Legislature(1995 - 1996)
01/16/1996 01:07 PM House CRA
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 383 - REIMBURSE FOR LOCAL SERVICE TO INEBRIATES Number 1122 CO-CHAIR IVAN introduced the next item of business, HB 383, indicating the committee packets contained the bill; the sponsor statement; a zero fiscal note from the Department of Health and Social Services; a fiscal note from the Department of Community and Regional Affairs; relevant statutes; support documents; and a legal opinion from Division of Legal and Research Services regarding use of the mental health trust income account. He invited Tom Wright to present the bill on his behalf. Number 1180 TOM WRIGHT, Legislative Assistant to Representative Ivan, presented the sponsor statement. Under AS 47.37.170, he said, a person who appears intoxicated and incapacitated in a public place will be taken into protective custody and placed in an approved public treatment facility or a state or municipal detention facility. This person must then be examined by a licensed physician or other qualified health practitioner as soon as possible. If the person is found to be incapacitated by alcohol, the person is detained for no more than 48 hours in a health facility or for no more than 12 hours in a detention facility. The costs of this program to the municipalities and the public health facilities are tremendous. He said Representative Ivan introduced HB 383 to offer a solution that will reduce or eliminate the fiscal responsibilities that municipalities and public health facilities bear each year undertaking what Representative Ivan feels is an unfunded mandate. MR. WRIGHT explained that the situation was exacerbated by what occurred in Dillingham over the last year. He referred to the fiscal note from the Department of Health and Social services, which he said contained a history of what took place there. In addition, he said, the problem was ongoing statewide. CO-CHAIR IVAN thanked Mr. Wright and asked if there were questions or comments from the committee. Hearing none, he proceeded to take testimony from teleconference participants. Number 1295 CRISTY TILDEN, Program Director for Drug and Alcohol Services, Bristol Bay Area Health Corporation, testified via teleconference from Dillingham in support of HB 383. She said the issue has been significant for both Dillingham and other communities statewide. As a health professional, she supports measures providing treatment and safety for persons incapacitated by drugs or alcohol. However, the statute as written compels good treatment without compensation. She commented that it has been a bitter pill for Dillingham and other communities. MS. TILDEN added that she is a member of the Advisory Board on Alcoholism and Drug Abuse. She said the board supports HB 383 but has further suggestions to improve the statute, including adding substances besides alcohol and redefining "incapacitated." Number 1438 JAN McCARTNEY, Patient Accounts Manager, Bristol Bay Area Health Corporation, testified via teleconference from Dillingham. She stated she supports HB 383, and stressed the hardship put on small communities by unfunded mandates. Number 1527 GEORGE YOUNG, Fire Chief, City of Bethel, spoke via teleconference in support of HB 383. He asked whether the bill was intended to apply only when a municipality placed people under protective custody, or if it would also allow medical services, including fire department services, to recover losses from people rendered unconscious or having impaired mobility. CO-CHAIR IVAN responded that HB 383 asks the state to provide funding to reimburse municipalities or established villages that have detention facilities. MR. YOUNG reiterated his support, and added he would seek information on how to make this applicable to ambulance services not involved with protective custody. Number 1631 CHRIS LIU, Police Chief, City of Bethel, testified via teleconference from Bethel, expressing gratitude that the needs of the people in the delta were being addressed. From 1985-1995, an average of 938 persons were detained for protective custody, with 1,124 people detained in 1995. The financial burden was significant, costing the police department hundreds of thousands. He and his fellow chiefs of police agreed the state of Alaska must address unfunded mandates, this being the most significant one. Number 1719 DAVE TRANTHAM spoke via teleconference from Bethel, testifying as a senior citizen in support of HB 383. He agreed with previous speakers that this unfunded mandate was costly, and added that the City of Bethel had attempted to collect a $300 fee from individuals picked up for their own protection. However, the City was often unable to collect, and the cost was passed on to Bethel's citizens through taxation and reduced services in other areas. He expressed appreciation to the committee and the Alaska State Legislature for joining with Bethel to help solve this problem. Number 1927 ANASTASIA COOK, Association of Village Council Presidents (AVCP) Receiving Home, Bethel, testified via teleconference in support of HB 383. Children of people in protective custody were often placed in emergency shelters and receiving homes. One-third to one-half of the AVCP Receiving Home's cases related to protective custody; often the children were in the shelters for three weeks to a month. She asked that these children be kept in mind. Number 1938 BOB CHARLES, Vice President of Operations, Association of Village Council Presidents (AVCP), Bethel, testified via teleconference in support of HB 383. As a follow-up to Ms. Cook's testimony, he asked the committee to consider amending the bill to reimburse both those who care for children impacted by protective custody cases and Village Public Safety Officers who provide services relating to such cases, as the two groups are often poorly compensated. CO-CHAIR IVAN thanked Mr. Charles and asked him to please forward any proposed amendments to Tom Wright for consideration. Number 2050 EDMON MYERS, Administrator, Kodiak Island Hospital/Care Center, testified via teleconference in support of HB 383, saying he concurred with the majority of testimony heard previously. At his hospital, there were $70,000 to $80,000 in unreimbursed costs that probably fell within the relevant categories. Patients in "gray areas" probably represented an additional $100,000 to $120,000. Unreimbursed costs were compensated for by other users and hurt the medical community a great deal. In addition, the hospital maintained a security force to protect staff from inebriated patients, adding to costs. MR. MYERS said Kodiak police officers often call an ambulance to transport inebriated persons to the hospital, resulting in a question as to when the person is in protective custody. Police may wait at the back door and arrest a person once they had been medically evaluated and released. HB 383 would eliminate problems of defining protective custody for purposes of reimbursement. Number 2239 DENNIS OAKLAND, Chief of Police, City of Homer, testified via teleconference in support of HB 383. Despite Homer having fewer inebriates than some other communities, he said, unreimbursed expenses ran into the hundreds of thousands of dollars for incarceration, medical and attached liability costs. In addition, because reimbursement was affected, many inebriated individuals who committed minor crimes were charged with those crimes in situations where they might not otherwise have been charged, adding to the criminal justice system load. He added that the 17 communities in Alaska with contract jails are not reimbursed for individuals brought in under Title 47. Number 2312 CO-CHAIR AUSTERMAN referred to recommendations forwarded to the committee by Mr. Oakland and asked if he wanted to address those in his testimony. MR. OAKLAND deferred to the author of that information, William Walters, who had been in charge of the Homer jail for several years. CO-CHAIR IVAN noted that Representative Al Vezey had joined the meeting and called on William Walters to testify. Number 2357 WILLIAM WALTERS, Judicial Services Officer, Police Department, City of Homer, spoke via teleconference and said the problem in Homer was getting individuals out of a jail environment and under medical supervision. Because many intoxicated persons had severe medical crises as they withdrew from alcohol, the jail was not the appropriate place for them. Hospitals were concerned with liability, unreimbursed costs and the lack of statutory detention authority at the medical facility. He referred to his written suggestions to add a liability waiver absent gross negligence or intentional misconduct on the part of the facility, and to provide authority in section 170(a) whereby medical staff "may" detain these people. MR. WALTERS stated support for HB 383 in concept, but added he would like a provision in the bill for direct reimbursement by the state to medical facilities, rather than having a facility petition the municipality; this would save significantly on administrative costs. However, he could live with the bill as is, if necessary. Tape 96-1, Side B Number 001 GARY GRANDY, Administrator, Petersburg Medical Center (PMC), and Council Member, Petersburg City Council, testified via teleconference in support of HB 383. He said PMC includes a hospital, nursing home and physicians' offices; their bad debts amount to about $100,000 per year. He gave an example of an inebriated person who attempted suicide, resulting in a medical bill of $5,000. The medical center sought reimbursement from the Indian Health Services and SEARHC programs, but those programs, which do not pay costs related to alcohol, reimbursed only a few hundred dollars for treatment of the patient's wrists. Mr. Grandy said the hospital has $10,000 to $20,000 per year written off the books, which they can no longer absorb. MR. GRANDY expressed concern about numerous demands on the mental health trust. He wondered if the committee would look at using general funds, which are fed in part by alcohol and tobacco taxes. Number 126 GREG PORTER, Administrator, Cordova Medical Center, testified via teleconference, stating he supported HB 383 and concurred with previous testimony. A small facility owned by the City of Cordova, the center's costs for these cases ranged from $60,000 up per year. Mr. Porter said he understood the need for medical treatment of inebriates, as he knew of patients who had nearly died in the jail. However, the city had no funds to support the hospital and operated hand-to-mouth. Number 134 MIKE HOLSMAN, Planning Officer, Department of Health and Human Services, Municipality of Anchorage, testified via teleconference in support of HB 383, agreeing with previous speakers. A burden on local hospitals and police, the problem costs the Municipality of Anchorage several hundred thousand dollars per year of local taxpayer money. He asked the committee to look at statewide actions to prevent or reduce public drinking. He noted that many inebriates have incomes of $750-850. He suggested inebriates pay for their treatment; for example, their checks could be reduced or their permanent fund dividends garnished. Number 328 CHRIS HLADICK, Manager, City of Dillingham, testified via teleconference. He agreed with previous testimony and supported HB 383. He added he also supported an amendment to the bill providing direct reimbursement to medical facilities. Number 387 MARY PAVIL, Representative, Orutsaramuit Native Council, and Council Member, City of Bethel, testified via teleconference in support of HB 383. She asserted that as long as it was not a crime to be drunk in public, communities would be mandated to put people in protective custody. She commended the police department for saving a large number of lives and suggested hidden costs be covered as well as more obvious ones. Number 445 CO-CHAIR IVAN noted that the teleconference testimony was concluded and called on Kimberly Metcalfe-Helmar to testify. Number 471 KIMBERLY METCALFE-HELMAR, Special Assistant, Office of the Commissioner, Department of Community and Regional Affairs (DCRA), said the department's concern with HB 383 was the reimbursement program envisioned in the bill. The grants administrator in the Division of Administrative Services would most likely oversee the program. DCRA feels additional staff would be required to operate the new program effectively. They have asked for a Range 13 administrative assistant under the supervision of the existing grants administrator. Number 531 REPRESENTATIVE ELTON asked whether, in the DCRA review, they had looked at how much money would be disbursed through the program. MS. METCALFE HELMAR said they had not; the amounts were uncertain at this point. REPRESENTATIVE ELTON stated one of his concerns was that collections might not be a big priority if all that was required for reimbursement was filling out a form. MS. METCALFE HELMAR responded that DCRA's concern was whether they could handle the workload and what the staffing would be. Number 768 LOREN JONES, Director, Division of Alcoholism and Drug Abuse, Department of Health and Social Services, said their concern was to protect people and engage them in treatment, with an eye to avoiding repeat occurrences. If a treatment facility was available, police officers, community service patrols or medical personnel would take a person there. However, he explained, many communities heard from via teleconference either lacked residential or detoxification facilities, or had needs exceeding available resources. In those cases, individuals sometimes ended up in jail instead of getting appropriate treatment. Number 725 REPRESENTATIVE ELTON asked Mr. Jones for an estimate of the amount of money the state would need to fund reimbursements under HB 383. MR. JONES replied that the advisory board and others had identified approximately $1 million that could be used to provide increased and better detoxification services. However, he could not estimate the needs of police departments, medical facilities or other providers. CO-CHAIR IVAN said the Bristol Bay area is doing their best to solve the problems. He stated he believed if there is a mandate, the state has the responsibility to address the issue. Alcoholism prevention programs statewide need to be reassessed. Number 887 MR. JONES said his department had worked hard with many of the communities that testified. He agreed that some of the proposed amendments would be ideas the department would like to work on. Number 931 HARLAN KNUDSON, President/CEO, Alaska State Hospital and Nursing Home Association, said several members of the association had testified previously. He stated that they strongly support HB 383. He admitted that because of the $500 million fiscal gap, it seemed a bad time to ask for funding; however, the issue was vitally important. He suggested the committee look at reports like "Healthy People 2000," and offered to be a resource on the issue. Number 1006 CO-CHAIR IVAN asked if there were questions from the committee. Hearing none, he concluded the testimony on HB 383, adding that he would invite further testimony from people across the state at a future meeting. He proposed appointing a subcommittee and asked for direction from the committee. REPRESENTATIVE ELTON commented that Mr. Knudson was right; the committee must look at not only what was being spent but also the cost to communities if the money was not spent. He indicated concern about the substantial amount of new money required. He referred to a memo from Bartlett Memorial Hospital in Juneau addressing the need for reimbursement, and stated he thought this was perhaps one of the most important issues facing many communities, including his own. Representative Elton commended Co- Chair Ivan for addressing the issue, and volunteered to serve on the subcommittee. Number 1159 CO-CHAIR IVAN appointed Co-Chair Austerman to head a subcommittee to consider HB 383; Co-Chair Austerman indicated he would contact committee members and form the subcommittee. Number 1242 REPRESENTATIVE VEZEY said he understood the communities to be saying that providing the services in question was not a high priority in their budgets and communities were therefore turning to the state for funding. He wondered if they were getting a vote at the local level telling the committee this was their top priority. Number 1281 CO-CHAIR IVAN said he appreciated Representative Vezey's comments, and that he also understood the dire situation in some of the municipalities. Dillingham, especially, was trying to address other priorities as well. He suggested the subcommittee look for ways and means to fund the program by everyone involved.
| Document Name | Date/Time | Subjects |
|---|