02/25/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB214 | |
| Confirmation Hearing(s): State Medical Board | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 214 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 25, 2014
3:10 p.m.
MEMBERS PRESENT
Representative Pete Higgins, Chair
Representative Wes Keller, Vice Chair
Representative Benjamin Nageak
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
HOUSE BILL NO. 214
"An Act relating to mental health patient rights, notifications,
and grievance procedures."
- HEARD & HELD
CONFIRMATION HEARING(S):
State Medical Board
Sai-Ling Liu, D.O. - Nome
- CONFIRMATION(S) ADVANCED
PREVIOUS COMMITTEE ACTION
BILL: HB 214
SHORT TITLE: MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES
SPONSOR(s): REPRESENTATIVE(s) HIGGINS, TARR, GATTIS
01/21/14 (H) PREFILE RELEASED 1/10/14
01/21/14 (H) READ THE FIRST TIME - REFERRALS
01/21/14 (H) HSS, JUD, FIN
02/18/14 (H) HSS AT 3:00 PM CAPITOL 106
02/18/14 (H) Heard & Held
02/18/14 (H) MINUTE(HSS)
02/25/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
BARBARA HENJUM, Acting Director
Central Office
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the discussion of
HB 214.
JASON HOOLEY, Special Assistant
Office of the Commissioner
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
214.
MELISSA RING, CEO
Alaska Psychiatric Institute (API)
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
214.
RON HALE, Hospital Administrator
Alaska Psychiatric Institute (API)
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Answered questions during discussion of HB
214.
LAURIE HERMAN, Director of Government Relations
Providence Health & Services, Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 214.
CINDY GOUGH, Director of Behavioral Health Services
Providence Alaska Medical Center
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
JOSHUA SONKISS, MD
North Pole, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
LAURA MCKENZIE, Director
Compliance Officer
Quality Improvement and Risk Management
North Star Behavioral Health
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
KAREN PERDUE, CEO and President
Alaska State Hospital and Nursing Home Association (ASHNHA)
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
KATE BURKHART, Executive Director
Alaska Mental Health Board
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
ANDREA SCHMOOK
Los Angeles, California
POSITION STATEMENT: Testified during discussion of HB 214.
SAI-LING LIU, D.O., Appointee
to the State Medical Board
Nome, Alaska
POSITION STATEMENT: Spoke as an appointee to the State Medical
Board.
ACTION NARRATIVE
3:10:00 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:10 p.m.
Representatives Higgins, Seaton, Pruitt, and Keller were present
at the call to order. Representatives Tarr, Nageak, and
Reinbold arrived as the meeting was in progress.
3:11:39 PM
The committee took an at-ease from 3:11 p.m. to 3:14 p.m.
HB 214-MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES
3:14:34 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE BILL NO. 214, "An Act relating to mental health patient
rights, notifications, and grievance procedures."
3:15:37 PM
REPRESENTATIVE SEATON, referencing an earlier comment that the
appeals process would not accomplish anything unless it was
exempt from Civil Rule 82, clarified that this did not apply to
administrative appeals. He shared that other mechanisms would
be reviewed to ensure there were not constraints on people for
making an appeal.
CHAIR HIGGINS acknowledged that proposed HB 214 was still a work
in progress, and that suggestions for changes would be received
to allow the bill to move forward.
3:17:53 PM
BARBARA HENJUM, Acting Director, Central Office, Division of
Behavioral Health, Department of Health and Social Services,
stated that her comments were on behalf of the Division of
Behavioral Health and the Alaska Psychiatric Institute (API).
She clarified that she was not speaking on behalf of other
designated evaluation and treatment facilities, or any private
community behavioral health centers. She reported that an
earlier statement that the Department of Health and Social
Services (DHSS) had submitted a zero fiscal note for previous
versions of the proposed bill was incorrect, as the earlier
fiscal note had reflected the cost of a 24/7 crisis line, staff
costs to develop the program which included training to
community providers and to DHSS staff for their function as
investigators, and associated costs for buying services for the
expanded grievance process from other departments.
CHAIR HIGGINS clarified that the aforementioned fiscal note had
not been adopted by the previous committee during an earlier
hearing on a similar proposed bill.
REPRESENTATIVE SEATON asked if Ms. Henjum was referring to the
current fiscal note [Included in members' packets]. He asked
why, as current law required a grievance procedure, as well as
an advocate employee, was there an increased cost for legal
advice and administrative hearings.
MS. HENJUM offered her belief that the proposed bill would
expand the role of Department of Health and Social Services for
response to grievances filed in hospitals or other treatment
facilities, as well as another level of review for each of these
which could require advice from the Department of Law (DOL).
CHAIR HIGGINS explained that, as there were no longer attorneys
based in DHSS, it was now necessary for the department to get
legal advice from DOL, for which services DHSS would be billed.
REPRESENTATIVE SEATON asked for clarification to which of the
procedures were new under the proposed bill.
MS. HENJUM replied that it would now be required for grievances
at API and other hospitals to be sent to Department of Health
and Social Services for response, even though these hospitals
had their own existing grievance procedures.
CHAIR HIGGINS questioned the difference between complaints and
grievances.
MS. HENJUM suggested that this difference was semantic.
CHAIR HIGGINS noted that, in 2013, there were 163 complaints and
15 grievances, and he asked what definition was used to
determine each. He suggested a change in the language of the
proposed bill to determine what issues would be moved to the
next level after being heard by the department. He opined that
grievances for patient rights could be moved on, while the
others could be dealt with in-house.
MS. HENJUM acknowledged the common goal of the committee and
DHSS for the Alaska mental health patient grievance procedures
and the rights of this population.
REPRESENTATIVE SEATON asked if this appeal was referenced on
page 3, lines 11-12, of the proposed bill. He pointed to page
4, lines 27-29, which stated that "The department shall review
all grievances and responses to grievances for compliance with
this section and intervene when necessary to protect rights
under AS 47.30.840, and asked if this would include a normal
procedure to protect the rights of individuals.
3:27:42 PM
JASON HOOLEY, Special Assistant, Office of the Commissioner,
Department of Health and Social Services, said that the
impartial body [page 3, line 12 of the proposed bill] would be
the Office of Administrative Hearings [Department of
Administration] and that the new requirements would include that
DHSS intervene when necessary and review all the grievances and
responses to grievances, to regularly monitor compliance with
the established procedure in the proposed bill, and to analyze
recommendations by the department to improve mental health
evaluation treatment and procedures through a report to the
governor and the legislature.
REPRESENTATIVE SEATON offered his belief that this should be the
current duty of Department of Health and Social Services. He
asked if the proposed bill required that this be a regular duty
and therefore would account for the proposed fiscal note.
CHAIR HIGGINS directed attention to the fiscal note, which
accounted for the cost for any legal opinions. He pointed out
that only 15 cases in the prior year may have needed a legal
opinion.
REPRESENTATIVE SEATON asked if a hearing by the Office of
Administrative Hearings was billed to DHSS.
MR. HOOLEY, in response, said that the Division of Behavioral
Health provided regulation oversight and site review. He stated
that current grievance processes were required to be
administered in-house, and that all of the grantees and
designated evaluation and treatment facilities adhered to this
requirement. He noted that there were additional requirements
in the proposed bill for the department to act upon any of these
procedures which were not resolved, in conjunction with DOL and
the Office of Administrative Hearings. This was the basis of
cost in the attached fiscal note.
3:32:10 PM
MS. HENJUM clarified that each licensed medical facility in
Alaska was accredited by the Joint Commission, as well as the
Centers for Medicare and Medicaid Services. Each of these
entities, as well as the DHSS, required grievance procedures and
policies and reviewed any grievance activities. She noted that
site reviews of grantees by DHSS included a review for the
appropriate management of grievance activities.
REPRESENTATIVE SEATON asked for clarification that the proposed
bill would expand the oversight or simply change the timing for
review of the grievance procedures and the unresolved
grievances.
MS. HENJUM offered her belief that it would also expand the
oversight role from hospitals.
CHAIR HIGGINS asked to confirm that the requirement for the
department already included a review of the grievance procedures
for hospitals and the other accredited institutions.
MS. HENJUM agreed that this was currently being conducted for
behavioral health grantees, although she needed clarification
that this also included hospitals. She suggested that much of
the proposed bill was duplicative, as there was already federal
law, state law, and accreditation standards, a multi-tiered
system, all of which required grievance procedures and review of
the grievance processes. She added that the Disability Law
Center of Alaska was a federally designated protection and
advocacy agency for individuals with mental illness in Alaska,
and also reviewed concerns and complaints for these same types
of issues.
MS. HENJUM discussed concerns mentioned in previous committee
testimony for API, stating that some were very old, and reported
that API was continuing to evolve. She pointed to the API
advisory board members and staff, which had been established for
quality improvement, monitored the API grievance process, and
made quick revisions if necessary. She stated that DHSS looked
forward to collaboration with the bill sponsor to ensure a
standardized process and meaningful supplement to patient's
rights, currently enumerated in statute and in practice.
REPRESENTATIVE KELLER asked if there was a data base to track
and address these grievances.
MS. HENJUM opined that there was not tracking to this "broad
scope", although it was possible to obtain information about the
current grantees and any grievances received.
CHAIR HIGGINS acknowledged that, although there was some
duplication in the proposed bill, it was asking that the
procedures be done better, "and that's what this bill's all
about." As the sponsor, he stated that this was not a request
to do new procedures, only that these procedures be
standardized, so the administration could review them, as well.
He referenced a case with the Disability Law Center of Alaska,
as an example for the necessity of the proposed bill, and read:
"based on the information available it appears that both
patients' complaints went straight to a risk management
investigation track by API... and that API no longer followed
the patient grievance policies and procedures that speak to the
timelines and extensions. The notice of appeal to the Alaska
Court System for the liability to file complaints with outside
agencies are not included in the notice to the patient." He
acknowledged that the aforementioned case was in 2011, and that
there had been improvement since this case.
MS. HENJUM replied that there had been significant changes made
to the grievance procedure at API as a result of the report from
the Disability Law Center of Alaska.
REPRESENTATIVE TARR asked about the types of grievance
incidences, and what type of treatment was included.
3:39:55 PM
MELISSA RING, CEO, Alaska Psychiatric Institute (API), Division
of Behavioral Health, Department of Health and Social Services,
said that, as she had only been with API for a few weeks,
although she did not know of the actual nature of the
grievances, she had an understanding for the types of complaints
often made by people with mental illnesses. She expressed some
of her concerns for the proposed bill which included the
definition for a grievance. She offered that a grievance was
often defined as a rights violation, per the rights outlined in
the state statute and the Centers for Medicare and Medicaid
Services. She declared that every patient complaint was
approached with the seriousness, dignity, and respect which it
deserved. She offered that often the patient was asking for a
second opinion or another person, such as a patient advocate, to
speak with. She expressed her concern that a broad definition
of grievance as a complaint would result in "pretty high
numbers." She expressed that for some of these rights
violations, the person felt resolution after meeting with the
patient advocate. She stated that the API definition of
grievances would include some rights violations that were not
resolved by the patient advocate, as well as some complaints
that were not rights violations, which included court ordered
hospital stays.
CHAIR HIGGINS interjected that these court decisions were
initiated by a request from API for a decision.
MS. RING, in response, clarified that these requests were
submitted with a medical opinion, not an administrator's
opinion. She expressed her concern that every hospital within
the service delivery system with psychiatric units would need to
have the exact same process. She reported that she would follow
any process as dictated by the State of Alaska. However, she
pointed out, many private hospitals had their own process, which
were often determined by an owner corporation. She directed
attention to the various lists of rights from Centers for
Medicare and Medicaid Services (CMS), The Joint Commission, and
the State of Alaska, and questioned why all the groups did not
use the same list. She expressed concern for "saddling our very
important private partners with this type of governmental
procedure." She offered her belief that, as every grievance
would have to go to DHSS before and after resolution, there
should be concern for patient privacy. She recommended that
each party could submit its own grievance procedures for review,
as well as a review of its aggregate of complaints and
resolutions. She suggested that patients be invited to submit
complaints to DHSS, CMS, or the Joint Commission to ensure
oversight.
3:47:57 PM
REPRESENTATIVE TARR, referencing stories of patient rights
violations, asked why patients would perceive this violation.
MS. RING acknowledged that mistakes were made and that patient
rights were violated by hospitals. She shared that when
explaining the grievance procedure as part of her staff
presentation, she ensured that the process allowed patients to
point out the mistakes, and to get a second opinion. She opined
that it was a robust process for appropriately addressing the
patient issues.
REPRESENTATIVE SEATON, directing attention to the six grievance
procedures listed on page 3, lines 8-15, of the proposed bill.
He asked if any of these would not be included in a grievance
process.
MS. RING explained that each hospital would have its own
standardized form [for filing a grievance]. She said that an
appeal procedure that included an administrative appeal to an
impartial body designated by the department would most likely
not be in every grievance procedure; however, the offer for
appeal to CMS and the Joint Commission would be included. She
expressed confidence that a standardized notice of the grievance
and appeal procedure was already being done. She opined that
timely records review and maintenance were a Joint Commission
standard for grievances filed.
REPRESENTATIVE SEATON stated that he was not hearing any
disagreement, as long as there was a standardized form within
the institution.
3:52:52 PM
RON HALE, Hospital Administrator, Alaska Psychiatric Institute
(API), Division of Behavioral Health, Department of Health and
Social Services, echoed the sentiments of Ms. Ring.
REPRESENTATIVE SEATON asked if the form provided was approved by
the department. He asked what grievance procedures would be
onerous to an institution, and whether any aspects of the
proposed bill would de-rail or complicate the existing
procedure.
MR. HALE replied that he would use whatever standardized form
was determined by the department. He suggested asking some of
the other non-state facilities.
CHAIR HIGGINS offered an anecdote regarding his office
procedure. He suggested discussion with the other facilities to
standardize the forms and the procedures.
3:56:02 PM
LAURIE HERMAN, Director of Government Relations, Providence
Health & Services, Alaska, addressing the February 18, 2014
testimony of Lorraine Lamoureux, declared that Providence Health
& Services, Alaska categorically denied all of these allegations
made by Ms. Lamoureux regarding Providence [Alaska Medical
Center] and Bret Bohn. She stated that federal and state
privacy laws did not allow any discussion for specifics
regarding care. She reported that the Office of Public Advocacy
(OPA) was the guardian for Bret Bohn and would have to authorize
the disclosure of any information regarding his medical care,
and that there had not been any such authorization. She stated
that Adult Protective Services had filed an emergency petition
for appointment of a temporary guardian for Bret Bohn. The
court had appointed an attorney to represent Mr. Bohn as his
temporary guardian, as well as a court visitor to act as an
independent investigator for the court. She pointed out that
Mr. Bohn's parents had participated in these proceedings, all of
which were on public record. She explained that the appointment
by the court of a temporary or permanent guardian gave them the
sole authority for health care decisions for the patient, which
included decisions regarding medication, and length of hospital
stay. She noted that Providence Health & Services Alaska
conferred with and obtained the necessary consent from the
guardian regarding treatment. She stated that visitation was
only restricted if the patient requested, or if it was medically
necessary and in the best interest of the patient. She noted
that there were many types of medical situations which
restricted visitation, including those by family members. She
declared that Providence Health & Services Alaska attempted to
work with the family and the patient to reinstitute this
visitation as soon as this was in the best interest of the
patient, and requested by the patient. If a guardian had been
appointed, then Providence Health & Services Alaska also
conferred with them regarding any restrictions on visitation.
3:59:48 PM
CINDY GOUGH, Director of Behavioral Health Services, Providence
Alaska Medical Center, read from a prepared statement, stating
that Providence Alaska Medical Center had served Alaskans since
1902, and that it currently served in eight communities with
acute care, physician clinics, long term and assisted living,
palliative and hospice care, and home health. She reported that
it was the state's largest private employer. She stated that
all of the staff at Providence cared about "Alaskans who suffer
with behavioral health illnesses, and we all want to see that
they receive excellent care and are put on a path to a healthy
life." She offered her belief that the proposed bill was not
necessary and was not in best interest of patients and care
givers. She declared that the Joint Commission, as well as
federal laws for participation in Medicare and Medicaid,
required that Providence meet certain guidelines regarding
grievances, procedures, and visitation. She declared that
professional ethics mandated respect for the patients, their
rights, and their best interests. She reported that Providence
had policies and procedures in place in the Behavioral Health
unit that covered many of the points addressed in the proposed
legislation, which included the right to file a complaint,
access to file a complaint 24/7, and a designated on-site
patient advocate. She declared that it was not necessary to add
another layer of state mandated grievance policy, and would not
result in tangible patient benefits. She stated that this
proposed bill would only impose additional reporting and
paperwork on the staff, instead of focusing on patient care and
treatment. She offered that facilities should have the option
to develop grievance and other procedures tailored to their own
facilities and patient populations, within federal guidelines,
applicable accreditation standards, and its own professional
ethics. She raised issues of concern regarding visitation in
the proposed bill, which included lack of definitions for a
"reasonable opportunity," "natural support systems," and "help
networks," as referred to on page 2, lines 29-31, and page 3,
line 1 of the proposed bill. She opined that this lack of
precise definitions would increase the likelihood of disputes.
She pointed out that the proposed bill mandated visitation, but
did not contain any exception for restrictions on visitation
which were medically necessary for the health of the patient.
She declared that family members were included in the treatment
of the patients at Providence unless the patient wished to not
have visitors or the physician determined that the medical needs
of the patient required restrictions on visitations. She
declared that the proposed bill did not allow that health care
providers be allowed to exercise their medical judgment when
such restrictions were medically necessary. She emphasized that
Providence took great interest and care to ensure that the
grievance procedure was handled quickly and properly. She
shared that Adult Protective Services, the Joint Commission, the
Alaska State Medical Board, and the Disability Law Center were
other avenues for patient grievances. She offered her belief
that the complex grievance procedures in the proposed bill were
unnecessary and would replace valuable patient care time with
labor intensive processes which did not advance patient care or
treatment.
4:05:49 PM
CHAIR HIGGINS asked how many grievances were filed at Providence
during the previous year.
MS. GOUGH replied that there had been ten, which included
grievances and patient complaints, within the psychiatric
emergency department and the behavioral health unit.
REPRESENTATIVE KELLER asked if the ten grievances were written.
MS. GOUGH explained that there had been other complaints within
the division that were resolved, and that these ten grievances
had been designated to an advocate for resolution.
REPRESENTATIVE KELLER asked if the patients were aware that the
advocate was easily accessible.
MS. GOUGH stated that patients were given all of this written
information along with their patient rights upon admittance.
CHAIR HIGGINS asked to clarify patient rights.
MS. GOUGH replied that these rights included the hospital
patient rights and those statutorily driven rights.
CHAIR HIGGINS stated that the proposed bill incorporated those
rights, and added three more rights, which could require a
change in procedures. He asked "what's the real push back on
this bill, other than the fact that you have your own
procedures." He offered his belief that "your real heartache
with this is that you don't want to have oversight from the
administration."
MS. GOUGH stated that she had outlined her areas of concern
during her testimony.
CHAIR HIGGINS asked to clarify that she did not like the
oversight on procedures by the administration.
MS. HERMAN, in response, stated that one size did not fit all,
as patient populations varied in each facility. She asked for a
closer definition on visitation, page 2, line 31, which she
considered could lead to more disputes.
CHAIR HIGGINS stated his agreement, and suggested deleting
"reasonable."
MS. HERMAN asked for a definition for "natural support system."
4:10:46 PM
REPRESENTATIVE TARR, noting that "reasonable" was used in the
existing statute and the proposed bill, offered her belief that
there was a legal definition for "reasonable." She asked if
there was more appropriate, specific language consistent with
other policy language to allow for this intent, especially with
regard to the controversial case related to the proposed bill.
MS. HERMAN offered to work on language for greater clarity to
the aforementioned definitions. She stated that there could not
be any comment on a specific case.
CHAIR HIGGINS declared that it was not the intent "to decide
right or wrong on any specific case, that's not the purpose
behind this bill." He emphasized that the proposed bill was
written to review and improve specific procedures.
REPRESENTATIVE PRUITT suggested caution for discussion of a
specific case.
REPRESENTATIVE KELLER asked Ms. Herman what the response would
be if a legislator called her office with a specific problem
from a constituent.
MS. HERMAN replied that state and federal patient protection
regulations would not allow discussion specific to the care of a
patient.
CHAIR HIGGINS expressed his agreement.
4:14:48 PM
JOSHUA SONKISS, MD, reported that he was a medical doctor, as
well as a board certified psychiatrist with specialty training
in the diagnosis and treatment of mental illness. He stated
that he had an additional board certification in forensic
psychiatry, a medical subspecialty which dealt with "the
interface of mental illness and the law." He said that he was
the Medical Director of the Behavioral Health unit at Fairbanks
Memorial Hospital, as well as the president-elect of the Alaska
Psychiatric Association. He shared that he was currently
providing outpatient mental health services to residents on the
North Slope. He shared some information on his personal life to
convey to the committee that "like my patients, I'm not just a
label, I'm a whole human being." He offered to provide factual
information necessary before consideration of the proposed bill.
He stated that he had provided written testimony to the
committee. He asked that the committee gather and consider as
much factual information as possible before making a decision on
the proposed bill. He expressed caution to not base a decision
on impassioned testimony by a few individuals. He addressed
earlier testimony regarding an alleged conspiracy between
hospitals and state agencies "to profit by depriving patients of
their rights." He reminded the committee that courts decided
whether a patient should be detained by the mental health
system, and that medical ethics and case law required that
medical professionals make these requests. He shared that the
vast majority of mental health care services were not delivered
by psychiatrists, as other medical specialists wrote more
prescriptions than psychiatrists. He declared that there was
not a rational basis to impose the provisions of the proposed
bill solely on mental health out-patient clinics, and not to
include "the thousands of family practitioners, pediatricians,
gynecologists, and others who diagnose and treat mental illness
in our state." He addressed previous testimony that psychiatric
patients were cut off from their families. He reported that the
Behavioral Health unit received weekly calls from anxious family
members asking about their loved ones. He pointed out that it
was not allowable to provide information or contact, as the
Health Insurance Portability and Accountability Act (HIPAA)
prevented health care workers from providing patient information
without patient consent. He noted that most mental health care
workers wanted to communicate with family members; however,
patients often did not want to speak with family members. When
there was not patient consent to speak with families, under
HIPAA, the health care workers were not allowed to even
acknowledge the patient had been admitted to the facility.
Although many people felt that these HIPAA requirements should
be changed, the proposed bill would not change these
requirements and it would not protect privacy violators from
severe penalties. He asked that committee members seek
information on physical and sexual assault statistics in mental
health versus other health care settings. He stated that judges
had expert knowledge for due process rights for psychiatric
patients, and that a review of state and federal privacy laws
would explain the family perception that contact had been
prevented. He expressed concern that the lack of a methodical
and determined search for facts would allow for the committee to
be misled by misinformation and misunderstanding for the rights
of patients with mental illness.
4:21:29 PM
REPRESENTATIVE TARR asked if the ability of the courts to make
the correct decision was limited during court intervention, or
did they rely on [health care] professionals for the necessary
information.
DR. SONKISS replied that the experienced judges who made
frequent civil commitment decisions were the best. He noted
that, as there was a bias by judges and society to not commit
patients, mental health professionals had to be well prepared,
and that patient rights were well protected in Alaska.
CHAIR HIGGINS stated that the proposed bill was not intended to
diagnose or treat mental [health] patients. He emphasized that
the purpose of the proposed bill was to "give adequate notice,
standardize forms, advocate assistance, rapid written
administrative response, and a right to appeal." He noted that
it also addressed telephonic access. He asked for clarification
that non-support of the proposed bill was a declaration against
these rights.
DR. SONKISS replied that this assessment was incorrect. He
stated that he was "very much in support of those rights, and
I've written and advocated in favor of those rights." He
expressed his agreement that, historically, those rights had
been violated. He explained that the reality for mental illness
and civil rights had changed over the last 40 years, and that
psychiatric patient rights "are better protected than the rights
of any other class of citizen in the country." He expressed his
agreement for maintaining vigilance in protection of these
rights. He pointed out that the addition of another
administrative layer to processes already in place and enforced
by agencies more powerful than the State of Alaska did not add
much, and that the money to fund this administrative layer would
be taken from the already financially stretched clinical
services. He emphasized that the vast majority of mental health
care prescriptions were written by doctors, not psychiatrists,
outside the mental health clinics, and he questioned why the
proposed bill did not address these other outpatient clinics.
CHAIR HIGGINS said that this response did not address his
question.
REPRESENTATIVE TARR noted that the written testimony from Dr.
Sonkiss was not in her packet, and she asked to receive it.
4:27:55 PM
LAURA MCKENZIE, Director, Compliance Officer, Quality
Improvement and Risk Management, North Star Behavioral Health,
read from a prepared statement:
Mr. Chairman and the Committee - thank you for this
opportunity to provide testimony regarding North Star
Behavioral Health's concerns regarding House Bill 214,
mental health patient rights and grievances.
I would like to start by stating that North Star has
been in business for over 28 years, and provides
voluntary behavioral health treatment exclusively for
children and adolescents at both our acute hospital,
and residential treatment facilities. We welcome
external oversight and community agency involvement in
our facilities, and fully support our patients having
access to grievance procedures.
We view their feedback as an important tool in our
performance improvement efforts, and take our
responsibilities for their treatment seriously. North
Star is committed to providing the children in our
facilities and the employees who care for them, a safe
environment that complies with, or exceeds all local,
state and federal requirements. As part of that
culture of safety is continuous monitoring of all
patients to prevent the unlikely occurrence of serious
events such as sexual or physical abuse which are
crimes, not grievances as outlined in this bill.
North Star program(s) are licensed by the State of
Alaska, the Center for Medicaid and Medicare Services
and accredited by the Joint Commission on
Accreditation of Health Care Organizations.
Monitoring is also conducted by external organizations
such as the Disability Law Center, State of Alaska
Office of Children's Services, the Division of
Behavioral Health, and the Division of Juvenile
Justice. Additionally inherent with treating
children, each patient has one or more of the
following who monitor and participate in care:
parents, family, Guardian Ad Litem(s), Social Workers,
external community treatment providers and school
personnel. One can surmise from reviewing all
involved parties that multiple levels of monitoring
and or investigation are already in place.
As part of the requirements for licensure and
operation we must have a grievance procedure that is
patient friendly, efficient, and responsive to
concerns. You have previously heard testimony that
behavioral health patients do not have rights, or have
fewer rights than prisoners. This is not accurate as
patients at North Star have rights in 30 different
categories, just like adults in other hospitals. We
maintain a vigorous program that is written into
policy and shared at multiple points. Information
about this process is given to every patient and
parent upon admission as part of the intake paperwork,
and also in the parent or patient handbook.
Additionally, we have this information posted on every
unit, and groups regarding rights and grievance
procedures are held with the patients. We have a
designated Patient Advocate who is responsible for
responding to grievances. We have installed locked
boxes on each unit so that patients can submit
concerns directly to the Advocate. The Advocate's
picture is even on the box to assist patients with
identifying him when making a complaint. We have
additional management staff trained and available
during times the Advocate is not on duty to assure
continuous access to this process at all times.
Additionally, we provide the contact information for
State of AK Facilities Licensing, Disability Law
Center, and the Joint Commission to all employees as
part of orientation; it is printed in the patient and
parent handbook and it is posted on our website.
Complaints are investigated and a written response is
given within a couple of days, not 2 weeks as previous
testimony would allege. Parents/guardians and other
support systems are involved in all aspects of
treatment, and that includes complaint resolution.
Concerns are then reviewed each month for trends and
opportunities to improve by the Quality Council,
Medical Executive Committee, and the Governing Board
each quarter. Additional review of the complaint data
is done by external agencies during annual, tri-annual
and unannounced regulatory surveys. Inquiries and
surveys in response to complaints are not uncommon,
and can last up to four days while involving multiple
departments.
A complaint received last month from a patient stated:
"wake up time is too early on the weekends." This is
a typical complaint we receive and clearly would not
rise to the level necessitating investigation and
response by an external party. Another point worth
discussion is the inherent benefit of having an
internal advocate who can investigate and work with
the clinical team to address concerns, thus preventing
triangulation and preserving the therapeutic alliance
between patient and treatment team. Please note, that
all patients are admitted to North Star on a voluntary
basis and with the consent of their parent who can
discharge their child at any time of they are unhappy.
As you can see, a patient receiving treatment at North
Star Behavioral Health already has the participation
of up to ten separate agencies and entities. It is
questionable, how the addition of the process outlined
in this bill will add value. HB 214 is unnecessary,
redundant, and an inefficient use of resources given
the onerous regulations and oversight already provided
to health care facilities. I am available to answer
any questions that the committee may have.
4:34:17 PM
CHAIR HIGGINS reiterated that the proposed bill was asking for
standardization of forms. He stressed that the proposed bill
was not redundant. He acknowledged that the proposed bill would
also send grievances to the next level for resolution, which he
opined was not unreasonable. He stated that the proposed bill
was "not redundance, you're doing it already, and the
administration in statute is supposed to do this already, too,
so we're just adding three new statutes to it."
MS. MCKENZIE offered that, as the Division of Behavioral Health
and the [Division of Corporations, Business, and Professional]
Licensing already existed, there was a redundancy to add another
state division.
CHAIR HIGGINS explained that the proposed bill created an
alignment within the division, as its purpose was not to create
more bureaucracy, but to streamline and to get patient
satisfaction.
4:36:32 PM
KAREN PERDUE, CEO and President, Alaska State Hospital and
Nursing Home Association (ASHNHA), observed that there had been
repeated statements that effective licensing and accreditation
bodies already existed. She reported that patient grievances
lodged with state or federal agencies could prompt unannounced
visits and investigations, as these bodies monitored the
implementation of complaint procedures and did follow up
investigations on individual complaints. She declared that
there was a difference for a process to monitor whether a
complaint procedure was in place, and the process for a
procedure to appeal individual complaints to the department.
She explained that there was concern for the expense to private
facilities. She said that an appeal process could be in a state
hearing for a private patient in a private hospital. She opined
that her experience determined that this was "unusual" as
private hospitals were not familiar with the handling of
individual patient grievances at the state appeal level.
CHAIR HIGGINS explained that the proposed bill governed due
process and grievance procedures in "all state and private
mental health hospitals, clinics, and units, which receive
public funds." He said that bill was not applicable if a
facility did not receive public funds.
MS. PERDUE said that Fairbanks Memorial Hospital, Bartlett
Regional Hospital, and Providence Alaska Medical Center all
received some form of state funding for assistance with the
management of patients. She pointed out that patients were
occasionally diverted to Bartlett Regional or Fairbanks Memorial
Hospitals, as API was usually quite full, and these facilities
were provided with Medicaid funding for these services. She
stated that Providence Alaska Memorial Center assisted with its
psychiatric emergency room. She emphasized that a legitimate
complaint process required bodies and expertise, and that this
cost needed to be reflected in a fiscal note.
4:40:37 PM
KATE BURKHART, Executive Director, Alaska Mental Health Board,
Division of Behavioral Health, Department of Health and Social
Services, stated that she spoke on behalf of the board, and that
the board was appointed by the governor. She stated that,
although she had provided written comment, she would offer ideas
for improvement of the proposed bill "if it must pass." She
declared that the board did not feel a statutory grievance
procedure was necessary or was a benefit to its constituents,
even though the mental health population was especially
vulnerable and needed additional protection. She reported that,
if the House Health and Social Services Standing Committee
insisted upon passage of a bill related to this topic, the board
believed that the bill should be very basic, reflect the
grievance issues related to treatment, care, or patient rights,
and apply solely to those facilities which provided involuntary
mental health services pursuant to AS 47. She explained that
the board did not believe that any bill related to a statutory
grievance procedure should apply to community behavioral health
centers, based on the same rationale offered by previous
testimony. She offered support for the right to a trained
patient advocate, and that patients should have the right to
make the grievance in writing and in other ways. She questioned
the use of a standardized form, as federal regulations required
the opportunity to make a grievance by telephone, in person, or
by e-mail, in a manner that allowed for a patient to best
communicate. She directed attention that not all patients were
capable of communication in writing or in English, and that a
limitation for grievances to a standardized form would not meet
the needs of patients. She suggested that a proposed bill,
instead of establishing a policy and procedure in statute,
should direct the Department of Health and Social Services to
promulgate regulations that require a written grievance
procedure, adequate notice of that procedure, and notice of the
patient advocate. She pointed out that the providers were
already offering access to informal and formal grievance
procedures and the opportunity to file a civil action. She
reiterated concerns for equating grievances about abuse,
physical, and sexual assault, with complaints about wake up
times. She encouraged that any provisions for emergency
grievances be limited to seclusion, restraint, safety, and
welfare. She suggested that a discreet definition for
grievances should be a written or oral complaint related to
treatment, care, or rights, with a provision that neither the
patient nor the advocate can be penalized for accessing the
grievance procedure. She encouraged that the committee weigh
the allocation of resources, as the vast majority of constituent
input to the Alaska Mental Health Board was about access to
services. She declared that a redirection of limited resources
away from clinical services toward administrative processes was
not supported by the majority of her constituents.
REPRESENTATIVE TARR asked if those suggestions could be
submitted in writing.
MS. BURKHART said that they had already been submitted.
4:46:02 PM
ANDREA SCHMOOK shared that she was a former patient at API in
1977, and had received services at Anchorage Community Mental
Health until her recovery from a serious mental illness in 1984.
She said that she was forcibly treated against her will and
committed to API in 1977. She shared that she had been a
consumer advocate for mental health in state hospitals, she did
contract consulting at API, she had established and developed
the API office of Consumer Family Affairs, and she had served on
the Alaska Mental Health Board. She reported that the advisory
board at API had developed a grievance policy that was currently
in place. She reported that proposed HB 214 was similar to the
[grievance] policy at API. She suggested that some of the
problems in the proposed bill were in the definitions and she
stated that the proposed bill was too hospital prescriptive and
should not include community behavioral health centers, as some
requirements in the proposed bill did not make sense for
community centers. She noted that the proposed bill used
"patient" whereas in a community behavioral health center, a
person was a "client," therefore the language of the proposed
bill would need to define each. She suggested removal of the
references to designated facilities, as it was impossible for
community behavioral health centers to meet the standards in the
proposed bill. She stated that she had submitted her written
testimony. She said that the proposed bill needed to be re-
written in order to be less prescriptive. She noted that API
already had its own grievance policies, which were occasionally
revised. She pointed out that community behavioral health
centers were accredited, and had policy and grievance
requirements approved by the Centers for Medicare and Medicaid
Services. She reminded the committee that the proposed bill
would be costly for staff time, during a time when staff
resources were already limited. She noted that a grievance
policy must be culturally significant to the individuals being
served, so that its access is meaningful and easy for the
patient.
CHAIR HIGGINS left public testimony open and HB 214 was held
over.
^CONFIRMATION HEARING(S): STATE MEDICAL BOARD
CONFIRMATION HEARING(S):
State Medical Board
4:53:24 PM
CHAIR HIGGINS announced that the final order of business would
be the confirmation to the State Medical Board. He reminded the
committee that signing the confirmation committee report does
not reflect the intent of any member to vote for or against an
individual in any other session for the purpose of confirmation.
SAI-LING LIU, D.O., Appointee to the State Medical Board, in
response to Representative Keller, explained that her clinical
work in the region for the last 24 years had given her an
excellent background, which had prepared her to participate in a
"broader aspect for the state."
4:55:50 PM
REPRESENTATIVE KELLER made a motion to advance the confirmation
of Sai-Ling Liu, D.O., appointee to the State Medical Board, to
the joint session for consideration. There being no objection,
the confirmation was advanced.
4:57:06 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:57 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 214 Providence Letter 2 19 2014.PDF |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| HB214-LAW-CIV-02-21-14.pdf |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| HB 214 API Compliance Hearings 2 25 2014.PDF |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| HB 214 API Grievances 2009-2013 2 25 2014.PDF |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| HB 214 North Star Behavioral Health Testimony 2 25 2014.PDF |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| CSHB 214 AMHB talking Points 2-24-14 (2).pdf |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |
| CSHB 214 AMHB talking Points 2-24-14 (1).pdf |
HHSS 2/25/2014 3:00:00 PM |
HB 214 |