Legislature(2021 - 2022)BUTROVICH 205

03/08/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HCR 10 AMERICAN HEART MONTH TELECONFERENCED
Heard & Held
-- Invited & Public Testimony --
+= SB 124 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled: TELECONFERENCED
+= SB 156 PROHIBIT COVID-19 VACCINE DISCRIMINATION TELECONFERENCED
Moved CSSB 156(HSS) Out of Committee
**Streamed live on AKL.tv**
             SB 124-MENTAL HEALTH FACILITIES & MEDS                                                                         
                                                                                                                                
2:05:05 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  announced   the                                                               
consideration  of  SENATE  BILL  NO.  124  "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."                                                                                                         
                                                                                                                                
2:05:52 PM                                                                                                                    
CHAIR WILSON solicited a motion.                                                                                                
                                                                                                                                
2:05:55 PM                                                                                                                    
SENATOR HUGHES moved  to adopt the committee  substitute (CS) for                                                               
SB 124, work order 32-GS1730\B, as the working document.                                                                        
                                                                                                                                
2:06:07 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
2:06:25 PM                                                                                                                    
STEPHEN WILLIAMS,  Chief Executive Officer, Alaska  Mental Health                                                               
Trust Authority,  Anchorage, Alaska,  offered to provide  a brief                                                               
overview of SB 124. He said  he would cover the components of the                                                               
Crisis Now  model. The state  would like to implement  this model                                                               
in  many communities  throughout  the state  to address  Alaskans                                                               
experiencing a behavioral health  crisis more appropriately. This                                                               
bill would relieve the first  responders, such as law enforcement                                                               
and  emergency  medical  technicians   (EMT),  from  the  current                                                               
default response. He  envisioned that the Crisis  Now model would                                                               
allow for  early intervention by  mental health  professionals to                                                               
assist Alaskans  experiencing a mental health  crisis. Currently,                                                               
if an  Alaskan facing a  behavioral health crisis calls  911, law                                                               
enforcement or EMTs  would respond. While that  response is good,                                                               
those professionals  are not  trained for  or have  the necessary                                                               
tools to address someone in a behavioral health crisis.                                                                         
                                                                                                                                
MR. WILLIAM explained  that the goal is to provide  the person in                                                               
crisis   with   the   appropriate   care   by   the   appropriate                                                               
professionals to  address the situation,  keeping the  person and                                                               
others  safe. He  elaborated  that taking  someone  into care  is                                                               
currently   limited  to   the  designated   evaluation  treatment                                                               
facilities in Anchorage, Mat-Su,  Fairbanks, and Juneau. However,                                                               
when beds in those facilities are  full, the only other option is                                                               
to  transport  the person  to  a  hospital  emergency room  or  a                                                               
correctional facility.  Neither of those settings  is appropriate                                                               
for someone experiencing a behavioral  health crisis, and neither                                                               
is designed  to address  the individual  and their  mental health                                                               
needs.                                                                                                                          
                                                                                                                                
2:08:41 PM                                                                                                                    
MR. WILLIAMS  stated that SB 124  would use the framework  of the                                                               
Crisis Now model  that has demonstrated success  in other states.                                                               
That  model would  consist  of  a crisis  call  center, a  mobile                                                               
crisis team  that includes  a mental  health professional,  and a                                                               
trained  peer, such  as someone  in recovery  or someone  who had                                                               
experienced a behavioral health crisis.  It would establish a 23-                                                               
hour 59-minute crisis stabilization  center that law enforcement,                                                               
EMTs, and  a mobile  crisis team will  accept as  the appropriate                                                               
facility  to  transport  a  person  facing  a  behavioral  health                                                               
crisis. The  23-hour 59-minute crisis stabilization  center would                                                               
accept  the   individuals  and  place  them   under  their  care,                                                               
relieving  the entity  from  dropping them  off  to resume  their                                                               
traditional duties. He related that  it would create a short-term                                                               
crisis residential center  that would allow someone  to receive a                                                               
longer period  of care if needed,  up to 7 days,  and receive the                                                               
services  and support  needed to  return to  their community.  He                                                               
summarized that  SB 124  would effectuate  the various  pieces of                                                               
the  model,  so  the  behavioral health  crisis  system  of  care                                                               
provides  a   full  continuum  of   services  to   provide  early                                                               
intervention in the least restrictive manner.                                                                                   
                                                                                                                                
2:10:36 PM                                                                                                                    
HEATHER  CARPENTER, Health  Care  Policy Advisor,  Office of  the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
Juneau, Alaska,  reminded members about  the work done  last year                                                               
on  SB  124.  She  explained  that SB  124  builds  on  the  1115                                                               
behavioral  health  waiver  that   sets  up  a  Medicaid  payment                                                               
structure  for these  services,  by instituting  a mobile  crisis                                                               
team,  a crisis  stabilization center,  and a  crisis residential                                                               
center. She highlighted that the  bulk of care when someone needs                                                               
mental health  services is  voluntary, just  as the  current care                                                               
provides.                                                                                                                       
                                                                                                                                
2:11:06 PM                                                                                                                    
MS. CARPENTER  said unfortunately, when a  situation arises, such                                                               
as  when a person with  "grave disability" as defined in statute,                                                               
poses imminent harm to themselves  or others, law enforcement and                                                               
other providers must be able  to act appropriately to ensure that                                                               
person can receive care. She indicated  that was the reason for a                                                               
narrow  change to  the state's  involuntary commitment  statutes,                                                               
which are used  very heavily today. She indicated  that this bill                                                               
comes  from   the  Department  of  Health   and  Social  Services                                                               
settlement  with the  Disability Law  Center. She  explained that                                                               
the  department and  state were  sued in  late 2018  due to  some                                                               
individuals   being  held   in   correctional  facilities   while                                                               
experiencing mental health crises  because the Alaska Psychiatric                                                               
Institute or other locations lacked  room. The judge in that case                                                               
ordered the department to do more than increase its beds at API.                                                                
                                                                                                                                
2:12:11 PM                                                                                                                    
MS. CARPENTER  reviewed some  key takeaways on  SB 124.  She said                                                               
the  bill would  create  a no-wrong  door  approach to  providing                                                               
medical  care to  a person  in a  psychiatric crisis.  This means                                                               
that if  a police officer  were to drop  someone off at  a crisis                                                               
stabilization   center  or   crisis  residential   center,  those                                                               
facilities would  act as emergency facilities  because they would                                                               
not turn someone away. SB  124 would provide law enforcement with                                                               
additional tools to  protect public safety. It  would also expand                                                               
the   number  of   facilities  allowed   to  conduct   a  72-hour                                                               
evaluation, which  is required by  statute if someone is  held on                                                               
an ex  parte hold. It would  add less restrictive levels  of care                                                               
outside of  inpatient hospital  settings. These  facilities could                                                               
act faster and  provide a more appropriate response  to a crisis,                                                               
expanding the  number of  first responders  that can  transport a                                                               
person in crisis to an appropriate facility.                                                                                    
                                                                                                                                
2:13:10 PM                                                                                                                    
MS. CARPENTER stated that the  bill would not change an officer's                                                               
authority or  ability to make an  arrest. It does not  change who                                                               
has  the   current  statutory  authority  to   administer  crisis                                                               
medication, who  can order an  involuntary commitment,  or reduce                                                               
the  individual rights  of  an  adult or  juvenile  in crisis  or                                                               
parental  rights,  or  the  existing due  process  rights  of  an                                                               
individual in crisis.                                                                                                           
                                                                                                                                
MS. CARPENTER  highlighted some key  improvements that  were made                                                               
in the committee substitute (CS) for  SB 124. She stated that new                                                               
language would  define a "health  officer  in Section  22 because                                                               
the  definition of   peace officer   was changed  to reflect  the                                                               
definition as  given elsewhere  in statute.  She related  that it                                                               
would  also change  the length  of stay  at a  crisis residential                                                               
center from "up to 5 days" to "up to 7 days."                                                                                   
                                                                                                                                
2:14:18 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:14:28 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:14:29 PM                                                                                                                    
MS. CARPENTER  explained that it  increases the stay in  a crisis                                                               
residential  center  in  recognition  of  adding  provisions  for                                                               
protecting patient rights.  One of the key  things the department                                                               
worked on during the interim  was to obtain feedback from patient                                                               
advocates and from  the Disability Law Center and  the court. The                                                               
72-hour  clock  must   start  when  a  person   enters  a  crisis                                                               
stabilization center, the 23-hour,  59-minute center, or a crisis                                                               
residential  center,  whichever  is entered  first.  That  change                                                               
mirrors precisely  how the system  works today when  someone goes                                                               
on  an  ex  parte  hold  to  API,    a  hospital,  or  Designated                                                               
Evaluation  and Treatment  (DET) facilities.  The bill  will also                                                               
ensure  that  an  attorney is  appointed  immediately.  Based  on                                                               
feedback from the legislature, she  noted that one key change was                                                               
to  add  a  requirement  that   guardians  are  notified  of  any                                                               
hearings. The  Alaska Court  System (ACS)  will notify  them. She                                                               
related  that  there  are  more  private  guardians  than  public                                                               
guardians in the  state. One provision added in  Section 26 would                                                               
direct  the  department  and  the   Alaska  Mental  Health  Trust                                                               
Authority  (AMHTA)  to work  together  and  submit a  report  and                                                               
recommendations  called an  action  plan for  patient rights.  It                                                               
would  include  patient  grievance   and  appeal  policies,  data                                                               
collection  on patient  grievances, appeals  and resolution,  and                                                               
patient reports of harm, restraint, and resolution.                                                                             
                                                                                                                                
MS. CARPENTER offered to provide a detailed sectional analysis.                                                                 
                                                                                                                                
2:16:22 PM                                                                                                                    
CHAIR WILSON stated  that in the interest of  time, the committee                                                               
would forgo a  detailed sectional analysis of SB 124  and move to                                                               
invited testimony.                                                                                                              
                                                                                                                                
2:17:12 PM                                                                                                                    
CHAIR WILSON opened invited testimony on SB 124.                                                                                
                                                                                                                                
2:17:26 PM                                                                                                                    
JAMES  COCKRELL,  Commissioner,   Department  of  Public  Safety,                                                               
Anchorage,  Alaska,  began  invited   testimony  on  SB  124.  He                                                               
emphasized his view  that the state needs to  provide more mental                                                               
health services.  He clarified that  this was his  personal view,                                                               
not  the  department's  opinion,  based on  his  law  enforcement                                                               
experience  and   a  relative  that  suffered   a  mental  health                                                               
breakdown.  He  said  his  relative  spent 81  days  in  a  state                                                               
correctional  facility when  they should  have been  in a  mental                                                               
health facility. While  he said he did not fault  the officer for                                                               
making  the  arrest,  the  state  needs  to  keep  mental  health                                                               
patients  out   of  jail  and   in  professional   mental  health                                                               
facilities.                                                                                                                     
                                                                                                                                
COMMISSIONER COCKRELL  paraphrased prepared remarks. He  spoke in                                                               
support  of SB  124.  He  stated that  the  Department of  Public                                                               
Safety  supports sub-acute  mental health  facilities for  people                                                               
experiencing  mental  health  crises. The  department  views  law                                                               
enforcement  responses  to  mental  health  calls  as  a  serious                                                               
priority. Troopers  often respond  to incidents where  people are                                                               
experiencing  suicidal thoughts,  manic  or delusional  episodes,                                                               
depression, or  due to drugs or  alcohol. The person is  not safe                                                               
and poses a risk to themselves or others.                                                                                       
                                                                                                                                
COMMISSIONER  COCKRELL  related  that  law  enforcement  officers                                                               
often must  choose between taking  the person to the  hospital or                                                               
to  jail,  when  neither   seems  appropriate,  creating  tension                                                               
between their duty  to serve and their duty  to protect. Troopers                                                               
may  investigate a  crime  and discover  that  the subject  needs                                                               
immediate  assistance. This  provides  the type  of situation  in                                                               
which a crisis  stabilization center can offer  an alternative to                                                               
placing the  person having  a behavioral  health crisis  in jail,                                                               
providing  full scale  medical services,  or simply  leaving them                                                               
alone to suffer.  Currently, if troopers have a Title  47 hold in                                                               
Mat-Su, they  will transport  the person  to the  Mat-Su Regional                                                               
Hospital emergency room.                                                                                                        
                                                                                                                                
COMMISSIONER  COCKRELL  indicated  that  first  responders  spend                                                               
excessive  time waiting  to  transfer  those experiencing  mental                                                               
health crises  from emergency  holding facilities.  Although this                                                               
experience  is   difficult  and  frustrating,  it   is  a  common                                                               
experience for  many Alaska State Troopers  throughout the state.                                                               
Often, an  officer must  seek care for  an individual  in crisis.                                                               
Even though that person has  not committed a crime, officers must                                                               
keep them  in custody, usually  handcuffed in  the back of  a law                                                               
enforcement  vehicle. In  his  personal  experience, the  trooper                                                               
would transport the  person from the Mat-Su to  Anchorage only to                                                               
discover  that the  Alaska Psychiatric  Institute (API)  is full,                                                               
which means they must drive them back to the Mat-Su.                                                                            
                                                                                                                                
COMMISSIONER  COCKRELL  recalled that  it  was  not uncommon  for                                                               
troopers to  spend their entire  shift trying to find  a suitable                                                               
place to  leave a person in  crisis. He offered his  view that it                                                               
is not  fair to the person  in crisis and prevents  troopers from                                                               
performing other important public safety duties.                                                                                
                                                                                                                                
2:21:16 PM                                                                                                                    
COMMISSIONER COCKRELL  said the  bill would create  an additional                                                               
option for individuals  in crisis by promptly  connecting them to                                                               
the  appropriate care  needed.  Under the  bill, law  enforcement                                                               
could take individuals  experiencing a mental health  crisis to a                                                               
23-hour,  59-minute  crisis  stabilization center,  or  a  crisis                                                               
residential center rather than transport  them to local emergency                                                               
rooms or  jails. SB 124 would  ensure that people have  access to                                                               
swift,  appropriate   care,  minimizing   the  impact   on  first                                                               
responders. The  centers described  in SB  124 were  developed in                                                               
collaboration with stakeholders  to provide a person  in a mental                                                               
health  crisis who  is  perceived likely  to  harm themselves  or                                                               
others better  access to care.  He highlighted that  the existing                                                               
options in  the community  are limited by  current law.  He urged                                                               
members to take prompt and favorable  action on SB 124 to provide                                                               
additional tools for police officers in Alaska.                                                                                 
                                                                                                                                
2:22:31 PM                                                                                                                    
SENATOR  HUGHES  asked whether  SB  124  would  be less  or  more                                                               
restrictive.                                                                                                                    
                                                                                                                                
COMMISSIONER COCKRELL  answered that the  options in SB  124 will                                                               
give  officers the  discretion to  take a  person experiencing  a                                                               
mental health crisis to a  place where they can receive immediate                                                               
help.                                                                                                                           
                                                                                                                                
2:23:16 PM                                                                                                                    
SENATOR  HUGHES related  her understanding  that taking  a person                                                               
experiencing  a mental  health crisis  to a  crisis stabilization                                                               
center or a  crisis residential center would  be less restrictive                                                               
than taking them to jail or a hospital emergency room.                                                                          
                                                                                                                                
COMMISSIONER COCKRELL  agreed that  it would be  less restrictive                                                               
for an  individual to go to  a crisis residential center  than an                                                               
emergency room or prison.                                                                                                       
                                                                                                                                
2:23:51 PM                                                                                                                    
SENATOR HUGHES expressed concern that  provisions in SB 124 could                                                               
be  wrongfully used  against someone.  Suppose  someone voices  a                                                               
position on something  controversial, and the person  is taken to                                                               
a  medical facility  and drugged.  She said  she did  not believe                                                               
that was  what SB 124 does.  Still, she needed to  know the types                                                               
of  behavior  officers  use  to   identify  that  the  person  is                                                               
suffering  from  mental  illness  rather than  the  person  being                                                               
disagreeable  or  holding an  opposing  view.  She surmised  that                                                               
officers  would  need  to  observe  incoherent  speech  or  other                                                               
behaviors  that indicate  the person  needed  to go  to a  crisis                                                               
residential center and be given psychotropic drugs.                                                                             
                                                                                                                                
2:25:16 PM                                                                                                                    
COMMISSIONER COCKRELL  stated that  the department  currently has                                                               
the  authority in  Title 47  to take  the person  into protective                                                               
custody. SB 124  would not change law  enforcement's authority to                                                               
take  someone into  protective custody  under  Title 47  or to  a                                                               
treatment  center.  He  emphasized  that  police  must  currently                                                               
protect first amendment rights,  including freedom of speech. The                                                               
US Constitution  is clear that  police cannot arrest  someone for                                                               
speech, so law enforcement must  ensure that the individual is at                                                               
risk of harming  themselves or others. For instance,  a person at                                                               
the Walmart  store protesting something  has the right to  do so.                                                               
Currently,  law   enforcement  could   charge  the   person  with                                                               
disorderly conduct  or trespassing.  However, he was  unsure that                                                               
any  law enforcement  agency in  the  state had  been accused  of                                                               
being  overzealous  regarding  Title  47.  He  said  he  did  not                                                               
envision that  law enforcement would  make any  changes regarding                                                               
arrests.                                                                                                                        
                                                                                                                                
2:26:39 PM                                                                                                                    
SENATOR  HUGHES asked  what  officers look  for  to determine  if                                                               
someone is having a behavioral  health crisis and ensure they are                                                               
not   interfering  with   someone's   individual  liberties   and                                                               
constitutional rights.                                                                                                          
                                                                                                                                
COMMISSIONER  COCKRELL  answered  that the  individual  officer's                                                               
experience  would determine  their actions.  He highlighted  that                                                               
incoherent speech  alone would not  suffice and that  the officer                                                               
must determine that the person  was at risk of harming themselves                                                               
or  another  person.  Someone  running  back  and  forth  through                                                               
traffic trying to get hit would  be at risk of harming themselves                                                               
and  would  likely be  identified  as  someone suffering  from  a                                                               
mental  health crisis.  Officers encounter  people who  are under                                                               
the influence  of drugs or  alcohol daily, but they  don't arrest                                                               
them. He  said police  officers are  trained to  make assessments                                                               
and use  discretion when assessing  behavior, such as  someone is                                                               
brandishing a  weapon, threatening people, or  taking some action                                                               
to harm themselves or others.  However, an officer would not take                                                               
someone into custody for talking.                                                                                               
                                                                                                                                
SENATOR HUGHES thanked him for his examples.                                                                                    
                                                                                                                                
2:28:54 PM                                                                                                                    
SENATOR REINBOLD said he addressed several of her concerns.                                                                     
                                                                                                                                
2:29:10 PM                                                                                                                    
CHAIR  WILSON  removed  his  objection  to  adopt  the  committee                                                               
substitute (CS) for  SB 124, work order 32-GS1730\B;  he found no                                                               
further  objection, and  Version  B was  adopted  as the  working                                                               
document.                                                                                                                       
                                                                                                                                
2:29:17 PM                                                                                                                    
SENATOR REINBOLD expressed concern  that Tamara Lich was arrested                                                               
for organizing  a convoy protest  in Canada, which she  viewed as                                                               
disturbing. She noted that many  countries arrest their political                                                               
enemies.  She stated  that  she  wants to  avoid  those types  of                                                               
issues  and ensure  that  the bill  doesn't  have loopholes.  She                                                               
referred to  a letter  dated March 7,  2022, from  Jim Gottstein.                                                               
She  asked whether  he would  support the  definition of  gravely                                                               
disabled. She  asked whether she  should read the letter  for the                                                               
record.                                                                                                                         
                                                                                                                                
CHAIR  WILSON  answered  no.  He  offered  his  belief  that  the                                                               
department would address the letter.                                                                                            
                                                                                                                                
2:31:22 PM                                                                                                                    
SENATOR REINBOLD  noted that Mr.  Gottstein had  highlighted four                                                               
pages  of concerns.  She  further noted  that  the Commission  on                                                               
Human Rights and others had listed concerns.                                                                                    
                                                                                                                                
2:21:16 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
2:32:38 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
2:32:44 PM                                                                                                                    
SENATOR BEGICH  asked whether it was  fair to say each  case that                                                               
officers deal  with is individualized  and different.  He related                                                               
his understanding  that SB 124  would offer law  enforcement less                                                               
intrusive  means to  get people  who may  be experiencing  mental                                                               
health crisis  to professionals  who are more  able to  make that                                                               
determination.                                                                                                                  
                                                                                                                                
COMMISSIONER  COCKRELL   answered  that  he  viewed   SB  124  as                                                               
providing a  much more  humane approach  to those  experiencing a                                                               
behavioral health crisis.                                                                                                       
                                                                                                                                
2:33:24 PM                                                                                                                    
CHAIR WILSON  related that some  people might be  experiencing an                                                               
episode of active psychosis, noting  that law enforcement handles                                                               
numerous calls  from people who  are suicidal. He asked  how many                                                               
of these cases troopers handle and if SB 124 would help them.                                                                   
                                                                                                                                
COMMISSIONER  COCKRELL offered  to provide  those figures  to the                                                               
committee. He noted  that rural Alaska experiences  a high volume                                                               
of suicides.                                                                                                                    
                                                                                                                                
2:34:07 PM                                                                                                                    
SENATOR HUGHES  asked if a  minor was struggling with  suicide if                                                               
law enforcement or someone else would pick them up.                                                                             
                                                                                                                                
COMMISSIONER  COCKRELL  responded that  it  would  depend on  the                                                               
community.  He  stated that  the  parents,  Office of  Childrens                                                                
Services (OCS), or law enforcement agencies could get involved.                                                                 
                                                                                                                                
2:34:53 PM                                                                                                                    
CHAIR WILSON  stated that one  emergency physician in  the Mat-Su                                                               
Valley indicated that  they had kids in their  emergency room for                                                               
up to 30  days. He said he couldn't imagine  they could not place                                                               
an  individual.  He  further  recalled  that  the  Department  of                                                               
Corrections indicated they still use  facilities in the state for                                                               
that purpose. He highlighted the need to fix this situation.                                                                    
                                                                                                                                
2:35:38 PM                                                                                                                    
SENATOR BEGICH,  in response to Senator  Hughes' question, stated                                                               
that the ability  to place someone in  protective custody extends                                                               
to juveniles.                                                                                                                   
                                                                                                                                
2:35:49 PM                                                                                                                    
SENATOR  REINBOLD expressed  concern  about  parental rights  and                                                               
informed consent. She expressed  concern about using psychotropic                                                               
drugs for children  and the process for appointing  a guardian ad                                                               
litem.                                                                                                                          
                                                                                                                                
2:37:39 PM                                                                                                                    
MARK  REGAN, Legal  Director, Disability  Law  Center of  Alaska,                                                               
Anchorage,  Alaska, provided  invited  testimony,  noting he  had                                                               
submitted   written  testimony.   He   offered   his  view   that                                                               
improvements from  last year  were that  everyone is  appointed a                                                               
lawyer at the  beginning of the process. Everyone  is entitled to                                                               
a hearing within  72 hours to decide whether  someone should stay                                                               
in the system, which is an important improvement.                                                                               
                                                                                                                                
MR. REGAN  stated that he  would like  to testify in  response to                                                               
Senator Hughes'  initial questions  to the commissioner.  She had                                                               
asked whether  SB 124, the Crisis  Now bill, would impose  a less                                                               
restrictive or  more restrictive system. He  provided examples to                                                               
show this was  a less restrictive system. For  example, suppose a                                                               
person was  picked up  in Anchorage  and taken  to a  hospital on                                                               
hold  because API  was at  capacity and  not taking  patients. In                                                               
that  case,  the  person  might   be  taken  to  Alaska  Regional                                                               
Hospital. He  stated that he had  been in the holding  areas used                                                               
to hold those  with mental health issues. He  characterized it as                                                               
a  very sterile,  nontherapeutic place  that is  not peaceful  or                                                               
calming. He  related that if  a person  was picked up  in Haines,                                                               
the  person  could be  held  in  the  Haines jail  cell  awaiting                                                               
transportation to Juneau. He offered his  view that a cell is not                                                               
where a person suffering a  mental health crisis belongs. He said                                                               
he knew someone  in Bethel who had been in  a cycle of short-term                                                               
mental  health treatment  for suicidal  or  other threats.  While                                                               
suffering a  mental health crisis,  he was  taken to and  held at                                                               
the Yukon  Kuskokwim Hospital, flown to  Anchorage for evaluation                                                               
and short-term  treatment at  API, and flown  back to  Bethel. He                                                               
recalled hearing him describe his experience as frightening.                                                                    
                                                                                                                                
2:40:52 PM                                                                                                                    
MR. REGAN  stated that  under SB  124, people  experiencing these                                                               
mental health crises could be  transported to a center where they                                                               
receive short-term  treatment instead  of short-term  holds. They                                                               
would receive attention from medical  professionals who are there                                                               
to help  them recover  their mental  health. He  highlighted that                                                               
often  mental  health  treatment   is  short-term  treatment.  He                                                               
indicated  that SB  124  allows the  legislature  to improve  the                                                               
situation  for hundreds  of Alaskans  by making  it possible  for                                                               
them to receive  short-term treatment closer to  where they live.                                                               
For  example,  he envisioned  that  Bethel  could have  a  crisis                                                               
residential  center so  the person  experiencing a  mental health                                                               
crisis  would  not  need  to  be  transported  to  Anchorage  for                                                               
evaluation.  Haines  could  have a  crisis  stabilization  center                                                               
where  the person  could  calm  down and  not  be  held in  jail.                                                               
Anchorage could  provide centers that  are much less  sterile and                                                               
less threatening  than an Alaska Regional  Hospital holding area.                                                               
He offered  the Disability  Law Center  of Alaska's  approval for                                                               
the changes incorporated in SB 124.                                                                                             
                                                                                                                                
2:42:24 PM                                                                                                                    
SENATOR REINBOLD  stated she still  has concerns but  thanked him                                                               
for  assisting [a  constituent]  to obtain  a  hearing and  legal                                                               
counsel.                                                                                                                        
                                                                                                                                
MR.  REGAN  noted  that  most  of   the  work  was  done  by  the                                                               
department, the  Alaska Mental Health Trust  Authority, and other                                                               
advocates.                                                                                                                      
                                                                                                                                
2:43:36 PM                                                                                                                    
SENATOR  BEGICH noted  that  Mr.  Jim Gottstein  was  one of  the                                                               
people  who  has written  about  involuntary  commitment and  the                                                               
potential  damage  to  individuals. He  stated  that  stakeholder                                                               
groups  have requested  that SB  124  include several  recognized                                                               
ways  to  enshrine  patient  rights,  some  of  which  have  been                                                               
accomplished  in  the bill.  He  asked  whether  he was  open  to                                                               
working on a Patient's Bill of Rights.                                                                                          
                                                                                                                                
2:44:35 PM                                                                                                                    
MS.  CARPENTER answered  that the  department had  discussed this                                                               
with patient advocates, including  Mr. Gottstein. She offered her                                                               
view  that  Section  26  would  be a  great  spot  to  address  a                                                               
comprehensive Patient's Bill of Rights.                                                                                         
                                                                                                                                
CHAIR WILSON asked  whether she suggested referencing  it but not                                                               
including it in statute.                                                                                                        
                                                                                                                                
MS. CARPENTER agreed.                                                                                                           
                                                                                                                                
2:45:23 PM                                                                                                                    
SENATOR  BEGICH said  he hoped  to work  with the  department and                                                               
advocate for it. He stated that  he spoke to the department about                                                               
the   report    to   the   legislature,    providing   assessment                                                               
recommendations  from  the  stakeholders. He  asked  whether  the                                                               
committee  supports   the  department   in  creating   an  annual                                                               
dashboard  and  reporting data.  He  acknowledged  that it  might                                                               
require  some  department  expenditure,   but  it  would  provide                                                               
citizens  access to  the  information. He  indicated  he was  not                                                               
requesting  information on  individuals  that  would violate  the                                                               
Health  Insurance  Portability  and Accountability  Act  of  1996                                                               
(HIPAA) but to post aggregate data.                                                                                             
                                                                                                                                
2:46:10 PM                                                                                                                    
MS.  CARPENTER  agreed  that  the  department  could  consider  a                                                               
dashboard.  Still,  she  hoped that  the  department  would  have                                                               
flexibility  on the  design.  She offered  to  work with  patient                                                               
advocates  and providers  to  understand how  to  make that  data                                                               
public.                                                                                                                         
                                                                                                                                
2:46:42 PM                                                                                                                    
SENATOR  BEGICH said  he received  a letter  from Mr.  Gottstein,                                                               
dated  March  7,  2022,  regarding SB  124  with  four  excellent                                                               
recommendations.  He expressed  an interest  in the  department's                                                               
viewpoint.                                                                                                                      
                                                                                                                                
2:48:08 PM                                                                                                                    
MS. CARPENTER responded that she  found the letter addressing the                                                               
committee substitute  (CS) for  SB 124,  Version B,  helpful. She                                                               
said DHSS, the  Department of Law, and AMHTA  reviewed and agreed                                                               
with  his  recommendations.  She   related  that  the  first  two                                                               
recommendations  came  from old  court  hearings.  The first  one                                                               
would update  the definition  in AS  47.39.015 (7),  for "gravely                                                               
disabled," which  would match a  lawsuit outcome. The  second one                                                               
would  update  the  court-ordered  administration  of  medication                                                               
statutes. She indicated the department  supports this concept but                                                               
would like to carefully review the  language to ensure that it is                                                               
correct.  She directed  attention  to the  changes Mr.  Gottstein                                                               
suggests at the  bottom of page 3 of the  letter. She highlighted                                                               
a   similar   recommendation   to  AS   47.30.707,   the   crisis                                                               
stabilization, and  AS 47.30.708, which  had a typo.  She offered                                                               
her view  that it  would add  clarity. Still, it  might be  a bit                                                               
repetitive,  so a  court  might interpret  that  a respondent  is                                                               
suffering from  an acute behavioral  health crisis and  is likely                                                               
to cause harm  to self or others. However, the  department has no                                                               
problem  offering the  language to  ensure  that it  is clear  to                                                               
professionals.   Finally,    Mr.   Gottstein   added    a   small                                                               
recommendation to  add to the  report section to  consider things                                                               
that  could  improve  patient   outcomes,  which  the  department                                                               
supports.                                                                                                                       
                                                                                                                                
2:50:16 PM                                                                                                                    
SENATOR  BEGICH responded  that  made him  feel more  comfortable                                                               
with the  legislation. He recalled  hearing some  criticism about                                                               
the House version  of the bill, and he was  unsure whether it was                                                               
a valid  criticism. However, he  had observed such effort  by the                                                               
department and the trust. He would  like to see the bill meet the                                                               
needs  of advocates  for patient  rights and  have mental  health                                                               
professionals evaluate  those with behavioral health  crises, not                                                               
the police. He  related that in the early  2000s, the legislature                                                               
provided the  department with screening and  assessment tools for                                                               
youth  experiencing substance  use  or mental  health issues.  He                                                               
offered his view that placing  mental health practitioners in the                                                               
department   ensured   that   youth  received   the   appropriate                                                               
treatment,  which is  key. He  emphasized lowering  the level  of                                                               
escalation into  the system.  He characterized SB  124 as  a good                                                               
faith effort. He offered to help draft amendments.                                                                              
                                                                                                                                
2:52:30 PM                                                                                                                    
CHAIR WILSON  asked whether  the court-ordered  administration of                                                               
medication would be a separate  bill since SB 124 doesn't address                                                               
it as a separate in-depth item.                                                                                                 
                                                                                                                                
MS. CARPENTER  answered that the  department did not  rewrite the                                                               
involuntary  commitment statutes  in order  to narrowly  focus on                                                               
crisis  stabilization and  crisis residential  centers. The  bill                                                               
would  allow  the   court-ordered  and  involuntary  psychotropic                                                               
medication to be  administered by the same  medical providers but                                                               
allow these drugs to be  given in crisis stabilization and crisis                                                               
residential  centers  when  someone  is  in  imminent  danger  to                                                               
themselves or others.                                                                                                           
                                                                                                                                
2:53:29 PM                                                                                                                    
SENATOR  HUGHES recalled  the  opening  statement indicated  that                                                               
there  were more  private than  public guardians.  She asked  how                                                               
many have  guardians, the difference  between private  and public                                                               
guardians, and  whether the guardians must  consent to administer                                                               
psychotropic drugs.                                                                                                             
                                                                                                                                
2:54:48 PM                                                                                                                    
CHAIR WILSON deferred to Mr.  Wall. He recalled that psychotropic                                                               
drugs  could  be  given  in times  of  crisis  without  obtaining                                                               
permission.                                                                                                                     
                                                                                                                                
2:55:38 PM                                                                                                                    
ALBERT  WALL,  Deputy  Commissioner,  Department  of  Health  and                                                               
Social Services  (DHSS), Juneau, Alaska, responded  that a public                                                               
guardian  is  assigned  by  the  court.  In  contrast,  a  person                                                               
establishes  a  private  guardian   through  their  attorney.  He                                                               
elaborated  that the  court assigned  public  guardians to  those                                                               
individuals who  cannot make decisions for  themselves, primarily                                                               
due to their  mental condition. Suppose a person were  to show up                                                               
in  court   but  obviously  suffered  from   some  mental  health                                                               
condition and  did not have a  guardian. In that case,  the court                                                               
will  assign  a public  guardian,  typically  via the  Office  of                                                               
Public  Advocacy. Some  individuals  with a  disability, such  as                                                               
dementia, but have  the means can hire someone to  care for them,                                                               
often  a family  member.  Suppose his  mother  had dementia,  but                                                               
while she was still lucid, she  asked him to become her guardian.                                                               
In  that instance,  an attorney  would draft  her wishes,  and he                                                               
would become her private guardian.                                                                                              
                                                                                                                                
2:57:23 PM                                                                                                                    
SENATOR HUGHES asked how many have guardians.                                                                                   
                                                                                                                                
2:57:38 PM                                                                                                                    
MR. WALL indicated that the  number changes over time. He offered                                                               
to  report  figures  to  the committee.  He  stated  that  crisis                                                               
medications  are  given  in  an   inpatient  setting  when  their                                                               
clinical and mental condition is such  that they pose a danger to                                                               
themselves or others.  Suppose a person is in  a heightened state                                                               
of  anxiety  and  may  be exhibiting  suicidal  ideation  and  is                                                               
uncontrolled,  such that  the medical  staff  cannot reason  with                                                               
them.  A psychiatrist  would make  a  clinical determination  and                                                               
prescribe  medication.   He  stated  that  the   court  would  be                                                               
involved. He explained that crisis  stabilization is separate. It                                                               
is  not  addressing  bringing   people  to  crisis  stabilization                                                               
centers   and  administering   medication  against   their  will.                                                               
Instead, a crisis stabilization center  is a place where a person                                                               
goes to become stable over time.  If they need inpatient care, an                                                               
ex parte  or inpatient  care can be  prescribed. Still,  a crisis                                                               
stabilization center is not considered  inpatient care, nor where                                                               
crisis  medications   would  routinely  be   administered.  Those                                                               
medications would  not be  administered without  court oversight.                                                               
He deferred to  one of the attorneys to further  elaborate on the                                                               
process.                                                                                                                        
                                                                                                                                
3:00:15 PM                                                                                                                    
SENATOR HUGHES offered  her view that if someone  has a guardian,                                                               
the  guardian  should  be  involved if  any  medication  will  be                                                               
administered. She said  she would like to see that  happen at the                                                               
crisis stabilization  centers. She  acknowledged that  if someone                                                               
was suicidal, there might not be time to involve the guardian.                                                                  
                                                                                                                                
3:00:56 PM                                                                                                                    
MR.  WALL  assured  the  committee  that  a  guardian  is  always                                                               
involved.  The  issue  relates  to  the  moment  of  crisis.  For                                                               
instance,  if an  individual goes  to  an emergency  room with  a                                                               
heart  attack and  is unconscious,  the  doctors will  administer                                                               
medication  to  keep  them alive.  He  highlighted  that  medical                                                               
professionals are  trained to  do so.  The psychiatric  matter is                                                               
similar  to that  because crisis  medications are  only given  to                                                               
patients hurting  themselves or  others, so there  is no  time to                                                               
call  someone to  ask.  He characterized  it  as a  life-or-death                                                               
matter. He  indicated that  the court is  involved in  the crisis                                                               
med order, and guardians and patients are always informed.                                                                      
                                                                                                                                
3:02:53 PM                                                                                                                    
MR. WILLIAMS  added that crisis  medications are the  last resort                                                               
for  intervention. Other  approaches  are built  into this  least                                                               
restrictive system, which is designed  to protect the individual.                                                               
He  indicated that  if  the lower  levels  of intervention  fail,                                                               
crisis medications provide  a medically-trained professional with                                                               
a means to keep the person safe from further harm.                                                                              
                                                                                                                                
3:03:48 PM                                                                                                                    
CHAIR WILSON held SB 124 in committee.                                                                                          

Document Name Date/Time Subjects
HCR 10 Sponsor Statement.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
HCR 10 - CDC Heart Disease Facts.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
HCR 10 2021 AMA 2021 Update.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/10/2022 1:30:00 PM
HCR 10
SB 156 Amdmt I.6 Begich.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 156 Amdt I.7 Reinbold.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 124 Version GS 1730 A.PDF SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 Transmittal Letter.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 Sectional Analysis Version GS1730 A.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 - Sectional Anaylsis Ver. Work Draft CS.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 Definitions in AS 47.30.915.pdf SHSS 3/8/2022 1:30:00 PM
SJUD 4/27/2022 1:30:00 PM
SB 124
SB 124 - Fiscal Note - SB124-DOH-MS-2-4-2022.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 - Fiscal Note - SB124-JUD-ACS-4.28.21.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 - Fiscal Note - SB124-DPS-DET-03-07-22.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 - Fiscal Note -SB 124-DFCS-IMH-3-4-2022.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB 124 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf SHSS 3/8/2022 1:30:00 PM
SB 124
SB124-HB172Ltr Psych Rights 2.22.22.pdf SHSS 3/8/2022 1:30:00 PM
HB 172
SB 124
SB 124 CS Work Draft V. B.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/17/2022 1:30:00 PM
SHSS 3/22/2022 1:30:00 PM
SB 124
SB 124 - Memo to DHSS-HB 172 (SB 124) response to Gottstein comments 3.3.2022.pdf SHSS 3/8/2022 1:30:00 PM
HB 172
SB 124
SB 156 Letters 3.3.22.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 156 Testimony (Sponsor) 3.7.22.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 156 Testimony 3.7.22.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 156 Amdmt I.8 Reinbold.pdf SHSS 3/8/2022 1:30:00 PM
SB 156
SB 124 - Letter Psych Rights 3.7.22.pdf SHSS 3/8/2022 1:30:00 PM
SHSS 3/17/2022 1:30:00 PM
SB 124