Honolulu, Hawaii

                , 2019


RE:   H.B. No. 1221

      H.D. 1





Honorable Scott K. Saiki

Speaker, House of Representatives

Thirtieth State Legislature

Regular Session of 2019

State of Hawaii




     Your Committee on Health, to which was referred H.B. No. 1221 entitled:




begs leave to report as follows:


     The purpose of this measure is to amend the definitions of "dangerous to others" and "dangerous to self" to include the refusal to take medication or undergo mental health treatment necessary to help prevent self-inflicted violence and violence to others.   


     The Department of the Attorney General, Department of Health, and Hawaii Disability Rights Center testified in support of this measure.  Kaiser Permanente commented on this measure.  


     Your Committee notes the concerns of the Department of Health in its written testimony on this measure that while this measure's proposed revisions to the definitions of "dangerous to other" and "dangerous to self" to include refusal of mental health treatment may be well intended, these revisions may have a significant impact on the implementation of emergency admission, emergency end involuntary hospitalization.  Refusal of treatment alone is not sufficient to establish dangerousness.  The refusal of treatment must be sufficiently associated with causing an elevated risk of danger.  Your Committee agrees with the Department of Health in deferring to the Department of the Attorney General for proposed language establishing a link between refusing treatment and dangerousness.


     Accordingly, your Committee has amended this measure by:


     (1)  Amending the definitions of "dangerous to self" and "dangerous to others" to specify that refusal of medication or mental health treatment is considered to be "dangerous" only if dangerous behaviors will predictably result when the person does not receive medication or mental health treatment;


     (2)  Clarifying that the refusal only applies to psychiatric medication;


     (3)  Amending the definition of "dangerous to self" to apply only to refusal of psychiatric medication, and expanding the definition to include persons suffering from serious mental illness; and


     (4)  Changing its effective date to July 1, 2050.


     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1221, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1221, H.D. 1, and be referred to your Committee on Judiciary.



Respectfully submitted on behalf of the members of the Committee on Health,