does not provide. She noted that Kansas ranks the 50th worst among states for reducing the overuse of anti-psychotic medication; noteworthy nationally Kansas ranks of first for not using physical restraints. Ms. McFatrich advocated for informed written consent to be the current standard of care for a resident in a nursing facility or care home (Attachment 7).
Rocky Nichols, speaking on behalf of Mike Burgess, a proponent of HB 2704, addressed possible changes to include all nursing facilities and those for mental health, and a limitation to the number of times emergency exceptions can be used in succession when dealing with unacceptable behaviors (Attachment 8).
Karla Benkula shared the story of her mother's experience as a resident in a nursing home. Ms. Benkula followed the downward spiral of care and subsequent failing capacity her mother experienced while being given anti-psychotic medications; Ms. Benkula was not informed of this action nor had she given consent for its use for her mother. She stressed the need for HB 2704 to be passed to help ensure the rights of individuals are adequately protected (Attachment 9).
Written Only testimony as Proponents of HB 2704 was submitted by:
Jessica Lucas, Citizen (Attachment 10).
Margaret Farley, Member, Kansas Trial Lawyers Association (Attachment 11).
Charlene Wagner, Olathe, Kansas (Attachment 12).
Lisa Van Dusen, Wichita, Kansas (Attachment 13).
Sean Gatewood, Co-Administrator, KanCare Advocates Network (Attachment 14).
Vignesh Ganapathy, Policy Director, American Civil Liberties Union, Kansas (Attachment 15).
Rachel Monger, speaking as an opponent to HB 2704, referred to a graph showing average national data in the use of antipsychotic medication in nursing homes. She reported that the reduction in usage was declining until 2016 when the reported rates spiked. Ms. Monger listed several reasons for the increase, saying that Medicaid funding cuts, backlogs of the eligibility system, an increase in fines and additional federal nursing home regulations contributed to the factors behind antipsychotic use in nursing care homes. She requested the Committee consider allowing an in-depth study of the complexity of drug usage and develop recommendations, as well as action plans, to alleviate future inappropriate antipsychotic drug use (Attachment 16).
Chad Austin, an opponent to the bill, said there is very little to address the core issue of ensuring antipsychoric medications are administered appropriately in adult care homes. He noted that Centers for Medicare and Medcaid Services (CMS) have regulations that require each resident's drug regimen be free from unnecessary drugs. Mr. Austin advised the committee to consider requesting further study of this issue (Attachment 17).
Rachelle Colombo, holding a position in opposition to HB 2704, spoke to the issue of informed consent related to the prescribing of antipsychotic medications to persons in adult care homes. Both Kansas and Federal laws require residents to be fully informed of the risks and benefits of any proposed medication and care. She requested having a stakeholder group be convened for additional discussion and study (Attachment 18).
Written Only testimony as Neutral was provided by Linda MowBray, Kansas Health Care Association and Kansas Center for Assisted Living (Attachment 19).
Written Only testimony as Opposition was provided by:
Vicki Whitaker, Executive Director, Kansas Association of Osteopathic Medicine (Attachment 20).
Carolyn Gaughan, CAE, Executive Vice-President, Kansas Academy of Family Physicians (Attachment 21).
The hearing on HB 2704 was closed.
