Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-5298

Title:

AN ACT CONCERNING ELECTROCONVULSIVE THERAPY.

Vote Date:

4/2/2013

Vote Action:

JFS to Judiciary

PH Date:

2/20/2013

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

The bill adds to the procedure requirements before a patient can be administered electroconvulsive therapy (ECT) without informed consent.

The bill substitutes the term “electroconvulsive therapy” for “shock therapy” throughout the statutes and revises the definition of electroconvulsive therapy to reflect current practice. Additionally, the bill requires that probate hearings authorizing ECT be conducted under similar procedures as involuntary commitment hearings. The bill would 1) require two impartial, court-appointed physicians (including one psychiatrist) to examine the patient and report to the court; 2) specify that the patient is entitled to court-appointed counsel, if indigent; and 3) require the applicant to prove the existing standard by clear and convincing evidence, rather than a preponderance of the evidence, by law, for the court to authorize ECT without a patient's consent, it must find that the patient is incapable of informed consent and there is no other, less intrusive beneficial treatment.

RESPONSE FROM ADMINISTRATION/AGENCY:

Representative Sandy Nafis and Senator Paul Doyle: Submitted testimony in support of the bill. To allow this act to be performed without their consent is unacceptable and inhumane. I received information from a constituent that has had personal experience receiving Electroshock therapy. He and his family decided not to agree to Electroshock therapy, after viewing footage and lecture on the subject. However, his physicians along with the Probate Judge agreed that the Electroshock would be the best treatment for him. As a result he has experienced far more emotional issues.

Judge Paul J. Knierim, Probate Court Administrator: It is my view that the existing statute adequately addresses the concerns that underlie this bill and, further, that the bill would inadvertently preclude treatment of patients who are not capable of giving informed consent.

Section 17a-543 addresses the rights of patients in facilities for the diagnosis, observation and treatment of persons with psychiatric disabilities. Informed consent of the patient is a prerequisite to treatment. Section (c) already precludes the administration of shock therapy without the patient's informed consent. The sole exception arises when the patient lacks the capacity to give informed consent. It is only when the patient lacks the ability to give that consent that the option of a court order becomes possible. This very narrow exception results in less than one hundred applications statewide in a given year.

NATURE AND SOURCES OF SUPPORT:

Kirk W. Lowry, Legal Director; The Connecticut Legal Rights Project: The Connecticut Legal Rights Project supports the bill. We do have concerns about due process, burden of proof, effective assistance of counsel, access to and opportunity to present effectiveness evidence, full written standards for the risks and benefits of Electroconvulsive Therapy (ECT) for each specific patient, access to independent psychiatrists knowledgeable in ECT procedures and the detailed risks and benefits of ECT, access to cognitive functioning and /or neuropsychological reports for each patient establishing a baseline and cognitive deficits after ECT, and whether a special conservator with knowledgeable of ECT should be appointed as a surrogate decision-maker instead of by court order alone.

Stephen Mendelsohn, Member, Second Thoughts Connecticut: I strongly support the bill. The bill seeks to protect the rights of people to refuse electroshock therapy, which is a controversial and brain-disabling psychiatric intervention. We should strive for fully informed, un-coerced consent, and I urge the committee to consider strengthening this legislation to include “un-coerced” in Connecticut General Statutes Section 17a-543.

Kelly Roman, Executive VP; Fisher Wallace Laboratories: Despite Electroconvulsive Therapy (ECT) as a “last resort” therapy option, most psychiatrists fail to exhaust non-invasive treatment options before turning to ECT. Specifically, psychiatrists often fail to treat patients with Cranial Electrotherapy Stimulation (CES) or Transcranial Magnetic Stimulation (“TMS”) prior to prescribing ECT, CES and TMS are easily accessible, non-invasive brain stimulating technologies and cause no serious side effects. It is important that the bill emphasize that before ECT is used to treat a patient – whether voluntarily or involuntarily –psychiatrists should, in nearly all cases, attempt to treat patients with CES and TMS. Both treatments are cleared by the FDA for the treatment of depression and neither cause seizures or memory loss.

Christopher Dubey: Provided testimony on his personal experience of undergoing involuntary electroshock therapy by probate court order. After being lectured and watching an informational video, I objected to electroconvulsive therapy (also known as ECT). However, the probate judge sided with the psychiatrists, including one hired by my family. In my long history of psychiatric treatment, I have learned that medical records are never entirely accurate. I would like to let the committee know that the reason opponents of electroshock prefer not to use the phrase “electroconvulsive therapy” is because many of us feel that the phrase is a medical euphemism for a treatment that isn't necessarily therapeutic.

Catherine D. Ludlum, Second Thoughts Connecticut: I strongly support the proposed bill.

I have been working in the disability field for over 25 years. It seems like common sense that such a life-altering procedure should only be done with fully informed and no coerced consent of the consent of the individual. This legislation would go a long way toward ensuring that people have the right to refuse or to accept Electroshock.

In 2000, the National Council on Disability issued a report with recommendations that came directly from the people who testified sharing their first hand experiences with the psychiatric system. The foremost change stated repeatedly was to eliminate the coercion from mental health services.

Michael Chavin, M.D: Provided testimony regarding his personal experience as an anesthesiologist who assisted psychiatrists in 2,000 Electroshock procedures. The realization that assisting with procedure was in total violation of my pledge as a doctor to uphold the Hippocratic Oath to “do no harm”. That psychiatrists' insensitive and uncaring thirst to shock their patients in often assembly line fashion, amount to no less than medical masquerading as medical care.

James Gottsetin, Esq, CEO & Pres; Psychiatric Rights, Law Project for Psychiatric Rights, Inc. (PsychRights): Supports HB 5298 and provided detailed information, citing electroshock therapy as being a barbaric procedure that should never be forced on anyone.

The legitimate scientific evidence is overwhelming that electroshock is neither safe nor effective. There have been no studies showing anything but short term benefit while overwhelming evidence shows electroshock causes brain damage, including memory and cognitive losses in everyone.

David McCannon, Joe Lee, Naomi Pinson, Laura Borst, Lennard J. Davis, Florence Miller, and Hayley Quinn: all provided testimony in support for banning forced electroshock therapy (ECT). Some shared stories of their personal experiences with ECT.

John Breeding, Ph.D: I am in strong support of the proposed legislation. I am a psychologist in Texas, where forced electroshock has been illegal since 1993. The humane thing in Connecticut is to do the same by passing the bill.

Lucy Johnstone: I am a Consultant Clinical Psychologist in the UK. My objections to using Electroconvulsive Therapy (ECT) are based on my many years working with service users who have without exception had reasons for their depression which could not be addressed by electroshock. In many cases ECT was a significant extra trauma and compounded their feelings of shame, failure and abuse. The use of ECT is not helpful and actively damaging, both physically and psychologically.

Scott Elder, Vice President, Electromedical Products International, Inc.: Provided testimony on a product that they manufacture called the Alpha-Stim CES device that is a safe and effective alternative treatment option for anxiety, depression and insomnia.

NATURE AND SOURCES OF OPPOSITION:

Harold I Schwartz, M.D, Psychiatrist-in-Chief; Institute of Living & V.P.; Behavioral Health at Hartford Hospital: Provided testimony in opposition to the proposed bill. Electroconvulsive therapy (ECT) is a long established and important treatment option for the treatment of some of the most severe psychiatric conditions. Electroconvulsive Therapy (ECT) is an evidence based treatment that is highly effective and delivered in a safe and humane manner. ECT today is delivered in the equivalent of a surgical recovery room. The typical ECT patient is a severely depressed (often psychotically depressed and suicidal) patient who has failed to respond to multiple medication trials. Such patients have no other options for treatment. Some will die without this treatment of last resort. Their lack of capacity to consent is functionally the same as a refusal. Their condition requires a review by probate court and a decision to administer ECT ordered by the court.

We have one or two new cases from Connecticut Valley Hospital per month. These patients are among the most chronically and severely mentally ill in the State. Many have had life threatening reactions to medication and cannot be treated with anti-psychotic medications and lack the competence to consent to ECT. They receive monthly maintenance Electroshock Therapy (ECT) by court order and without it; they would have no treatment options of any kind. Their psychosis would remain untendered, their behavior often unmanageable, and their lives even bleaker than they need to be.

Reported by: Virginia Monteiro

Date: April 17, 2013