Legislature(2021 - 2022)DAVIS 106
03/22/2022 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB172 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 172 | TELECONFERENCED | |
| += | HB 292 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 172-MENTAL HEALTH FACILITIES & MEDS
3:10:55 PM
CO-CHAIR SNYDER announced that the only order of business would
be HOUSE BILL NO. 172, "An Act relating to admission to and
detention at a subacute mental health facility; establishing a
definition for 'subacute mental health facility'; establishing a
definition for 'crisis residential center'; relating to the
definitions for 'crisis stabilization center'; relating to the
administration of psychotropic medication in a crisis situation;
relating to licensed facilities; and providing for an effective
date." [Before the committee was CSHB 172(JUD).]
3:13:44 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 1 to CSHB 172(JUD),
labeled 32-GH1730\O.1, Dunmire, 3/18/22, which read as follows:
Page 11, following line 10:
Insert a new bill section to read:
"* Sec. 21. AS 47.30.915(9) is amended to read:
(9) "gravely disabled" means a condition in
which a person as a result of mental illness
(A) is in danger of physical harm arising
from such complete neglect of basic needs for food,
clothing, shelter, or personal safety as to render
serious accident, illness, or death highly probable if
care by another is not taken; or
(B) is so incapacitated that the person is
incapable of surviving safely in freedom [WILL, IF NOT
TREATED, SUFFER OR CONTINUE TO SUFFER SEVERE AND
ABNORMAL MENTAL, EMOTIONAL, OR PHYSICAL DISTRESS, AND
THIS DISTRESS IS ASSOCIATED WITH SIGNIFICANT
IMPAIRMENT OF JUDGMENT, REASON, OR BEHAVIOR CAUSING A
SUBSTANTIAL DETERIORATION OF THE PERSON'S PREVIOUS
ABILITY TO FUNCTION INDEPENDENTLY];"
Renumber the following bill sections accordingly.
Page 13, line 1, following "date":
Insert "of secs. 1 - 28"
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 24"
Page 14, line 7:
Delete "Section 28"
Insert "Section 29"
3:13:46 PM
CO-CHAIR SNYDER objected for the purpose of discussion.
3:14:01 PM
HEATHER CARPENTER, Health Policy Advisor, Office of the
Commissioner, Department of Health and Social Services (DHSS),
explained that the department and the committee received a
series of suggested amendments from James Gottstein. She stated
that Amendment 1 would update the definition of "gravely
disabled". This definition change is in response to a statute
declared unconstitutional by the Alaska Supreme Court.
3:14:34 PM
REPRESENTATIVE MCCARTY voiced the opinion that the use of the
word "freedom" on line 11, as numbered in the amendment, is
vague and leads to interpretation. He stated this usage would
be "existential" and questioned how the court had responded.
3:15:53 PM
NANCY MEADE, General Counsel, Office of the Administrative
Director, Alaska Court System (ACS), responded that Mr.
Gottstein recommended the amendment in reference to a 2007
decision by the Alaska Supreme Court. The court had taken the
decision from the U.S. Supreme Court, which saw the former
definition capturing too many people in civil commitment
proceedings. She explained that because civil commitments are
an infringement on an individual's liberties, there would have
to be strong grounds to take the individual involuntarily. She
said that the Alaska Supreme Court case quoted the U.S. Supreme
Court. In summary, it relayed that given the importance of the
liberty right involved, people may not be involuntarily
committed if they are dangerous to no one and can live safely in
freedom. She stated that the Alaska Supreme Court relied upon
this language, and this is the source of Mr. Gottstein and
DHSS's acknowledgment of a more appropriate definition.
REPRESENTATIVE MCCARTY argued that if the word "freedom" has no
parameters, this would lead to major interpretation issues and
could result in Title 47 rights being violated. He stated that
the U.S. Supreme Court has not done away with involuntary holds,
so using the word "freedom" would be too vague.
3:18:11 PM
REPRESENTATIVE PRAX concurred with Representative McCarty.
MS. MEADE clarified, because of the 2007 decision, this has been
the practice, and this standard has become familiar. She
expressed the understanding that this amendment is being
suggested now as a cleanup on something which was decided many
years ago.
3:19:25 PM
MS. MEADE, in response to Representative Spohnholz, stated that
the language "safely in freedom" is exactly what the Supreme
Court said. In response to a follow-up question, she answered
that freedom in this case would be freedom from a Title 47 hold.
3:20:41 PM
CO-CHAIR SNYDER removed her objection to the motion to adopt
Amendment 1.
REPRESENTATIVE MCCARTY objected.
A roll call was taken. Representatives Snyder, Zulkosky,
Fields, Spohnholz, Prax, and Kurka voted in favor of Amendment 1
to CSHB 172(JUD). Representative McCarty voted against it.
Therefore, Amendment 1 to CSHB 172(JUD) was adopted by a vote of
6-1.
3:21:20 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 2 to CSHB 172(JUD),
labeled 32-GH1730\O.2, Dunmire, 3/18/22, which read as follows:
Page 11, following line 1:
Insert new bill sections to read:
"* Sec. 19. AS 47.30.839(b) is amended to read:
(b) An evaluation facility or designated
treatment facility may seek court approval for
administration of psychotropic medication to a patient
by filing a petition with the court, requesting a
hearing on the capacity of the person to give informed
consent and on the proposed use of psychotropic
medication. The petition shall provide specific
information regarding the factors listed in
AS 47.30.837(d)(2)(A) - (E).
* Sec. 20. AS 47.30.839(g) is amended to read:
(g) If the court determines by clear and
convincing evidence that the patient is not competent
to provide informed consent and [, BY CLEAR AND
CONVINCING EVIDENCE,] was not competent to provide
informed consent at the time of previously expressed
wishes documented under (d)(2) of this section, that
the proposed use of medication is in the best
interests of the patient considering at a minimum the
factors listed in AS 47.30.837(d)(2)(A) - (E), and
that there is no feasible less intrusive alternative,
the court shall approve the facility's proposed use of
psychotropic medication. The court's approval under
this subsection applies to the patient's initial
period of commitment if the decision is made during
that time period. If the decision is made during a
period for which the initial commitment has been
extended, the court's approval under this subsection
applies to the period for which commitment is
extended."
Renumber the following bill sections accordingly.
Page 13, line 1, following "date":
Insert "of secs. 1 - 29"
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 25"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 25"
Page 14, line 7:
Delete "Section 28"
Insert "Section 30"
REPRESENTATIVE SNYDER objected for the purpose of discussion.
3:21:34 PM
MS. CARPENTER stated that Amendment 2 was suggested by Mr.
Gottstein and would address the statute for the court ordered
administration of medication. This would also be a cleanup from
the previous lawsuit. She continued that the language is a
little different from Mr. Gottstein's draft, but he has approved
the edits. She said, per this amendment, the court would
determine that clear and convincing evidence exists [before
medication could be administered]. She deferred to Steven
Bookman for any further questions.
3:22:17 PM
STEVEN BOOKMAN, Senior Assistant Attorney General, Human
Services Section, Civil Division - Anchorage, Department of Law
(DOL), in response to Representative McCarty, stated that a
patient who poses a risk of harm to others but is competent
enough to refuse medication becomes a difficult issue. He
continued that the individual would have to be committed without
administering noncrisis medication. In response to a follow-up
question, he stated that he had referenced "noncrisis"
medication, as this could be used for the health and safety [of
all involved], while [crisis] medication would be used for
restraint when an individual is actively hurting staff in a
violent situation.
3:24:35 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 2 to CSHB 172(JUD) was adopted.
3:24:47 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 3 to CSHB 172(JUD),
labeled 32-GH1730\O.3, Dunmire, 3/18/22, which read as follows:
Page 4, line 30, following the second occurrence of
"that":
Insert "the respondent is suffering an acute
behavioral health crisis and, as a result, is likely
to cause harm to self or others or is gravely
disabled,"
Page 4, line 31, following "center":
Insert ","
Page 13, line 1, following "date":
Insert "of secs. 1 - 27"
CO-CHAIR SNYDER objected for the purpose of discussion.
3:24:54 PM
MS. CARPENTER stated that Amendment 3 is another of Mr.
Gottstein's amendments in response to ACS. She stated the
amendment would clarify that when an individual in a crisis
stabilization center suffers an acute behavioral health crisis,
as defined, he/she could be held at a higher level of care.
3:25:40 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 3 to CSHB 172(JUD) was adopted.
3:25:49 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 4 to CSHB 172(JUD),
labeled 32-GH1730\O.4, Dunmire, 3/18/22, which read as follows:
Page 5, line 25, following "crisis":
Insert "and, as a result, is likely to cause harm
to self or others or is gravely disabled,"
Page 13, line 1, following "date":
Insert "of secs. 1 - 27"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 4 is similar to Amendment 3.
She said that it clarifies the definition in the proposed
legislation that an individual [in a behavioral health crisis]
"has to be likely to cause harm to self or others or is gravely
disabled."
3:26:20 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 4 to CSHB 172(JUD) was adopted.
3:26:32 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 5 to CSHB 172(JUD),
labeled 32-GH1730\O.5, Dunmire, 3/19/22, which read as follows:
Page 13, line 10, following "could":
Insert "improve patient outcomes and"
REPRESENTATIVE SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 5 is the last of Mr.
Gottstein's suggested amendments. She stated that it would add
a small, but important provision in Section 26, making reports
more thorough. The provision would require DHSS and the Alaska
Mental Health Trust Authority (AMHTA) to look at items which
could improve patient outcomes.
3:27:08 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 5 to CSHB 172(JUD) was adopted.
3:27:24 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 6 to CSHB 172(JUD),
labeled 32-GH1730\O.6, Dunmire, 3/19/22, which read as follows:
Page 5, line 3:
Delete "AS 47.30.700"
Insert "this section"
Page 5, line 9:
Delete "under AS 47.30.700 - 47.30.707"
Page 5, line 22, following "obtained":
Insert "under AS 47.30.707"
Page 5, line 23:
Delete "AS 47.30.700"
Insert "this section"
Page 5, line 29, following "an":
Insert "ex parte"
Page 13, line 1, following "date":
Insert "of secs. 1 - 27"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 5 would implement small
changes requested by ACS to ensure clarity and ease for
implementation of the proposed statutes.
3:28:16 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 6 to CSHB 172(JUD) was adopted.
3:28:26 PM
The committee took an at-ease from 3:28 p.m. to 3:29 p.m.
3:29:05 PM
CO-CHAIR ZULKOSKY explained that in order to keep "like content
with like content," she would skip to an amendment ending in
"O.17" and would call it "Amendment 17."
CO-CHAIR ZULKOSKY moved to adopt Amendment 17 to CSHB 172(JUD),
labeled 32-GH1730\O.17, Dunmire, 3/21/22, which read as follows:
Page 5, line 6, following "application":
Insert "and appoint an attorney to represent the
respondent"
Page 5, line 27, following "application":
Insert "and appoint an attorney to represent the
respondent"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 17 was initiated by the
Disability Law Center of Alaska and pairs well with the
amendments requested by ACS. If the court's amendments are
adopted, she said this amendment should be added to clarify that
an attorney would be appointed immediately to represent the
respondent. She offered that this is DHSS's intent and the
intent of the work done in the House Judiciary Standing
Committee.
3:30:14 PM
REPRESENTATIVE MCCARTY requested an explanation on the flow of
events which would involve an attorney.
MS. CARPENTER stated that the entire involuntary commitment
process would have a great deal of attorney involvement, as this
reflects the right to have representation. She stated that the
amendment would make a small change for the ease of ACS in terms
of how an individual would be held. She stated that an attorney
would be appointed and involved whenever the individual enters
the system through a crisis center. She expressed the
importance of having attorney representation as soon as the
process starts.
REPRESENTATIVE MCCARTY, with a follow up, questioned if
currently an attorney is called when an individual is in a Title
47, 24-hour hold. He expressed the belief that this has never
been protocol. [The question was deferred to Mr. Bookman.]
3:32:19 PM
MR. BOOKMAN responded that under the current system, an attorney
is appointed when the ex parte order is issued to begin the 24-
hour evaluation process. He continued that the attorney may not
choose to take legal action, or the client may not want to talk
to the attorney, but attorneys are appointed at this time.
REPRESENTATIVE MCCARTY commented that he had been referring to
before the ex parte order was issued. He expressed the
understanding that attorneys would not be involved in a Title
47, 24-hour review at this point.
MR. BOOKMAN responded in the affirmative. He stated that during
a 24-hour hold the attorney would not be appointed by the
actions of a physician or peace officer. He stated that the
attorney is appointed when the court grants the ex parte
petition.
REPRESENTATIVE MCCARTY questioned whether the amendment would
initiate attorney involvement before the evaluation, as this is
not the current protocol. He stated that now there is a 24-hour
buffer before the 72-hour ex parte order is put into place.
MR. BOOKMAN expressed the belief that the intent of the
amendment would be to replicate the current process, as much as
possible. He stated that an attorney would be appointed when
there is a 72-hour evaluation period. He added that this is
also the current process. He explained that some of the crisis
residential centers would be acting as 72-hour evaluation
facilities, and this would be a restriction of liberty. At this
point, the court would issue the order for an attorney to be
appointed.
3:35:06 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 17 to HB CSHB 172(JUD) was adopted.
3:35:14 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 7 to CSHB 172(JUD),
labeled 32-GH1730\O.7, Dunmire, 3/19/22, which read as follows:
Page 5, line 6, following "application":
Insert ", and the respondent may remain at the
crisis stabilization center until admission to a
crisis residential center"
Page 13, line 1, following "date":
Insert "of secs. 1 - 27"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 7 was requested by DHSS to
address the possible time delay a patient may have while waiting
to be moved from the crisis stabilization to the residential
center. The amendment would allow the individual to be held at
a crisis stabilization center without a time limit.
3:35:58 PM
The committee took a brief at-ease at 3:35 p.m.
3:36:03 PM
REPRESENTATIVE MCCARTY questioned the situation when the
stabilization center is 100 percent full and more individuals
arrive who need stabilizing.
MS. CARPENTER responded that this is a good question. She
stated that currently DHSS has a coordinator who tracks the
daily Title 47 filings, and this person would be aware when a
patient needs to be moved. She stated that the flow would be a
coordinated effort to determine if a center is at maximum
capacity and when someone needs to be diverted for a higher
level of care. She remarked that DHSS would work with ACS and
DOL to do this in the normal course of business.
3:37:38 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 7 to CSHB 172(JUD) was adopted.
3:37:44 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 8 to CSHB 172(JUD),
labeled 32-GH1730\O.8, Dunmire, 3/19/22, which read as follows:
Page 12, line 26, following "days":
Insert "for an involuntary admission"
Page 13, line 1, following "date":
Insert "of secs. 1 - 27"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER stated that Amendment 8 was requested by DHSS and
addresses the definition of a crisis residential center. This
definition has been cross-referenced with the involuntary
commitment statute. She said this clarification would be needed
so DHSS has the flexibility to work with the Section 1115
Medicaid waiver ("1115 waiver") which would allow an individual
to stay longer than seven days at the residential center. She
stated that this would address only voluntary admissions, as
involuntary admissions would be a "hard seven days." She added
that the clarification in the definition would allow the 1115
waiver providers to operate as intended.
3:39:01 PM
The committee took a brief at-ease at 3:39 p.m.
3:39:56 PM
REPRESENTATIVE PRAX expressed the opinion that the language
"involuntary admission" is a contradiction in terms. He said
that "involuntary detention" would better describe the
situation.
MS. CARPENTER stated that the department, in its work with the
Division of Behavioral Health and DOL, agreed upon this term as
accurate. She deferred to Gennifer Moreau-Johnson.
3:40:51 PM
GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral
Health, Department of Health and Social Services, explained that
it was determined the word "detention" carried stigma and should
be avoided. She explained that the department has tried to
avoid the "criminalization" of people who are in a mental health
crisis; therefore, "admission" rather than "detention" was used.
REPRESENTATIVE PRAX responded that it is a small detail, and he
supports Amendment 8 as long as the courts and the attorneys
understand the usage.
MS. CARPENTER stated that this section contains licensing
statutes which belong to the department. The department would
be licensing these facilities, so there would be an
understanding. She added that protections are in place in the
rest of the legislation, and the seven-day involuntary hold at a
crisis residential center would be "a hard stop."
3:42:24 PM
CO-CHAIR SNYDER removed her objection. There being no further
objection, Amendment 8 to CSHB 172(JUD) was adopted.
3:42:29 PM
CO-CHAIR ZULKOSKY moved to adopt Amendment 9 to CSHB 172(JUD),
labeled 32-GH1730\O.9, Dunmire, 3/19/22, which read as follows:
Page 2, line 13, following the first occurrence of
"officer":
Insert "and the arresting officer's employing
agency"
Page 2, line 31, following "officer":
Insert "and the arresting officer's employing
agency"
Page 3, line 20, following "officer's":
Insert "and the peace officer's employing
agency's"
Page 3, line 21:
Delete "is"
Insert "and the peace officer's employing agency
are [IS]"
CO-CHAIR SNYDER objected for the purpose of discussion.
MS. CARPENTER explained that DHSS and AMHTA brought Amendment 9
forward from conversations with the Alaska Network on Domestic
Violence and Sexual Assault. She stated that this is a small
but important amendment to the alternative to arrest statutes.
The amendment would require a good-faith effort by the arresting
officers and their employing agencies to provide contact
information [to the provider]. She explained that when an
individual [taken to a crisis center as an alternative to
arrest] is going to be released, it would ensure that
notifications go out [to the victim]. If the officer who did
the alternative to arrest was off duty, the employing agency
would also receive notification, improving the likelihood that
the victim be notified.
3:43:33 PM
REPRESENTATIVE PRAX stated that taken on its own, the amendment
could convey that the arresting officer cannot be trusted. He
stated that the explanation provided clarity, but he suggested
that "and" should be changed to "or" in the amendment.
MS. CARPENTER explained that the department chose "and" because
both the original arresting peace officer and officer's
employing agency should be contacted as a dual notification.
The provider would call the member of the police department and,
for example, the dispatch at the officer's employing agency.
She stated that this may be seen as repetitive, but it would be
crucial for the victims.
CO-CHAIR SNYDER stated that this would add continuity.
3:45:03 PM
REPRESENTATIVE MCCARTY voiced appreciation for Amendment 9, as
traumatized individuals need extra support.
3:45:49 PM
REPRESENTATIVE KURKA, questioning continuity, stated that if the
officer is not on duty, he/she would not receive the
communication. He questioned the timing and whether the agency
would be contacted by the [provider] after the officer's status
is determined.
MS. CARPENTER responded that DHSS would work with the Department
of Public Safety (DPS) on this question. She stated that there
would be work "standing up" the statutes and their operation.
She reminded the committee that currently there are no crisis
stabilization and residential centers to be utilized for this
alternative to arrest statute. She stated that DHSS, DPS, and
DOL would be working together on the flow.
3:47:20 PM
REPRESENTATIVE SPOHNHOLZ expressed the opinion that expecting a
mental health professional to track down an officer's schedule
would be unrealistic. She expressed concern that the onus would
be on the mental health professional, and there should be
continuity. She stated that after a reasonable effort had been
made to inform the arresting officer, the mental health
professional would contact the employing agency; this would
function as appropriate communication with law enforcement for
the purpose of victim advocacy.
MS. CARPENTER maintained that the wording in the amendment would
not change. The mental health professional would have to inform
both the peace officer and the agency, as this serves as a
tracking mechanism. She stated that there is concern how the
alternative arrest might be utilized, and if the employing
agency is contacted, there would be better tracking and
statistics. This would be important in the long run for
reporting on the system's viability.
3:49:42 PM
CO-CHAIR SNYDER removed her objection to the motion to adopt
Amendment 9 to CSHB 172(JUD).
3:49:47 PM
REPRESENTATIVE MCCARTY objected for a comment. He shared that
he has witnessed this process in action and "it is very
impressive." He then removed his objection. There being no
further objection, Amendment 9 to CSHB 172(JUD) was adopted.
3:50:36 PM
REPRESENTATIVE KURKA moved to adopt Amendment 10 to CSHB
172(JUD), labeled 32-GH1730\O.10, Dunmire, 3/19/22, which read
as follows:
Page 8, line 9, following "AS 47.30.838":
Insert ", and only if the crisis stabilization
center or crisis residential center
(1) either
(A) ascertains the date the respondent last
underwent a physical examination; or
(B) cannot ascertain the date the
respondent last underwent a physical examination and
performs a physical examination;
(2) administers the psychotropic medication
only as a last resort; and
(3) conducts an examination based on a
checklist developed by the department to exclude
commonly known issues that may contribute to
conditions and symptoms that mimic psychiatric
disorders"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA explained that Amendment 10 was recommended
by the Citizens Commission on Human Rights. He stated that the
amendment would add protections on the use of psychotropic
medication. He expressed concern that there could be abuse in
the administration of these drugs. He speculated that, when a
patient in crisis is brought in, there would be no knowledge of
the patient's medication or physical examination history; this
amendment would require an examination to take place.
CO-CHAIR SNYDER questioned the frequency the crisis medications
would be utilized in the crisis stabilization and residential
centers.
MS. CARPENTER responded that the department reached out to
[Recovery Innovations International] in Arizona, as these would
be the same sort of facilities. She stated that for the 500 to
550 admissions per month to those facilities, fewer than 40
events per month required the intervention of crisis medication.
She estimated about 8 percent of those served received a last-
resort intervention. She stated that the crisis medication
statute stipulates administering these drugs only after
everything else has been tried. Responding to a follow-up
question, she voiced the belief that in relation to Alaska, this
comparison would be reasonable, as these are not the highest
levels of facilities.
3:54:05 PM
REPRESENTATIVE SPOHNHOLZ questioned the practicality of the
amendment. She voiced understanding of the intent, as some
untreated physical health conditions could create psychiatric
crises. For example, she said an advanced urinary tract
infection could create psychosis. Considering the
circumstances, she speculated this type of examination would be
difficult prior to administering medication.
MS. CARPENTER offered appreciation for the intention of the
amendment but referenced several concerns. She reminded the
committee that when a patient first comes to a crisis
stabilization or residential center, he/she would have a
physical examine within three hours. She explained that in a
crisis situation there would be the possibility of immediate
danger to the patient or provider, and there may not be time or
patient cooperation for an examination. Crisis medication is
already being administered as a last resort, per the statute,
and attending physicians have been trained in the use and side
effects of these drugs. She added that physicians also
regularly consult pharmacists. She argued that DHSS has
concerns the amendment could cause further harm and injury to
the patient and providers. In response to a follow-up question,
she explained that without the amendment there would be the
requirement for an examination within three hours of admission
to a crisis stabilization or residential center.
3:56:59 PM
REPRESENTATIVE MCCARTY questioned whether the examination would
be observational or more detailed. He gave examples of a blood
panel or urinalysis. He stated that if the patient's history
could be referenced, it could be determined that the patient had
not been taking his/her [prescription] medication.
MS. CARPENTER responded that lab work would be available, but on
a voluntary basis. Blood work cannot be forced on an
involuntary patient. She continued that if an individual
required a crisis medication, but he/she calmed down and became
willing, then blood work could move forward. She warned that
there are legal protections.
REPRESENTATIVE MCCARTY questioned the difference between a
medical emergency where an unconscious individual has procedures
done without consent in a psychiatric emergency situation.
MS. CARPENTER explained that federal law covers a physical
injury in a medical emergency, but other rights cover the
individual when an ex parte has been filed for an involuntary
commitment. She said these facilities have to operate under the
involuntary commitment statutes. She deferred to Mr. Bookman.
MR. BOOKMAN explained that the key would be the unconscious
person versus the conscious person who refuses consent. For
example, if there was an unconscious person at a crisis
residential center, and the medical provider believed there was
an emergency that required the use of a blood draw, this would
be the same as a medical emergency. But if the respondent is
awake and refusing a blood draw, and there is not a life
sustaining emergency, the patient would control the blood draw.
4:01:05 PM
REPRESENTATIVE MCCARTY, with a follow up, referenced the
Diagnostic and Statistical Manual of Mental Disorders. He
stated that this manual describes how the mind-body relationship
affects mental health. He stated that by a physical examination
[it could be determined if a bodily disfunction] is affecting
mental processing. He expressed the opinion that if this cannot
be done, [the legislation] would be a waste of time. He stated
there should be an attempt to understand what is physically
affecting mental processing. He argued that someone who is
conscious on an involuntary hold, but not functioning
effectively, could not be stabilized by the center. In this
scenario it seems like effective energy is being wasted. He
reiterated that people in crisis would be in a hold situation,
but [health care professionals] would not be able to diagnose
the real problem.
MR. BOOKMAN responded that this is a fair point. Sharing his
experience at Alaska Psychiatric Institute (API), he said some
individuals brought in for the 72-hour evaluation do not
cooperate with a blood test, urine screen, and, in some cases,
wound evaluation. He stated that it can be difficult to help
someone. Experiences in other states have shown a calmer
environment can lead a person to open up and engage in a way the
person would not in an emergency room or hospital. He stated
that in regard to the medication, this would only be given when
someone is being hurt in the moment, or about to. Whatever the
reason the person is having a crisis, the medication would
address the manifestation, but not the underlying condition. He
deferred to Steve Williams on the issue of the mind-body
connection.
4:04:34 PM
STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority, Department of Revenue (DOR), stated that he
appreciated the vein of the conversation. He explained that Mr.
Bookman was correct - in a crisis situation the safety of the
individual and provider should be addressed. Once things
settle, there could be further examination to ascertain what has
been driving the crisis and how to respond to that.
CO-CHAIR SNYDER maintained her objection.
4:05:23 PM
REPRESENTATIVE KURKA, providing final commentary, voiced the
opinion that a physical examination should be done before a
person is injected with a psychotropic drug; a physical
examination may not be easy, but it is common sense.
4:06:06 PM
A roll call vote was taken. Representatives Kurka voted in
favor of Amendment 10 to CSHB 172(JUD). Representatives Snyder,
Zulkosky, Fields, Spohnholz, Prax, and McCarty voted against it.
Therefore, Amendment 10 failed to be adopted by a vote of 1-6.
4:07:01 PM
REPRESENTATIVE KURKA moved to adopt Amendment 11 to CSHB
172(JUD), labeled 32-GH1730\O.11, Dunmire, 3/21/22, which read
as follows:
Page 3, following line 24:
Insert a new bill section to read:
"* Sec. 11. AS 18.85.100 is amended by adding a new
subsection to read:
(h) For a person for whom counsel is appointed
under AS 47.30.708(h), the attorney services and
facilities and the court costs shall be provided at
public expense."
Renumber the following bill sections accordingly.
Page 5, line 31:
Delete "if needed"
Page 7, following line 20:
Insert a new subsection to read:
"(h) A respondent is entitled to be represented
by an attorney at a hearing under (d) of this section
to the same extent as a person retaining an attorney
and to be provided with the necessary services and
facilities of this representation, including
investigation. If a respondent is unable to secure
representation, the court shall appoint an attorney
employed by the Public Defender Agency before the
hearing to represent the respondent at public expense.
Representation in connection with the hearing may
include preparation before the hearing is held as well
as representation at the hearing. Representation of
the respondent shall continue after the hearing is
held under (d) of this section if the court holds
additional hearings under (f) of this section."
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 24"
Page 14, line 7:
Delete "Section 28"
Insert "Section 29"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA stated that Amendment 11 would guarantee
the patient would have the right to an attorney immediately.
The amendment would also guarantee that the cost for the court
appointed attorney would be covered, as in the criminal process.
4:07:59 PM
MS. MEADE expressed the understanding that the intent of the
amendment would be to ensure a public defender is appointed to
an individual whose liberties are potentially going to be
curtailed. Concerning the first part of Amendment 11, she
expressed the belief that this already exists under Title 47.
When the ex parte is ordered, a public defender is appointed.
She stated this would be "ultra-clarified" by Amendments [6] and
17, which would assure the court appoints an attorney before any
other decisions are made concerning the individual. She stated
Amendment 11 would add a provision to the authorizing statute so
the public defender could only act when told to do so by the
legislature. She voiced concern that this would create
confusion, as the amendment would make these proceedings appear
different from all the other public defender representations.
She explained the very definition of appointing counsel means at
public expense. If a person has his/her own attorney, the court
does not appoint that attorney. She expressed concern that this
process is already fully understood, and restating the process
in the amendment would be confusing, as people might think other
proceedings would not be at public expense.
MS. MEADE, concerning the second part of Amendment 11, stated
there is a similar concern. The amendment would add a section
to the crisis residential center statute addressing attorney
appointments. She reminded the committee that the proposed
legislation already provides for an attorney, so this would be
duplicating and confusing. She explained that the legislature
does not amend every statute when somebody is entitled to a
public defender, rather this is provided in the public defender
statute.
4:11:30 PM
REPRESENTATIVE KURKA stated that Amendment [6] would only apply
to the 72-hour hold. He stated that the patient would not be
given an attorney "out of the gate." He expressed the belief
that Amendment 11 would do this.
CO-CHAIR SNYDER clarified that the discussion concerns
Amendments 6 and 17, not Amendments 2 and 17.
4:12:39 PM
MS. MEADE, agreeing with the earlier testimony, stated that the
individual could not have an attorney immediately. She
explained if the individual is to be held in a crisis
stabilization center longer, the proposed legislation would
provide for an attorney within 24 hours. A petition would be
filed, and if the court grants the petition to hold the
individual, there would be a hearing. The hearing would be set,
and the counsel would be simultaneously appointed. This is
required because of Title 47. She voiced uncertainty as to how
counsel could be appointed any earlier.
4:14:34 PM
The committee took an at-ease from 4:14 p.m. to 4:18 p.m.
4:18:42 PM
REPRESENTATIVE KURKA [withdrew Amendment 11.]
REPRESENTATIVE KURKA moved to adopt Amendment 12 to CSHB
172(JUD), labeled 32-GH1730\O.12, Dunmire, 3/19/22, which read
as follows:
Page 3, following line 9:
Insert a new bill section to read:
"* Sec. 9. AS 12.25.031 is amended by adding a new
subsection to read:
(j) An individual being transported to a crisis
stabilization center, crisis residential center, or
evaluation facility by a peace officer, or an
individual involuntarily committed to a crisis
stabilization center, crisis residential center, or
evaluation facility under (b) of this section,
possesses all rights the individual would possess if
under arrest."
Renumber the following bill sections accordingly.
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 24"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 24"
Page 14, line 7:
Delete "Section 28"
Insert "Section 29"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA stated that Amendment 12 would ensure an
individual in the [mental health crisis] system would maintain
the same rights as an individual under [criminal] arrest.
MS. CARPENTER voiced concern, as this amendment would affect the
alternative to arrest statutes. She stated that DHSS spoke with
DPS and Mr. Bookman, as well as an attorney with the Criminal
Division. She expressed the belief that this would cause
confusion. Once an individual is in a crisis stabilization or
residential center and held in an ex parte, this individual's
rights would be covered under the civil commitment statutes.
She argued that the amendment mixes criminal and civil law,
adding confusion to public safety.
4:20:28 PM
REPRESENTATIVE SPOHNHOLZ questioned Ms. Meade's opinion of the
amendment, and she inquired whether it would require Miranda
rights be read to individuals held at the crisis centers.
4:20:55 PM
MS. MEADE, after considering the question, responded with the
realization that the amendment would give the individual all the
rights an arrested person would have, and this would include the
reading of Miranda rights.
REPRESENTATIVE SPOHNHOLZ, referencing trauma-informed language
and the destigmatization of mental illness, questioned Ms.
Moreau-Johnson as to whether the reading of Miranda rights to
psychiatric patients would "seem trauma-informed and ... patient
centered."
4:22:03 PM
MS. MOREAU-JOHNSON responded that this is a big question. She
stated that she would like to follow up at a later date. She
expressed the opinion that her inclination would be the reading
of Miranda rights would probably supersede concern with any
aspect of stigma.
REPRESENTATIVE SPOHNHOLZ voiced the opinion that having Miranda
rights read to a person who is in the middle of a psychiatric
crisis could make the crisis much worse. She stressed that the
idea of creating these centers would be to create a more trauma-
informed experience and not to treat [behavioral health
patients] as if they are criminals. She reasoned that this
could unintentionally amplify an already stressful situation.
She expressed concern about Amendment 12.
4:23:56 PM
MS. MEADE, in response to Representative McCarty, stated that
there is a lengthy and well-established body of law about what
police can do in terms of physical interventions. She voiced
the opinion that whether the police pick up somebody for arrest
or transport, they are guided by the same principles which
restrict the use of violence and superfluous restraint. Patient
rights are already in Title 47. These rights were written by
the legislature in order to curtail a person's liberty as little
as possible, but also with protections for patients and others
in light of the behavioral health crisis. She argued that
Amendment 12 would not add to the body of law, but it may add
confusion about a person's rights.
4:28:53 PM
CO-CHAIR SNYDER maintained her objection to the motion to adopt
Amendment 12 to HB 172.
4:30:00 PM
REPRESENTATIVE KURKA voiced the understanding that Miranda
rights could potentially have a negative effect on an individual
[in a behavioral crisis]. But he reasoned Miranda rights exist
because individuals need to be informed of their rights. He
expressed the understanding that limited protections already
exist in statute, but if individuals are involuntarily detained
and their liberty is suspended, the same guaranteed rights with
criminal prosecution should apply here. He argued that there is
no reason an individual having a mental crisis should have
lesser rights. He maintained that he strongly supports
Amendment 12, unless it can be proven that the amendment would
be entirely duplicative.
4:31:26 PM
REPRESENTATIVE PRAX queried what might happen if, when an
individual is detained and transported to a stabilization
center, the person confesses to criminal activity.
MS. MEADE responded that she did not know the answer.
4:32:10 PM
MR. BOOKMAN concurred with Ms. Meade. He said this is a
difficult question, and he would not want to guess.
4:32:34 PM
A roll call vote was taken. Representatives Kurka voted in
favor of Amendment 12 to CSHB 172(JUD). Representatives Snyder,
Zulkosky, Fields, Spohnholz, Prax, and McCarty voted against it.
Therefore, Amendment 12 failed to be adopted by a vote of 1-6.
4:33:10 PM
REPRESENTATIVE KURKA moved to adopt Amendment 13 to CSHB
172(JUD), labeled 32-GH1730\O.13, Dunmire, 3/19/22, which read
as follows:
Page 10, line 31:
Delete "during not [NO] more than three crisis
periods"
Insert "[DURING NO MORE THAN THREE CRISIS
PERIODS]"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA stated that Amendment 13 would eliminate
the possibility of medication being administered without the
patient's consent or a court order.
4:34:11 PM
The committee took a brief at-ease at 4:34 p.m.
4:34:34 PM
MS. CARPENTER, in response to Representative McCarty, explained
that in current statute, before a court order is needed, a
patient can be given medication for up to three crisis periods.
This amendment would remove the ability to administer crisis
period medications. She added that the amendment would take
away this tool for newly established centers, as well as all
other facilities, including hospitals. She continued that
crisis medication is considered to be a last resort tool. If
the ability to use this is removed, facilities would have to
wait for a court order, and the individual in acute crisis, who
is harming himself or herself or a provider, would have to be
physically restrained.
MR. BOOKMAN responded to a follow-up question concerning the
timeframe for a court order. He explained it would be difficult
to have a hearing take place within 24 hours. A petition would
have to be written, filed, and sent to the public defender, and
a judge would need to be found. He stated that the lead up to
the hearing would be the delay.
4:38:21 PM
MS. CARPENTER, in response to series of questions from
Representative Prax, affirmed that the only alternative to
medication [for an individual in acute crisis] would be physical
restraint. She voiced the understanding that [part of the
intent] of the legislation would be to protect people providing
the services. She explained that patient trauma [from physical
restraint] could cause a setback for any recovery. She
maintained that providers have said that the ability to
prescribe crisis medications is crucial in psychiatric care.
Responding to the question of whether patients would prefer
drugs to restraint, she expressed the belief that medications
are preferable. She continued that crisis medications would be
used for an immediate crisis, not as a long-term [solution].
4:40:42 PM
CO-CHAIR ZULKOSKY shared her experience of collaborating with
medical professionals in Alaska. She described these
professionals as compassionate, thoughtful, and meaningful in
their work. She argued that tools which help these
professionals make good decisions should not be taken away. She
reminded the committee that all physicians take the Hippocratic
Oath to do no harm. She stated that she would not support
Amendment 13.
4:41:31 PM
REPRESENTATIVE KURKA, regarding [the three crisis periods for
which patients can be given medication], offered a hypothetical
situation in which a patient is brought in for a fourth crisis
episode, and he questioned whether this patient would be subject
to physical restraint. He concluded that, in this scenario,
medication could not be administered without a judicial
decision.
MS. CARPENTER, in response, stated that this would not be
correct. She explained that each time a patient has a crisis
situation, this would be considered a fresh admission, and the
clock would start over for the 72-hour evaluation. In response
to a follow-up question, explained that a crisis period refers
to an episode of care. She stated that a crisis period is seen
as a 24-hour period.
REPRESENTATIVE KURKA expressed the understanding that three
separate "druggings" could happen within a 24-hour period.
MS. CARPENTER responded, "I would not describe it the way you're
describing it as forced drugging." She stated that the three
crisis periods would be before a court order is issued. She
deferred to Mr. Bookman.
MR. BOOKMAN explained that a crisis period is a 24-hour period.
He continued that the number of times medication could be
administered within the 24-hour period would be a clinical
decision, depending on the situation and type of medication. He
confirmed that Ms. Carpenter was correct; the ability to
administer medication at this point would have to be reviewed,
and during a fourth crisis period physical restraint would be
likely. He stated that during the second or third crisis period
[within 24 hours] the provider would apply to the court in
advance for additional crisis medication to avoid the inhuman
practice of physical restraint.
4:45:03 PM
REPRESENTATIVE MCCARTY expressed the belief that there have been
incongruent responses. He requested clarity on the actual
crisis period when judges are not available within 24 hours.
MR. BOOKMAN explained that the practice now is providers at
hospitals are authorized to give medication for three crisis
periods without court approval. They have this authority
immediately on patient admission. If there is an additional
crisis, providers must ask the court for additional authority.
4:47:07 PM
MS. CARPENTER, responding to Representative Kurka, confirmed
every time a patient is brought in, it is considered to be a new
crisis period. She stated that the clock would start over for a
patient on a Title 47 involuntary commitment hold for the 72-
hour evaluation. She reiterated that an individual would be
treated as a brand-new patient each time.
4:48:10 PM
REPRESENTATIVE KURKA voiced the belief that this seems
incongruent with Mr. Bookman's response. He expressed concern
that someone would get an injection without consent. He stated
that judicial oversight would be prudent considering the adverse
effects of psychotropic drugs.
4:48:52 PM
A roll call vote was taken. Representatives Kurka, Prax, and
McCarty voted in favor of Amendment 13 to CSHB 172(JUD).
Representatives Snyder, Zulkosky, Fields, and Spohnholz voted
against it. Therefore, Amendment 13 failed to be adopted by a
vote of 3-4.
4:49:50 PM
The committee took an at-ease from 4:49 p.m. to 4:52 p.m.
4:52:19 PM
REPRESENTATIVE KURKA moved to adopt Amendment 14 to CSHB
172(JUD), labeled 32-GH1730\O.14, Dunmire, 3/19/22, which read
as follows:
Page 6, line 5, following "holidays":
Insert ", except that if the exclusion of
Saturdays, Sundays, and legal holidays from the
computation of the 72-hour period would result in the
respondent being held for longer than 72 hours, the
72-hour period ends at 5:00 p.m. on the next day that
is not a Saturday, Sunday, or legal holiday"
Page 10, line 7, following "facility":
Insert ", except that if the exclusion of
Saturdays, Sundays, and legal holidays from the
computation of a 72-hour evaluation period or 48-hour
detention period would result in the respondent being
held for longer than 72 hours or 48 hours, as
applicable, the period ends at 5:00 p.m. on the next
day that is not a Saturday, Sunday, or legal holiday"
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA explained that Amendment 14 addresses the
potential problem concerning the exemption of Saturdays,
Sundays, and holidays from a 72-hour hold time. The problem
would be if an individual is held on a Thursday and Friday with
the release set for Saturday, then there is a holiday, the
individual could potentially be held until Tuesday. He
explained that 72 hours could turn into 6 days. He stated the
amendment would not eliminate the exemption for weekends or
holidays, but it would tighten up the timeframe to avoid an
excessive period an individual could be held without his/her
consent.
4:53:21 PM
MS. CARPENTER explained that the department did look at this and
there are some concerns. She stated the first concern is the
current timeframe statute has not included weekends or holidays
since 1984, and this has been the normal operation. There is
also the concern this amendment could create a bulk of hearings
on Mondays, or the day after a holiday. The court system would
need to be prepared to handle many hearings at once. She voiced
the concern that public defenders would need to have sufficient
preparation time in order to effectively represent the
respondent. She pointed out staffing differences between
weekends and weekdays at facilities. She concluded that a 72-
hour evaluation would be needed to determine whether an
individual should be committed further.
4:54:32 PM
CO-CHAIR SNYDER questioned Representative Kurka to provide an
example.
REPRESENTATIVE KURKA first noted that the question came up
during a House Judiciary Standing Committee meeting, when a
[representative of the court system] had testified that weekends
were not the issue; it was a question of obtaining a
professional for the evaluations. In response to Co-Chair
Snyder, to exemplify how the amendment would work, he said if an
individual had been picked up on a Friday to be released on a
Sunday, he/she would be there until the next business day. But
if Monday happened to be a holiday, the hearing would be on a
Tuesday. He said, "What this amendment avoids is that you don't
count the time somebody spends at all on a weekend ... if
somebody is picked up on a Friday, we skip the weekend, and we
would skip a holiday on Monday, and we would count then Tuesday
and Wednesday for the evaluation period."
4:56:27 PM
REPRESENTATIVE SPOHNHOLZ expressed confusion about how the
amendment would change the scenario; if the court said that
there is not a problem for legal proceedings to take place over
the weekend, it does not seem to change anything.
4:57:25 PM
MS. MEADE explained that the court always has magistrate judges
on duty around the clock to handle various emergencies,
including the ex parte hearing and a mental commitment. She
stated that the amendment would extend the ex parte hearing for
detentions at a crisis center, and this would have more of an
impact on DHSS. She explained that, per the amendment, if an
individual had been arrested Thursday night, and the process had
not come together on Friday, then the crisis center would
release the individual on Monday at 5 p.m. She explained that
the burden would be on the department because, more often than
not, the court would be able to have the 72-hour hearing shortly
after getting the petition from the department. She stated that
the department would have the potential difficulty of getting
the request to court in time.
REPRESENTATIVE SPOHNHOLZ, with a follow-up request, asked the
department for a description of the barriers created by the
amendment. She also requested a description of how the
amendment would be implemented.
MS. CARPENTER deferred to Mr. Bookman.
MR. BOOKMAN explained that there are two factors with court
approval. The first factor is the court's approval of the
original ex parte petition, and this happens quickly, around the
clock. The second factor, under the current system, is the
hearing on an extended commitment. This extended commitment
could be up to 30 days. This hearing will take place after the
72-hour evaluation. He offered that these hearings are not
easily done; for example, right now, they are held in Anchorage
in block hearings in the afternoon on Monday, Wednesday, and
Thursday. He stated that the court frequently runs out of time,
schedules are pushed back, and finding a judicial officer for
these other time slots can be very difficult. He expressed the
belief that with delayed schedules there would be difficulties
for the public defender to call witnesses, interview people, or
speak with clients. He indicated that he understood about the
concern on the 72-hour timeframe over the weekends, but he
expressed the belief that there would be a positive benefit to
patients having enough time to be evaluated. He stated that
Amendment 14 would impose "significant logistical burdens," not
only on the department but for health care providers.
5:01:57 PM
REPRESENTATIVE MCCARTY clarified that the 72-hour hold is an
actual timeframe. He said, "So when the 72 hours is up, that
person can walk unless an ex parte is placed on them to extend
that period of time." He suggested if the assessment is not
attained in time, a 96-hour hold would be needed.
MR. BOOKMAN responded in the affirmative, stating that it can be
difficult to fully evaluate someone during the 72-hour period;
therefore, no 30-day commitment petition would be filed, or, if
one is filed, it would not be granted. He stated that providers
at API have expressed the desire for more time to evaluate
patients. He stated that after 72 hours, the individual on
involuntary hold has to leave API, or there has to be a hearing.
He continued that there have been times when a public defender
requested the hearing be postponed a day. He expressed the
assumption that with more preparation time, the petition for a
30-day commitment likely would be denied. He said, "There's a
lot going on and not a lot of time to prepare for these."
Concerning time, he stated that petitions frequently continue to
the next day, and there have been times he was in court until 7
p.m. doing these hearings. He summed up that ACS and DOL are
very aware of due process rights.
5:04:55 PM
REPRESENTATIVE FIELDS stated that he would not be supporting
Amendment 14.
5:05:04 PM
A roll call vote was taken. Representatives Prax and Kurka
voted in favor of Amendment 14 to CSHB 172(JUD).
Representatives Snyder, Zulkosky, Fields, Spohnholz, and McCarty
voted against it. Therefore, Amendment 14 failed to be adopted
by a vote of 2-5.
5:05:48 PM
REPRESENTATIVE KURKA moved to adopt Amendment 15 to CSHB
172(JUD), labeled 32-GH1730\O.15, Dunmire, 3/19/22, which read
as follows:
Page 11, line 2:
Delete "a new section"
Insert "new sections"
Page 11, following line 4:
Insert a new section to read:
"Sec. 47.30.913. Health outcome metrics. (a)
Crisis residential centers, crisis stabilization
centers, and subacute mental health facilities shall
assess the severity of an individual's mental illness
each day and keep a record of the assessment. The
assessment shall use an objective scale relating to an
individual's ability to function in society and the
impact that the individual's mental health has on the
individual's daily life.
(b) A crisis residential center, crisis
stabilization center, and subacute mental health
facility shall submit a quarterly report to the
department relating to aggregate assessment data
gathered under (a) of this section without disclosing
information that would identify an individual.
(c) The department shall prepare an annual
report compiling the quarterly aggregate assessment
data reports received under (b) of this section. Not
later than February 15 of each year, the department
shall submit the report to the senate secretary and
the chief clerk of the house of representatives and
notify the legislature that the report is available."
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA explained that Amendment 15 addresses
accountability. He stated that it would require DHSS to give a
report on the assessments of the facilities and track the
improvements, as it is important to know the results of this new
process.
5:06:34 PM
MS. CARPENTER voiced appreciation for the motives but expressed
the belief that Section 26 in the legislation proposes a better
way to share publicly these metrics and data. She pointed to
language in the amendment which referenced using an "an
objective scale" in the assessments. She said, "We don't really
understand what that means - an objective scale." She added
there are concerns that [the report proposed by the amendment]
would not be data driven. She explained that DHSS has to report
on a regional or statewide basis because a small data sample
could identify individuals easily; to protect individuals,
information from regions with small numbers should not be shared
publicly. In addition, the department is tracking health
outcomes through the 1115 waiver, which is a requirement by the
federal government.
5:07:50 PM
CO-CHAIR SNYDER expressed appreciation for Representative
Kurka's amendment in the House Judiciary Standing Committee and
the department's effort to find middle ground. She said the
information the amendment addresses could be explored through
Section 26. She expressed hesitancy to add another burden of
reporting while implementing "this very significant bill." She
stated that she would not be supporting Amendment 15.
5:08:45 PM
REPRESENTATIVE KURKA, addressing Section 26 of the proposed
legislation, questioned whether it would give the legislature
reports on the status of patient improvement.
MS. CARPENTER responded in the affirmative. She stated that
reports of harm, grievances, appeals, restraint, and resolutions
would all be tracked. She stated that earlier the committee
adopted [Amendment 5] which looked at improving patient
outcomes. She expressed the belief that the department would be
able to provide an action plan to the legislature on making the
data available to the public in an easy way. `
5:10:00 PM
REPRESENTATIVE MCCARTY moved to adopt Conceptual Amendment 1 to
Amendment 15 [which would insert the language "industry standard
and reliable" after "objective" on line 10 of the amendment,
which read, "assessment shall use an objective scale relating to
an individual's ability to function in"].
REPRESENTATIVE FIELDS objected.
CO-CHAIR SNYDER requested that Representative McCarthy speak to
the conceptual amendment.
REPRESENTATIVE MCCARTY, concerning objective scale, explained
Conceptual Amendment 1 would insert "industry standard and
reliable" before "objective scale".
REPRESENTATIVE FIELDS removed his objection.
5:11:16 PM
REPRESENTATIVE PRAX objected for the purpose of discussion.
REPRESENTATIVE MCCARTY explained that in the [mental health]
industry there are psychometric assessments to determine the
state of the individual. He continued that an industry
standard, or established reliable standard, has been validated
by its use "tens of thousands of times." He voiced the idea
that using this standard would make the process more objective.
REPRESENTATIVE PRAX removed his objection.
5:12:10 PM
CO-CHAIR SNYDER announced that there being no further objection,
Conceptual Amendment 1 to Amendment 15 was adopted.
5:12:22 PM
CO-CHAIR SNYDER questioned whether the conceptual amendment
addressed the department's concerns with Amendment 15.
MS. CARPENTER maintained the belief that the process outlined in
Section 26 would involve providers, patient advocates, and other
public stakeholders in the process. She stated that Amendment
15, as amended, would add another reporting requirement to
providers.
CO-CHAIR SNYDER remarked that adding another report seemed out
of order.
5:13:19 PM
REPRESENTATIVE SPOHNHOLZ voiced the interpretation that
Amendment 15, as amended, would provide transparency around
patient outcomes, which could be helpful. She reasoned if the
number of providers is expanded, per the proposed legislation,
it could be useful to have an annual report on performance. She
cited that the state has had challenges with other organizations
accessing patient outcomes. She stated that she supports
Amendment 15, as amended.
5:14:23 PM
REPRESENTATIVE FIELDS requested additional clarity on the
difference between this amendment and Section 26.
MS. CARPENTER responded that there are a couple of differences.
The amendment, as amended, would require immediate reporting.
Providers would report on a quarterly basis, and the department
would have to prepare an annual report for the legislature by
February 15. She stated, in terms of Section 26, there would be
a year to come up with the ground rules and a structure for how
data would be collected, reported, and where it should be
reported. She stated that the amendment would add the
requirement for providers to report immediately on a quarterly
basis and the legislature to report annually.
5:15:20 PM
REPRESENTATIVE FIELDS, in a follow up, requested the
interpretation of the phrase "shall access the severity of an
individual mental illness everyday". He questioned whether a
psychiatrist would examine an individual's mental condition
every day.
MS. CARPENTER explained that this would be subjective from
facility to facility. She expressed hope that there would be
overall goals, or standards, used. But the process, as written,
would be very subjective. She voiced concern about how the data
would be aggregated and put forward to the legislature. She
explained that the department uses a contractor for the 1115
waiver for reporting data outcomes. In response to a follow-up
question, she stated that DHSS does not know what an objective
scale would be.
REPRESENTATIVE SPOHNHOLZ voiced the understanding that an
objective scale is defined, rather than based on the perspective
of the individual person doing the analysis. She stated this is
why the conceptual amendment specifies "an industry standard".
She stated that the difference in the conceptual amendment
versus Section 26 is the report in Section 26 would be focused
on the grievance and appeals process. She said this was
designed in consultation with patient advocates concerned about
grievance procedures in the state. She stated this would be a
one-time report to make recommendations on the appeals process
for patients with concerns about operations in facilities. She
continued that in Amendment 15, as amended, the providers would
give the information to the department on a quarterly basis, and
the department would report to the legislature annually. She
added this would allow some visibility into the effectiveness of
the massive new system. She conceded that there are valid
questions about implementation and the industry standard, but
the department is well qualified to answer these questions.
5:19:04 PM
CO-CHAIR ZULKOSKY voiced her appreciation for transparency
related to the outcomes of the crisis centers. She expressed
concern over the unfunded mandate put on health care providers
to provide quarterly data. She stated that in addition to
handling individuals in crisis, updating required accreditations
for facilities, and completing other types of reporting, a
quarterly report would be added. She expressed the opinion that
this would undermine the programs and the health professionals'
ability to focus on their work. She continued that not only
would the reporting requirement be an additional burden, but it
would provide non-defined information, as the scope of the
amendment is unclear to the department. She expressed concern
that the providers, who are doing crisis stabilization work, had
not been consulted. She expressed the opinion that adding a
quarterly report would be meaningful, but she expressed the
preference that it be done through DHSS, so the legislature
would not be micromanaging the department. She concluded that
there have been no expert opinions on an objective scale, and
she would not support Amendment 15, as amended.
5:21:41 PM
REPRESENTATIVE FIELDS voiced his concern that it would be
"subjective information masquerading as objective information,"
which becomes a problem when the aggregated information is
presented as valid. He expressed the opinion that one of two
things would happen: facilities would be required to access the
severity as a "check-the-box exercise," which would be a
"meaningless paperwork exercise," or there would be a cost,
which is unknown and may not be billable. He said, "I don't
know that there is an objective scale. We have no evidence that
there is, and if so, what is it?" He pointed out the size of
the report the amendment would require: a daily, per person,
report aggregated into a quarterly report, aggregated into an
annual report. He said this "strikes me as a massive exercise
by DHSS and the providers." Based on the structure, he
expressed confidence that the information in the report would be
misleading. He strongly opposed Amendment 15, as amended. He
suggested that if better reporting is needed, this should be
worked out with DHSS.
5:22:51 PM
REPRESENTATIVE KURKA asked, "What are we trying to accomplish
with the bill?" He stated that people are being "locked up"
because they are a danger to themselves or to the public, with
state resources paying for the treatment. He expressed the
belief that it is only reasonable to have an assessment of what
is working and what is not working. He stated that he is new to
the issue but expressed the understanding that the state has not
done a good job with the entire process, and there is concern
for how facilities would define a daily assessment. He argued
that this tracking is already being done daily; if this is so,
he expressed a greater concern with how patients are treated.
5:24:16 PM
REPRESENTATIVE PRAX stated that he concurs with Co-Chair
Zulkosky and Representatives Fields. He offered the opinion
that management relies too much on reports and data and not
enough by "being in the room ... walking around and taking a
look at what is happening."
5:24:45 PM
REPRESENTATIVE MCCARTY explained that Amendment 15, as amended,
assesses an individual's progress. For example, he said an
objective scale would be like the Minnesota Multiphasic
Personality Test, the Becks Depression [Inventory] or the
Hamilton Anxiety [Rating Scale]. He stated that institutions
make money on these reliable objective scales. He referenced
that when organizations in Alaska discuss continuity of
psychometric assessments in substance abuse, they follow the
standard for the American Society for Addiction Medicine. He
argued that nationally accredited organizations in the state
have to follow these standards, otherwise assessments would not
transfer. He discussed the Alcohol Safety Action Plan which
looks at recidivism but also determines the effectiveness of
organizations [addressing the problem]. He shared that in the
past, he had done assessments by hand. He voiced the belief
that because of technology, these assessments would be less of a
burden. He added that records would follow the patient as
he/she moves from a stabilization center to a residential
center. He stated that as the patient moves through treatment
centers, each center would be objectively evaluated. He pointed
out that individual assessments on patients would be done
several times, so progression could be tracked. He insisted
that technology gives capability without imposition, adding if
the state does not have the technology, this would need to be
updated.
5:28:10 PM
CO-CHAIR SNYDER voiced agreement with Representative Spohnholz'
point on transparency for data and tracking. She stated that
sometimes it is difficult to obtain data which would help inform
decisions in the legislature. She questioned whether other
states have the technology available to make daily, quarterly,
and annual reports seamless. She suggested that the maker of
the amendment and DHSS work together to produce an amendment
which is consistent with the spirit of Amendment 15, as amended,
but would deliver the quality of data which would be useful.
She stated that this could be done with resources currently
available to DHSS. She offered that she would not support
Amendment 15, as amended, but would follow up with
Representative Kurka and DHSS.
5:29:45 PM
REPRESENTATIVE SPOHNHOLZ, because of the complexity of
discussion, offered her support to Co-Chair Snyder's willingness
to work with Representative Kurka and DHSS on an alternative
amendment. She voiced the opinion that appropriate metrics need
to be identified. She stated that she would not support
Amendment 15, as amended, but could support an amendment in the
future that addresses transparency.
5:30:52 PM
REPRESENTATIVE KURKA withdrew Amendment 15, as amended.
5:31:14 PM
REPRESENTATIVE KURKA moved to adopt Amendment 16 to CSHB
172(JUD), labeled 32-GH1730\O.16, Dunmire, 3/18/22, which read
as follows:
Page 4, line 24:
Delete "(b)"
Insert "(c)"
Page 4, line 28, following "center.":
Insert "The examination must include evaluation
of whether the respondent is suffering from
(1) medication-induced psychosis caused by
the respondent's use of a prescribed medication or
other drug or psychoactive substance;
(2) psychosis caused by drug withdrawal; or
(3) a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from a medication or other drug.
(b) After the examination described in (a) of
this section, the mental health professional shall
consult with a physician trained to distinguish
symptoms caused by medication or other drugs from
symptoms caused by a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from medication or other drugs, to
determine whether the respondent is suffering from a
condition described in (a) of this section. If a
respondent is suffering from a condition described in
(a)(1) or (2) of this section, a mental health
professional may not apply for an ex parte order under
AS 47.30.700 authorizing detention at the crisis
residential center."
Reletter the following subsection accordingly.
Page 4, line 29:
Delete "If"
Insert "Except as provided in (b) of this
section, if"
Page 5, line 12, following "facility.":
Insert "The examination must include evaluation
of whether the respondent is suffering from
(1) medication-induced psychosis caused by
the respondent's use of a prescribed medication or
other drug or psychoactive substance;
(2) psychosis caused by drug withdrawal; or
(3) a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from a medication or other drug.
(b) After the emergency examination described in
(a) of this section, the mental health professional
shall consult with a physician trained to distinguish
symptoms caused by medication or other drugs from
symptoms caused by a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from medication or other drugs, to
determine whether the respondent is suffering from a
condition described in (a) of this section. If a
respondent is suffering from a condition described in
(a)(1) or (2) of this section, a mental health
professional may not admit the respondent to the
crisis residential center or apply for an ex parte
order under AS 47.30.700 authorizing admission to the
crisis residential center."
Reletter the following subsections accordingly.
Page 5, line 13:
Delete "The"
Insert "Except as provided in (b) of this
section, the"
Page 5, line 21:
Delete "If"
Insert "Except as provided in (b) of this
section, if"
Page 5, line 29:
Delete "(c)"
Insert "(d)"
Page 7, line 1:
Delete "(d)"
Insert "(e)"
Page 7, line 6:
Delete "(d)"
Insert "(e)"
Page 8, line 22, following "facility.":
Insert "The examination must include evaluation
of whether the respondent is suffering from
(1) medication-induced psychosis caused by
the respondent's use of a prescribed medication or
other drug or psychoactive substance;
(2) psychosis caused by drug withdrawal; or
(3) a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from a medication or other drug."
Page 8, line 27:
Delete "If"
Insert "Except as provided in (c) of this
section, if [IF]"
Page 9, following line 7:
Insert a new subsection to read:
"(c) After the emergency examination described
in (a) of this section, the mental health professional
shall consult with a physician trained to distinguish
symptoms caused by medication or other drugs from
symptoms caused by a psychiatric or psychological
condition unrelated to a respondent's use of or
withdrawal from medication or other drugs, to
determine whether the respondent is suffering from a
condition described in (a) of this section. If a
respondent is suffering from a condition described in
(a)(1) or (2) of this section, a mental health
professional may not admit the respondent to a crisis
residential center, hospitalize the respondent, or
arrange for hospitalization on an emergency basis."
Reletter the following subsections accordingly.
CO-CHAIR SNYDER objected for the purpose of discussion.
REPRESENTATIVE KURKA stated that Amendment 16 would address
quality by assessing professionals' qualifications to make
examinations and understand the effects of the drugs. He added
that this would ensure medical personnel observes the totality
of patients and how the drugs may affect them.
5:32:13 PM
MS. CARPENTER voiced the understanding that the amendment would
remove the option for the crisis centers to serve an individual
with a substance abuse disorder who is experiencing a
psychiatric crisis. She reiterated that a psychiatric crisis
would be defined as an individual being in immediate danger to
himself or herself or others or considered gravely disabled.
She stated that this means these patients could not be served in
these lower-level facilities. She continued that the amendment
would not allow the current hospitalization track, including
API. She suggested that this amendment could lead to more
arrests, because the only other option would be to take these
individuals to a correctional facility in order to keep them
safe. She offered that DHSS cannot support Amendment 16
because, by increasing the likelihood of individuals waiting in
a correctional facility, it would go against the settlement with
the Disability Law Center.
5:33:25 PM
MS. CARPENTER, in response to Representative Kurka, explained
that the reason the amendment would nullify the entire
legislation is because an examination would be required before
allowing individuals to go to any of these facilities. She
described that the amendment is written in multiple sections.
The first part of the amendment would not allow a crisis
stabilization center to apply for an ex parte. If somebody
falls into this category, the second section would not allow a
crisis residential center to hold him/her. She added that the
same language in the current hospitalization statutes would be
removed. She stated that the court system and DHSS read this
the same way, and it limits all of the options to use crisis
facilities. She stated that the intended use for these
facilities would be individuals with a substance abuse disorder
experiencing a psychiatric crisis; not allowing this would go
against the intention of these facilities.
5:35:45 PM
REPRESENTATIVE MCCARTY agreed with Ms. Carpenter's comments. He
said that if Amendment 16 were to pass, it would take away the
ability to recognize the state of these individuals and whether
they have psychosis because of prescribed medication. He
insisted that the reason for the crisis stabilization center is
for individuals with psychosis resulting from prescribed
medication or from drug withdrawal. He deduced, if the
amendment passes, a good number of people who need to be
stabilized would be eliminated. He stated that it is counter to
the whole purpose of the bill.
5:37:26 PM
REPRESENTATIVE KURKA withdrew Amendment 16.
5:37:52 PM
CO-CHAIR SNYDER entertained a motion on CSHB 172(JUD), as
amended.
5:38:16 PM
REPRESENTATIVE ZULKOSKY moved to report CSHB 172(JUD), as
amended, out of committee with individual recommendations and
the accompanying fiscal notes.
5:38:31 PM
REPRESENTATIVE PRAX objected, voicing his belief that it would
be nice to "digest" the conversation. He requested that the
committee put the legislation aside.
CO-CHAIR SNYDER expressed appreciation of the sentiment but said
she does not share it.
5:39:03 PM
REPRESENTATIVE KURKA voiced partial agreement. He stated that
it is a "heavy bill" and would do a lot of things. He described
that a new infrastructure would be built. He stated
individuals' rights have been addressed, but parental rights of
minors in these facilities have not yet been addressed. He
offered the opinion that the proposed legislation needs more
work.
5:39:40 PM
CO-CHAIR SNYDER reminded that this is not the only day the
committee has "hashed out" important considerations. She stated
that there had been hard work and collaborations with the House
Judiciary Standing Committee and DHSS. Amendments have been
worked through during five hearings in the House Judiciary
Standing Committee, and this is the House Health and Social
Services Standing Committee's fourth hearing, "walking through
17 amendments today." She stated that from this perspective,
she is keen to take the vote.
5:40:33 PM
REPRESENTATIVE FIELDS concurred.
5:40:37 PM
A roll call vote was taken. Representatives Snyder, Zulkosky,
Fields, Spohnholz, and McCarty voted in favor of reporting CSHB
172(JUD), as amended, out of committee with individual
recommendations and the accompanying fiscal notes.
Representatives Prax and Kurka voted against it.
5:41:22 PM
The committee took a brief at-ease at 5:41.
5:41:32 PM
CO-CHAIR SNYDER announced that by a vote of 5-2, CSHB 172(HSS)
was reported out of the House Health and Social Services
Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 292, Medicaid personal care services_ 03 15 22.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 292 |
| HB 292, One Pager.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 292 |
| HB 292, AK Guardianship Overview.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 292 |
| HB 292 Amendment Packet, 3.22.22.pdf |
HHSS 3/22/2022 3:00:00 PM HHSS 3/29/2022 3:00:00 PM |
HB 292 |
| HB 172 Amendment Packet, 3.22.22.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 172 |
| HB 172, Amendment #17.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 172 |
| HB172- Follow-up to HHSS 3.22.2022.pdf |
HHSS 3/22/2022 3:00:00 PM |
HB 172 |