Bill Would Reverse Ruling on Mentally Ill : Health: Patients who are confined against their will would lose the right to refuse certain drugs prescribed by their psychiatrists. The measure has passed the Senate and is pending in the Assembly.

State lawmakers are close to overturning a landmark court decision that gave mentally ill patients confined against their will the right to refuse antipsychotic drugs ordered by their psychiatrists.

The court decision required psychiatrists to receive the informed consent of their patients before medicating them. Except in an emergency, doctors must obtain a judge’s order declaring the patient incompetent to participate in his own medical decisions.

But legislation that has cleared the Senate and is pending in the Assembly would require only a second opinion from a fellow doctor before psychiatrists could force the drugs on their patients.

The measure is sponsored by the California Alliance for the Mentally Ill, a group representing families of the mentally ill. Alliance members, backed by psychiatrists and mental hospitals, say that many patients will be left in shackles or returned to the streets untreated if their doctors cannot medicate them immediately.

But opponents, including advocates for former patients who say they were drugged unnecessarily, contend that the court decision has prompted a healthy change in the way psychiatrists relate to their patients.

At issue is a 1987 appellate court decision that was made final by the state Supreme Court last year.

The case stemmed from the experience of Eleanor Riese, a Bay Area woman who, suffering from chronic schizophrenia, admitted herself to St. Mary’s Hospital and Medical Center in San Francisco in 1985 and agreed to take antipsychotic medication.

After several days in the hospital, Riese complained about the effect of the drugs and refused to take any more. At that point, five hospital staff members held her down while she was injected with the drug Mellaril. Riese was then declared an involuntary patient and forced to take medication until she was discharged.

Riese was the plaintiff in the successful class-action suit filed by patients’ rights advocates in San Francisco.

Writing for the state Court of Appeal, Justice J. Anthony Kline said the forcible use of powerful mind-altering drugs involves “moral and ethical considerations” outside the purview of the medical profession.

To exempt these decisions from outside review, Kline wrote, would “invest physicians with a degree of power over others that cannot be squared with the intent of our Legislature and with the great value our society places on the autonomy of the individual.”

Hospitals and psychiatrists predicted that the decision would cause chaos as patients engaged in a wholesale boycott of medication. But only a relative handful of patients around the state who otherwise would have been drugged against their will have objected and been found by the courts to be competent to resist the medication.

In Los Angeles County, of more than 10,000 people ordered held in mental hospitals since last August, only 233 have filed petitions objecting to their medications, according to the county’s patients’ rights office. Of those, 123 were found to be competent to make their own decisions. The numbers are similar in San Francisco.

But supporters and opponents of the Riese decision say that statistics alone do not tell the whole story.

Grace McAndrews, executive director of the California Alliance for the Mentally Ill, said that, for the sake of due process, some patients who need medication but object to it are being restrained in seclusion while they await their hearings.

“What we are doing is condemning these people to a fate equally as awful or worse than what was occurring in the back wards of the state hospitals in the ‘40s and ‘50s,” McAndrews said. “This is terrible. It is inhumane and cruel.”

The legislation, introduced by Sen. Robert Presley (D-Riverside), would return to psychiatrists almost the same latitude to administer drugs as they had before the Riese decision.

The bill would allow the forcible use of drugs whenever a second psychiatrist concurred that the patient lacked the capacity to make his own decisions. Even if the patient had the capacity, medication could still be administered if the person had been admitted to the hospital as a danger to himself or others.

Patients who continued to resist drug treatment would be entitled to a judicial hearing but could be medicated in the meantime.

The measure, which passed the Senate on a 23-7 vote, is scheduled for a key hearing today in the Assembly Health Committee.

Presley, the powerful chairman of the Senate Appropriations Committee, and Assemblyman Bruce Bronzan (D-Fresno), head of the Health Committee, present a formidable team backing the bill. The Alliance for the Mentally Ill, whose members tell heart-rending stories about their family members’ experiences, also carries great weight in the Legislature.

“We are not trying to coerce,” said Dan Weisburd, president of the Alliance, whose son has been in and out of 20 mental hospitals in the last 10 years. “What we are trying to do is rescue, to free from their psychosis people who are in desperate need.”

Opponents argue that the evidence suggests few patients in need of medication are being deprived. The vast majority either accept the drugs or are medicated without their consent in an emergency.

“The decision has not proven to be disruptive,” said Robert Bunker, a San Francisco lawyer who represents patients. “Why gut it before it has had a chance to fulfill its promise?”

Assemblyman Burt Margolin (D-Los Angeles), the bill’s chief opponent in the Legislature, said too many hospitals and doctors use drugs as a substitute for the time-consuming individual attention that their patients deserve.

“What these hospitals are essentially telling us is that they can’t afford to spend the time with the patient,” Margolin said. “They want a quick-fix, rubber-stamp, involuntary medication procedure because they don’t have the resources to do it.”

Patient advocates contend that the decision’s greatest effect has been on those patients whose cases never reach the courts. To get their informed consent, doctors are talking to them and explaining the need for medication. When they leave the hospital, these advocates argue, the patients are more likely to continue treatment because they have participated in the decisions.

“Before Riese, many involuntary patients came in and they were just zapped with medication,” said Barbara Lurie, director of the patients’ rights office in Los Angeles County. “Nobody really worked with them. Most patients are very savvy about their medication. They know which ones work and which ones don’t. But often their preferences weren’t even listened to.”

The proponents of the Presley bill acknowledge that there were occasional abuses before the Riese decision. But they say the pendulum now has swung too far in the other direction, taking too much authority away from the doctors who are closest to the patient.

“I want the safeguards there to protect them,” Weisburd said. “But the second opinion of a psychiatrist is better than the billable hours of an attorney.”