Legislature(2003 - 2004)
03/05/2003 03:15 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 135-MARITAL & FAMILY THERAPISTS CHAIR ANDERSON announced that the first order of business would be HOUSE BILL NO. 135, "An Act relating to marital and family therapists." Number 0085 The committee took an at-ease from 3:16 to 3:18 pm. [The following paragraph is reconstructed from the sponsor statement and sectional analysis because it was not recorded on the tape.] REPRESENTATIVE PEGGY WILSON, Alaska State Legislature, sponsor of HB 135, stated that the law establishing the Board of Marital and Family Therapy has been in place for 10 years, and it's time to update the language. She said HB 135 will upgrade Alaska laws on marriage and family therapy so they are on a par with other states' laws and are consistent with other forms of counseling services in the state. Section 1 adds the board to the list of boards that may request the Division of Occupational Licensing to contract for substance abuse treatment for licensed therapists. Section 2 authorizes the board to order a licensed marital and family therapist to submit to a physical or mental examination if there is a credible question about the therapist's capacity to practice safely. Number 0123 REPRESENTATIVE WILSON said Section 3 addresses the direct clinical contact time required for licensing. The requirement is changed from three years to 1,500 working hours and allows one-on-one client contact to be counted. Section 4 makes exceptions to the confidentiality rule in two situations: if there is a threat of physical harm to an identified victim or a disclosure to the board regarding unethical or unlawful conduct. Number 0200 REPRESENTATIVE WILSON explained that Section 5 prohibits sexual contact between therapist and client during treatment and for two years after treatment ends. She said this is important because a client in a vulnerable frame of mind could be harmed by a sexual relationship with a therapist. By way of comparison, she said social workers are prohibited from sexual contact with a client for their lifetimes. Section 6 allows the suspension of a license if the therapist refuses the examination ordered under Section 2 of the bill. Section 7 requires a disclosure statement so the client learns in advance some key details of therapy: the fees, the therapist's professional education, and the confidentiality exceptions. Representative Wilson concluded that the section also prohibits a licensed therapist from practicing if the person lacks the appropriate qualifications under the law. Number 0377 REPRESENTATIVE LYNN began discussion of what he would later offer as Amendment 1. He raised a question about the language in the new subsection (5), page 3, lines 29-31, which reads: "(5) a communication to a potential victim or to law enforcement officers where a threat of imminent serious physical harm to an identified victim has been made by a client;". He asked about the use of the word "or" instead of "and" on line 29. He said the therapist should warn both the victim and the law enforcement officer. Number 0400 REPRESENTATIVE WILSON said she would not oppose such an amendment. REPRESENTATIVE GATTO noted that substituting the word "and" for "or" would require that both the potential victim and the police both be notified, never singularly. He said he doesn't think that's the intent of the law. Number 0516 LARRY HOLMAN, Chairperson, Board of Marital and Family Therapy; Immediate Past President, Alaska Association for Marriage and Family Therapy, spoke in support of HB 135. He explained that this bill is the result of a collaboration between the regulatory board, which is charged with protecting the public, and the professional association, which promotes the marriage and family therapist profession. He said it's an unusual collaboration because the interests are different but both groups want to achieve the same results. He said the issue of sexual relationships has not been clearly spelled out in the board's regulations, and that both groups wanted no misinformation or misunderstanding about the ethics of these cases. The groups also wanted to update the initial laws from when therapists were first regulated; today the laws fall short of the standards for other professions both in Alaska and nationwide. He said all of Alaska's other regulatory boards and mental health professions have laws similar to HB 135. He explained that the Board of Marital and Family Therapy supports these inclusions as vital to the protection of the public. The Alaska Association for Marriage and Family Therapy supports HB 135 because its goal is to maintain credibility and high ethical standards for therapists. Each provision derives from years of practice. MR. HOLMAN commented on the possible amendment discussed earlier that would substitute "and" for "or" on page 3, line 29. He said the intent of that language is really to make it clear to someone that there may be imminent serious physical harm. He said "and" is not necessary and "or" is sufficient. Number 0754 VIVIAN FINLAY, Member, Board of Marital and Family Therapy, noted that she is a licensed marriage and family therapist practicing in Wasilla. She said the group's professional ethics prohibit sexual contact between the therapist and the client during treatment and for two years after treatment ends. She said she wanted to make sure that the law is at least as strong as the group's ethical code. If an association ethic is violated, a therapist would lose the state license. In March 2001, the Board of Marital and Family Therapy discussed these changes and resolved to support future legislation. She also commented on the possible amendment regarding notifying a potential victim and law enforcement about imminent harm. Professional standards already require therapists to report serious threats to a potential victim or a law enforcement officer. She suggested leaving the "or" in place because therapists' ethical standards do not require both. Number 0870 REPRESENTATIVE GATTO asked about the liability for not reporting imminent harm. MS. FINLAY said her understanding is that if therapists don't follow state regulations, they can be investigated, and their licenses can be revoked. Number 0905 REPRESENTATIVE LYNN asked Ms. Finlay to confirm that the profession's ethical requirements require reporting to the victim or law enforcement but not to both. He then asked if the profession's ethical standards should be raised to require both. MS. FINLAY confirmed that the association's standards require reporting to one or the other person but not both. She explained that therapists have to do what is most appropriate in the situation. If a person threatens to go home and kill somebody at home, the therapist would likely contact the potential victim. Because no crime has been committed, the therapist doesn't necessarily notify the police, but the person might want to do that as well. Number 0961 CHAIR ANDERSON described a less volatile scenario in which a husband talks about hitting his wife sometime. Chair Anderson suggested that in this circumstance, contacting the wife would be reasonable but contacting the police wouldn't be reasonable. MS. FINLAY said it's a judgment call for the therapist; this is why ethics aren't black and white. Therapists probably wouldn't report that instance because there's no threat of harm happening immediately. REPRESENTATIVE LYNN said he objects to situational ethics. Number 1136 BILL PLATTE, Member, Board of Marital and Family Therapy, explained that therapists are obligated to report imminent threats of harm. He said in his 23 years of experience as a marital and family therapist, every time he's reported, it was to law enforcement. He added that there have been times when reporting to the potential victim would have been problematic. He said he favors the "or" as written in HB 135. CHAIR ANDERSON asked why Mr. Platte wouldn't call the spouse if the other spouse was threatening murder. MR. PLATTE replied, in that specific situation, that he would contact both the threatened spouse and law enforcement. He would do everything in his power to protect the potential victim. Number 1219 REPRESENTATIVE LYNN asked for a hypothetical situation in which Mr. Platte wouldn't contact the spouse. MR. PLATTE explained that he wouldn't contact the spouse in a situation when the potential victim might act inappropriately; in that case, he would prefer to involve law enforcement right away. REPRESENTATIVE GATTO agreed that if the victim decided to retaliate and the therapist didn't act, the therapist would be held liable. CHAIR ANDERSON said the "and" would force the therapist to contact both the potential victim and law enforcement every time, and the therapist could be sued if the person didn't do so. REPRESENTATIVE LYNN said in this kind of dispute, every key person should be notified. It would be a judgment call as to which party was contacted first. Number 1323 CHAIR ANDERSON reviewed the language in question in context of the bill, Section 4, page 3, which addresses confidentiality. The section states that a therapist can never reveal the content of communications with a client except for four reasons plus two additional reasons added by Representative Wilson. The language in question says that the therapist can break that pledge of confidentiality and notify the potential victim, law enforcement, or both, and not be held liable for releasing the information. He pointed out that this section deals with release of information and confidentiality. He said that adding an "and" to this section does not force the therapist to call both parties. MR. PLATTE agreed with Chair Anderson. Number 1419 REPRESENTATIVE LYNN said he would prefer to raise the required reporting from a judgment call to a higher ethical standard. Number 1429 CHAIR ANDERSON reiterated that this section of the bill, which deals with licensure, releases therapists from confidentiality in certain cases. He suggested that required reporting is probably covered in other state law, perhaps in the criminal statutes. Number 1462 REPRESENTATIVE ROKEBERG asked Mr. Platte about the new Section 7 on page 5 that requires a disclosure statement to clients. He inquired whether this statement is already provided by therapists and whether this disclosure would change the relationship with a potential client. He asked several questions about the administrative procedures associated with this disclosure. MR. PLATTE replied that this disclosure is already in place and being used by therapists. Any therapist who does managed care or employee-assistance work already has a form like this. There's nothing in this section that would cause a problem to a potential client, he added. For managed-care clients, a signed copy is already kept in the file. He said following the requirements of this section it would be a minor adjustment. His disclosure form is one page in length. REPRESENTATIVE ROKEBERG asked Mr. Platte to provide the committee with an example of a disclosure statement. Number 1583 REPRESENTATIVE GATTO referred to language on page 5, lines 24- 26, "the Board of Marital and Family Therapy, which regulates all licensed marital and family therapists". He asked if there are marital and family therapists practicing in the state who are not licensed. MR. PLATTE replied that there are unlicensed therapists, but that they are not allowed to call themselves "licensed marital and family therapists." He explained that they can practice counseling in the state, but he didn't think they could call themselves "marital and family therapists." REPRESENTATIVE GATTO disagreed, saying he believes that a person can use the title "marital and family therapist." Number 1657 MR. HOLMAN explained that a person can practice any kind of therapy in Alaska without a license. He said marital and family therapists do not have a "title law." Psychologists do have a title law, and only licensed psychologists can use that title. REPRESENTATIVE GATTO said that answered his question. The unlicensed therapists would not have to provide the disclosure required under this bill. He reflected that there are two separate groups of marital and family therapists, licensed and unlicensed, and many clients will not notice the distinction. Number 1725 REPRESENTATIVE ROKEBERG commented that there are certain occupations that have specific prohibitions against unlicensed people using the titles. For example, the committee looked at HB 9 on home inspectors, which required that a person using that title must meet the provisions of law. He asked why there hasn't been a specific request from licensed marital and family therapists to protect their title. Number 1844 MR. HOLMAN agreed that it's a great idea to protect the title of licensed marital and family therapists. He explained that the board and the association have been focused on provisions of this particular bill for the past several years. He said one of his goals as the chairperson of the board is to begin to look at title protection. One protection in place now for licensed therapists is that people who practice without a license do not qualify for third-party payments and cannot work for managed care. Insurance companies will not pay for unlicensed professionals unless they work under the direct supervision of a licensed professional. CHAIR ANDERSON asked if there have been cases of counselors abusing the title of marital and family therapists. MR. HOLMAN replied that it's not a huge problem. He said several people had their licenses revoked; they continued to practice therapy, but they didn't call themselves marital and family therapists. There is not widespread misuse of the title because the therapist cannot get payment and there aren't that many clients willing to pay for this counseling out of pocket. REPRESENTATIVE ROKEBERG replied to a question from Chair Anderson, saying that he was not going to propose an amendment on the subject of title protection. It might require opening up the entire bill. Number 1939 REPRESENTATIVE WILSON commented that on page 5, line 9, a marital and family therapist may not charge for services unless the person provides the disclosure statement. She said many unlicensed therapists in small communities are qualified but don't pay the $700 licensure fee because of the small number of clients. Number 1982 MS. FINLAY said this clean-up bill and the language quoted by Representative Wilson on page 5, line 9, only apply to licensed therapists. If the person is a member of the Alaska Association for Marriage and Family Therapy, he/she has to be licensed in Alaska, and then must use the required disclosure statement. REPRESENTATIVE GATTO said he is reading this bill to see whether he could become a marital and family therapist without getting a license. Number 2139 CHAIR ANDERSON summarized the committee's intentions on HB 135, saying several committee members indicated they would like to prohibit unlicensed marital and family therapists from practicing but they do not want to initiate the change at this stage of the legislation. Number 2168 REPRESENTATIVE ROKEBERG asked about Section 1 on pages 1-2 of the bill, in which this board can refer licensed persons who abuse alcohol or drugs for treatment. He asked if there's a cost associated with this treatment and, if so, whether there should be a fiscal note attached. REPRESENTATIVE WILSON replied that if the person is in alcohol rehabilitation, the person can be referred to marital counseling. Number 2214 REPRESENTATIVE LYNN reiterated his concerns about reporting imminent harm to the potential victim and the police. Number 2225 REPRESENTATIVE LYNN moved to adopt Amendment 1, on page 3, line 29, in paragraph (5), line 29, deleting "or" and adding "and". Number 2277 CHAIR ANDERSON objected. REPRESENTATIVE WILSON commented that it's important not to put the person doing the counseling in a position of extreme liability. For example, a therapist can always locate the police but may not be able to notify the potential victim. CHAIR ANDERSON explained his objection to the amendment. He applauded the intent of the amendment, which is when serious physical harm is threatened, the potential victim and the police must both be contacted. But, he said, it does not belong in this section of the bill. REPRESENTATIVE LYNN said he is less concerned about the liability to the therapist and more concerned about the harm to a potential victim. If the therapist made a documented effort to contact both, then there would be no liability. A roll call vote was taken. Representative Lynn voted in favor of Amendment 1. Representatives Crawford, Dahlstrom, Gatto, Rokeberg, and Anderson voted against it. Therefore, Amendment 1 failed by a vote of 1-5. Number 2357 REPRESENTATIVE LYNN moved to report HB 135 out of committee with individual recommendations and the accompanying zero fiscal note. There being no objection, HB 135 was reported from the House Labor and Commerce Standing Committee.