Education & Advocacy Track:Parent Advocates

Moving LegislationPresenters:

• Karen H. Perry, Co-Founder and Executive Director, Narcotics Overdose Prevention and Education (NOPE) Task Force, and Member, Rx Summit National Advisory Board

• Gary R. Martin, EdD, Dean of Students, Lynn University, and Vice President, NOPE Task Force

• Charlotte Wethington, MA, Recovery Advocate, Transitions, Inc.

Moderator: Michael C. Barnes, JD, Executive Director, Center for Lawful Access and Abuse Deterrence (CLAAD), and Member, Rx Summit National Advisory Board

Disclosures

• Karen H. Perry; Gary R. Martin, EdD; Charlotte Wethington; and Michael C. Barnes, JD, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– Kelly Clark – Employment: Publicis Touchpoint Solutions;

Consultant: Grunenthal US– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center– Carla Saunders – Speaker’s bureau: Abbott Nutrition

Learning Objectives

1. Identify state laws enacted as the result of parental advocacy.

2. Explain the purpose and components of the Overdose Prevention Act.

3. Describe Casey’s Law for involuntary treatment, as well as its passage, impact and applicability to other states.

Parent Advocates Moving Legislation

Karen H. PerryCo-Founder, Executive Director

NOPE Task Force

Gary R. Martin, Ed.DDean of Students, Lynn University

Disclosure Statement

Karen Perry and Gary Martinhave no financial relationships with proprietary entities that produce

health care goods and services

Learning Objectives

1. Identify state laws enacted as the result of parental advocacy.

2. Explain the purpose and components of the Overdose Death Prevention Act- “Richie’s Law”

3. Describe Casey’s Law for involuntary treatment, as well as its passage, impact and applicability to other states.

Richard PerryAge 21

Florida Hospital Consent to Treatment

Hospital Release Orders

Facts

• In 2013, there were 35,663 unintentional drug overdose deaths in the United States. (Source: Center for Disease Control)

• 2.5 million emergency department visits are attributed to drug misuse or overdose. (Source: Drug Abuse Warning Network (DAWN), 2011 National ED Estimates)

• 26.8% of the people who died from a drug overdose had experienced a prior drug overdose with a hospital visit. (Source: Palm Beach County Sheriff’s Office Overdose Suppression Project 2013)

• 82.3 % of the decedents had a known substance abuse history (Source: Palm Beach County Sheriff’s Office Overdose Suppression Project 2013)

• 51.3 % of the decedents were under the care of a physician (Source: Palm Beach County Sheriff’s Office Overdose Suppression Project

2013)

Heart Attack Victim Care

The first 24 hours following a heart attack are usually spent in a coronary care unit (CCU) or an intensive care unit(ICU).

Where skilled staff will:

•Continuously monitor your heart rhythm •Administer a series of test and blood work•Administer medication as needed •Review patient’s history•Contact primary care and/or cardiac care physicians

Cardiac Care Day Two

If you remain stable after 24 hours

You may be transferred to the "telemetry" floor of the hospital

• Continue to receive care by a cardiac care team.

• Depending upon the severity of the heart attack and how quickly you received treatment, you may be able to go home within two to four days.

Overdose Patient

Treat and Street

Intervention Point

Overdose Death Prevention Act (ODPA)

A bill that requires specific rules that would apply to an emergency care practitioner when the patient suffers a non-fatal unintentional overdose.

ODPA Rules and Procedures

• Proper medical stabilization (detox)

• Substance Abuse Screening Brief Intervention and Referral to Treatment (SBIRT)

ODPA Rules and Procedures

• Notify patient’s primary care physician.

• Notify all patient’s prescribing doctors within last 12 months.

ODPA Rules and Procedures

• Notify the patient’semergency contact or nextof kin.

• Provide materials on addiction treatment, treatment facilities and practitioners.

• Provide local involuntary treatment laws.

HIPAA

The HIPAA law currently indicates that emergency room

physicians may notify next of kin if they feel it important or necessary for survival of the patient.

This linked-document (authored by the U.S. Department of Health and Human Services) provides a summary of the HIPAA Privacy Rule. http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

HIPAA

Federal Register-Volume 65. No. 250 (12-28-2000) Section 164.502(g) – Personal Representatives

“We continue to allow covered entities to use their discretion to disclose certain protected health care information to family members, relatives, close friends, and other persons assisting in the care of an individual, in accordance with 164.510(b). We recognize that many health care decisions take place on an informal basis, and we permit disclosures in certain circumstance to permit this practice to continue. Health care providers may continue to use their discretion to address these informal situations” (p. 82501).

Readmissions

Because Centers for Medicare & Medicaid Services will penalize hospitals that see too many patients return within a month, now is the time to create strategies to avoid readmissions.

Local Overdose Death Data

247 drug overdose deaths in Palm Beach County in the year 2012

• More than Suicides

• More than Homicides

• More than Fatal Car Accidents

Combining and Mixing Drugs

• Multiple contributable drugs found in majority of overdose fatalities

• Average of 2.7 drugs found in overdose cases

81

66

41

231

54

84

11

0

50

100

150

200

250

Cocaine Alcohol OTC Prescription DrugsOnly

Illicit Drugs Only Prescription andIllicit Drugs

Not Toxicology

Nu

mb

er

of

Deced

en

ts w

ith

Dru

g i

n T

oxic

olo

gy

Toxicology FindingsCompiled from 304 Closed Overdose Death Investigations

2

9

78

51

78

69

11

13

02

0

10

20

30

40

50

60

70

80

90

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 90-100 Unknown

Nu

mb

er

of

Deced

en

ts

Years of Age

Decedent's AgeData Compiled from 304 Closed Overdose Death Investigations

82.57%

43.09%

36.18%

22.04%26.64%

20.72%18.75%

51.32%

15.79%

33.22%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

SubstanceAbuseHistory

SubstanceAbuse

Treatment

Drug RelatedArrest

SuicideAttempt

Non-FatalOverdose

MarchmanBaker Act

BipolarDiagnosis

ReceivingMedical

Treatment

PainManagement

Patient

Employed atTime ofDeath

Decedent's HistoryData Compiled from 304 Closed Death Investigations

40.13%

32.57%

67.76%

38.16%

59.87%

48.68%

35.20%

17.43%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Died inMunicipality

Taken to Hospital Died at Home Discovered byFamily

Died While OthersPresent

Others Aware ofFatal Drug Use

Others RecognizedVictim's Distress

Unusual SnoringHeard

Circumstantial VariablesData Compiled from 304 Closed Overdose Death Investigations

Education and Advocacy

Be informed of local issues

Build relationships

Educate Legislators and community partners

Create tool kit for community partners

Attend and provide testimonials at important legislative meetings

Contact Information

Karen H. PerryNOPE Task Force

561-478-1055 x201kperry@nopetaskforce.org

Gary Martin, Ed.D.Lynn University 561-237-7157

gmartin@lynn.edu

Parent AdvocatesMoving Legislation

Charlotte Wethington, MA

Recovery Advocate

Transitions, Inc.

Disclosures

• Charlotte Wethington, MA, has disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Casey’s StoryPassion

Purpose

Matthew Casey Wethington Act for Substance Abuse Intervention

What is Casey’s Law?

• An involuntary

treatment act in

Kentucky for those

who suffer from the

disease of addiction

History of the Act

• Became a law on April 9, 2004

• Became effective July 13, 2004 in

Kentucky

• Inspired by the death of Matthew Casey

Wethington, who died of a heroin

overdose at the age of 23

What does this law provide?

Who can use the law?

• A means of

intervening with

someone who is

unable to recognize

his or her need for

treatment due to their

impairment

• Parents, relatives

and/or friends can

petition the court for

treatment on behalf of

the person who is impaired

First Step

• Obtain the petition from:

– Your local Circuit Court Clerk’s Office –ask for Ask for the Verified Petition for Involuntary Treatment (Alcohol/Drug Abuse) otherwise known as form AOC 700A

– www.caseyslaw.org

Definitions for Completing the Petition

Respondent Petitioner

• The person needing

substance abuse

intervention

• The person seeking

to involuntarily

commit someone

else into treatment

Steps for Completing the Petition

• Step One: Enter the Respondent’s name, address and physical residence

• Step Two: Enter Petitioner’s name, address and physical residence

• Check box that corresponds with Petitioner's relationship to the Respondent

• Step Three: Check box that corresponds with Petitioner's relationship to the Respondent

Steps for Completing the Petition

• Step Four: List the name, address and residence of persons related to the Respondent

• Step Five: Provide all evidence Petitioner has that Respondent has an alcohol/drug abuse issue

• Step Six: Attach additional sheets of paper if needed

Evidence for Alcohol/Drug Abuse

• Witnessing

intoxication

• Witnessing drug use

• Behavioral changes

• Failing drug screens

• Criminal substance

abuse charges

• Theft

• Track marks

• Loss of interest

• Occupational, social

issues

• Admitting

alcohol/drug issue

• Changes in physical

appearance

Steps for Completing the Petition

• Step Seven: Provide all evidence to

support why Petitioner believes the

Respondent is a danger or threat of

danger to self, family or others

• Attach additional sheets of paper if needed

Evidence of Threat

• Respondent has threatened or talked of suicide

• Respondent has threatened or talked of harming others (homicide)

• Respondent is unable to provide basic survival needs (homeless, unemployed)

• History of driving while intoxicated

• Theft (breaking into homes, stealing from others…)

• History of Overdose

Steps for Completing the Petition

• Indicate what length of treatment the Petitioner is seeking

• Involuntary treatment for:

– 60 consecutive days or less

– 360 consecutive days or less

• Sign and date the petition

• Swear before the Court Clerk (staff) that all in the petition is true

• Petition is then presented to a District Court Judge

• The District Court Judge will then decide if there is just cause to continue with the petition

The Final Step in Filing

• By signing the petition, the petitioner

guarantees payment for ALL COSTS

incurred on behalf of the respondent

• This includes but is not limited to the initial

evaluations, transportation and placement

in a treatment program

What Now?

• If the Judge agrees that there is just cause he/she will:

• Set a hearing date

• Order the Respondent to be examined by both a Licensed Physician and a Qualified Health Professional (Psychiatrist, CADC, LCSW, LRN)

** (Most counties require the names of the two evaluators upon filing the petition) **

The Hearing

• The hearing must be conducted within 14

days of the Petition being signed by the

Judge

• The Judge can chose to set the date sooner

if the examinations can be completed

• Or the Judge can extend the hearing date if a

problem with the evaluations arise

• The Respondent will be represented by legal

counsel on the day of the hearing

Summons of Involuntary Treatment

• The Respondent is then notified to attend both examinations and to appear at the scheduled hearing

• The Respondent can request that a Qualified Health Professional (at the Respondents expense) be permitted to witness and participate in their examinations

• The Respondent is also notified that failure to comply with this summons may result in being held in contempt of court

Appointment of Counsel

• A public defender is appointed to

represent the Respondent and is obligated

to represent the desires of the Respondent

Examinations

• The Petitioner is responsible for the cost

and the selection of the two evaluators,

one of which must be a physician

• Have the examination appointments set

when filing the petition

• If the Respondent does not keep the

scheduled appointments he/she can be

held in contempt of court

Examinations

• The Judge may order that the Respondent

be held on a 72 hour hold if he/she feels

the Respondent is in imminent danger

• The Petitioner is responsible for all fees

associated with the cost of evaluations

Certification of Qualified Health Professional

• This form is completed by the professional

completing each examination

• It is then sent to the court no longer than

twenty-four (24) hours prior to the hearing

• This also provides the professional’s

recommendations for treatment

At the Hearing

• The Judge will examine all evidence

including but not limited to:

– Respondent’s testimony

– Petitioner’s testimony

– Examination reports

Judgment and Order for Involuntary Treatment

The Court will be looking for three things:

1. Does the Respondent suffer from alcohol and/or other drug abuse; and

2. Does the Respondent present an imminent threat of danger to self, family or others as a result of alcohol and other drug abuse; and

3. Can the Respondent reasonably benefit from treatment?

Judgment and Order for Involuntary Treatment

• If the Judge feels that all three criteria are

met, then the Judge will order treatment

• Since the Petitioner is responsible for

payment of any ordered treatment, the

Petitioner also chooses where the

Respondent will complete treatment

Judgment and Order for Involuntary Treatment

• The Judge determines who will be

responsible for transportation of the

Respondent to the treatment program

• If the Judge orders the Sheriff’s office to

transport, then the Petitioner may be

responsible for reimbursement to the

Sheriff’s office for the cost of transportation

Noncompliance

• So what happens if the Respondent fails

to complete anyone of these steps?

• The respondent may be held in Contempt

of Court

• Contempt of Court is punishable in jail by

any length of time the Judge sets each

time the Respondent does not complete

the Judge’s orders

Passion + Purpose + Persistence= Power

7

BE

PERSISTENT

5

CREATE

A

PLAN

4

IDENTIFY

YOUR

MISSION

3

FIND

ALLIES

2

DEFINE

YOUR

PURPOSE

1

HONOR

YOUR

PASSION

THE SKY’S THE LIMIT

6

TAKE

ACTION

Charlotte Wethington, M.A.

Recovery Advocate

Transitions Inc.

cwethington@transitionsky.org

http://caseyslaw.org/

https://www.facebook.com/caseywethingtonact