Legislature(2003 - 2004)

03/25/2003 03:00 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
HB 167-ALCOHOLISM AND DRUG ABUSE GRANTS                                                                                       
                                                                                                                                
Number 1699                                                                                                                     
                                                                                                                                
CHAIR WILSON announced  that the next order of  business would be                                                               
HOUSE BILL  NO. 167,  "An Act relating  to grants  for alcoholism                                                               
and drug  abuse programs; and  providing for an  effective date."                                                               
Chair Wilson stated that this is  the third hearing for this bill                                                               
and  there are  individuals on  line that  did not  have time  to                                                               
speak to the bill in previous hearings.                                                                                         
                                                                                                                                
CHAIR  WILSON noted  for the  record that  Representative Kapsner                                                               
has joined the meeting.                                                                                                         
                                                                                                                                
Number 1616                                                                                                                     
                                                                                                                                
KEVIN MURPHY, Acting Director, Gateway  Center for Human Services                                                               
in Ketchikan;  President, Substance Abuse  Directors Association,                                                               
testified  via teleconference  on HB  167.   He said  he believes                                                               
this is  an important  bill because of  the tremendous  impact on                                                               
programs that  will be  required to raise  the cash  match across                                                               
the state.   Many programs are already facing waiting  lists.  He                                                               
told the committee that 70  percent of people that need treatment                                                               
either do not get it or  cannot afford it, and the programs serve                                                               
many of these  people.  To ask  the programs to go  back to their                                                               
communities to pay  for an additional 15 percent at  this time is                                                               
really difficult.   Mr. Murphy asked the committee to  look at an                                                               
increase of 12.5 percent off the  10 percent match.  The programs                                                               
could at  least trim budgets,  and the small programs  could live                                                               
with that and  not face having to cut services  or kill programs.                                                               
He  thanked   the  committee  for   their  time  and   asked  for                                                               
consideration  of  an  alternative  position to  the  25  percent                                                               
reduction.                                                                                                                      
                                                                                                                                
Number 1532                                                                                                                     
                                                                                                                                
CHAIR  WILSON agreed  that HB  167  will implement  a 25  percent                                                               
reduction  in  the  grant  funding for  alcohol  and  drug  abuse                                                               
programs,  and  that while  these  programs  are not  funded  100                                                               
percent by grant funds, the reduction  will have an impact on the                                                               
programs.                                                                                                                       
                                                                                                                                
Number 1504                                                                                                                     
                                                                                                                                
STEPHEN  SUNDBY,  Ph.D.,  Behavioral  Health  Director,  Bartlett                                                               
Memorial  Hospital and  Juneau  Recovery  Hospital, testified  in                                                               
opposition to  HB 167  and answered  questions from  the members.                                                               
He  said  he agrees  with  Mr.  Murphy  on  the impact  of  these                                                               
reductions.  There have not been  increases in funding in over 10                                                               
years, so  the communities  have had  to pick up  the slack.   He                                                               
told  the committee  that the  Juneau community  well overmatches                                                               
the 25 percent, so they interpret  this as a 15 percent reduction                                                               
in their grant.   What that means is that  the hospital will take                                                               
an $84,000 cut.   Currently, the hospital receives  a little over                                                               
$560,000.   With that  reduction, including  benefits, that  is a                                                               
loss of  a counselor.   So  services are going  to be  reduced if                                                               
this passes.  He asked that the  bill not be passed as is because                                                               
it will reduce services.                                                                                                        
                                                                                                                                
Number 1453                                                                                                                     
                                                                                                                                
CHAIR WILSON  asked Dr. Sundby  what the  full budget is  for the                                                               
Juneau Recovery Hospital.                                                                                                       
                                                                                                                                
DR.  SUNDBY told  the  committee  that the  full  budget is  $2.8                                                               
million.    He  said  it receives  $560,000  from  AIDEA  [Alaska                                                               
Industrial  Development   and  Export  Authority].     So  Juneau                                                               
Recovery Hospital  has met the  25 percent  match for years.   He                                                               
commented that what  he believes he hears is that  this bill will                                                               
reduce AIDEA's budget for grants.   So what AIDEA will have to do                                                               
is reduce the grant dollars somewhere.                                                                                          
                                                                                                                                
CHAIR WILSON inquired if that means  this hospital will take a 15                                                               
percent reduction.                                                                                                              
                                                                                                                                
DR.  SUNDBY replied  that is  correct; it  will be  a 15  percent                                                               
reduction.  He  said the way he understands the  bill is that the                                                               
in-kind reimbursement will go from 10  to 25 percent, so it would                                                               
be a 15  percent cut in the  grants that will have to  be made up                                                               
by the communities.                                                                                                             
                                                                                                                                
REPRESENTATIVE SEATON  said he wants  to clarify how  the numbers                                                               
work with this bill.  He  said if a community is already matching                                                               
over 25  percent, which is  what this bill would  accomplish, the                                                               
grant  amount would  actually get  decreased as  if there  were a                                                               
match.    Even  though  the hospital  is  already  matching  that                                                               
amount,  the hospital  will  not get  the  same grant  previously                                                               
obtained.                                                                                                                       
                                                                                                                                
DR. SUNDBY  responded that  is correct.   Even  if AIDEA  were to                                                               
keep the Juneau  Recovery Hospital at the same  grant amount, the                                                               
money would have to be made up somewhere else.                                                                                  
                                                                                                                                
Number 1360                                                                                                                     
                                                                                                                                
REPRESENTATIVE  KAPSNER  asked  how this  reduction  will  impact                                                               
people.   If  the program  loses one  counselor, how  many people                                                               
will be  impacted by that loss?   Are some of  these people Title                                                               
47 individuals in treatment?  What  does this reduction mean to a                                                               
waitlist for families and jobs?                                                                                                 
                                                                                                                                
DR. SUNDBY replied that the  outpatient counselors are carrying a                                                               
caseload  of just  under  30.   If  the program  were  to lose  a                                                               
counselor, that means  there are 30 people, just  at this moment,                                                               
that  would not  be receiving  treatment.   So these  individuals                                                               
would  have to  be  waitlisted.   If  those  individuals were  in                                                               
treatment  for   six  months,  the  reduction   would  impact  60                                                               
individuals per year  at the barest minimum who would  have to be                                                               
waitlisted.                                                                                                                     
                                                                                                                                
Number 1315                                                                                                                     
                                                                                                                                
REPRESENTATIVE  KAPSNER asked  what it  means when  an individual                                                               
has to be waitlisted.                                                                                                           
                                                                                                                                
DR. SUNDBY responded that it means  the individual is placed on a                                                               
list and as  soon as someone comes off of  treatment and there is                                                               
a slot open, then the individual begins treatment.                                                                              
                                                                                                                                
REPRESENTATIVE  KAPSNER  asked if  people  who  are on  waitlists                                                               
typically keep on abusing substances until they begin treatment.                                                                
                                                                                                                                
DR. SUNDBY said that is correct.                                                                                                
                                                                                                                                
REPRESENTATIVE KAPSNER  commented that  these individuals  do not                                                               
just wait until there is room for them in the program.                                                                          
                                                                                                                                
DR. SUNDBY replied that if  they can wait, then these individuals                                                               
probably would not need the treatment.                                                                                          
                                                                                                                                
CHAIR WILSON asked if there is a waitlist right now.                                                                            
                                                                                                                                
DR. SUNDBY said  that for many programs there  are waitlists, but                                                               
for the Juneau Recovery Hospital  there is no waitlist currently.                                                               
If someone  needs treatment today,  the hospital can have  him or                                                               
her assessed  within a week  and into  treatment right away.   If                                                               
the hospital  were to  lose a  counselor, then  that would  put a                                                               
bigger load  on the  counselors there, and  it is  a contributing                                                               
factor in the  turnover rate.  The more asked  of counselors, the                                                               
more the stress  level goes up, and the more  likely the hospital                                                               
will lose staff.  This is a  major issue for all of the treatment                                                               
providers.                                                                                                                      
                                                                                                                                
REPRESENTATIVE  KAPSNER asked  Dr. Sundby  if the  60 people  per                                                               
year he mentioned are only  for the Juneau Recovery Hospital, not                                                               
statewide.                                                                                                                      
                                                                                                                                
DR. SUNDBY  responded that is  not statewide.  He  clarified that                                                               
the number he provided is  a conservative estimate for the Juneau                                                               
Recovery Hospital.                                                                                                              
                                                                                                                                
Number 1227                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA commented  that if an individual  who is on                                                               
the  waitlist begins  or continues  to  drink, in  order for  the                                                               
treatment to be successful the individual must be sober.                                                                        
                                                                                                                                
DR. SUNDBY told  the members that it is essential  to strike when                                                               
the  individual  is willing  to  come  into  treatment.   If  the                                                               
individual  does  not  get  in   right  away,  there  is  a  lost                                                               
opportunity.    In  response to  Representative  Cissna  question                                                               
about detoxification,  Dr. Sundby said individuals  are placed in                                                               
a medically  managed detoxification  program if it  is available.                                                               
Currently, that  is available and  there is no waitlist  for that                                                               
treatment; however,  for services beyond that  such as outpatient                                                               
services, an  individual may  have to  wait in  line to  get that                                                               
treatment.  It is not a  very good option, because the individual                                                               
has probably  gone back out  and will  likely have to  go through                                                               
detoxification again.                                                                                                           
                                                                                                                                
Number 1150                                                                                                                     
                                                                                                                                
MR.   MURPHY  responded   to  Representative   Kapsner's  earlier                                                               
question concerning the  number of individuals on  waitlists.  He                                                               
said that  he will supply  the committee  with the numbers.   Mr.                                                               
Murphy  told  the  committee  that  the  number  is  significant,                                                               
especially  with  respect  to   women  and  children's  programs.                                                               
Alcohol  and drug  abuse treatment  programs are  being asked  to                                                               
lessen the impact  on the Division of Family  and Youth Services,                                                               
where parents and children have  substance abuse issues.  This is                                                               
a  population group  that has  a  very high  percentage of  those                                                               
needing treatment.   There continues to be a  greater and greater                                                               
need of higher-treatment capacities.   That is one of the primary                                                               
reasons  this legislation  is so  crucial at  this time.   It  is                                                               
essential that the state not reduce treatment capacity.                                                                         
                                                                                                                                
REPRESENTATIVE KAPSNER said that because  she is pregnant, she is                                                               
very concerned about Fetal Alcohol  Syndrome (FAS).  She asked if                                                               
individuals  who   have  been  identified  under   Title  47  are                                                               
waitlisted.                                                                                                                     
                                                                                                                                
MR. MURPHY  responded that  pregnant women  are a  first priority                                                               
and are  not waitlisted.   Also, anyone  who is using  needles or                                                               
may  have other  health-related  issues  are at  the  top of  the                                                               
priority list, and a bed would be found for those individuals.                                                                  
                                                                                                                                
Number 1015                                                                                                                     
                                                                                                                                
REPRESENTATIVE KAPSNER  asked what would  happen if a  mother had                                                               
small children.                                                                                                                 
                                                                                                                                
MR.  MURPHY  responded  that  the   Women's  Resource  Center  in                                                               
Anchorage does accommodate  some children, but it has  had to cut                                                               
its beds from 45  to 17 beds in the last year and  a half.  There                                                               
is a  definite shortage  for a patient  who needs  placement with                                                               
small children.                                                                                                                 
                                                                                                                                
Number 0990                                                                                                                     
                                                                                                                                
REPRESENTATIVE GATTO  commented that  it is  so important  to get                                                               
pregnant women into treatment as soon  as possible.  He asked Mr.                                                               
Murphy,  if  a  woman  walks  in who  is  pregnant,  whether  his                                                               
facility would  be able to  admit her into treatment  right away,                                                               
or whether she  would be placed first on the  list to prevent the                                                               
disaster that will inevitably occur.                                                                                            
                                                                                                                                
MR.  MURPHY replied  that the  City of  Ketchikan contributes  to                                                               
this  program, so  between the  city  and the  state grants,  the                                                               
program would find a treatment bed  for this woman.  He said that                                                               
for people who  come to the treatment facility and  show a desire                                                               
for treatment, his program will find  a bed for them or work with                                                               
them while they are on the waiting list.                                                                                        
                                                                                                                                
Number 0907                                                                                                                     
                                                                                                                                
JANET  MCCABE,   Chair,  Partners  for  Progress,   testified  in                                                               
opposition to HB  167.  She told the committee  that Partners for                                                               
Progress  is the  nonprofit organization  that  works with  Judge                                                               
Wanamaker's'  wellness court  [Anchorage  Wellness  Court].   The                                                               
organization  supports  the  development  of  therapeutic  courts                                                               
throughout  the state.   She  asked the  members to  look at  the                                                               
second page of  the handout she provided to  the committee titled                                                               
"Alaska Almanac of Alcoholism and Jail".                                                                                        
                                                                                                                                
MS.  MCCABE told  the committee  her organization  is opposed  to                                                               
this  bill  for  three  major  reasons.    First,  the  treatment                                                               
agencies are really  important to the therapeutic  courts.  These                                                               
are  key  elements to  their  success,  since without  treatment,                                                               
agencies there  would be  no working  therapeutic courts.   These                                                               
agencies  are already  strapped for  money, and  this bill  would                                                               
require that  they raise another  15 percent  of the cost  at the                                                               
same time that municipal revenue  sharing is being reduced.  This                                                               
actually  gives community  alcohol-abuse programs  a double  cut.                                                               
She pointed  out that  alcohol abuse is  hugely expensive  to the                                                               
state  and the  public.   Regardless of  an individual's  view of                                                               
alcoholics,  it   is  a  practical   matter  that   treatment  be                                                               
delivered.   Of  the 8  or 9  percent of  problem drinkers,  each                                                               
problem drinker  will affect  at least  four additional  people -                                                               
mothers, fathers,  children, families, victims, et  cetera.  This                                                               
means that  between 30  to 40 percent  of Alaska's  population is                                                               
affected  by  alcoholism.    Some  of  the  problems  are  pretty                                                               
obvious,  for example,  driving  under the  influence of  alcohol                                                               
[DUI],  child  abuse and  neglect,  poor  health and  dependence,                                                               
domestic  violence,  and  all  the  costs  associated  with  this                                                               
problem.   The cost of  alcohol abuse in Alaska  is $453,000,000.                                                               
Treatment programs like this should not  be cut.  It is important                                                               
to think of the long-term problem.                                                                                              
                                                                                                                                
Number 0725                                                                                                                     
                                                                                                                                
MS. MCCABE  told the  committee that  one Fetal  Alcohol Syndrome                                                               
(FAS)  child will  cost the  public about  $1.4 million  over the                                                               
child's life.   Alcohol abuse  is the  gorilla in our  midst, and                                                               
community programs  designed to address alcohol  abuse should not                                                               
be cut.   The final  reason for opposition  to this bill  is that                                                               
last year when  the legislature passed HB 225  increasing the tax                                                               
rate on  alcoholic beverage sales,  it was directed that  half of                                                               
the  tax collected  be deposited  in the  Alcohol and  Drug Abuse                                                               
Treatment Fund.   Much of this money comes  from local businesses                                                               
and communities,  and she said  it does not seem  consistent with                                                               
the  previous  policy to  cut  treatment  money  this year.    In                                                               
conclusion, she  said she believes  this bill is contrary  to the                                                               
intent  of  the   Alcohol  Beverage  Sales  Tax   last  year  and                                                               
especially harmful to the Alaska population overall.                                                                            
                                                                                                                                
Number 0649                                                                                                                     
                                                                                                                                
MARLA  LIPPARD,  Clinical  Director,  Gastineau  Human  Services,                                                               
testified in opposition  to HB 167.  She told  the committee that                                                               
Gastineau  Human Services  (GHS) provides  correctional services,                                                               
substance abuse, and  mental health treatment, and  is opposed to                                                               
HB 167, which would  raise the match from 10 to  25 percent.  All                                                               
regions of Alaska  currently lack the treatment  capacity to deal                                                               
with their local  needs.  The demand far exceeds  the capacity to                                                               
provide treatment.   The  statistics just  given by  Partners for                                                               
Progress  demonstrate  that  it  makes  no  sense  to  lower  the                                                               
treatment capacity.   Public  safety, emergency  health services,                                                               
and the  criminal justice  system end up  paying more.   Families                                                               
and communities  end up paying more  in personal losses.   If the                                                               
formula from  respected national  research shows  $7 is  paid for                                                               
every $1  invested in treatment, she  said this kind of  cut will                                                               
cost the state  an estimated $21 million in other  costs.  Across                                                               
Alaska, programs will have to  find an additional $3.6 million in                                                               
their  communities   to  make  up   the  difference,   when  most                                                               
municipalities  are  struggling  to  keep  core  services.    Ms.                                                               
Lippard  told the  committee that  treatment  facilities in  some                                                               
communities are going to close.   Treatment programs have not had                                                               
an increase to their budgets,  primarily through state grants, in                                                               
10  years.   It  has  already  cost  their operating  budgets  25                                                               
percent.                                                                                                                        
                                                                                                                                
MS.  LIPPARD said  that  HB 167  would cut  $1.5  million out  of                                                               
programs serving thousands in the  Anchorage bowl area.  It would                                                               
cut nearly  $250,000 for programs out  of Bristol Bay.   It would                                                               
cut   more   than   $500,000  in   programs   serving   Southeast                                                               
communities,  and  nearly $350,000  out  of  the Fairbanks  area.                                                               
Gastineau Human  Services serves 300-400 indigent  and low-income                                                               
individuals  in the  Juneau area  every year.   It  is done  on a                                                               
$360,000  budget and  cannot be  done on  any less.   There  is a                                                               
waitlist at  any time  of approximately 70  people.   In summary,                                                               
Ms. Lippard  asked the committee  to consider 12.5 percent  or 15                                                               
percent, but not 25 percent, as a reduction.                                                                                    
                                                                                                                                
Number 0425                                                                                                                     
                                                                                                                                
JANET FORBES,  Outpatient Coordinator, Gastineau  Human Services,                                                               
testified in  opposition to HB 167.   She said GHS  has a waiting                                                               
list that is two to three months  out.  That is one to two people                                                               
per day that are waiting for  assessments.  It puts the community                                                               
at risk and  it puts families at risk.   Gastineau Human Services                                                               
receives referrals from the court  system at enormous rates.  The                                                               
inmate substance abuse treatment (ISAT)  program was cut from the                                                               
prisons,  so that  means GHS  will be  getting those  individuals                                                               
into the  treatment programs.   If  this money  is cut,  GHS will                                                               
probably  lose  two or  three  counselors,  while the  number  of                                                               
individuals who  require case management  will continue  to rise.                                                               
This  will put  more and  more  people at  risk.   She urged  the                                                               
committee to definitely consider not cutting this funding.                                                                      
                                                                                                                                
Number 0331                                                                                                                     
                                                                                                                                
MS.  FORBES  noted that  GHS's  treatment  program picks  up  FAS                                                               
issues, mental health issues, and  medical issues, and serves the                                                               
person as  a whole.  This  bill is not just  cutting treatment of                                                               
chemical dependency.   She urged  the committee not to  cut these                                                               
programs.  She agreed with  Ms. Lippard's statement that possibly                                                               
12  percent or  15  percent,  but not  25  percent  [would be  an                                                               
acceptable reduction].                                                                                                          
                                                                                                                                
CHAIR  WILSON  asked  if  GHS collects  statistics  to  see  what                                                               
percentage is successful.                                                                                                       
                                                                                                                                
Number 0246                                                                                                                     
                                                                                                                                
MS.  FORBES  replied that  it  does  keep statistics,  which  are                                                               
turned in to  the state.  Recovery is a  process and GHS normally                                                               
sees individuals  once, twice,  or even  three times  through the                                                               
system.  That is not uncommon.   Gastineau Human Services has had                                                               
individuals who have  come through the program  that were chronic                                                               
alcoholics.  These are people that  lived on the street, that are                                                               
now  leading fruitful  lives.   At times  they relapse,  but they                                                               
keep  coming  back, and  that  is  the  key.   These  people  are                                                               
employed,  off the  street,  and not  into  the criminal  justice                                                               
system as they used to be.                                                                                                      
                                                                                                                                
CHAIR WILSON  asked what percentage have  been successful through                                                               
the GHS program.                                                                                                                
                                                                                                                                
MS.  LIPPARD responded  that for  individuals who  complete GHS's                                                               
program, after  one year approximately 70  percent have full-time                                                               
employment.                                                                                                                     
                                                                                                                                
CHAIR WILSON asked  what is the percentage of  those who complete                                                               
the program.                                                                                                                    
                                                                                                                                
MS. LIPPARD  replied that 40  percent complete the program.   She                                                               
told the committee that GHS  has assistance in getting completion                                                               
because many [referrals] are court-mandated.                                                                                    
                                                                                                                                
CHAIR WILSON asked  for clarification that of the  40 percent who                                                               
complete  the program,  70 percent  are full-time  employed after                                                               
one year.                                                                                                                       
                                                                                                                                
MS. LIPPARD commented that GHS  surveys these individuals at that                                                               
one-year  mark, and  while they  may be  employed when  surveyed,                                                               
does not mean they  have been employed the entire year.   It is a                                                               
state  survey that  is designed  and worded  by the  state.   The                                                               
question reads something  like:  "Are you  employed full-time (30                                                               
to 40 hours)."                                                                                                                  
                                                                                                                                
Number 0065                                                                                                                     
                                                                                                                                
REPRESENTATIVE KAPSNER  asked Ms. Lippard  if she knows  of other                                                               
indicators of success.   She said she knows  there are functional                                                               
and working alcoholics.  If so, what are those indicators?                                                                      
                                                                                                                                
MS. LIPPARD said  an obvious indicator is  whether the individual                                                               
is drunk or not.                                                                                                                
                                                                                                                                
REPRESENTATIVE  KAPSNER  asked if  an  indicator  could be  fewer                                                               
family visits to  the shelter or that the individual  was a binge                                                               
drinker,  but not  to the  extent  that the  person lost  his/her                                                               
house, car, or job.                                                                                                             
                                                                                                                                
MS. LIPPARD said  that there are indicators such  as fewer visits                                                               
to the hospital, or law  enforcement involvement.  She offered to                                                               
forward the  outcome statistics to  the committee that  she feels                                                               
might be helpful.                                                                                                               
                                                                                                                                
TAPE 03-28, SIDE A                                                                                                            
Number 0001                                                                                                                     
                                                                                                                                
CHAIR  WILSON  asked  Mr.  Lindstrom  if  he  could  present  the                                                               
committee with  statistics on the  success of  treatment programs                                                               
throughout the  state.   Are there some  programs that  have been                                                               
more successful than others?                                                                                                    
                                                                                                                                
Number 0068                                                                                                                     
                                                                                                                                
ELMER LINDSTROM,  Special Assistant  to the  Commissioner, Office                                                               
of the  Commissioner, Department  of Health and  Social Services,                                                               
testified  on HB  167 and  answered questions  from the  members.                                                               
Mr.  Lindstrom  asked  the  members  to  look  at  the  "Chemical                                                               
Dependency Treatment  Outcome" study that  he referred to  at the                                                               
last committee  hearing on  this bill.   This  study was  done in                                                               
1998, and  while the  department does  collect ongoing  data, the                                                               
department does  not have any  more recent reports to  share with                                                               
the committee.                                                                                                                  
                                                                                                                                
MR. LINDSTROM asked the members  to look at the Executive Summary                                                               
of the  report.   These bullets  will give  the committee  a good                                                               
sense  of  the  types  of   outcomes  that  the  department  felt                                                               
confident provided good data at that  point in time.  It is quite                                                               
consistent  with  outcomes  in other  jurisdictions.    Generally                                                               
speaking, clients  in outpatient  treatment who receive  at least                                                               
50 hours  of care have  the best chance of  success.  There  is a                                                               
somewhat less  successful rate  for residential  patients because                                                               
those patients are more severely  impacted than folks that are in                                                               
outpatient treatment  at the  outset.  He  told the  committee he                                                               
does not  have any really current  data, but he said  he believes                                                               
this might be useful information for the committee.                                                                             
                                                                                                                                
Number 0231                                                                                                                     
                                                                                                                                
REPRESENTATIVE  KAPSNER asked  if the  statistics are  comparable                                                               
with other states.                                                                                                              
                                                                                                                                
MR. LINDSTROM  responded that these  outcome statistics  are very                                                               
comparable  with   other  jurisdictions.    He   pointed  to  the                                                               
[undated]   "Dear  Reader"   letter  in   the  packet   [Chemical                                                               
Dependency Treatment Outcome Final  Report - December 1998] where                                                               
it  says [paragraph  four, last  sentence], "These  findings also                                                               
compare very positively to studies  done at programs elsewhere in                                                               
the nation."   Mr.  Lindstrom said  he would  follow up  with the                                                               
division to see  if there is more current data  available, but he                                                               
believes  this   is  the  best  and   most  credible  information                                                               
collected.                                                                                                                      
                                                                                                                                
CHAIR  WILSON read  the first  bullet in  the Executive  Summary,                                                               
where it said:                                                                                                                  
                                                                                                                                
     Of Alaskan  patients surveyed, 56  percent of  those in                                                                    
     outpatient  programs  abstained  from alcohol  for  one                                                                    
     year  after  treatment,  compared   to  42  percent  of                                                                    
     residential  patients.     Outpatients  in   the  study                                                                    
     received  an  average  of  59   hours  of  care,  while                                                                    
     patients  in residential  programs received  an average                                                                    
     of 39 days of inpatient care.                                                                                              
                                                                                                                                
Number 0366                                                                                                                     
                                                                                                                                
MR.  MURPHY told  the members  that he  has been  working with  a                                                               
committee for the  last six months that includes  the Division of                                                               
Alcoholism  and Drug  Abuse, the  Division of  Mental Health  and                                                               
Developmental Disabilities,  and the  Center for  Substance Abuse                                                               
Treatment  to have  a web-based  evaluation system  that will  be                                                               
coming on  line in the  next six months.   In terms of  having an                                                               
integrated outcome  data system, this is  something the Substance                                                               
Abuse  Directors  Association  has  pushed for.    He  said  this                                                               
program will provide the outcome data  needed on a daily basis to                                                               
assist in policy decisions.                                                                                                     
                                                                                                                                
Number 0481                                                                                                                     
                                                                                                                                
MR. LINDSTROM  told the  committee that  the department  would be                                                               
happy  to  sit down  with  the  committee  and have  an  in-depth                                                               
briefing and  discussion on the  subjects of  outcome, treatment,                                                               
and success.                                                                                                                    
                                                                                                                                
Number 0499                                                                                                                     
                                                                                                                                
REPRESENTATIVE COGHILL pointed out that  the issue is as huge and                                                               
deep as the  committee wants to go in Alaska,  and that there are                                                               
some specifics in the package that  he wants to ask Mr. Lindstrom                                                               
about.  Representative Coghill said  there are 58 programs out of                                                               
the 115 programs  that are exempted from  the match requirements.                                                               
There are 15  programs that are under-$30,000 grants  that show a                                                               
10  percent match  rate.   He said  he got  a letter  from Pamela                                                               
Watts  in  which  she  suggested  that  these  programs  be  held                                                               
harmless.   Representative Coghill  asked if  that is  true under                                                               
this particular legislation.                                                                                                    
                                                                                                                                
MR.  LINDSTROM responded  that while  he has  not counted  up the                                                               
numbers,  he suspects  that  Representative  Coghill has  counted                                                               
accurately.   These are the  small suicide-prevention  grants for                                                               
small  communities  that  are  exempted  entirely.    Some  other                                                               
prevention  grants  were exempted  entirely,  such  as the  local                                                               
match  requirement  for  some   small  treatment  programs,  very                                                               
specifically serving women  and children for some  of the reasons                                                               
the members  have heard  in previous  testimony.   The department                                                               
retains  the ability  under statute  to  further exempt  programs                                                               
from the match  on an individual basis.   However, the department                                                               
wants to caution  the committee that an exemption  from a program                                                               
would by  all likelihood require further  reductions elsewhere in                                                               
the grants.                                                                                                                     
                                                                                                                                
Number 0664                                                                                                                     
                                                                                                                                
MR. LINDSTROM said he does not  intend to turn the meeting into a                                                               
budget  meeting, but  asked the  members  to look  at the  budget                                                               
proposed by  the governor  relative to the  current work  plan in                                                               
the  current year.   There  is  a significant  increase when  all                                                               
funding sources are considered of  about $4 million for substance                                                               
abuse  programs.   The department  is focusing  on those  program                                                               
areas mentioned  earlier, specifically,  women and  children, and                                                               
adolescents in  rural areas.  There  are a whole host  of changes                                                               
that are going on, and there  are losses of federal funds in some                                                               
areas, a  loss of mental  health trust  funds in some  areas, and                                                               
some increases  in mental health trust  funds in other areas.   A                                                               
lot of  things are going  on in the  budget, but the  bottom line                                                               
and  the demonstration  of  this  administration's commitment  to                                                               
substance  abuse treatment  "when you  net all  of those  out" is                                                               
that there is about a $4 million increase in funding.                                                                           
                                                                                                                                
MR.  LINDSTROM  said what  was  heard  from  a lot  of  treatment                                                               
providers  this afternoon  is that  it will  not be  easy to  get                                                               
there.   He  said he  is not  underestimating the  problems folks                                                               
were describing with  regard to how difficult it will  be to meet                                                               
the enhanced match requirement, nor  does he want to minimize the                                                               
work  that providers  and  the  state will  have  to  do to  help                                                               
generate additional Medicaid  funding into the programs.   But if                                                               
everyone  works  together and  things  go  as the  administration                                                               
believes it  can, he  said the  end result  for fiscal  year 2004                                                               
will  be  an  increase  in  total  funding  for  substance  abuse                                                               
treatment programs in the state.                                                                                                
                                                                                                                                
Number 0776                                                                                                                     
                                                                                                                                
MR. LINDSTROM  said that in  the absence of this  bill's passing,                                                               
he  does  not   want  any  of  the  providers   to  believe  that                                                               
necessarily  means that  the $1.6  million  associated with  this                                                               
bill will  somehow magically  be restored to  the budget.   These                                                               
funds are out  of the budget as proposed by  the governor, and it                                                               
will be a budget reduction in the absence of this bill.                                                                         
                                                                                                                                
REPRESENTATIVE COGHILL  reiterated that  there is a  provision in                                                               
this bill to  provide exemptions where it can  be demonstrated as                                                               
necessary.    At this  point,  over  half  of the  programs  have                                                               
already demonstrated that  need.  Thirteen of  those programs are                                                               
in  those  exempt  areas  or  Class A  grant  awards,  which  are                                                               
$30,000-limit grants.  A significant  portion of the programs are                                                               
being relieved  of this  possible reduction.   He said  for those                                                               
that are not exempt, community effort will be appropriate.                                                                      
                                                                                                                                
CHAIR WILSON announced that she  will hear the last person signed                                                               
up to testify today.   At the next meeting there  will not be any                                                               
testimony taken.                                                                                                                
                                                                                                                                
Number 0894                                                                                                                     
                                                                                                                                
ERIN  CRUZ,  Correctional   Programs  Director,  Gastineau  Human                                                               
Services,  testified in  opposition  to  HB 167.    She told  the                                                               
members  that she  sees  700  people per  year  come through  the                                                               
community residential center; 10 percent  of those go through the                                                               
treatment programs, and  they are all indigent and  coming out of                                                               
prison.  These  people need to have treatment before  they can go                                                               
to school, work, or get on their feet.                                                                                          
                                                                                                                                
Number 0950                                                                                                                     
                                                                                                                                
MS. CRUZ  told the  committee if this  treatment goes  away there                                                               
will be  other repercussions that will  occur.  There will  be an                                                               
increase  in  domestic violence,  an  increase  in fetal  alcohol                                                               
syndrome, and other domino effects  with these people not getting                                                               
into treatment.   There will probably be a $40,000  cut, but [GHS                                                               
is] dealing off of a budget  of $360,000.  The budget has already                                                               
been  dropped to  $330,000, and  if another  $40,000 is  cut, the                                                               
legislature   needs   to   understand    that   there   will   be                                                               
repercussions.   It  will affect  not only  alcoholics, but  also                                                               
their families.   There will be  a lot more people  in hospitals.                                                               
Ms. Cruz  said that  while she  hears all  the numbers,  the real                                                               
impact is what  will happen to the people.   She pointed out that                                                               
one in six people in Alaska is an alcoholic.                                                                                    
                                                                                                                                
Number 1010                                                                                                                     
                                                                                                                                
REPRESENTATIVE CISSNA asked about the  workforce issue.  She said                                                               
she is aware of the  enormous pressure on nonprofit organizations                                                               
with cuts to  the budgets and rising insurance costs.   She asked                                                               
if  the decrease  in funding  will  affect GHS's  ability to  get                                                               
workers and retain them.                                                                                                        
                                                                                                                                
Number 1075                                                                                                                     
                                                                                                                                
MS.  CRUZ responded  that  this cut  will  absolutely affect  its                                                               
employees.  She said GHS has  been working on the 2004 budget and                                                               
finds that  it will be a  $153,000 loss in the  behavioral health                                                               
programs, and two  programs have ended that  were very beneficial                                                               
to  this community.    Many programs  are at  or  just below  the                                                               
break-even point, and  GHS is really scrambling for  grants.  She                                                               
told the  committee that May 1  is the last day  of the recycling                                                               
program, the  junk busters  program will  end, and  several other                                                               
programs cannot be  done anymore.  Gastineau  Human Services will                                                               
lose  one  to  three  counselors.   Its  personnel  work  at  150                                                               
percent, and it is  not possible to ask more of  them.  There has                                                               
been discussion  about cutting  wages, but if  that is  done, GHS                                                               
will lose people.                                                                                                               
                                                                                                                                
Number 1123                                                                                                                     
                                                                                                                                
CHAIR WILSON  commented that  these are  not easy  decisions that                                                               
have to  be made, and no  matter what the members  do, it affects                                                               
people.                                                                                                                         
                                                                                                                                
CHAIR  WILSON announced  that  next Thursday  this  bill will  be                                                               
heard  again.   This has  been the  third hearing  on HB  167, so                                                               
testimony will not be taken at that meeting.                                                                                    
                                                                                                                                
Number 1167                                                                                                                     
                                                                                                                                
REPRESENTATIVE  COGHILL asked  if  there  would be  a  vote on  a                                                               
proposed amendment today.                                                                                                       
                                                                                                                                
CHAIR  WILSON stated  that there  would  not be  any votes  taken                                                               
today.   At  the  next  meeting there  will  be discussion  among                                                               
committee members, and amendments will  be taken up at that time.                                                               
[HB 167 was held over.]                                                                                                         

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