Bill Regulating Drugging of Mentally Ill Loses Out

Persistent attempts by a powerful lawmaker to make it easier for psychiatrists to administer anti-psychotic drugs to mentally ill patients ended early Saturday morning as time ran out on the Assembly’s 1989-90 session.

The abrupt and dramatic finish short-circuited a year of debate on a little-noticed issue that has troubled the mental health community and bitterly divided advocates for the mentally ill.

The struggle, and the back-room intrigue that accompanied it, aptly demonstrated the maxim that in the Legislature, no bill is dead until the session is adjourned.

Assemblyman Bruce Bronzan, a Fresno Democrat, was seeking a final floor vote on his bill just after midnight Friday when Assembly Speaker Willie Brown announced that Bronzan’s measure and all other non-emergency bills were dead for the year. Only urgency measures requiring two-thirds votes could be acted on after the Legislature’s midnight deadline.

The failure of Bronzan’s measure left intact a state Appellate Court decision that gave mentally ill patients who are involuntarily hospitalized in non-emergencies the right to refuse medication ordered by their doctors unless the patients are found to lack the mental capacity to participate in their own treatment.

Psychiatrists, hospitals, county mental health directors and a group representing families of the mentally ill sought to overturn the court’s decision. They argued that the ruling was bad for patients because in many cases patients are forced to wait for medication until after a court hearing is held to assess their condition.

But civil rights groups, professional patients’ advocates and some former patients contended that it was worth delaying medication for some patients to avoid unnecessarily drugging people who were stable enough to decide the issue for themselves.

The contest pitted Bronzan, an influential lawmaker who is often mentioned as a possible heir to Speaker Brown, in a personal struggle against fellow liberal Burt Margolin, a Los Angeles Democrat with close ties to civil libertarians.

The complex matter came down to a single question: What standard of proof should be used to determine whether patients have the capacity to determine their medical destinies?

Margolin argued that doctors should be required to present “clear and convincing evidence” that a patient was incapacitated, a relatively difficult standard of proof, but one that is now in place and met in 98% of the cases. Bronzan offered a method that Margolin feared would have allowed involuntary medication when only a “preponderance of evidence” was presented to show that the patient was incapable of participating in treatment decisions.

In the final week of the session, the two lawmakers tried in vain to reconcile their differences. Twice in one day, Bronzan declared the issue dead, and the patients’ advocates relaxed, only to see the matter rise again.

By the last day, Bronzan and Margolin each had a bill poised for final passage. Bronzan’s Senate allies amended his solution into a bill on the Senate floor, where it was approved and sent to the Assembly. Friday morning, Margolin and Assemblyman John Burton (D-San Francisco) amended their proposal into a bill on the Assembly floor and sent it to the Senate. That measure died without a vote in the upper house under fire from a heavy lobbying effort by hospitals and psychiatrists.

All Friday evening, as the Legislature rushed to adjourn, Bronzan repeatedly tried to take up his measure on the Assembly floor. Time after time, Burton protested. Each time, Speaker Brown passed over Bronzan’s measure to avoid a lengthy debate that would delay action on scores of other pending bills.

As the clock pushed toward midnight, Bronzan again sought a vote. Burton rose to speak and delayed proceedings just long enough. When the debate ended, Brown declared that the time was 12:02, and no action on the measure could be taken.

Afterward, Bronzan complained that the impasse would harm patients who often will be left in isolation and then taken in shackles to court for hearings on their mental capacity. “It’s a humiliating, embarrassing and inhumane way of doing this,” he said.

Margolin denied that patients would be mistreated. If the state goes too far in restricting the ability of patients to resist medication, he said, “We run the risk of doing serious injury to their health and brutalizing those people in a way that no civilized society should.”