Saturday February 16, 2013

BRATTLEBORO -- In the weighty debate about end-of-life choices for the terminally ill, a local legislator played a critical -- and controversial -- role in state Senate deliberations this past week.

The Senate bill was designed to allow terminally ill patients in Vermont to legally receive a lethal dose of medication if they so choose.

The initial bill, modeled on Oregon's "Death With Dignity Act," included provisions designed as safeguards: For instance, patients had to be mentally competent and had to request the medication three times, including once in writing.

Also, two doctors had to agree that a patient had fewer than six months to live.

But on Wednesday, Sen.

Peter Galbraith, D-Townshend, joined Sen. Robert Hartwell, a Bennington Democrat, in offering a sweeping amendment that replaced much of the original bill with a more hands-off provision: Doctors who write lethal prescriptions to the terminally ill, the legislation said, could not be held criminally or civilly liable and would not be subject to professional disciplinary action.

Subsequent debate produced two 15-15 ties in the Senate, with Lt. Gov. Phil Scott twice breaking that tie in favor of preserving the Galbraith-Hartwell version of the bill.

Ultimately, that version was approved Thursday by the Senate in a 22-8 vote.

"We actually developed a 2-to-1 consensus around the idea of patient choice," Galbraith said Friday.

The second-term senator said he had been listening to both opponents and proponents of the initial bill when he was struck that there was "a lot of common ground."

Proponents wanted terminally ill patients to be able to choose to end their own lives.

"The opponents were saying, ‘We don't want to see a state-sponsored process for suicide,'" Galbraith said.

Galbraith said he talked to many constituents about the issue. He believes the changes he proposed -- and which eventually were approved -- were a good compromise.

"I drafted an amendment that leaves the end-of-life decision between a doctor and her patient," he said.

In response to critics who say the amended bill lacks safeguards for patients, Galbraith said he did not believe those processes were realistic in end-of-life situations.

"This is not the way it really works," Galbraith said.

He added that a constituent praised his work with the following message: "Thank you for getting rid of these hurdles."

However, others remain convinced that changing the initial bill was a bad idea. Among those voting against the amended bill was Sen. Jeanette White, a Putney Democrat.

White's objections were recorded by Wednesday's official Senate journal: "While I want to see this bill go forward, this bill as it now exists is 180 degrees from the original intent and is such a travesty that I would rather have the other body start anew (than) try to improve this bill."

On Friday, White detailed her objections.

"This has no safeguards. There is no requirement for competency, no age requirement, no requirement that the doctor advise you of the availability of palliative care, no requirement that the doctor even advise you of what might be a lethal dose ... no requirement that the patient ask for the drug or suggest his intentions," White wrote in an e-mail to the Reformer.

"This bill gives physicians immunity with no protection for patients," White added. "According to the attorney general's office, it seems to be so broad as to cover any form of professional discipline or tort liability even for misconduct or gross negligence. And because it is all ‘wink wink,' there is no ability for an after-the-fact review."

White said there were a variety of reasons behind the revised bill's passage in Thursday's final vote.

"Some voted for it because they saw it as a way to kill the original (bill), some because they just did not want to have to vote on this highly charged issue, some because they believed it provided a good answer to a thorny issue (and) some to at least keep something alive that might have the chance to be improved on by the House," she said.

The matter now will be taken up by the House, where Speaker Shap Smith reportedly expressed doubts about an end-of-life bill that was "changed on the fly" in the Senate.

Galbraith does not agree with that characterization.

"It was not changed on the fly. This is how the legislative process works," he said. "This was the result of a deliberative process."

In other legislative news that involved Windham County:

-- Gov. Peter Shumlin is pushing to allow many more Vermont students to be able to take college courses while still in high school. And Windham County -- cited by Shumlin as a "great model" for such dual-enrollment programs -- is playing a central role in that discussion.

On Wednesday, several local school leaders traveled to Montpelier to testify before the House Education Committee to talk about the success of dual-enrollment programs here.

Tom Yahn, who directs Windham Regional Collegiate High School, was one of those who made the trip. He's excited by the possibility of spreading the program statewide.

"It could be a real boon to students across Vermont," Yahn said. "It could also encourage more students to stay in Vermont."

The collegiate high school is a collaboration between Brattleboro Union High School, Windham Regional Career Center and several colleges.

Juniors and seniors can take college courses at either high school. And some also travel to college campuses.

"We have some students this semester who are going to (Community College of Vermont)," Yahn said. "And we have a handful of students going to Marlboro College. The colleges have been amazingly cooperative."

Other colleges involved in the effort are Vermont Technical College, SIT Graduate Institute, Vermont Technical College, Manchester Community College, Lakes Region Community College and River Valley Community College.

Yahn said 350 local students participated in the program last year. Administrators particularly target students who may not have been considering post-secondary education.

"We're really trying to reach out to first-generation (college students) or low-income kids," he said.

There are cost benefits for students: Taking a three-credit college course at the high-school level costs just $100, and there are scholarships for those who cannot afford that, Yahn said.

Other benefits include allowing students "to realize college-level expectations in the familiar and supportive settings of their high schools, and to then experience a supported transition to classes on a college campus," Windham officials wrote in a document supporting their testimony before the Education Committee.

Also making the trip to Montpelier were Ron Stahley, Windham Southeast Supervisory Union superintendent, and Steven John, Windham Central Supervisory Union superintendent.

"The major reason for me to testify was to be certain that the Education Committee members appreciate the importance of making dual enrollment accessible to students in small rural high schools such as Leland & Gray," John said. "Previous legislation did not address this question of equitable access to this important opportunity for learning."

State Rep. Valerie Stuart, a Brattleboro Democrat, said she is optimistic that dual enrollment can spread around the state.

"I think it's going to happen, because it's a good investment," said Stuart, who sits on the Education Committee.

"It's going to improve first-generation college performance," Stuart said. "It gets more kids into college and, more importantly, more kids stay in college."

-- State Rep. Mike Mrowicki, a Putney Democrat, said officials continue to pursue solutions to rampant abuse of opioid prescription drugs.

Mrowicki said there are "multiple layers to this medical epidemic" including addicts who "doctor shop" so they can get several prescriptions. The problem was the subject of a joint hearing of the House Human Services Committee, on which Mrowicki sits, and the Judiciary Committee.

Mrowicki quoted a Fletcher Allen Health Care doctor as saying that "not everyone addicted to opioids has a swastika tattooed on their forehead. Most are regular folks who look just like you or me."

Insurance-payment policies, Mrowicki said, are part of the problem. Using the example of chronic lower-back pain, he said insurers are much more likely to cover a painkiller prescription rather than alternative solutions such as chiropractic treatment, acupuncture or massage.

"As we move forward with health reform, I feel it is essential we look at all the effective alternatives to drug therapy in regards to pain management," Mrowicki said.

He added that "the legislature is looking at whether we need to establish specific credentialing and ongoing education for doctors prescribing opioids."

-- Six Windham County lawmakers signed onto a new House bill that would restrict members of the state's Executive Branch from taking certain private-sector jobs for one year after leaving office.

It is, essentially, a conflict-of-interest bill that extends beyond an official's employment by the state. Any ex-official cannot take a job with "a person who is regulated by the public body in which the public official served or was employed," the bill says.

Also, the former official cannot accept employment that "involves a matter in which the public official directly and substantially participated during the term of his or her public office."

Penalties could include a civil fine of up to $10,000, repayment of wages and reimbursement of the state's investigatory and court costs.

-- A new House bill that would mandate a three-year moratorium on wind-turbine construction received initial backing from 45 House members -- almost a third of that legislative body.

But none were from Windham County.

The House bill joins a three-year turbine moratorium that previously had been proposed in the Senate. That measure has attracted support from Galbraith and from officials in the Town of Windham, which has been fighting a wind-power developer that plans to place weather-measurement towers on a ridgeline there.

Mike Faher is the Reformer's political beat writer. He can be reached at mfaher@reformer.com or 802-254-2311, ext. 275. He also has a political blog at www.Reformer802.com/underthedome.