State committee discusses Chapter 51 alternatives

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Elected officials and members of the public met Wednesday to discuss changing Wisconsin laws related to advanced Alzheimer’s disease and related dementias.

The state’s Special Committee on Legal Interventions for Persons with Alzheimer’s Disease and Related Dementias, which met for the second time Wednesday, was formed in the wake of the state Supreme Court’s 2011 ruling in Helen E.F. In that case, the high court ruled that Alzheimer’s disease alone does not justify an involuntary civil commitment under Wisconsin Chapter 51, even if a patient has exhibited disruptive or dangerous behaviors that an assisted living facility is unable to handle.

The case centered on plaintiff and Fond du Lac patient Helen E.F., an 85-year-old woman with advanced Alzheimer’s dementia who was detained under Chapter 51 in 2010. The court decided that because Alzheimer’s disease is a progressive, long-term condition, she could not be “rehabilitated” under Chapter 51 and was instead subject to Chapter 55, which requires that people under protective placement must have the least restrictive environment and care that meets their need.

Committee members — Rep. Dan Knodl, R-Germantown; Rep. Penny Bernard Schaber, D-Appleton; Sen. Neal Kedzie, R-Elkhorn; Sen. Robert Wirch, D-Pleasant Prairie; and 12 members of the public — on Wednesday discussed laws related to guardianship, protective placement, involuntary commitment and involuntary treatment of adults with dementia, including those who also have a psychiatric illness. They repeatedly stressed the importance of improving ways of handling treatment and management of these cases.

“When we talk about legal interventions, we are talking about removing a person’s constitutional right to self-determination,” said committee member Tom Hlavacek, executive director of the Southeastern Chapter of the Alzheimer’s Association. “We have to keep that in front of us at all times.

“That being said, (Chapter) 51 does not work in the majority of cases. It has been a default for failures of other parts of the system. That’s why I agree with the Supreme Court’s decision.”

Robert Mueller, Waukesha corporation counsel, agreed the laws needed to be improved. He said Helen E.F. had not changed his perspective on whether Chapter 51 can be used for involuntary commitments.

“I think Chapter 51 carries all sorts of problems,” Mueller said. “When you get committed under Chapter 51 as an elderly person with dementia, it greatly limits your ability to be placed (in a long-term care facility), because placement facilities say, ‘You’ve been committed under Chapter 51. We’re not going to take you.’

“I don’t care if we figure out a way to fix Chapter 55 or something else,” he added. “I want to make sure we find a way to let facilities give people the care we need. We need to take cases out of the legal realm as much as we can.”

Mueller advocated for expanding advanced planning measures, including giving agents greater ability to act for people with advanced dementias; passing focused rules to improve training of facility staff; and enhancing physician’s ability to treat individuals in familiar home environments, which he said would require guardians and powers of attorneys to be able to approve treatment they currently cannot.

Senior Staff Attorney Mary Matthias said Wednesday that legislative counsel will now begin coming up with draft legislation on changes to Chapter 55 that would enable short-term psychiatric admissions for people who have dementia without a diagnosed mental illness.

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