Legislature(2021 - 2022)GRUENBERG 120
05/14/2021 01:00 PM House JUDICIARY
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Audio | Topic |
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Start | |
HB172 | |
HB183 | |
SB122 | |
Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
*+ | HB 172 | TELECONFERENCED | |
*+ | HB 183 | TELECONFERENCED | |
+ | TELECONFERENCED | ||
+= | SB 122 | TELECONFERENCED | |
HB 172-MENTAL HEALTH FACILITIES & MEDS 1:42:21 PM CHAIR CLAMAN announced that the first 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." CHAIR CLAMAN stated that there was a proposed committee substitute and explained the changes that would occur should the committee substitute be adopted. He said that the first change would be to create separate sections for crisis stabilization centers, crisis residential centers, and evaluation facilities to clarify the purpose and use of each facility. The next change would be a clarification that the process for involuntary commitment starts over for readmission into a crisis residential center or a crisis stabilization center. He said that the next change would be to establish a definition of "health officer" which refers to a non- law enforcement officer who may be involved in the process. He stated the next change would be a standard for the court to determine ex-parte applications for involuntary admission crisis residential center and would clean up the definitions section of the bill. Next it would amend the criminal procedure provisions in Title 12 to include crisis residential centers and would amend the domestic violence provision in Title 18 to include crisis residential centers. 1:44:05 PM REPRESENTATIVE SNYDER moved to adopt the proposed committee substitute (CS) 32-GH1730\I, Dunmire, 5/14/21, as a working document. There being no objection, Version I was before the committee. CHAIR CLAMAN noted that the bill had been presented by the governor's office and that he had been working with the department on the development of the committee substitute that was now before the committee. 1:45:16 PM STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health Trust Authority, shared with the committee an anecdote from an Alaska State Trooper during his law enforcement experience in responding to an individual experiencing a mental health crisis. He stated that upon responding, the trooper had been required to evaluate the situation to determine whether a mental health crisis existed, and further consider potential impacts to public safety. He explained that the trooper was required to place the individual in handcuffs and place him/her in the back of the patrol car, even though the individual had not committed any crime. He further explained that when the trooper arrived at the local hospital seeking emergency mental health care, he was informed that the emergency room was full, and the individual would not be accepted for care. He shared that the trooper placed the individual back in the patrol vehicle and drove his entire shift seeking care for the individual and was unable to attend to other law enforcement duties. He stated that HB 172 would establish lower levels of care in which law enforcement or other first responders would have the ability to take an individual [who has committed no crime] to seek the care required. 1:49:03 PM HEATHER CARPENTER, Health Care Policy Advisor, Office of the Commissioner, Department of Health and Social Services, referred to the presentation entitled, "HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf," [included in the committee packet] and drew attention to slide 2, which read [original punctuation provided]: Currently, Alaskans in crisis are primarily served by law enforcement, emergency rooms, and other restrictive environments ? Behavioral health crisis response is outside the primary scope of training for law enforcement, and reduces focus on crime prevention ? Limited Designated Evaluation & Treatment (DET) capacity in four communities: Juneau (BRH), Fairbanks (FMH), Mat-Su (MSRH), Anchorage (API) ? Emergency rooms are not designed for and can be overstimulating to someone in an acute psychiatric crisis MS. CARPENTER explained that the four community DET facilities each have a limited number of beds available for voluntary or involuntary care for a patient, consisting of 12 beds in Juneau, 20 beds in Fairbanks, 16 beds at MSRH, and additional beds at the Alaska Psychiatric Institute (API.) she explained that if someone is not located in one of those communities there exists a need to transport him/her to one, which often requires air travel. She stated that emergency rooms are busy and are not a therapeutic environment for an individual experiencing a behavioral health crisis, and they would await proper care until a time at which they could be transported to a DET. MS. CARPENTER drew attention to the infographic at the bottom of slide 2 and explained that the approach for treatment for a physical health crisis was incompatible with that which is necessary for treatment of a behavioral health crisis. 1:51:06 PM MR. WILLIAMS referred to the presentation entitled, "HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf," [included in the committee packet] and drew attention to slide 3, which read [original punctuation provided]: HB172 will: ? Effectuate a "No Wrong Door" approach to stabilization services ? Enhance options for law enforcement and first responders to efficiently connect Alaskans in crisis to the appropriate level of crisis care ? Support more services designed to stabilize individuals who are experiencing a mental health crisis ? 23-hour crisis stabilization centers ? Short-term crisis residential centers MR. WLLIAMS drew attention to the infographic at the bottom of slide 3 and explained that it depicted a more appropriate approach to a behavioral health emergency. He added that, in addition to the 23-hour crisis stabilization center, the short- term residential stabilization center as defined in HB 172 would provide 120 hours, or 5 days of service. He added that individuals who are seeking care on a non-voluntary basis are a small percentage of those seeking care; however, the facilities would need to have the ability to accept either voluntary or involuntary patients. 1:53:24 PM MS. Carpenter drew attention to slide 4 that provided background information on the conception of HB 172, entitled, "Building Blocks of Psychiatric Crisis System Reform," which read as follows [original punctuation provided]: ? SB74 Medicaid Reform (2016) Improve Access, quality, outcomes, and contain costs ? 1115 Behavioral Health Waiver Targets resources and services to "super utilizers" Provides flexibility in community behavioral health services and supports Creates new crisis service types that promote interventions in the appropriate settings and at the appropriate levels ? System must be intentionally designed and promote a "no wrong door" philosophy MS. CARPENTER added that the 1115 waiver would provide more treatment options, closer to a patient's home, and drive down costs by diverting patients from costly inpatient hospital care to the lower levels of care [that would be created should HB 172 pass] in all 9 regions served. She explained that appropriately trained mental health professionals would select appropriate levels of care to prevent a behavioral health crisis from escalating. 1:56:28 PM MR. WILLIAMS referred to slide 5, entitled, "GOAL: Design and implement a behavioral health crisis response system analogous to the physical health system," and explained the infographic depicted differences between physical and behavioral health crises. He said that the system proposed by HB 172 is based on the "Crisis Now" framework, which was in use in other states such as Arizona and Georgia and had the endorsement of organizations including the Substance Abuse Mental Health Services Administration, the National Association of State Mental Health Program Directors, National Alliance on Mental Illness (NAMI), and the National Action Alliance on Suicide Prevention. [HB 172 was set aside and brought back before the committee following a recess to a call of the chair.] HB 172-MENTAL HEALTH FACILITIES & MEDS 3:37:16 PM CHAIR CLAMAN announced that the next order of business would be a return to 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." 3:37:36 PM MR. WILLIAMS referred to the presentation entitled, "HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf," [included in the committee packet] and drew attention to slide 6, which depicted the stakeholder engagement. He explained that some of the stakeholders may be or become providers of care, and others may exist as a safety net within communities to prevent escalations to needs in crisis care and provide aftercare. 3:40:04 PM MS. CARPENTER referred to slide 7, entitled, "Enhanced Psychiatric Crisis Continuum of Care" and explained that the bracketed services illustrate the existing gap in available care. She provided an example from Bartlett Regional Hospital (BRH), which provides Crisis Now approach to its system to aid in achieving its goal of providing the most appropriate service at the most appropriate time with the most appropriate setting to its patients. She stated that BRH serves all Southeast Alaska and has elected to expand its services to cover multiple levels of care needed. She stated that 33 percent of patients who are assessed for a mental health crisis are admitted for care, and it provides lower levels of care for those not admitted. She stated that, having only 12 beds available, it must make choices to serve patients in an inpatient setting when a Crisis Now approach may be more appropriate. MR. WILLIAMS referred to slide 8, entitled, "Crisis Stabilization Center (23 hour)," and explained that it is one of the components of the new system of care as proposed in HB 172. He shared the content of the slide, which read as follows [original punctuation provided]: Provides prompt, medically monitored crisis observation and psychiatric stabilization services ? No wrong door - walk-in, referral, and first responder drop off ? Staffed 24/7, 365 with a multi-disciplinary team ? High engagement/Recovery oriented (Peer Support) ? Immediate assessment and stabilization to avoid higher levels of care where possible ? Safe and secure ? Coordination with community-based services MR. WILLIAMS added that the environment would be designed to be recovery-oriented and would include medical and behavioral health professionals as well as people with lived experience as part of the staffing. 3:44:39 PM MR. WILLIAMS referred next to slide 9, entitled, "Short-Term Crisis Residential Stabilization Center," and explained that it is the next component level of the new system of care as proposed in HB 172. He shared the content of the slide, which read as follows [original punctuation provided]: A 24/7 medically monitored, short-term, crisis residential program that provides psychiatric stabilization ? Safe and secure serves voluntary and involuntary placements ? High engagement/Recovery oriented (Peer Support) ? Multi-disciplinary treatment team ? Short-term with 16 or fewer beds ? Stabilize and restore avoid need for inpatient hospitalization where possible Coordination with community-based services MR. WILLIAMS explained that this next level of care would be appropriate for patients who were not able to achieve stabilization at the Crisis Stabilization Center (23-hour) as determined by staff at that facility. 3:45:52 PM MR. WILLIAMS drew attention to slide 10, entitled, "Enhanced crisis response would reduce the number of people entering the most restrictive levels of care," on which an infographic depicted outcomes discovered by experiences collected from care providers in other states, and the data reflected had been collected in the State of Georgia and had been interpolated from over 1.5 million calls to its crisis care line. He explained that for every 100 calls received by the crisis care line, 90 were resolved over the telephone, and of the 10 instances of a crisis mobile team dispatched, 7 of those did not result in transport. He explained that of the three crisis interventions that required transport, only one instance occurred in which care for more than 23 hours had been required. He added that the City of Phoenix, Arizona had reported similar outcomes. MS. CARPENTER drew attention to slide 11, entitled, "Alaska Statute Title 47," and explained that Title 47 is the statute which addresses involuntary commitment. She explained that HB 172 would update this statute. She stated that stakeholders had collaborated and made observations of successful programs in other locations to inform the drafting of HB 172. She noted that a settlement had been reached between the State of Alaska and the Disability Law Center in September 2020, a part of which was an agreement to advocate for statutory changes that would permit involuntary holds and 72-hour evaluations for patients at a less restrictive setting. She added that the settlement with the Disability Law Center had culminated in the draft HB 172 and committee substitute before the committee for its consideration. 3:51:05 PM MR. WILLIAMS referred to slide 12 of the presentation, entitled, "Current Flow for Involuntary Commitment," and recalled his earlier testimony regarding the Alaska State Trooper who had spent more than 8 hours in attempting to seek care for an individual. He explained that, should the committee substitute be adopted and HB 172 pass, the process of transfer from law enforcement to the crisis stabilization center could be reduced to take no more than 10 minutes, as evidenced by data provided from the State of Georgia and the City of Phoenix. MR. WILLIAMS referred to slide 13 of the presentation, entitled, Proposed Statutory Changes," and slide 14, entitled, "Flow for Involuntary Commitment with Statutory Changes," which depicts the anticipated flow for involuntary commitment under HB 172 as different than currently exists, as depicted on the previous slide. 3:55:13 PM MS. CARPENTER drew attention to slide 15, entitled, "Key Takeaways," and summarized it as follows [original punctuation provided]: HB172 Does: ? Provide law enforcement with additional tools to protect public safety ? Expand the number of facilities that can conduct a 72-hour evaluation ? Add a new, less restrictive level of care ? Facilitate a faster and more appropriate response to a crisis, expand the types of first responders that can transport an individual in crisis to an appropriate crisis facility ? Create a "no wrong door" approach to providing medical care to a person in psychiatric crisis HB172 Does Not: ? Interfere with an officer's authority or ability to make an arrest ? Change who has the current statutory authority to administer crisis medication ? Change current statutory authority for who can order an involuntary commitment ? Reduce the individual rights of the adult or juvenile in crisis; the parents' rights of care for their child; or existing due process rights of the individual in crisis 3:58:14 PM REPRESENTATIVE SNYDER asked whether a peace officer would be allowed to take an individual in crisis to either a stabilization center or a residential center or whether there would exist a sequential order of priority that the officer would be obligated to follow. MS. CARPENTER answered that a community might not have all the services that would be permitted under HB 172 and that the bill had been conceived to serve all communities in Alaska. MR. WILLIAMS added that Alaska is unique in its [diverse] communities and that HB 172 would provide a framework for communities to operate within the suite of services that they may have and had been developed in conjunction with community feedback. 4:01:56 PM CHAIR CLAMAN opened public testimony on HB 172. 4:02:31 PM STEVE PEARCE, Agent, Citizens Commission on Human Rights, stated his organization's concerns with HB 172 including that it would double the period of involuntary confinement prior to judicial action and recommended that it be changed to allow for earlier judicial representation. He stated that a stated goal of the bill was to achieve recovery and he questioned whether patients [as stakeholders] had provided any feedback and that recovery could indicate psychiatric compliance and not [necessarily] an improvement in health. He stated that forced medication may occur immediately upon confinement and that patients may have other health factors that may contribute to problems with compliance or resistance to ongoing treatment. He referred to a letter that was provided [included in the committee packet]. 4:05:18 PM MARK REGAN, Legal Director, Disability Law Center of Alaska, referred to written testimony that had been submitted to the committee and noted that it had been drafted in response to the underlying bill and had not taken into consideration the committee substitute before the committee. He summarized from the letter [included in the committee packet.] He suggested that the committee substitute before the committee would not provide an individual with attorney representation when a judicial order for an individual to be involuntarily held occurs. He noted that the different systems for civil commitment for medium term, 30-days or more for evaluation should provide for short-term treatment as a stated goal. He asked that the language in the proposed bill and committee substitute be carefully reviewed to ensure that an individual is not subject to multiple 3-day holds in a crisis residential center. CHAIR CLAMAN asked whether the right to counsel for involuntary commitment is explicitly stated in current statute. MR. REGAN answered that a peace officer would typically bring an individual to a residential facility, or they would be admitted to an emergency room and that individuals were often turned away for treatment. He stated that, the way the bill is drafted, individuals would have more direct access to evaluation and treatment. He suggested that individuals may be required to wait up to 8 days for treatment. CHAIR CLAMAN stated that the committee would continue to consult with the Disability Law Center of Alaska for its input on HB 172. 4:11:42 PM LISA GENTEMANN testified in opposition to HB 172. She stated her concern that the passage of HB 172 could result in legal harm to Alaskans. She stated that patient consent and human dignity should be considered. 4:13:13 PM RENEE RAFFERTY, Regional Director of Behavioral Health, Providence Health Services, testified in support of HB 172. She stated that HB 172 would expand the crisis care continuum and would provide a framework from the perspective of the provider. She stated that jails and emergency rooms may be harmed because the facilities are not equipped with medication and facilities for care and evaluation and are subject to high costs. She encouraged additional consideration and improvement on the language contained in the bill. 4:15:49 PM CHAIR CLAMAN ascertained that there was no one else who wished to testify, closed public testimony, and announced that HB 172 was held over.
Document Name | Date/Time | Subjects |
---|---|---|
SB 122 v. B 4.7.2021.PDF |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM |
SB 122 |
SB 122 Sponsor Statement v. B.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SJUD 4/21/2021 1:30:00 PM |
SB 122 |
SB 122 Sectional Analysis v. B.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM SJUD 4/21/2021 1:30:00 PM |
SB 122 |
SB 122 Fiscal Note LAW-CRIM 4.9.2021.pdf |
HJUD 5/10/2021 1:00:00 PM HJUD 5/12/2021 1:00:00 PM HJUD 5/14/2021 1:00:00 PM HJUD 5/17/2021 1:00:00 PM |
SB 122 |
SB 122 v. B Amendment #1 HJUD 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
SB 122 |
HB 183 v. B 4.21.2021.PDF |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM |
HB 183 |
HB 183 Sponsor Statement v. B 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM |
HB 183 |
HB 183 Sectional Analysis v. B 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
HB 183 Supporting Document - Criminal Justice Taskforce Recommendation 12.3.2020.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM HJUD 1/26/2022 1:30:00 PM |
HB 183 |
HB 183 Additional Document - A Sunset Review of the Office of the Governor, Alaska Criminal Justice Commission 6.12.2020.2020 |
HJUD 5/14/2021 1:00:00 PM HJUD 1/21/2022 1:00:00 PM HJUD 1/26/2022 1:30:00 PM |
HB 183 |
HB 183 Fiscal Note DHSS-BHA 5.7.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
HB 183 Fiscal Note JUD-AJC 5.13.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 183 |
HB 172 Work Draft Committee Substitute v. I 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
HB 172 Transmittal Letter 4.9.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
HB 172 Additional Document - Introduction Presentation to HJUD Committee 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
HB 172 Supporting Document - Letters Received by 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/16/2022 1:30:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
HB 172 Opposing and Amend Letters and Testimony Received by 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
HB 172 Fiscal Note DPS-AST 4.7.2021.pdf |
HJUD 5/14/2021 1:00:00 PM HJUD 2/21/2022 1:00:00 PM HJUD 2/23/2022 1:30:00 PM |
HB 172 |
HB 172 Fiscal Note DHSS-DET 3.30.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
HB 172 Fiscal Note DHSS-MS 3.30.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
HB 172 Fiscal Note JUD-ACS 4.28.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
HB 172 |
SB 122 v. B Amendment #1 HJUD Legal Memo 5.14.2021.pdf |
HJUD 5/14/2021 1:00:00 PM |
SB 122 |