Legislature(2001 - 2002)
04/17/2001 01:46 PM House FIN
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* first hearing in first committee of referral
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HOUSE BILL NO. 76
An Act authorizing the commissioner of health and
social services to provide for the design and
construction of psychiatric treatment facilities to
replace the facilities of the Alaska Psychiatric
Institute.
REPRESENTATIVE NORMAN ROKEBERG noted that HB 76 would
provide the replacement of the Alaska Psychiatric Institute
(API) go forward with a mixture of funds already
appropriated ($22,200,000) and proceeds from certificates of
participation to be issued by the State Bond Committee. The
legislation provides that the Commissioner of the Department
of Health & Social Services would work with the Department
of Corrections, the University of Alaska-Anchorage,
Providence Hospital in Anchorage, Alaska Regional Hospital
in Anchorage and the Municipality of Anchorage in the design
and construction of the replacement for API.
Representative Rokeberg discussed that the bill would
require that, as a part of any replacement of API, a
forensic psychiatric unit be included. Currently, there is
a 10-bed forensic psychiatric unit and the legislation would
require that such a unit be a part of the replacement
facility. The unit would be a facility for the assessment,
treatment, custody and confinement of mentally abnormal
criminal offenders as is the current facility.
The legislation encourages various State and local agencies
to cooperate in the development of the replacement facility.
Representative Rokeberg urged Committee's support of the
legislation.
Representative Rokeberg stressed the need to bring better
treatment facilities for patients. He noted that a forensic
unit would help provide local support. Issues are being
resolved. The facility is needed and the Legislature has
already provided substantial funds.
Representative Hudson noted that the total funding would be
$58 million dollars and that $19 million dollars was already
available. Representative Rokeberg understood that there was
$22 million dollars currently available.
KAREN PERDUE, COMMISSIONER, DEPARTMENT OF HEALTH AND SOCIAL
SERVICES, provided information regarding the legislation.
[Copy on File]. She observed that the issue has been before
the State for many years.
RANDAL BURNS, CEO, ALASKA PSYCHIATRIC INSTITUTE, ANCHORAGE,
provided information regarding the legislation. [Copy on
File]. He spoke in support of the replacement and noted
that the building does not meet standards. There are urgent
problems making its replacement necessary.
· API is permeated with hazardous material asbestos;
· Its fire, life safety and mechanical support
systems are worn out;
· The roof needs replacement; and
· The structure does not meet the current seismic
code.
Mr. Burns commented that API must be replaced:
· It was not designed as a psychiatric hospital and
its physical layout is not conductive to patient
care and treatment;
· API has had 39 years of hard use; and
· The need to replace the old API was recognized
long ago and replacement efforts have been ongoing
for 13 years.
Mr. Burns continued that a March 2001 report just issued by
Koonce Pfeffer Bettis, Inc. of Anchorage estimates the cost
of renovation to range between $74.5 million and $81.1
million dollars. It would be cheaper to construct a new
facility than to abate the asbestos and make the renovations
needed to make API a modern, efficient psychiatric hospital.
Mr. Burns commented on solutions that have been attempted in
the past.
· Constructing a replacement facility, however, the
implementation was halted when construction bids
substantially exceeded both engineering estimates
and appropriated funding and only the lack of
sufficient capital prevented success.
· Strategic partnerships with neighboring
institutions proved unsuccessful when essential
land swaps among partners could not be
accomplished and the partners withdrew and the
partners withdrew.
· Purchase a replacement was considered. Charter
North Hospital was the only real purchase
alternative. After two year, local planning and
zoning decisions and strong neighborhood
opposition made it impossible to complete the
purchase and use the facility.
Mr. Burns commented on what should be done now. He
recommended that the only realistic option for replacing API
would be the construction of a replacement hospital on land
very near the existing facility. He mentioned that there
has been an agreement made regarding the complicated
situations. The University of Alaska Medical landowners and
the institutions have agreed to a parcel from the Alaska
Mental Health Trust Authority (AMHTA) for the new facility.
AMHTA, Providence Hospital, the University and the
Department of Health and Social Services have signed an
agreement.
· The agreement sets forth the framework for land
conveyances, potential land purchases and
exchanges, and continued commitments to working
agreements.
· It sets the parameters for the future development
of the important University-Medical District in
Anchorage.
Mr. Burns advised that the parties believe building on the
U-Med parcel makes sense.
· The API parcels are zoned for the use;
· API is a well-established, accepted and necessary
institution on its present site;
· UAA nursing students do their psych rotations at
API each semester;
· UAA social work and psychology students intern at
API each semester; and
· WAMI medical students rely on API as a teaching
site.
Mr. Burns noted that building on the present site makes
sense because:
· API must be located near an acute care hospital in
case a person needs to be medically cleared before
admission to API and when the API patient needs
emergency medical care;
· The University Community Council and area
residents are supportive of API; and
· The Alaska Native Medical Center has stated that
it has no plans within the next 10 years to
provide inpatient psychiatric services and will
continue to rely on API.
Mr. Burns commented that replacing API would be the key to a
broader effort of:
· Developing private treatment alternatives to API
hospitalization;
· Enhancing the quality of care at API; and
· Replacing the API building.
Mr. Burns spoke to the intent of development of delivery for
community based services and the single point of entry. At
that point, it would be decided where each patient would be
sent.
Mr. Burns acknowledged that there have been questions of why
API is needed. He advised:
· That service is a core function of government and
that API provides the services that private
providers cannot or will not do;
· Patient needs can exceed local private treatment
options;
· Inpatient treatments is nonexistent or uncertain
in some communities; and
· API Treats forensic and NGRI patients and provides
competency evaluation services to the courts.
Mr. Burns commented on why the State should build a hospital
that can accommodate up to 72 beds.
· Successful operations of a smaller facility (54
beds) are contingent on a full array of private
community services;
· Community services are not all in place;
· Future bed needs at API are not predictable with
absolute precision; and
· Irresponsible to build for an ideal situation
without capacity to cope with emergencies or
population growth.
Mr. Burns discussed building with a flexible capacity in
mind. As the State's safety net, API must have a range of
inpatient bed capacity. He stressed that the bottom line is
that API cannot close its doors. API must admit any person
who is involuntarily committed or court-ordered to API for
evaluation and/or treatment.
Mr. Burns emphasized that the Legislature could help to
solve these problems through passing HB 76.
Representative Hudson asked if the increased operational
costs had been computed. Mr. Burns replied that the
operating costs would drop. Currently, a very "poor"
heating system exists, however, staying at the current bed
size, there would not be a reduction in staff costs.
Representative Hudson inquired if Alaskans are currently
being sent out-of-State. Mr. Burns replied that no one is
being sent out-of-State.
Commissioner Perdue commented that it was the intent to have
as small of a hospital as possible. The community hospitals
have developed the first level of response on these
concerns, which is being encouraged throughout the entire
State. In Anchorage, API is filling that function. API is
the last resort for many of the patients.
Commissioner Perdue stated that over the next ten years, it
is anticipated that there will be other community efforts
that help people to do readmissions to API.
Co-Chair Williams noted that it was not his intention to
move the bill from committee at this time. He noted that a
committee substitute would be prepared and at that time,
there would be public testimony taken.
Vice-Chair Bunde endorsed keeping the hospital at a small
size.
In response to Vice-Chair Bunde, Commissioner Perdue
acknowledged that hospital care is the most expensive care
and for patients that do not need that, it is important to
try to keep crisis from escalating. She pointed out that in
less than two decades, the community process has made
tremendous progress in meeting the needs of the mentally ill
in the Alaskan communities.
TAPE HFC 01 - 84, Side A
Representative Lancaster asked if the land agreement had
been resolved. Commissioner Perdue stated that the land
agreement had been settled.
JEFF JESSE, (TESTIFIED VIA TELECONFERENCE), EXECUTIVE
DIRECTOR, ALASKA MENTAL HEALTH TRUST AUTHORITY, ANCHORAGE,
testified in support of the proposed legislation and moving
forward with a committee substitute. He noted that a shared
vision for the interest exists, however, the funding
replacement is essential.
Representative Hudson inquired the approximate dollar value
in the land transactions. Mr. Jesse deferred to Steve
Blanche.
STEVE BLANCHE, EXECUTIVE DIRECTOR, ALASKA MENTAL HEALTH
TRUST LAND OFFICE, ANCHORAGE, responded that none of the
budget would go for the land. The hospital would be clearly
a beneficiary purpose under statute making it possible.
Representative Davies questioned if the land deal was
complete. Mr. Blanche replied that AMHTA believes that the
land deal has been substantially completed. It would
require a full set of processes required by statute
regarding the best interest decisions, complete appraisals
for transactions with Providence Hospital, public notice and
Trust Authority consultation. He noted that AMTHA has been
working on the concern for three years.
CAREN ROBINSON, CHAIR, ALASKA MENTAL HEALTH TRUST AUTHORITY,
JUNEAU, added that the members of the Trust Authority are
committed to everything that has been signed off and
acknowledged the rules and regulations, which need to be
followed.
MARGO WARING, ALASKA MENTAL HEALTH BOARD, JUNEAU, stated
that the Board had been working on a replacement for the API
facility for over twelve years. She commented that the
Board recognizes the need for a new building and the need
for a more therapeutic environment for the Alaskan citizens.
The Board has been the primary force in recognizing that the
future of the hospital has to be in an environment of
community-based services.
Ms. Waring added that the Board looks forward to the time
when there is a new hospital that can serve the goal for the
entire State that can focus on a treatment program and
treatment facility for psychiatric services.
Ms. Waring voiced appreciation for Representative Rokeberg's
attention to the needs of the State efforts for bringing
forward an acute care facility.
WENDY REDMAN, VICE PRESIDENT, STATEWIDE PROGRAMS, UNIVERSITY
OF ALASKA, FAIRBANKS, noted that the University has been
involved with the community plan. The Board of Regents have
voiced their support for the plan. She admitted that the
area that will be used will be a little "land-locked" and
that there will be many mutual programs and purposes. The
agreement of shared vision cannot go forward without the
construction funding. She urged the Committee's support for
the legislation.
HB 76 was HELD in Committee for further consideration.
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