Legislature(2021 - 2022)GRUENBERG 120
05/14/2021 01:00 PM House JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB172 | |
| HB183 | |
| SB122 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 172 | TELECONFERENCED | |
| *+ | HB 183 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 122 | TELECONFERENCED | |
HB 172-MENTAL HEALTH FACILITIES & MEDS
1:42:21 PM
CHAIR CLAMAN announced that the first order of business would be
HOUSE BILL NO. 172, "An Act relating to admission to and
detention at a subacute mental health facility; establishing a
definition for 'subacute mental health facility'; establishing a
definition for 'crisis residential center'; relating to the
definitions for 'crisis stabilization center'; relating to the
administration of psychotropic medication in a crisis situation;
relating to licensed facilities; and providing for an effective
date."
CHAIR CLAMAN stated that there was a proposed committee
substitute and explained the changes that would occur should the
committee substitute be adopted. He said that the first change
would be to create separate sections for crisis stabilization
centers, crisis residential centers, and evaluation facilities
to clarify the purpose and use of each facility. The next
change would be a clarification that the process for involuntary
commitment starts over for readmission into a crisis residential
center or a crisis stabilization center. He said that the next
change would be to establish a definition of "health officer"
which refers to a non-law enforcement officer who may be
involved in the process. He stated the next change would be a
standard for the court to determine ex-parte applications for
involuntary admission crisis residential center and would clean
up the definitions section of the bill. Next it would amend the
criminal procedure provisions in Title 12 to include crisis
residential centers and would amend the domestic violence
provision in Title 18 to include crisis residential centers.
1:44:05 PM
REPRESENTATIVE SNYDER moved to adopt the proposed committee
substitute (CS) for HB 172, Version 32-GH1730\I, Dunmire,
5/14/21, as a working document. There being no objection,
Version I was before the committee.
CHAIR CLAMAN noted that the bill had been presented by the
governor's office and that he had been working with the
department on the development of the committee substitute that
was now before the committee.
1:45:16 PM
STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority, shared with the committee an anecdote from an
Alaska State Trooper during his law enforcement experience in
responding to an individual experiencing a mental health crisis.
He stated that upon responding, the trooper had been required to
evaluate the situation to determine whether a mental health
crisis existed, and further consider potential impacts to public
safety. He explained that the trooper was required to place the
individual in handcuffs and place him/her in the back of the
patrol car, even though the individual had not committed any
crime. He further explained that when the trooper arrived at
the local hospital seeking emergency mental health care, he was
informed that the emergency room was full, and the individual
would not be accepted for care. He shared that the trooper
placed the individual back in the patrol vehicle and drove his
entire shift seeking care for the individual and was unable to
attend to other law enforcement duties. He stated that HB 172
would establish lower levels of care in which law enforcement or
other first responders would have the ability to take an
individual [who has committed no crime] to seek the care
required.
1:49:03 PM
HEATHER CARPENTER, Health Care Policy Advisor, Office of the
Commissioner, Department of Health and Social Services, referred
to the presentation [included in the committee packet], titled
"HB 172 Additional Document - Introduction Presentation to HJUD
Committee 5.14.2021.pdf," and drew attention to slide 2, which
read [original punctuation provided]:
Currently, Alaskans in crisis are primarily served by
law enforcement, emergency rooms, and other
restrictive environments
• Behavioral health crisis response is outside the
primary scope of training for law enforcement, and
reduces focus on crime prevention
• Limited Designated Evaluation & Treatment (DET)
capacity in four communities: Juneau (BRH), Fairbanks
(FMH), Mat-Su (MSRH), Anchorage (API)
• Emergency rooms are not designed for and can be
overstimulating to someone in an acute psychiatric
crisis
MS. CARPENTER explained that the four community DET facilities
each have a limited number of beds available for voluntary or
involuntary care for a patient, consisting of 12 beds in Juneau,
20 beds in Fairbanks, 16 beds at MSRH, and additional beds at
the Alaska Psychiatric Institute (API). She explained that if
someone is not located in one of those communities, there exists
a need to transport them to one, which often requires air
travel. She stated that emergency rooms are busy and are not a
therapeutic environment for an individual experiencing a
behavioral health crisis, and they would await proper care until
a time at which they could be transported to a DET.
MS. CARPENTER drew attention to the infographic at the bottom of
slide 2 and explained that the approach for treatment for a
physical health crisis was incompatible with that which is
necessary for treatment of a behavioral health crisis.
1:51:06 PM
MR. WILLIAMS drew attention to slide 3, which read [original
punctuation provided]:
HB172 will:
• Effectuate a "No Wrong Door" approach to
stabilization services
• Enhance options for law enforcement and first
responders to efficiently connect Alaskans in crisis
to the appropriate level of crisis care
• Support more services designed to stabilize
individuals who are experiencing a mental health
crisis
• 23-hour crisis stabilization centers
• Short-term crisis residential centers
MR. WILLIAMS drew attention to the infographic at the bottom of
slide 3 and explained that it depicted a more appropriate
approach to a behavioral health emergency. He added that in
addition to the 23-hour crisis stabilization center, the short-
term residential stabilization center as defined under HB 172
would provide 120 hours, or 5 days of service. He added that
individuals who are seeking care on a non-voluntary basis are a
small percentage of those seeking care; however, the facilities
would need to have the ability to accept either voluntary or
involuntary patients.
1:53:24 PM
MS. CARPENTER drew attention to slide 4, titled "Building Blocks
of Psychiatric Crisis System Reform," which provided background
information on the conception of HB 172 and read as follows
[original punctuation provided]:
• SB74 Medicaid Reform (2016)
Improve Access, quality, outcomes, and contain costs
• 1115 Behavioral Health Waiver
Targets resources and services to "super utilizers"
Provides flexibility in community behavioral health
services and supports
Creates new crisis service types that promote
interventions in the appropriate settings and at the
appropriate levels
• System must be intentionally designed and promote a
"no wrong door" philosophy
MS. CARPENTER added that the 1115 waiver would provide more
treatment options, closer to a patient's home, and drive down
costs by diverting patients from costly inpatient hospital care
to the lower levels of care [that would be created should HB 172
pass] in all 9 regions served. She explained that appropriately
trained mental health professionals would select appropriate
levels of care to prevent a behavioral health crisis from
escalating.
1:56:28 PM
MR. WILLIAMS referred to slide 5, titled "GOAL: Design and
implement a behavioral health crisis response system analogous
to the physical health system," and explained the infographic
depicted differences between physical and behavioral health
crises. He said that the system proposed under HB 172 is based
on the "Crisis Now" framework, which was in use in other states
such as Arizona and Georgia and had the endorsement of
organizations including the Substance Abuse Mental Health
Services Administration (SAMHSA), the National Association of
State Mental Health Program Directors (NASMHPD), the National
Alliance on Mental Illness (NAMI), and the National Action
Alliance on Suicide Prevention (NAASP).
[HB 172 was set aside and brought back before the committee
following a recess to a call of the chair.]
HB 172-MENTAL HEALTH FACILITIES & MEDS
3:37:16 PM
CHAIR CLAMAN announced that the next order of business would be
a return to HOUSE BILL NO. 172, "An Act relating to admission to
and detention at a subacute mental health facility; establishing
a definition for 'subacute mental health facility'; establishing
a definition for 'crisis residential center'; relating to the
definitions for 'crisis stabilization center'; relating to the
administration of psychotropic medication in a crisis situation;
relating to licensed facilities; and providing for an effective
date." [Before the committee, adopted as a working document
during the portion of the meeting prior to the recess, was the
proposed committee substitute (CS) for HB 172, Version 32-
GH1730\I, Dunmire, 5/14/21 ("Version I").]
3:37:36 PM
MR. WILLIAMS referred to the presentation [included in the
committee packet], titled "HB 172 Additional Document -
Introduction Presentation to HJUD Committee 5.14.2021.pdf," and
drew attention to slide 6, which depicted the stakeholder
engagement. He explained that some of the stakeholders may be
or become providers of care, while others may exist as a safety
net within communities to prevent escalations to needs in crisis
care and provide aftercare.
3:40:04 PM
MS. CARPENTER referred to slide 7, titled "Enhanced Psychiatric
Crisis Continuum of Care," and she explained that the bracketed
services illustrate the existing gap in available care. She
provided an example from Bartlett Regional Hospital (BRH), which
provides a Crisis Now approach to its system to aid in achieving
its goal of providing the most appropriate service at the most
appropriate time with the most appropriate setting to its
patients. She stated that BRH serves all Southeast Alaska and
has elected to expand its services to cover multiple levels of
care needed. She stated that 33 percent of patients who are
assessed for a mental health crisis are admitted for care, and
it provides lower levels of care for those not admitted. She
stated that having only 12 beds available, it must make choices
to serve patients in an inpatient setting when a Crisis Now
approach may be more appropriate.
MR. WILLIAMS referred to slide 8, titled "Crisis Stabilization
Center (23 hour)," and he explained that it is one of the
components of the new system of care as proposed under HB 172.
He shared the content of the slide, which read as follows
[original punctuation provided]:
Provides prompt, medically monitored crisis
observation and psychiatric stabilization services
• No wrong door - walk-in, referral, and first
responder drop off
• Staffed 24/7, 365 with a multi-disciplinary team
• High engagement/Recovery oriented (Peer Support)
• Immediate assessment and stabilization to avoid
higher levels of care where possible
• Safe and secure
• Coordination with community-based services
MR. WILLIAMS added that the environment would be designed to be
recovery-oriented and would include medical and behavioral
health professionals as well as people with lived experience as
part of the staffing.
3:44:39 PM
MR. WILLIAMS referred next to slide 9, titled "Short-Term Crisis
Residential Stabilization Center," and he explained that it is
the next component level of the new system of care as proposed
under HB 172. He shared the content of the slide, which read as
follows [original punctuation provided]:
A 24/7 medically monitored, short-term, crisis
residential program that provides psychiatric
stabilization
• Safe and secure serves voluntary and involuntary
placements
• High engagement/Recovery oriented (Peer Support)
• Multi-disciplinary treatment team
• Short-term with 16 or fewer beds
• Stabilize and restore avoid need for inpatient
hospitalization where possible
• Coordination with community-based services
MR. WILLIAMS explained that this next level of care would be
appropriate for patients who were not able to achieve
stabilization at the Crisis Stabilization Center (23-hour) as
determined by staff at that facility.
3:45:52 PM
MR. WILLIAMS drew attention to slide 10, titled "Enhanced crisis
response would reduce the number of people entering the most
restrictive levels of care," on which an infographic depicted
outcomes discovered by experiences collected from care providers
in other states, and the data reflected had been collected in
the State of Georgia and had been interpolated from over 1.5
million calls to its crisis care line. He explained that for
every 100 calls received by the crisis care line, 90 were
resolved over the telephone, and of the 10 instances of a crisis
mobile team dispatched, 7 of those did not result in transport.
He explained that of the three crisis interventions that
required transport, only one instance occurred in which care for
more than 23 hours had been required. He added that the City of
Phoenix, Arizona, had reported similar outcomes.
MS. CARPENTER drew attention to slide 11, titled "Alaska Statute
Title 47," and explained that Title 47 is the statute which
addresses involuntary commitment. She explained that HB 172
would update this statute. She stated that stakeholders had
collaborated and made observations of successful programs in
other locations to inform the drafting of HB 172. She noted
that a settlement had been reached between the State of Alaska
and the Disability Law Center in September 2020, a part of which
was an agreement to advocate for statutory changes that would
permit involuntary holds and 72-hour evaluations for patients at
a less restrictive setting. She added that the settlement with
the Disability Law Center had culminated in the draft HB 172 and
committee substitute before the committee for its consideration.
3:51:05 PM
MR. WILLIAMS referred to slide 12 of the presentation, titled
"Current Flow for Involuntary Commitment," and he recalled his
earlier testimony regarding the Alaska State Trooper who had
spent more than eight hours attempting to seek care for an
individual. He explained that should the committee substitute
be adopted and HB 172 pass, the process of transfer from law
enforcement to the crisis stabilization center could be reduced
to take no more than 10 minutes, as evidenced by data provided
from the State of Georgia and the City of Phoenix.
MR. WILLIAMS referred to slide 13 of the presentation, titled
Proposed Statutory Changes," and slide 14, titled "Flow for
Involuntary Commitment with Statutory Changes," which depicts
the anticipated flow for involuntary commitment under HB 172 as
different from what currently exists, as depicted on the
previous slide.
3:55:13 PM
MS. CARPENTER summarized slide 15, titled "Key Takeaways," which
read as follows [original punctuation provided]:
HB172 Does:
• Provide law enforcement with additional tools to
protect public safety
• Expand the number of facilities that can conduct a
72-hour evaluation
• Add a new, less restrictive level of care
• Facilitate a faster and more appropriate response to
a crisis, expand the types of first responders that
can transport an individual in crisis to an
appropriate crisis facility
• Create a "no wrong door" approach to providing
medical care to a person in
psychiatric crisis
HB172 Does Not:
• Interfere with an officer's authority or ability to
make an arrest
• Change who has the current statutory authority to
administer crisis medication
• Change current statutory authority for who can order
an involuntary commitment
• Reduce the individual rights of the adult or
juvenile in crisis; the parents' rights of care for
their child; or existing due process rights of the
individual in crisis
3:58:14 PM
REPRESENTATIVE SNYDER asked whether a peace officer would be
allowed to take an individual in crisis to either a
stabilization center or a residential center or whether there
would exist a sequential order of priority that the officer
would be obligated to follow.
MS. CARPENTER answered that a community might not have all the
services that would be permitted under HB 172 and that the bill
had been conceived to serve all communities in Alaska.
MR. WILLIAMS added that Alaska is unique in its [diverse]
communities and that HB 172 would provide a framework for
communities to operate within the suite of services that they
may have and had been developed in conjunction with community
feedback.
4:01:56 PM
CHAIR CLAMAN opened public testimony on HB 172.
4:02:31 PM
STEVE PEARCE, Agent, Citizens Commission on Human Rights, stated
his organization's concerns with HB 172, including that it would
double the period of involuntary confinement prior to judicial
action, and he recommended that it be changed to allow for
earlier judicial representation. A stated goal of the bill was
to achieve recovery and he questioned whether patients [as
stakeholders] had provided any feedback and that recovery could
indicate psychiatric compliance and not [necessarily] an
improvement in health. He stated that forced medication may
occur immediately upon confinement and that patients may have
other health factors that may contribute to problems with
compliance or resistance to ongoing treatment. He referred to a
letter that was provided [included in the committee packet].
4:05:18 PM
MARK REGAN, Legal Director, Disability Law Center of Alaska,
referred to written testimony that had been submitted to the
committee and noted that it had been drafted in response to the
underlying bill and had not taken into consideration the
committee substitute before the committee. He summarized from
the letter [included in the committee packet.] He suggested
that [Version I] would not provide an individual with attorney
representation when a judicial order for an individual to be
involuntarily held occurs. He noted that the different systems
for civil commitment for medium term, 30-days or more for
evaluation should provide for short-term treatment as a stated
goal. He asked that the language in the proposed bill and
committee substitute be carefully reviewed to ensure that an
individual is not subject to multiple 3-day holds in a crisis
residential center.
CHAIR CLAMAN asked whether the right to counsel for involuntary
commitment is explicitly stated in current statute.
MR. REGAN answered that a peace officer would typically bring an
individual to a residential facility, or they would be admitted
to an emergency room, and individuals were often turned away for
treatment. He stated that, the way the bill is drafted,
individuals would have more direct access to evaluation and
treatment. He suggested that individuals may be required to
wait up to eight days for treatment.
CHAIR CLAMAN stated that the committee would continue to consult
with the Disability Law Center of Alaska for its input on HB
172.
4:11:42 PM
LISA GENTEMANN testified in opposition to HB 172. She stated
her concern that the passage of HB 172 could result in legal
harm to Alaskans. She stated that patient consent and human
dignity should be considered.
4:13:13 PM
RENEE RAFFERTY, Regional Director of Behavioral Health,
Providence Health Services, testified in support of HB 172. She
stated that HB 172 would expand the crisis care continuum and
would provide a framework from the perspective of the provider.
She stated that jails and emergency rooms may be harmed because
the facilities are not equipped with medication and facilities
for care and evaluation and are subject to high costs. She
encouraged additional consideration and improvement on the
language contained in the bill.
4:15:49 PM
CHAIR CLAMAN ascertained that there was no one else who wished
to testify, closed public testimony.
CHAIR CLAMAN announced that HB 172 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 122 v. B 4.7.2021.PDF |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM |
SB 122 |
| SB 122 Sponsor Statement v. B.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SJUD 4/21/2021 1:30:00 PM |
SB 122 |
| SB 122 Sectional Analysis v. B.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SJUD 4/21/2021 1:30:00 PM |
SB 122 |
| SB 122 Fiscal Note LAW-CRIM 4.9.2021.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM |
SB 122 |
| SB 122 v. B Amendment #1 HJUD 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
SB 122 |
| HB 183 v. B 4.21.2021.PDF |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM |
HB 183 |
| HB 183 Sponsor Statement v. B 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM |
HB 183 |
| HB 183 Sectional Analysis v. B 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
| HB 183 Supporting Document - Criminal Justice Taskforce Recommendation 12.3.2020.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM HJUD 1/26/2022 1:30:00 PM |
HB 183 |
| HB 183 Additional Document - A Sunset Review of the Office of the Governor, Alaska Criminal Justice Commission 6.12.2020.2020 |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM HJUD 1/26/2022 1:30:00 PM |
HB 183 |
| HB 183 Fiscal Note DHSS-BHA 5.7.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
| HB 183 Fiscal Note JUD-AJC 5.13.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
| HB 172 Work Draft Committee Substitute v. I 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
| HB 172 Transmittal Letter 4.9.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Supporting Document - Letters Received by 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Opposing and Amend Letters and Testimony Received by 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
| HB 172 Fiscal Note DPS-AST 4.7.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
| HB 172 Fiscal Note DHSS-DET 3.30.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
| HB 172 Fiscal Note DHSS-MS 3.30.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
| HB 172 Fiscal Note JUD-ACS 4.28.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
| SB 122 v. B Amendment #1 HJUD Legal Memo 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
SB 122 |