Here I am again at the legislature.  This time its the House Health Committee.  Senate Bill 16 concerns the question of whether an advance health care directive can be used to involuntarily hospitalize a person with dementia for the purpose of providing psychiatric treatment. 

Dr. Maureen Nash is the person who brought this issue to the legislature.  She says that there is a tsunami of people with dementia coming to Oregon as we age.  There will be a 90% increase in occurence of dementia in the first 25 years of this century.  Many may need psychiatric care.  She says that sometimes family members present health care proxies so that they can admit a loved one with dementia to Dr. Nash's hospital for psychiatric treatment.  But the lawyers for Dr. Nash's hospital (Tuality) say that the law does not allow a health care representative to place a person with dementia in the hospital for treatment.  The person with dementia is often unaware of the need for treatment.  This means a person must go through civil commitment or a guardianship proceeding.

Rep. Greenlick wants to know why the bill doesn't just eliminate the provision of the law that does not permit an advance directive to be used to commit a person to a psych hospital.  Dr. Nash says dementia is different from severe and persistent mental illness.

A citizen testifies that his wife appointed him to be her health care representative.  His wife had an early onset of dementia and he was unable to admit her to Tuality Hospital because of the exclusion of mental health treatment.  He finally obtained a guardianship so that he could make this type of decision.

Dr. Tina Kitchin from DHS testifies that she worked on the advance directive laws that were passed in 1993.  She notes that it is complicated and many different perspectives were involved.  She says that dementia was very much in mind to those who crafted the law.  The law was designed to be empowering for those who wanted some control over their lives.  She was surprised when she heard that some hospitals believe that they don't have the authority to admit someone with dementia for psychiatric care.  Recently raised concerns are being addressed by amendments.

 Oops!  I'm being called up to testify.

Well, I put in my two cents along with David Nebel who was representing the Elder Law Section of the Oregon State Bar.  Rep. Greenlick wants to get rid of the prohibition of using the health care directive to put a person in a psych hospital.  I said that this will be threatening to many people with mental illness but that if he tries to do it, he should make sure that the directive contains clear information that it may be used for that purpose.   More to come soon on this.