Fax from Albany
September 26, 2003
Board Members, Affiliate Executive Directors, Interested Parties
Joseph A. Glazer, Esq., President/CEO
(518) 434-0439 ext. 20
PATIENT PROTECTIONS VETOED: Citing a myriad of reasons, Governor
Pataki vetoed legislation on Monday that would have provided additional
information on the administration of Electroconvulsive Therapy (ECT),
otherwise know as shock-treatment, here in New York. Rather than responding
to the calls from ECT patients and mental health consumers for additional
information about ECT, Governor Pataki took the advice of medical professionals
and hospitals that currently administer the procedure without any governmental
regulation, that the state need not monitor the administration of ECT.
an analysis of the veto, supporters, including MHANYS, identified numerous
flaws in the Governor’s rationale for vetoing this bill. A couple
of examples include:
- The Governor based his decision to veto the bill upon the advice
and recommendations of ECT providers and family members. However,
not a single consumer/survivor/ex-patient advocacy group supported
the veto of this legislation.
- The Governor’s veto message states that, “There is
no clinical or scientific basis upon which to target ECT for special
reporting.” However, the Food and Drug Administration classifies
ECT devices as Class III pre-market approval/experimental devices
that show an unreasonable risk of illness or injury.
- The Governor’s veto message states that, “ . . . most
ECT procedures are carried out either in state facilities or in hospitals
licensed by the Department of Health (DOH).” However, state
agency records and estimates made by ECT experts here in New York
vary by thousands of patients. In fact, no one really knows how many
people receive ECT, which should be reason enough to sign this bill
the very end of his veto message, the Governor does “direct DOH
and OMH to work with the sponsors and other interested parties to identify
methods for utilizing existing reporting mechanisms to obtain useful information
concerning the use and effect of ECT in state psychiatric centers and
nearly 3 years, the Legislature and mental health advocacy groups, including
MHANYS, have attempted to have hese discussions with state agencies. These
attempts have been met with limited cooperation, inadequate responses
to inquiries and sometimes no response whatsoever. MHANYS remains skeptical
that such a dialogue will ever actually occur or that any meaningful patient
protections will ever come to fruition without the power of law.
recognizing that the Legislature has over-ridden many of the Governor’s
vetoes this year, MHANYS holds out hope that both the Assembly and Senate
will deem this an issue of utmost importance and over-ride the Governor’s
veto in order to provide protection to mental health consumers throughout
New York. We will keep you informed on this issue as we are now hearing
that both houses of the Legislature are due back at least once before
the end of the year.
Text of NYAPRS Press Release on Governor’s Veto of ECT Legislation:
Advocates Denounce Governor Pataki's
of ECT Reporting Legislation
Call for Legislative Override, CQC Study
September 24, 2003 ~ Contact: Harvey Rosenthal (518) 436-0008
Mental health advocates are outraged by Governor Pataki's decision to
reject a heavily supported Senate-Assembly proposal that would have
consolidated and collected data on the use of electroshock treatment
in New York State.
this year, in an attempt to "protect...the mental health of the
people of the state...and ensure...the provision of safe and effective
electroconvulsive therapy..," both houses of the state legislature
concluded that there was "little information regarding how electroconvulsive
therapy is practiced in the state" and that currently "available
information...indicates that there exists considerable variation in
the nature of electroconvulsive therapy practices."
both houses overwhelmingly approved legislation requiring all facilities
and practitioners engaged in the use of electroshock to report to the
state Office of Mental Health on the number of persons who receive ECT,
the number of instances involuntary ECT orders are sought, the diagnoses
of those receiving ECT, the type and condition of equipment used to
administer ECT treatments, sources of payment for ECT treatments and
an assessment of injuries incurred from ECT treatments.
the clearly stated calls for this legislation from the ultimate stakeholders,
New Yorkers with psychiatric disabilities, from every corner of the
state, the Governor has chosen to let his policy here be driven by doctors
and hospitals who have consistently resisted greater accountability
in this area,” said Harvey Rosenthal, executive director of the
New York Association of Psychiatric Rehabilitation Services.
allegation that this information will have no public value is driven
by self interest, not public interest, and is not backed by facts, “
NYAPRS Public Policy Committee member and Mental Health Association
in Essex County Executive Director William Sullivan charged.
The bill was strongly supported by groups who are directly comprised
of New Yorkers with psychiatric disabilities, including NYAPRS, the
Mental Health Empowerment Project and the Mental Health Association
of New York State (see attached).
at question in this particular measure is the public confidence in the
state’s oversight role of a treatment they are particularly concerned
about,” Rosenthal said. “The fact remains that New Yorkers
with psychiatric disabilities have clearly and consistently expressed
serious concerns and calls for reassurance about ECT use, over the other
medication and therapy treatments currently available to us. It is irresponsible
to ignore that call for reassurance.”
clear to us that the way to remove the "stigma" from ECT is
to have a reporting system that provides the public with the information
they need to feel comfortable about ECT, “said Rosenthal.
painfully clear that the doctors, hospitals and family members don't
want to listen to their patients or loved ones in this regard...it's
even more disturbing that the Governor, and an Office of Mental Health
that has presented itself on being responsive to consumers first of
all, won't either,” Sullivan concluded.
advocates called for several actions today:
- They urged state legislators to override the Governor’s veto
and to put the force of law behind adequate state ECT data collection
- They urged that the Commission on Quality of Care follow up on
a promised survey of ECT use in non-state facilities.
Institute of Health: “Most Controversial Treatment in Psychiatry”
Governor’s veto message referenced the National Institute of Health
as endorsing ECT. Yet, NIH is among the first groups to recognize the
serious concerns associated with ECT use, practice and data collection.
therapy is the most controversial treatment in psychiatry. The nature
of the treatment itself, its history of abuse, unfavorable media presentations,
compelling testimony of former patients, special attention by the legal
system, uneven distribution of ECT use among practitioners and facilities,
and uneven access by patients all contribute to the controversial context
in which the consensus panel has approached its task...To prevent misapplication
and abuse, it is essential that appropriate mechanisms be established
to ensure proper standards and monitoring of ECT (NIH 1985 Consensus
Statement, pgs. 11-12).”
ECT has been in use for more than 45 years, there is continuing controversy
concerning the mental disorders for which ECT is indicated, its efficacy
in their treatment, the optimal methods of administration, possible
complications, and the extent of its usage in various settings. These
issues have contributed to concerns about the potential for misuse and
abuse of ECT and the desire to ensure the protection of patient's rights.”
(NIH 1985 Consensus Statement, pg 2).
Many New Yorkers Do Receive Electroshock?
- OMH reported that 134 individuals received ECT in OMH facilities
- DOH’s SPARCS data reports that 1822 individuals received
ECT in non-OMH facilities in 2000.
- In ECT expert and advocate Dr. Harold Sackheim’s unpublished
report made available to the Assembly in March 2002, he surmised
that in 1997, 3009 individuals received ECT in 59 of the 86 facilities
in NYC that offer ECT.
- Moreover, Dr. Sackheim estimated that there were nearly 7000
NYS residents that receive ECT annually, and cautioned that this
estimation is likely “conservative given the higher rates
associated with ECT use concentrated in metropolitan areas.”
- What about the other 5000+ New Yorkers who received ECT?
New York is Not Collecting Information About Electroshock Equipment
the American Psychiatric Association recommends (but has no authority
to mandate) that certain ECT machines not be used, many of those non-recommended
machines are still in use today (Mental Health Association of NYS).”
Shouldn’t New York State’s Mental Health Agency Oversee
the Governor expressed concern about an inappropriate expansion”
of the authority of the New York State Office of Mental Health, in July
2001, OMH Commissioner James Stone wrote to Assembly Mental Health Committee
Chair Martin Luster that ‘OMH is committed to ensuring that practitioners
administering ECT in NYS follow the latest (second edition, 2001) guidelines
published by the APA Taskforce on Electroconvulsive Therapy.’
NYS Office of Mental Health already licenses every general hospital
unit and private hospital. The Governor’s concerns about expanding
OMH’s role are inconsistent with its current responsibility to
send inspectors in these units reading records and checking for other
Watchdog Group: Inadequate Information,
Committee sought information regarding the prevalence of ECT use within
the State and found there were no available statistics. The Committee
requested the CQC (NYS Commission on Quality of Care) complete a survey
of ECT use in State operated psychiatric centers. The CQC found that
protocols varied at the five State-operated psychiatric centers that
recommended that OMH establish a Blue Ribbon Task Force to develop procedures
for consistent application throughout State facilities administering
ECT use, while simultaneously promoting the application of best practices
and strict adherence to statutory and regulatory standards for safeguarding
patient rights. The Committee has requested the CQC complete another
survey of ECT use in non-state operated facilities. The results of this
survey are not yet complete.” (NYS Assembly report, March 2002).
Special Responsibility to Track the
Rapidly Rising Use of Forced ECT Treatments
April 2001, the MHLS (state Mental Hygiene Legal Services) reported
a 73% increase in such applications between 1999 and 2000 (Assembly
am returning herewith, without my approval, the following bill:
Bill Number 2691, entitled:
“AN ACT to amend the mental hygiene law, in relation to the oversight
and regulation of electroconvulsive therapy (ECT)”
bill would require any site where electroconvulsive therapy (ECT) is
administered to collect and report information concerning the frequency
and circumstances of its use as well as certain patient outcomes to
the Office of Mental Health (OMH) on a quarterly basis. The bill would
require OMH to issue an annual report summarizing that information to
the Governor, the Temporary President of the Senate and the Speaker
of the Assembly by October 1st of each year. The bill would take effect
I understand and appreciate the concern over a procedure that many believe
to have been misused in the past, I am advised by the Office of Mental
Health, the New York State Psychiatric Association and the Greater New
York Hospital Association that ECT is a safe and effective treatment
for certain forms of mental illness. Indeed, for patients with serious
and often life-threatening mental illnesses for whom medication has
not proven safe or effective, ECT may be the only available treatment.
For these reasons, the National Association for the Mentally Ill in
New York State (“NAMI-NYS”), which advocates on behalf of
patients with mental illness, recognizes ECT as an accepted, safe and
effective medical treatment endorsed by the Surgeon General, the American
Medical Association, the American Psychiatric Association, and the National
Institutes of Health. In urging my disapproval of this bill, these patient
advocates, medical professionals, hospitals and regulatory agencies
all contend that there is no clinical or scientific basis upon which
to target ECT for special reporting, and in fact, singling out ECT in
this manner can only perpetuate the stigma associated with it.
these objections have considerable force, I need not address these concerns
because the bill suffers from technical flaws that command my disapproval.
First, I am advised that most ECT procedures are carried out either
in state facilities or in hospitals licensed by the Department of Health
(DOH), and DOH regulations require the reporting of data concerning
medical procedures, including ECT, to the Statewide Planning and Research
Cooperative System (SPARCS). To the extent that existing data collection
has proven inadequate, consideration should be given to modifying and
building upon SPARCS to obtain additional ECT related information. Second,
the New York State Psychiatric Association contends that much of the
data collected under the bill would be of questionable clinical usefulness.
Insofar as the collection of additional ECT data is warranted, we must
be sure that the data will permit researchers to draw statistically
valid conclusions. Finally, insofar as this bill would require entities
outside of OMH’s jurisdiction to report to OMH, I am concerned
that it would represent an inappropriate expansion of OMH authority.
spite of the powerful arguments against any legislation specifically
directed at the practice of ECT, I recognize that it is a matter of
special concern to many patient advocates. I therefore direct DOH and
OMH to work with the sponsors and other interested parties to identify
methods for utilizing existing reporting mechanisms to obtain useful
information concerning the use and effect of ECT in state psychiatric
centers and hospitals.
bill is disapproved.
MHANYS Annual Awards Luncheon and Public Hearing – October 23, 2003:
MHANYS will be holding its Annual Awards Luncheon to honor the recipients
of this year's awards at the Albany Marriott on 189 Wolf Road in Albany.
The luncheon will begin at 12:30 p.m. The cost is $35 per person. MHANYS
Public Hearing follows the Awards Luncheon. The Public Hearing is FREE
and open to public. For more information, or to reserve your ticket for
the Luncheon, call Lillian Lasher at (518) 434-0439 ext. 22. To sign up
to testify at MHANYS’ Public Hearing, please submit a completed
reacts to shock-bill veto. By Erika Rosenberg
Observer-Dispatch, September 25, 2003
(Also published in the Rochester Democrat and Chronicle)
-- A mental-health group bashed Gov. George Pataki Wednesday for vetoing
a bill to require new reports on electroshock therapy, saying he sided
with doctors and hospitals instead of patients.
incensed that the governor would choose the convenience of doctors"
over the wishes of patients, said Harvey Rosenthal, director of the New
York Association of Psychiatric Rehabilitation Services.
nixed a bill to require reports on the use of electroshock to treat mental
illness, saying the state already collects some information as part of
more general reports from hospitals. He wrote in a veto message that to
single out the treatment for additional reporting "can only perpetuate
the stigma associated with it."
mental-health advocates said the state's data only covers inpatient electroshock
treatments, and many people receive it on an outpatient basis.
believe that it's a controversial treatment that just deserves the full
oversight of the state," Rosenthal said. "The way to decrease
the stigma is a full public revelation of how it's being used."
critics have called for a ban on electroshock, or at least new restrictions
on how and when it can be forced on mental patients through court orders.
Rosenthal said his group hasn't taken a position opposing the treatment
and is simply seeking more information on its use.
American Psychiatric Association says electroshock in some cases is the
only effective method to treat people with severe depression, mania or
some kinds of schizophrenia who do not respond to medication.
mental-health advocates said despite collecting some information, New
York does not have reliable figures on how many people receive electroshock.
Estimates range from 2,000 to 7,000 or more a year.
more data would help determine whether people are appropriately receiving
electroshock, said William Sullivan, who runs a community mental-health
agency in Essex County. A similar report in Vermont showed many women
and older people getting the treatment, he said.
a beginning to determine first of all who is getting it. What are the
diagnostic criteria being used? Are there diagnostic criteria being used?
Are you going to find regional patterns?" said Sullivan. He added
he is concerned that some people receiving the treatment aren't fully
informed of the risks, which include memory loss that can be extensive.
Pataki spokesman said the governor has ordered mental-health and health
agencies to work with the advocacy groups on ways to use existing reporting
procedures to better track the use of electroshock.
Shock therapy law draws veto. By Erin Duggan
Albany Times Union, September 25, 2003
Albany-- Mental health advocates criticize Pataki's decision
health advocates blasted Gov. George Pataki Wednesday for vetoing a bill
to collect information about patients receiving electroshock treatments
in New York.
shock therapy can be involuntary, patients and their families want more
information about who's receiving the treatment, how often it's involuntary,
the outcomes and other information. The bill would require the information
be reported to the state Office of Mental Health.
the law, the numbers on the treatment vary widely, said Harvey Rosenthal,
executive director of the New York Association of Psychiatric Rehabilitation.
believe, as our membership does, that it's a controversial treatment that
deserves the full oversight of the state," he said.
his veto message, Pataki defended the treatment and said the state already
collects data on shock therapy treatments administered in state facilities
or hospitals licensed by the Department of Health, which are required
to report back to the state. He said the state should work to improve
that data collection, an idea Rosenthal dismissed.
bill is not an attack on the treatment," Rosenthal said.
records show about 1,850 New Yorkers received shock therapy treatment
in 2000, a number Rosenthal said doesn't count the people who receive
therapy in clinics not connected to the state. The actual number, he said,
is closer to 7,000.
doctors aren't listening to their patients," he said, "but we
thought the governor would."
Pataki vetoes electroshock bill. By Joel Stashenko (The Associated
Ithaca Journal, September 24, 2003
-- Special reporting requirements will not be imposed on New York health
providers who perform electroconvulsive therapy on patients, at least
not in 2003.
George Pataki announced Tuesday he has vetoed a bill that would have required
quarterly and annual reports to better track how often electroconvulsive
therapy (ECT), also called shock therapy, is being done in the state.
said his Office of Mental Health, the state Psychiatric Association, the
National Association for the Mentally Ill in New York and the Greater
New York Hospital Association had assured him ECT is safe and effective
at treating some mental illnesses that drug therapies have not worked
groups and agencies "all contend that there is no clinical or scientific
basis upon which to target ECT for special reporting, and in fact, singling
out ECT in this manner can only perpetuate the stigma associated with
it," Pataki said in a veto message.
said he was told that ECT is most often administered in state facilities
or in state hospitals licensed by the state Department of Health. In either
case, data about the procedures is already collected under an existing
Department of Health's medical reporting system, the governor said. He
suggested it might be possible to enhance that system to meet the goals
of the legislation.
Rosenthal, head of the state Association of Psychiatric Rehabilitation
Services, said the patients his group represents have consistently wanted
better reporting of ECT. He said it is clear that the procedure, involving
the administration of electric shocks to the head and brain, is on the
rise both generally and in its forced application to patients.
purpose behind the bill is to collect information on how often it's being
done, to whom, with what equipment and to what (medical) outcome,"
Rosenthal said. "We are not against ECT. But whether the governor
likes it or not, people are scared of ECT."
other bills addressed Tuesday:
The governor signed a bill imposing an additional 30-cent surcharge on
cell-phone users in Tioga County. The money raised from the surcharge
would go toward the county's 911 emergency system.
The governor vetoed a bill that would have required the state Department
of Transportation to conduct a statewide survey of roads and intersections
with a high incidence of traffic accidents involving elderly pedestrians.
Pataki said the bill had a laudable goal, but that it would cost the DOT
more than $1 million to comply. The governor said his administration has
taken several steps to enhance pedestrian safety for senior citizens and
Pataki vetoed legislation that would have increased the responsibility
of public entities to better inform the owners of land or buildings that
the government agency wants to acquire through eminent domain. The governor
said that although the bill's purpose is good, it would cost state agencies
millions of dollars to comply "in these times of fiscal uncertainty."
Pataki signed a measure that will require all colleges and universities
in the state to inform incoming students about the state's 2000 anti-bias
crime law, which calls for enhanced penalties for crimes committed on
the basis of a victim's gender, race, sexual orientation or other characteristics.
The related law will require colleges to explain procedures for reporting
bias crimes, counseling and support services for victims and ways students
can avoid being victimized.
The governor signed a bill that extends from 30 days to 45 days the time
banks must retain automatic teller machine surveillance tapes. Pataki
said the bill makes sense because it sometimes takes consumers more than
a month to realize they've been defrauded by transactions at ATM machines.
Pataki approved a bill requiring that child care providers be educated
about identifying, diagnosing and preventing shaken baby syndrome. The
syndrome results from the violent shaking of an infant or a toddler and
is responsible for 95 percent of the serious head injuries of children
under a year of age.
MHANYS’ 2004 Legislative Program
will be holding its sixth annual Public Hearing to develop its 2004
Legislative Program. The information gathered will be used to develop
and broaden the scope of our legislative agenda for the upcoming
session, as well as foster broad-based coalition building within
the advocacy community.
23, 2003, 2;30 - 4:00 p.m.
Albany Marriot (on Wolf Road)
MHA’s, MHANYS’ Board members, Mental Health Action Network
members, CMHP teams, and other interested parties.
testimony will be limited to 10 minutes.
will schedule the order of witnesses. In the event that you should
need to speak at a particular time, please notify MHANYS on the reply
- I plan
to attend MHANYS’ Public Hearing on October 23, 2003
- I plan
to make a public statement at the hearing. My statement will be limited
to 10 minutes, and I will answer any questions that may arise. I will
provide 10 copies of my testimony to MHANYS.
- I will
address my remarks to the following subjects: ________________________________________________________________
- I do
not plan to attend MHANYS’ Public Hearing, but would like to
submit the enclosed testimony
- I will
require assistance and/or handicapped accessibility. Please specify
type of assistance required: _____________________________________________
return this form no later than October 17, 2003 to:
Director of Public Policy
Mental Health Association in New York State, Inc.
194 Washington Avenue, Suite 415
Albany, NY 12210
Fax: (518) 427-8676
more information on MHANYS' Public Policy initiatives,
contact Michael Seereiter, Director of Public Policy
at (518) 434-0439, ext. 21, or e-mail email@example.com
next time, we remain,
Working to ensure available and accessible
mental health services for all New Yorkers