Legislature(2003 - 2004)

03/05/2003 03:15 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= 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.                                                                                    

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