Legislature(1993 - 1994)
02/25/1993 03:00 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 137: PAROLE FOR TERMINALLY ILL PRISONERS COMMISSIONER RUPP testified in Juneau on HB 137. He said the bill responds to a recommendation from the Alaska Sentencing Commission concerning special medical parole for terminally ill prisoners. He said the bill was prompted, at least in part, by concerns over HIV-positive prisoners. He said prisoners are dying in record numbers and the significant amounts of medical attention required of AIDS cases meant large medical expenses for dying prisoners. Commissioner Rupp said he believed the intention of Rep. Mulder, the sponsor, was to seek payment for such medical expenses not by the state, but by third parties, such as the federal government's Medicare or Medicaid programs. The state can furlough terminally ill prisoners, but retains responsibility for their medical treatment, he said. There are now eight to 10 prisoners who would qualify for terminal parole under HB 137, and medical expenses for one of those prisoners has already exceeded $500,000. The commissioner said he had attended a conference of state prison commissioners at which they shared ideas on how to fight increasing health care costs, costs fueled in large part by AIDS and HIV. COMMISSIONER RUPP said he would like to see the provisions for parole in HB 137 expanded to include prisoners suffering from chronic debilitating conditions, saying that prisoners whose condition confined them to bed could be better cared for in different facilities. He noted that the Department of Corrections did not have specialists in the care of the terminally ill on staff, nor did it have the funding or inclination to add them. The department therefore provides a patchwork of care for terminally ill prisoners that is not up to the standard of care provided by specialists in the area, and which therefore serves as another reason for the department's support of HB 137, he said. Number 193 COMMISSIONER RUPP said the bill would result in parole of some prisoners who would not otherwise be paroled, but there is no assurance such prisoners would be granted general parole, which is granted only at the discretion and independent authority of the Parole Board. The commissioner said he had asked the executive director of the Parole Board, Richard Collum, to be available to answer questions. He reminded the committee members that the Parole Board does not work for the Department of Corrections. Number 216 REP. TOOHEY asked whether terminally ill prisoners now are sent to a specific facility. Number 228 COMMISSIONER RUPP answered no, that the department did not have a specified facility or staff to deal with terminally ill prisoners. He said the department provides most care for such prisoners through contracted services. He added that the department is also responsible for the medical care of the prisoners it holds in jails, which can cause more problems than the population of terminally ill prisoners held in prisons. Current law holds the department responsible even if a prisoner is being held before trial, he said. In some cases, Commissioner Rupp said, people needing serious medical attention have committed offenses with the deliberate aim of being placed in jail and being provided medical care, though a third-party might have paid the medical costs had the person remained free. He called that practice a travesty perpetrated upon the Alaska public. He concluded by saying the points he had raised showed why the Department of Corrections supported HB 137. Number 246 CHAIR BUNDE, on behalf of Rep. G. Davis, asked how much it cost the department to care for a terminally ill prisoner, compared to the cost Medicare or other third-party payer. COMMISSIONER RUPP estimated that, as the department contracts for such services, the cost would be approximately the same for each. CHAIR BUNDE asked whether the department anticipated saving money by moving prisoners needing intensive medical care out of the prisons into other public facilities where Medicaid could pay for the care. COMMISSIONER RUPP answered that if the prisoners were moved to a state-funded system, then the state would continue to bear some expense. He added that it was likely that the state would pay less money because other health care facilities might have better contracts and be able to provide service at lower costs. Number 269 REP. TOOHEY asked whether the prisons treat sick prisoners inside prisons or in hospitals. COMMISSIONER RUPP said the prisons rely on the advice of the institution's attending physician whether to treat a prisoner inside the prison dispensary or at a facility outside the prison. The prison bears the cost of either choice, Commissioner Rupp said. He said treatment at an outside hospital costs more in part due to the necessity of sending guards along with prisoners. Number 282 REP. NICHOLIA asked, "What if an individual contracted AIDS in the jail because it was beyond their control?" COMMISSIONER RUPP answered that he would have to consider the methods by which inmates contract AIDS, and such people are more often participants rather than victims in such circumstances. Nevertheless, the Department of Corrections would be liable for the medical care of prisoners, he said. REP. NICHOLIA said she raised the question because there are some instances in which inmates who contract AIDS while imprisoned are unwilling victims. Number 300 COMMISSIONER RUPP said he would be concerned about the quality of care available for inmates. He said the department does not have the facilities or trained personnel to provide as good of care for terminally ill patients as the Alaska Psychiatric Institute, the Alaska Native health care system, or other services. He said he believed people deserve to die with dignity, and that there was not much dignity dying in a jail cell of terminal AIDS. Number 310 REP. VEZEY asked who sets the standards for care of terminally ill people. COMMISSIONER RUPP answered that the department has a physician, a medical officer, on staff who would remain in consultation with whatever medical authority was present at any of the department's 14 facilities. The initial standard of care would be established by the care-giver at the facility, with discussion with the departmental medical officer. The commissioner also mentioned that there is a four-member medical board which meets routinely to review cases for appropriateness of treatment, and which has ultimate decision-making authority on maintaining appropriate medical treatment. The board is primarily there to consider the cost of care and make sure that only appropriate care is provided. He said it would also consider whether and when to move prisoners from one facility to another for medical reasons. He said moving prisoners also entails a cost, which will be even higher given the requirements to comply with the Americans with Disabilities Act (ADA). Number 335 REP. VEZEY asked whether ADA addressed illnesses. COMMISSIONER RUPP answered no, the concern with ADA was that it required the department to make allowances for inmates with disabilities. He said that upgrading all the state's prison facilities to meet ADA standards would be prohibitively expensive, prompting them instead to upgrade one or two at a time, then move prisoners with special needs to those facilities. He commented that ADA was informally known as a "full employment act for attorneys." Number 353 REP. VEZEY said, "Staying on the same line of questioning, I was wondering how you were tying the ADA into health care, but. What is, to kind of approach the question from a different angle, what's to prevent you from prescribing a terminally ill patient two aspirin and sending them back to their jail cell? I mean, half a million dollars in medical expenses on terminally ill patients is a rather difficult sum of money to imagine. I know it can be done." Number 375 COMMISSIONER RUPP said he might want to refer the question to Dr. Townsend, but said that doctors must provide care according to medical standards, as a condition of their medical licenses. He said such standards, which include medical review, would help guide the standard of care. He said he could not imagine giving a terminally ill patient two aspirin and sending him back to his cell to die. He repeated that such questions might be better left to his medical officer to answer. REP. OLBERG asked a clarifying question, namely, whether state prisoners were guaranteed full medical benefits while the public at large was not. COMMISSIONER RUPP answered that this was true, though ironic. He said court decisions, including Russ v. State, and Estelle v. Gambel, require the state to assume responsibility for the medical condition of those it imprisons. Number 390 MARGO WARING, AN ALASKA MENTAL HEALTH BOARD STAFFER, testified in Juneau in support of HB 137. She said the board's executive committee was concerned about several cases in which prisoners suffering from Alzheimer's disease and other organic dementias, and therefore people of concern to the board, could have been better served had they been paroled to more appropriate facilities. Such parole would allow the families of such people to help select what facility to which the prisoner could be paroled. The board felt the demented should be released from prison when in the terminal stages of their illness, when continued incarceration would neither benefit them nor serve to protect the public. She said the issue was one of humane care. CHAIR BUNDE closed public testimony and asked the will of the committee. REP. VEZEY moved passage of HB 137 from the committee with individual recommendations. Number 422 REP. B. DAVIS asked about Commissioner Rupp's earlier statement that he would like to see the bill's provisions extend to prisoners with chronic, debilitating diseases. She said that such a provision would require a specific definition of that condition. COMMISSIONER RUPP said his medical people could have a definition drawn up quickly. Number 436 MS. LATOUR said she had asked Mike Stark, an attorney with the Department of Law's criminal division, whom she said has worked frequently with the Department of Corrections, whether a definition of terminally ill" had to be included in HB 137. She said Mr. Stark had answered no, the Department of Corrections had the authority through regulation to have its medical team determine a definition of terminally ill and to decide what chronic and debilitating illnesses would be. She said that while the department could set those guidelines, it would still be up to the Parole Board to determine whether a prisoner would win parole. REP. B. DAVIS said that while she appreciated Ms. LaTour's answer, she would have to have more than one person's answer before she was satisfied. Number 446 COMMISSIONER RUPP offered to have his medical people come up with a statement for inclusion in the bill. Number 450 GEORGE DOZIER, AIDE TO REP. PETE KOTT, testified on behalf of Rep. Kott. Mr. Dozier said he wanted to express concern over the lack of specific statutory standards and criteria for conditions of release. While it is important to be fiscally responsible, as was one goal of the bill, it is also important to protect the public health and safety, he said. CHAIR BUNDE said there was a motion on the floor to move HB 137 from the committee. REP. BRICE interrupted to say there was a motion to amend the bill. CHAIR BUNDE said he had not heard such a motion, but would entertain such a motion if offered. Number 464 REP. VEZEY said he was satisfied with the term "terminal illness," but he had reservations about "debilitating illness." He said it was too broad a term, encompassing too much, and would require specific a definition. Many illnesses, such as arthritis, are debilitating, he said. He expressed comfort with the term "terminal illness" and with the delegation to either the medical board or the Parole Board to define the term. Number 475 REP. TOOHEY expressed agreement with Rep. Kott's position on the question of "debilitating illness." A terminally ill person is not a danger to society and is debilitated to the point of inability to walk and probable inability to function without assistance. She said the committee could leave that discretion to the Corrections Department's medical (board). COMMISSIONER RUPP said that prisons are getting more geriatric prisoners, defined as inmates who are 55 years old and older. He said the growth of the age class of prisoners susceptible to Alzheimer's disease prompted concern over the disease relative to HB 137. He said prison authorities are concerned about how to deal with prisoners suffering from Alzheimer's disease and from mental illnesses. He said he has 700 mentally ill prisoners in his prison system, 350 of them acutely and chronically mentally ill. Some of them are approaching the condition in which they are not terminally ill, but might be considered debilitated. Number 497 REP. OLBERG asked whether the bill just provides the opportunity of parole to those who would not be eligible any other way. That is, a prisoner not eligible for parole, but terminally ill, becomes eligible for parole under the bill, he said. He shared the concern with over-broadening the bill to include debilitating diseases. Number 505 CHAIR BUNDE said he would oppose HB 137 if it were broadened to include prisoners suffering from Alzheimer's disease. It would be a shame to have such people in prison, but it would be even worse to have them on the street, he said. Number 510 CHAIR BUNDE repeated the motion to pass HB 137 from the committee with individual recommendations and without amendment to include debilitating illness. Hearing no objection to the motion, he declared the bill passed with individual recommendations. CHAIR BUNDE announced that the committee would hear HB 67 the following Tuesday, March 2, 1993. The meeting was ADJOURNED at 4:30 p.m.
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