Mental Health Association in New York State, Inc.
(Publication Archives)

Friday Fax from Albany

ECT 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.

At 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 hospitals.”

For 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.

However, 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:

Outraged Advocates Denounce Governor Pataki's
Veto 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.

Earlier 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."

Accordingly, 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.

“Despite 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.

“Psychiatrists' 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).

“What’s 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.”

“It's 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.

“It's 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.

The 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 and oversight.
• They urged that the Commission on Quality of Care follow up on a promised survey of ECT use in non-state facilities.

Nat. Institute of Health: “Most Controversial Treatment in Psychiatry”

The 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.

“Electroconvulsive 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).”

“Although 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).

How Many New Yorkers Do Receive Electroshock?

• OMH reported that 134 individuals received ECT in OMH facilities in 2000.

• 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

“While 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 ECT Use?

While 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.’

The NYS Office of Mental Health already licenses every general hospital psychiatric 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 compliance requirements.

State Watchdog Group: Inadequate Information,
Inconsistent Procedures

“The 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 perform ECT.

CQC 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).

A Special Responsibility to Track the
Rapidly Rising Use of Forced ECT Treatments

“In April 2001, the MHLS (state Mental Hygiene Legal Services) reported a 73% increase in such applications between 1999 and 2000 (Assembly report).”

VETO Message #153:

September 22, 2003

TO THE SENATE:

I am returning herewith, without my approval, the following bill:

Senate Bill Number 2691, entitled:
“AN ACT to amend the mental hygiene law, in relation to the oversight and regulation of electroconvulsive therapy (ECT)”

NOT APPROVED

This 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 immediately.

While 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.

While 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.

In 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.

The bill is disapproved.

George E. Pataki

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 Reply Form.

In the News:

Group reacts to shock-bill veto. By Erika Rosenberg
Utica Observer-Dispatch, September 25, 2003
(Also published in the Rochester Democrat and Chronicle)

ALBANY -- 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.

"We're 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.

Pataki 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."

But mental-health advocates said the state's data only covers inpatient electroshock treatments, and many people receive it on an outpatient basis.

"We 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."

Some 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.

The 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.

The 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.

Collecting 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.

"It's 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.

A 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

Mental health advocates blasted Gov. George Pataki Wednesday for vetoing a bill to collect information about patients receiving electroshock treatments in New York.

Because 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.

Without the law, the numbers on the treatment vary widely, said Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation.

"We believe, as our membership does, that it's a controversial treatment that deserves the full oversight of the state," he said.

In 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.

"This bill is not an attack on the treatment," Rosenthal said.

State 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.

"The doctors aren't listening to their patients," he said, "but we thought the governor would."

Pataki vetoes electroshock bill. By Joel Stashenko (The Associated Press)
Ithaca Journal, September 24, 2003

ALBANY -- Special reporting requirements will not be imposed on New York health providers who perform electroconvulsive therapy on patients, at least not in 2003.

Gov. 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.

Pataki 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 on.

These 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.

Pataki 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.

Harvey 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.

"The 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."

In 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 others.

· 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.

Public Hearing on
MHANYS’ 2004 Legislative Program

Reply Form

Name: ___________________________________________________________

Title: _____________________________________________________________

Organization: ______________________________________________________

Address: _________________________________________________________

Phone: ________________________ Fax:________________________

Please return this form no later than October 17, 2003 to:
Michael Seereiter
Director of Public Policy
Mental Health Association in New York State, Inc.
194 Washington Avenue, Suite 415
Albany, NY 12210
Fax: (518) 427-8676

For more information on MHANYS' Public Policy initiatives,
contact Michael Seereiter, Director of Public Policy
at (518) 434-0439, ext. 21, or e-mail policy@mhanys.org

Until next time, we remain,
Working to ensure available and accessible
mental health services for all New Yorkers