03/11/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB301 | |
| HB214 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 301 | TELECONFERENCED | |
| += | HB 214 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 11, 2014
3:03 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. 301
"An Act relating to duties and procedures of the state medical
examiner and the Department of Health and Social Services; and
relating to death certificates."
- MOVED CSHB 301(HSS) OUT OF COMMITTEE
HOUSE BILL NO. 214
"An Act relating to mental health patient rights, notifications,
and grievance procedures."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 301
SHORT TITLE: AUTOPSIES AND DEATH CERTIFICATES
SPONSOR(s): REPRESENTATIVE(s) HERRON
02/07/14 (H) READ THE FIRST TIME - REFERRALS
02/07/14 (H) HSS
02/20/14 (H) HSS AT 3:00 PM CAPITOL 106
02/20/14 (H) Heard & Held
02/20/14 (H) MINUTE(HSS)
03/04/14 (H) HSS AT 3:00 PM CAPITOL 106
03/04/14 (H) Heard & Held
03/04/14 (H) MINUTE(HSS)
03/11/14 (H) HSS AT 3:00 PM CAPITOL 106
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
02/25/14 (H) Heard & Held
02/25/14 (H) MINUTE(HSS)
03/11/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE BOB HERRON
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified as the sponsor of HB 301.
THOMAS STUDLER, Staff
Representative Pete Higgins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As staff for the bill sponsor,
Representative Pete Higgins, introduced the committee substitute
for HB 214.
FAITH MYERS
Volunteer Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
DORRANCE COLLINS
Volunteer Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 214.
DON ROBERTS
Kodiak, Alaska
POSITION STATEMENT: Testified in support of HB 214.
SCOTT CALDER
Fairbanks, Alaska
POSITION STATEMENT: Testified in support of HB 214.
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.
STACIE KRALY, Chief Assistant Attorney General-Statewide Section
Supervisor
Human Services Section
Civil Division (Juneau)
Department of Law
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of HB 214.
ACTION NARRATIVE
3:03:10 PM
CHAIR PETE HIGGINS called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Higgins, Keller, Seaton, Reinbold, Pruitt, and
Nageak were present at the call to order. Representative Tarr
arrived as the meeting was in progress.
HB 301-AUTOPSIES AND DEATH CERTIFICATES
3:04:15 PM
CHAIR HIGGINS announced that the first order of business would
be HOUSE BILL NO. 301, "An Act relating to duties and procedures
of the state medical examiner and the Department of Health and
Social Services; and relating to death certificates."
[In front of the committee was the proposed committee substitute
(CS) for HB 301, labeled 28-LS1196\P, Mischel, 2/27/14, which
the committee had adopted as the working draft on March 4,
2014.]
REPRESENTATIVE PRUITT moved to adopt proposed Amendment 1,
labeled 28-LS1196\P.1, Mischel, 3/7/14, which read:
Page 2, lines 8 - 15:
Delete all material and insert:
"(f) The state medical examiner shall designate
a location for conducting a post mortem examination
that is in the community closest to where the death
occurred if
(1) the state medical examiner has verified
that a facility with adequate technology, personnel,
and training is available at the location to enable
the state medical examiner to direct a remote
examination;
(2) the facility meets applicable
standards, including inspection and accreditation, for
conducting remote post mortem examinations established
in the Forensic Autopsy Performance Standards by the
National Association of Medical Examiners; and
(3) the cost of conducting the examination
in the community closest to where the death occurred
is less than the cost of conducting the examination or
autopsy at another location, including the cost of
transporting the body to and from another location to
conduct the examination."
REPRESENTATIVE KELLER objected for discussion.
REPRESENTATIVE PRUITT said that this amendment would conform the
proposed bill to the bill version in the Senate Finance
Committee, and he suggested that any questions be directed to
the bill sponsor.
3:05:52 PM
REPRESENTATIVE BOB HERRON, Alaska State Legislature, explained
that proposed Amendment 1 put into statute the issues that had
been brought up during the previous hearings on the bill. He
said that the state medical examiner would work toward the
"adequate technology, personnel, and training" in order to use
telemedicine carts for remote examinations in order to determine
whether remains were transported to the medical examiner in
Anchorage. He noted that there was clarification for the return
of the body to an appropriate location, instead of the place of
death.
3:07:08 PM
REPRESENTATIVE KELLER removed his objection to proposed
Amendment 1. There being no further objection, Amendment 1 was
passed.
REPRESENTATIVE HERRON explained that the statewide non-profits
could use this package as a revenue neutral model [Included in
members' packets] for a memorandum of understanding [MOU] to use
in working with the state medical examiner.
3:09:08 PM
REPRESENTATIVE KELLER moved to report CSHB 301, Version 28-
LS1196\P, Mischel, 2/27/14, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 301(HSS) was moved from the House
Health and Social Services Standing Committee.
The committee took an at-ease from 3:09 p.m. to 3:14 p.m.
HB 214-MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES
3:14:55 PM
CHAIR HIGGINS announced that the next order of business would be
HOUSE BILL NO. 214, "An Act relating to mental health patient
rights, notifications, and grievance procedures."
REPRESENTATIVE KELLER moved to adopt the proposed committee
substitute (CS) for HB 214, labeled 28-LS0869\C, Mischel,
3/7/14, as the working draft. There being no objection, it was
so ordered.
3:15:29 PM
THOMAS STUDLER, Staff, Representative Pete Higgins, Alaska State
Legislature, stated that the proposed bill was "a mental health
patient rights and grievance bill." He stated that the
committee substitute, Version C, had some significant changes.
He said that Section 1 of the proposed bill had remained
unchanged. Directing attention to Section 2, he explained that
the records could be made public during the appeal process, so
this clause was added to maintain the confidentiality. He
explained that in Section 3, AS 47.30.840(a)(5) was amended to
include "except as provided in (14) of this subsection" which
would allow a person being evaluated by in-patient care to have
visitors at reasonable times. He reported that paragraph (13)
had been amended by removing, "employed by and clearly
identified by an evaluation facility or unit or designated
treatment facility or unit," and would now allow the right for a
designated representative who was not an employee, as an
advocate, when filing a grievance. He stated that paragraph
(15) had been added, "has the right to confidentiality of the
person's record unless the person has consented in writing to
the release of the records." He moved on to Section 4 of the
CS, which replaced the 24 hour call center with "a telephone
call center." He noted that it was also possible to call 211
for assistance or an advocate. He shared that paragraph (3) was
amended by removing "to an impartial body designated by the
department" which gives the authority for administrative appeals
to the Office of Administrative Hearings so that it comported
with Section 2. He noted that paragraph (6) was amended, adding
"by the department" for the records review and maintenance. He
explained paragraph (7) which added "maintenance of
confidentiality of the grievance records, including the appeal
documents and decisions, unless the grievance provides prior
written consent to release some or all of the records;" to
clarify that the records were confidential. He detailed that
paragraph (8) was added, as this was a process for designating
the grievances by categories. He explained that Category 1 was
a grievance related to the physical or social environment under
the control of the facility; Category 2 was a grievance related
to patients' rights, and Category 3 was a grievance which
alleged that a criminal act had occurred. He offered his belief
that the categorical breakdown "separated the wheat from the
chaff."
3:20:53 PM
CHAIR HIGGINS stated that the facilities could handle many of
the grievances within the facility, and that the administration
would deal with a review of the worst offenses.
MR. STUDLER explained that AS 47.30.847(b)(1) was amended by
removing "patient records" and adding "patient's record of the
admission or an administrative file for the patient," to relieve
confusion that the grievance could be placed into the medical
records. He directed attention to AS 47.30.847(b)(3) which was
amended by adding "for a category 2 and 3 grievance, delivered
to the department with 24 hours." He said that AS
47.30.847(b)(4) had been deleted. He reported that AS
47.30.847(c) had been amended to change business days to
calendar days for a written response to a grievance, and then
the review by the commissioner was changed from five business
days to thirty calendar days. He said that AS 47.30.847(d) had
been deleted. Directing attention to AS 47.30.847(f), he said
that it was amended by changing "quarterly" to "annual" report
and AS 47.30.847(f)(1) was amended, adding "category 1, 2, and
3." He reported that AS 47.30.847(g) was amended by changing
the "biennial" report to an "annual" report from the department,
as well as changing "type" to "category." He concluded by
stating that Section 6 was added, repealing AS 47.30.660(b)(13)
which had delegated department authority to private
institutions.
3:24:33 PM
REPRESENTATIVE SEATON directed attention to page 4, line 24, and
asked for clarification.
MR. STUDLER replied that, in the originally proposed bill, the
grievant had five days to appeal to the commissioner after the
proposed resolution by the institution, and the CS would now
allow thirty days for appeal to the commissioner.
REPRESENTATIVE SEATON, referring to page 4, line 21, asked about
the sequence for five calendar days.
MR. STUDLER explained that those five days referred to the time
frame for the institution to report its resolution to the
department.
CHAIR HIGGINS directed attention to the flow charts for
Grievance Procedures [Included in members' packets].
MR. STUDLER addressed the flow chart titled "Current in Statute
AS.47.30.847 Grievance Procedure," explaining that it was
"pretty simplistic" as it started with the patient's right to
file a grievance, which was sent to the evaluation facility for
a formal grievance procedure inside the facility, and was
concluded with an evaluation by a designated staff member. He
pointed to a second flow chart, titled "CS HB 214 Version C
Grievance Procedure." This proposed procedure would begin with
an approved, standardized DHSS grievance form and policy to
avoid any confusion. The notice of grievance process would be
standardized, and the complaint box would be reviewed daily by
the facilities, which would maintain a complete record of all
the documents as the complaint moved forward. He noted that the
facility must respond to category 2 and 3 complaints to a
department within 24 hours, as well as responding to the
complainant within five calendar days. This response to the
complainant must include a description of the appeal process,
with an electronic copy sent to DHSS. The complainant would
then have 30 calendar days to appeal this response to the
commissioner. After this review by the commissioner, the
complainant could make a final appeal to the Office of
Administrative Appeals, which he described as "a fair and
impartial board that has no dog in this fight."
MR. STUDLER said:
the reasonable minds, I know, will bear out on this
and that we will have a good, fair, and impartial
process that an individual who is in a mental health
facility, and most certainly in a diminished capacity
at that time, has the right to file a grievance and is
being given the right guidance to file that to make
sure that their rights are, in fact, protected.
3:29:52 PM
CHAIR HIGGINS opened public testimony.
3:30:28 PM
FAITH MYERS, Volunteer Mental Health Advocate, reading from a
prepared statement, shared that both the States of Georgia and
Maine had made extensive improvements to the psychiatric patient
grievance procedure laws and rules, and now had top ratings for
quality of psychiatric patient care. She stated her support for
proposed CSHB 214.
3:31:37 PM
DORRANCE COLLINS, Volunteer Mental Health Advocate, reading from
a prepared statement, stated that the Alaska psychiatric patient
grievance law was a "throwback to the methods that were used 100
years ago." He referenced a letter from 2010 by the Disability
Law Center which stated that the law was "inadequate to protect
the rights of mental health patients to file a meaningful
grievance." He referenced a letter written in 2007 by the
Alaska Mental Health Board, the Alaska Mental Health Trust
Authority Board of Directors, and the Anchorage chapter of the
[National Alliance on Mental Illness], which called for a
revision of the law as it was "inadequate to protect the rights
of mental health patients to file a meaningful grievance." He
declared his support for the proposed HB 214.
3:32:48 PM
DON ROBERTS stated his support for proposed CSHB 214. He
declared that there were strong emotions from the patients as it
was about their livelihood and their treatment as citizens, and
that any "coercive authority of the state to restrict people's
movements" should be addressed.
3:33:47 PM
SCOTT CALDER expressed his support for the proposed CS, and the
external review and appeal, especially "in areas where the
coercive power of the state is involved." He asked the
committee to review page 4, line 26, of the proposed CS, and
suggested that the period to file an appeal or a grievance be
extended beyond the one year, as written.
3:35:25 PM
BARBARA HENJUM, Acting Director, Central Office, Division of
Behavioral Health, Department of Health and Social Services,
expressed that her division had some thoughts for consideration
with the proposed CS, Version C. She reasserted the DHSS belief
that the current statutory protections and agency policies and
procedures of federal, state, treatment providers, and
accreditation agencies adequately afforded the necessary
protections for mental health patients. Directing attention to
Version C, she stated that, as Section 6 repealed AS
47.30.660(b)(13), this would eliminate the ability of DHSS to
operate designated evaluation treatment and stabilization
facilities. She noted that this would eliminate these services
at Fairbanks Memorial Hospital, Bartlett Regional Hospital, and
other hospitals. She asked that this repeal be reconsidered.
She directed attention to page 3, lines 12-13, and suggested
that the grievance process should be directed at a state
operated psychiatric hospital, a unit designated by DHSS under
regulations, or a designated treatment facility, and not at
community mental health centers where constituents were served
in a voluntary or outpatient program.
MS. HENJUM asked that the multi-tiered grievance approach be
thoroughly deliberated by the House Health and Social Services
Standing Committee. She declared that criminal acts should be
further defined under category 3, and the intent of the language
should be clarified. She emphasized that alleged crimes for
physical or sexual abuse should immediately engage law
enforcement for investigation, as these were not grievances to
be treated by the department or the treatment entity, and should
be treated as alleged criminal acts. She said that category 1
grievances involving the designated treatment facility's
physical or social environment should also be clarified, as
these minor complaints could be handled immediately and
informally in-house. She offered her belief that a one year
period to allow for filing of a grievance seemed excessive, as
it was very difficult to investigate a grievance filed 11 months
after a patient left the hospital. She declared that this
provision delayed justice for the patient, as well as the
hospital and its staff. She said that subsequent appeals to the
commissioner and the Office of Administrative Hearings provided
additional levels of intervention; however, she asked, what
meaningful remedy would be available at that point for many
category 1 offenses, especially one year after the discharge of
the patient. She said that alleged crimes were and should be
immediately referred to law enforcement outside the provider and
the department. She declared that most other matters should be
handled immediately and informally within the treatment entity,
if possible, as was currently the case.
CHAIR HIGGINS asked Ms. Henjum to repeat the consequence of
repeal of AS 47.30.660(b)(13).
MS. HENJUM said that this was the authority for DHSS to
designate evaluation and stabilization programs in other
hospitals, and that its repeal would remove the ability to
provide those acute care services closer to the patient's homes.
CHAIR HIGGINS asked for her to provide her testimony in writing.
He offered his understanding that deletion of this would send
the grievances up the chain of command, instead of dealing with
them in-house.
3:42:30 PM
STACIE KRALY, Chief Assistant Attorney General-Statewide Section
Supervisor, Human Services Section, Civil Division (Juneau),
Department of Law, opined that Chair Higgins' understanding for
the repeal of AS 47.30.660(b)(13) may have been the intent of
the amended CS, but it had a much broader statutory authority
for DHSS to enter into contracts with patient facilities. She
explained that, as Alaska Psychiatric Hospital (API) was the
only state hospital, a system of care had been created by
contracting with local provider community hospitals for those
mental health services similar to API. She detailed that these
services could include a 72 hour commitment for evaluation and
determination for involuntary commitment, as well as a 30 day
stay. She pointed out that this repeal had "wiped out that
entire system" as it was the statutory authority for DHSS to
delegate these agreements with these providers. She stated that
this repeal was much broader than what was intended. She
suggested that there could be a "more surgical way to do that."
CHAIR HIGGINS asked for a written suggestion, declaring "we're
here to work with you, too, 'cause we want to make sure this
works."
3:45:05 PM
REPRESENTATIVE KELLER expressed his support of the repeal,
opining that "it highlights a very interesting subsection of law
that's a pretty broad delegation of authority."
MS. KRALY, in response to Representative Tarr, said that it was
AS 47.30.660(b)(13).
REPRESENTATIVE SEATON offered his belief that the system had
been changed to allow this authority because there was no local
treatment.
CHAIR HIGGINS stated a need for the language change. He stated
that the purpose of proposed HB 214 was not to hinder
facilities, but to make things better for everyone.
3:47:13 PM
CHAIR HIGGINS closed public testimony and said that HB 214 would
be held over for appropriate changes.
3:48:47 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 3:48 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB301CS(HSS)-DHSS-SMEO-03-04-14.pdf |
HHSS 3/11/2014 3:00:00 PM |
HB 301 |
| CS HB 214 Version C.pdf |
HHSS 3/11/2014 3:00:00 PM |
HB 214 |
| CS HB 214 Explanation of changes.pdf |
HHSS 3/11/2014 3:00:00 PM |
HB 214 |
| CSHB 214 Section Analysis.pdf |
HHSS 3/11/2014 3:00:00 PM |
HB 214 |
| Current Grievance Procedure.pdf |
HHSS 3/11/2014 3:00:00 PM |
|
| HB 214 New Grievance Procedure 2 28 2014.docx |
HHSS 3/11/2014 3:00:00 PM |
HB 214 |
| Reports by Facilities.pdf |
HHSS 3/11/2014 3:00:00 PM |
|
| HB214Testimony 2 11 2014.PDF |
HHSS 3/11/2014 3:00:00 PM |
HB 214 |