03/08/2022 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB297 | |
| HB172 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 172 | TELECONFERENCED | |
| *+ | HB 297 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 8, 2022
3:13 p.m.
MEMBERS PRESENT
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz
Representative Zack Fields
Representative Christopher Kurka
Representative Ken McCarty
MEMBERS ABSENT
Representative Liz Snyder, Co-Chair
Representative Mike Prax
COMMITTEE CALENDAR
HOUSE BILL NO. 297
"An Act relating to the duties of the Department of Health and
Social Services; relating to child protection; and relating to
children of active duty military members."
- HEARD & HELD
HOUSE BILL NO. 172
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 297
SHORT TITLE: MILITARY MEMBER CHILD PROTECTION
SPONSOR(s): REPRESENTATIVE(s) HOPKINS
01/31/22 (H) READ THE FIRST TIME - REFERRALS
01/31/22 (H) MLV, HSS
02/22/22 (H) MLV AT 1:00 PM GRUENBERG 120
02/22/22 (H) Heard & Held
02/22/22 (H) MINUTE(MLV)
02/24/22 (H) MLV AT 1:00 PM GRUENBERG 120
02/24/22 (H) Moved CSHB 297(MLV) Out of Committee
02/24/22 (H) MINUTE(MLV)
02/28/22 (H) MLV RPT CS(MLV) 6DP
02/28/22 (H) DP: CLAMAN, TARR, STORY, NELSON, SHAW,
TUCK
03/08/22 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 172
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
04/12/21 (H) READ THE FIRST TIME - REFERRALS
04/12/21 (H) JUD, HSS, FIN
05/14/21 (H) JUD AT 1:00 PM GRUENBERG 120
05/14/21 (H) Heard & Held
05/14/21 (H) MINUTE(JUD)
05/15/21 (H) JUD AT 1:00 PM GRUENBERG 120
05/15/21 (H) -- MEETING CANCELED --
02/14/22 (H) JUD AT 1:00 PM GRUENBERG 120
02/14/22 (H) -- MEETING CANCELED --
02/16/22 (H) JUD AT 1:30 PM GRUENBERG 120
02/16/22 (H) Heard & Held
02/16/22 (H) MINUTE(JUD)
02/21/22 (H) JUD AT 1:00 PM GRUENBERG 120
02/21/22 (H) Heard & Held
02/21/22 (H) MINUTE(JUD)
02/23/22 (H) JUD AT 1:30 PM GRUENBERG 120
02/23/22 (H) Heard & Held
02/23/22 (H) MINUTE(JUD)
02/25/22 (H) JUD AT 1:30 PM GRUENBERG 120
02/25/22 (H) Moved CSHB 172(JUD) Out of Committee
02/25/22 (H) MINUTE(JUD)
02/28/22 (H) JUD RPT CS(JUD) NEW TITLE 3DP 1DNP 1NR
1AM
02/28/22 (H) DP: DRUMMOND, SNYDER, CLAMAN
02/28/22 (H) DNP: EASTMAN
02/28/22 (H) NR: KREISS-TOMKINS
02/28/22 (H) AM: VANCE
03/08/22 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
TANIA CLUCAS, Staff
Representative Grier Hopkins
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented a PowerPoint presentation,
sectional analysis, and answered questions on CSHB 297(MLV) on
behalf of Representative Hopkins, prime sponsor.
TAMMIE PERREAULT, Northwest Regional Liaison
State Liaison Office
U.S. Department of Defense
Anchorage, Alaska
POSITION STATEMENT: Provided information and answered questions
during the hearing on CSHB 297(MLV).
JEREMY COMBS, Commander
Family Advocacy Officer
U.S. Air Force
Joint Base Elmendorf Richardson
Anchorage, Alaska
POSITION STATEMENT: Responded to questions during the hearing
on CSHB 297(MLV).
TRAVIS ERICKSON, Division Operations Manager
Office of Children's Services
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Offered information and responded to
questions during the hearing on CSHB 297(MLV).
STEVE WILLIAMS, Chief Executive Officer
Alaska Mental Health Trust Authority
Department of Revenue
Anchorage, Alaska
POSITION STATEMENT: Co-presented a PowerPoint presentation on
CSHB 172(JUD) on behalf of the sponsor, House Rules by request
of the governor.
HEATHER CARPENTER, Healthcare Policy Advisor
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Co-presented a PowerPoint presentation on
CSHB 172(JUD) on behalf of the sponsor, House Rules by request
of the governor.
GENNIFER MOREAU-JOHNSON, Director
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Answered questions on CSHB 172(JUD).
STACIE KRALY, Director
Civil Division
Department of Law
Juneau, Alaska
POSITION STATEMENT: Answered questions on CSHB 172(JUD).
MARK REGAN, Legal Director
Disability Law Center of Alaska
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony and answered
questions during the hearing on CSHB 172(JUD).
HELEN ADAMS, MD
Emergency Medical Physician
Alaska Chapter of Emergency Physicians
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony during the
hearing in support of CSHB 172(JUD).
JAMES COCKRELL, Commissioner
Department of Public Safety
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony during the
hearing in support of CSHB 172(JUD).
ACTION NARRATIVE
3:13:12 PM
CO-CHAIR TIFFANY ZULKOSKY called the House Health and Social
Services Standing Committee meeting to order at 3:13 p.m.
Representatives Kurka, McCarty, Spohnholz, and Zulkosky were
present at the call to order. Representatives Fields arrived as
the meeting was in progress.
HB 297-MILITARY MEMBER CHILD PROTECTION
3:14:02 PM
CO-CHAIR ZULKOSKY announced that the first order of business
would be HOUSE BILL NO. 297, "An Act relating to the duties of
the Department of Health and Social Services; relating to child
protection; and relating to children of active duty military
members."
[Before the committee was CSHB 297(MLV).]
3:14:33 PM
TANIA CLUCAS, Staff, Representative Grier Hopkins, Alaska State
Legislature, presented CSHB 297(MLV) on behalf of Representative
Hopkins, prime sponsor. She stated that the proposed
legislation is in response to the U.S. Department of the
Interior's ongoing Tiger Team collaboration with the U.S.
Department of Defense (DoD). In regard to child abuse
identification and reporting, the proposed legislation responds
to this as one of the ten key issues identified when DoD
considers quality of life for military families. She stated
that DoD uses these issues to make decisions related to
[military] installations and extended missions. She added that
currently there is no requirement in Alaska for civilian
authorities to notify DoD when a military child is involved in a
case of abuse or neglect. The proposed legislation would put
this into statute. The legislation would also ensure that
military families have access to resources with a local partner.
She concluded that providing these services would allow military
families to stay in Alaska.
3:17:03 PM
MS. CLUCAS introduced the sponsor statement for CSHB 297(MLV)
[included in the committee packet], which read as follows
[original punctuation provided]:
Alaska has approximately 14,000 children who are
classified as active-duty military dependents and over
5,000 children who are dependents of those who serve
in the National Guard and Reserves. Our state has the
3rd highest per capita population of military children
in the nation, coming in behind our sister state
Hawaii and the District of Columbia.
These young people are important to Alaska, and as
leaders of our state we have a responsibility for
their health and welfare. When unfortunate incidents
occur that affect the health and welfare of a child of
a military member requiring intervention by state
authorities, there is not currently a legal protection
to make sure that the appropriate officials within the
military chain of command are notified. House Bill 297
would place into statute the requirement that the
state agency who intercedes on behalf of a child's
welfare must notify the appropriate, identified,
authorities at the affiliated duty station. This would
allow for the creation of a coordinated and
collaborative approach to protective and
rehabilitative services can be offered to the child
and the child's family.
Getting families the help, guidance and support they
need to keep families together is the most important
thing we can do for the health of the child as they
grow up. Alaska is renowned for its support of our
military and for working with the Department of
Defense to ensure the health and safety of our
nation's military and Alaskan families are safe and
secure is essential.
Please join me in supporting HB 297 to help ensure
that military children and families are able to be
offered the most comprehensive support they need to
thrive.
MS. CLUCAS gave the sectional analysis on CSHB 297(MLV)
[included in the committee packet], which read as follows
[original punctuation provided]:
Section 1: Amended to reference new section added by
this legislation
Section 2: Adds language authorizing and requiring
communication of a report of harm to a military
dependant [sic] to the appropriate designated military
authority by civilian authorities.
3:19:20 PM
MS. CLUCAS directed the committee's attention to the PowerPoint
presentation [included in the committee packet]. She began with
[slide 2], stating that the legislation is being offered at the
request of the DoD State Liaison Office to address one of the
ten key issues listed. She provided that, of the listed issues,
the state has already addressed military spouse licensure and
the Purple Star Schools Program. The proposed legislation would
address child abuse identification and move this piece forward.
She said that Alaska's collaboration with DoD on these
priorities would ensure the state is a place DoD could continue
its mission. She stated that slide 3 exhibits the nationwide
progress on DoD's mission. She explained that the military has
changed over the last 40 years, and members are no longer
isolated on a base. She noted that over 70 percent of active-
duty military live within local communities, so the chain of
command may not be aware of any abuse issues; thus, a
collaboration of civilian and military authority is needed.
3:22:06 PM
MS. CLUCAS, moving to the next slide, pointed out the
significant number of military-affiliated children in Alaska and
the high rate of reported abuse cases involving these children.
She stated that, since [the terrorist attacks of September 11,
2001], the military has had more active deployments, and, with
this increase, there have been more reported cases of abuse in
stressed military families. She offered her understanding that,
since the advent of the Family Advocacy Program (FAP) in 2019,
DoD has recognized its extended responsibility to look after
these children. She stated that civilian authorities working
with FAP would not only help the DoD follow its own requirement,
but it would also provide for the health and welfare of those
vulnerable Alaskans.
3:25:47 PM
MS. CLUCAS, in response to a question from Representative
McCarty, addressed DoD's considerations when deciding to open
military bases and the state's efforts to make locations
attractive. She stated that because of the realignment of DoD's
criteria for mission locations, the interior of the state has
made efforts, including the formation of the Tiger Team. In
response to a follow-up question, she indicated that the
decision on mission placement would be made at a high level in
the DoD.
3:30:06 PM
TAMMIE PERREAULT, Northwest Regional Liaison, State Liaison
Office, U.S. Department of Defense, shared that she works for
the Under Secretary of Defense for Personnel and Readiness. She
stated that DoD relies on collaboration with local and state
governments to fulfill the statutory obligation to address child
abuse and neglect. She said DoD is grateful for the opportunity
to support the policies in [CSHB 297(MLV)]. She expressed hope
that Alaska would join the 31 other states with similar
legislation on this issue. She explained that the military
services have an obligation to understand what is happening with
military members, and she said information sharing between DoD
and local authorities must be accomplished at the start of an
abuse or neglect investigation, not after the adjudication.
MS. PERREAULT offered that the proposed legislation would ensure
child abuse and neglect within a military family is reported to
the appropriate military installation and the Office of Public
Advocacy. The legislation would enable the determination of a
family's military status when medical and counseling services
are sought through the military installation. She informed that
there would be minimal requirements for information sharing,
noting that, currently in Alaska, the framework relies on
individualized, local memorandums of understanding (MOUs) to
guarantee communication between local authorities and the
military community. She cautioned that many MOUs are not
regularly updated, and military families could possibly live
outside the area MOU's cover. She said that specific, state-
level guidance, which directs information sharing with the
military, would provide consistency among all branches of the
services and state and local agencies. Further, when there is
an allegation of abuse or neglect involving the military family,
the proposed policy, which draws on the best practices
nationwide, would provide consistency to support the MOU
process. She clarified that this would not be a military law
enforcement matter; it would be a victim-advocacy measure to
protect vulnerable children. She expressed gratitude for the
support Alaska has shown for military families in the state, and
she urged the committee to pass [CSHB 297(MLV)].
3:33:27 PM
MS. PERREAULT, in response to a question from Co-Chair Zulkosky,
said the proposed legislation is similar to legislation in other
states. She said that the legislation would provide
foundational groundwork to ensure there is coordination, by
statute. She reinforced that legislation would maintain DoD's
obligation to support military children.
3:35:08 PM
REPRESENTATIVE KURKA, in reference to reporting abuse of a child
by a member of the armed forces, questioned who is authorized by
law to have the reported information.
MS. PERREAULT deferred to Commander Jerry Combs.
3:36:32 PM
JEREMY COMBS, Commander, Family Advocacy Officer, U.S. Air
Force, Joint Base Elmendorf Richardson (JBER), explained that
when a report comes to the FAP office, the staff is required to
immediately notify the chain of command, which begins the safety
assessment process. He listed the entities that are notified:
the Office of Children's Services (OCS), the chain of command,
the local law enforcement, the Department of the Army, and the
U.S. Air Force Office of Special Investigations.
3:37:56 PM
TRAVIS ERICKSON, Division Operations Manager, Office of
Children's Services, Department of Health and Social Services,
said when OCS receives a report of child abuse or neglect, it
coordinates with a variety of other authorities. He said, "If
we know that there's a military duty member, we will alert the
Family Advocacy office, and if a crime has been committed, we
will also be coordinating with the Office of Special
Investigations and other local law enforcement, as indicated."
REPRESENTATIVE KURKA asked for further information regarding who
in the chain command would be authorized by law to share
information. He questioned whether this would involve federal
law.
MS. PERREAULT, to answer this question, offered to meet with
Representative Kurka after the hearing to provide details.
3:40:05 PM
MS. PERREAULT, in response to a question from Representative
Fields regarding the notification period, explained that the
previous committee of referral amended the legislation to
include a 15-day requirement, which was coordinated with OCS.
She offered her understanding that in other states a specific
timeline has not been mandated, but sometimes an issue that has
not come to the forefront becomes "stale." She added that,
conversely, some issues are emergent and come to FAP via a
police report or emergency room visit.
COMMANDER COMBS added that, in terms of domestic violence, time
is of the essence. He clarified that the staff at FAP are
"experts" and can act as consultants to the commanders. Only
those commanders, first sergeants, have the authority to issue
"no contact" or "protective" orders. He noted that as soon as
FAP receives a referral, one option would be to link the family
with a professional victim advocate within the office. He added
that office staff can also work with local authorities.
MR. ERICKSON remarked that the 15 days would be the outside
response time used to report to OCS. He offered his
understanding that the language in the proposed legislation is
"within 15 days". He said the typical OCS response time is from
immediate to a maximum of 7 days. He opined that the office
should be responding based on the urgency necessary to the
circumstance.
REPRESENTATIVE FIELDS suggested if 7 days would be outside of
the timeframe, the committee should consider an amendment to
change the 15 days [to fewer days].
3:45:14 PM
MS. CLUCAS, in response to Representative McCarty, noted the
last committee of referral had put forward the amendment to
change the requirement to 15 days. It concerned a committee
member that no outside limit for reporting had been made. The
intent would be to have an outside timeframe for reporting.
3:46:26 PM
CO-CHAIR ZULKOSKY announced that HB 297 was held over.
HB 172-MENTAL HEALTH FACILITIES & MEDS
3:46:57 PM
CO-CHAIR ZULKOSKY announced that the final order of business
would be HOUSE BILL NO. 172, "An Act relating to crisis
stabilization centers, crisis residential centers, and subacute
mental health facilities; relating to evaluation facilities;
relating to representation by an attorney; relating to the
administration of psychotropic medication in a crisis situation;
relating to the use of psychotropic medication; relating to
licensed facilities; relating to psychiatric patient rights;
amending Rule 6(a), Alaska Rules of Civil Procedure; and
providing for an effective date."
[Before the committee was CSHB 172(JUD).]
CO-CHAIR ZULKOSKY noted there would be no public testimony today
at the first hearing of HB 172.
3:48:38 PM
STEVE WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority (AMHTA), Department of Revenue, co-presented a
PowerPoint presentation on CSHB 172(JUD) on behalf of the
sponsor, House Rules by request of the governor. He stated that
currently Alaskans in mental health crises are reliant on first
responders and others to address their needs and access
available resources to resolve these crises. He said that,
while police officers ensure public safety, they are not trained
in the area of mental health, and emergency room or correctional
facility staff are not necessarily trained either. He noted, if
there are no other resources in the community to address an
individual's behavioral health crisis, that person may end up in
a correctional facility.
3:50:19 PM
HEATHER CARPENTER, Healthcare Policy Advisor, Department of
Health and Social Services (DHSS), co-presented a PowerPoint
presentation on CSHB 172(JUD) on behalf of the sponsor, House
Rules by request of the governor. She showed slide 2 of the
PowerPoint ["Transforming a Behavioral Health Crisis System of
Care", included in the committee packet]. She echoed that the
state has a limited amount of designated evaluation and
treatment facilities. She explained that these facilities are
designated by DHSS for inpatient care of individuals
experiencing an acute level of crisis, and they serve
involuntary and voluntary individuals. Currently these
facilities only exist in the following Alaska communities:
Juneau, at Bartlett Regional Hospital, with 12 beds; Fairbanks,
at Fairbanks Memorial Hospital, with 20 beds; the Matanuska-
Susitna Valley, at Matsu Regional Medical Center, with 16 beds;
and Anchorage, at the Alaska Psychiatric Institute (API). She
noted that hospital emergency rooms are often used to serve
individuals when other facilities are full. She described
emergency rooms as being "hectic" and not being "a therapeutic
environment." She pointed out that the information graphic on
slide 2 depicts the current flow for involuntary commitment.
She stressed that the state's behavioral health crisis fits
poorly into the system depicted.
MR. WILLIAMS stated when someone is in a physical health
emergency, it is a given the system will respond and the person
will be taken care of medically. He insisted this is what needs
to happen when someone experiences a behavioral health
emergency. Continuing to slide 3, he stated that the proposed
legislation would put into action a "no wrong door" approach to
stabilization services, and DHSS would be able to designate
facilities for lower levels of care for early intervention
during a behavioral health crisis. He described the two levels
of facilities as a 23-hour and 59-minute crisis stabilization
center and a short-term residential center for care up to 7
days. He stated that the legislation would not only address the
care of people in crisis, but it would also ensure their rights
are protected.
MS. CARPENTER stated that DHSS and AMHTA have been working
together for the last six years to improve the system of care.
She pointed out the building blocks for the system on slide 4.
She mentioned Senate Bill 74, passed during the Twenty-Ninth
Alaska State Legislature, as being a "huge step." To improve
the department's behavioral health system of care, Senate Bill
74 directed DHSS to apply for a Section 1115 Medicaid waiver
("1115 waiver"). She said the 1115 waiver "was a game changer,"
driving down the cost of health care by enabling payment to
providers of critical behavioral health support, which includes
crisis stabilization and crisis residential services. Through
the waiver, gaps are filled, and individuals can be diverted to
the appropriate level of care, instead of the higher level of
care at hospitals. By leveraging the 1115 waiver, she said
that, instead of flying individuals to one of four inpatient
treatment centers, the goal would be to have more treatment
options in all regions of the state. In the end, this would
save the state money. She added that most individuals in a
mental health crisis are treated on a voluntary basis, but there
needs to be an improved crisis response system for those who
cannot seek care on a voluntary basis.
3:56:06 PM
MR. WILLIAMS, referring to slide 5, pointed out the comparison
between the systems of care for physical and behavioral health
emergencies. He spoke about the work done between the
department and stakeholders to redesign the crisis system of
care to serve physical and mental needs. He offered that the
[Crisis Now] model is supported nationally. He listed multiple
organizations that have voiced support and offered that the
model has been proven in other states. He showed slide 6
regarding stakeholder engagement, stating that many individuals
and organizations have come forward in support of this issue.
He stressed that this is vital for the transformation of the
system and improving access to care, as "it's going to take
everyone," not just DHSS and AMHTA.
3:58:05 PM
MS. CARPENTER discussed slide 7, which shows the model for the
new crisis services. She stated that adding these services
would speed up care and leave open emergency room beds for
[physical medical emergencies].
MR. WILLIAMS addressed slide 8, which outlines the features of
the 23-hour and 59-minute crisis stabilization center. He
reinforced this would be the lowest level of intervention for an
individual in an actual facility. The services would be
provided by medical and mental health professionals, as well as
peers and others with real-life experience. The individual
would be received at the door by these providers, who would take
over the care and responsibility from a mobile crisis team, law
enforcement, or emergency medical services (EMS). This transfer
has been reported from other states as being less than 10
minutes. He stated that the goal would be to provide a safe
place to resolve a crisis without unnecessarily using the
highest level of care.
MR. WILLIAMS, moving on to slide 9, stated that short-term
crisis residential centers would be for individuals who require
more treatment because of an acute crisis. These centers would
be similar in terms of team makeup to the crisis stabilization
centers. He stated this would be a higher level of care to
hopefully resolve the crisis and reconnect the individual with
community services and support to maintain the gains made. He
reiterated that a key element would be services provided by
people with lived experience, who could relate to the individual
and help them understand the care that he/she would be receiving
at the location.
4:01:21 PM
He described the graphic [on slide 10] which depicts ten years
of data on the outcomes from the system in Georgia. The data
shows 90 percent of crisis calls were resolved over the phone
with a healthcare professional. For the remainder of the crisis
calls, a mobile crisis team had been dispatched to the
individual to assess the situation. The data shows seven out of
ten of those responses had been resolved in the community, with
no higher level of care or law enforcement needed. For the
three mobile crisis team responses that remained unresolved,
those individuals had been taken to a short-term stabilization
center. He continued that data shows only one out of three of
these situations had been transferred to the crisis residential
center for the seven days of access to treatment. He explained
that, with a system intentionally designed, resources would be
realigned into traditional roles: law enforcement would protect
public safety, investigate cases, write reports, and appear in
court, while mental health professionals would respond to
individuals in crisis.
4:04:03 PM
MS. CARPENTER stated that the involuntary commitment statutes
are found in Title 47 of the Alaska Statutes. The goal with
[CSHB 172(JUD)] would be to add new levels of care without
rewriting Title 47. She stated that DHSS, AMHTA, and
stakeholders had worked to identify the Crisis Now model as the
best path forward for Alaska. The team identified weaknesses
and strengths in the current system and reviewed the model in
action in other states. She stated that AMHTA has worked on the
implementation process of the Crisis Now model within Alaska,
while DHSS has implemented services from the 1115 waiver. She
referenced a lawsuit that DHSS settled with the Disability Law
Center of Alaska. The lawsuit concerned individuals in crisis
who had been held at correction facilities involuntarily. As
part of the settlement, DHSS had been directed to advocate for
statutory changes, as in the proposed legislation. She listed
key points of the proposed legislation: provide for less
restrictive and more immediate systems of care for patients;
create more facilities for patients; take the responsibility for
care away from hospital emergency rooms; provide law enforcement
with more options; and expand the types of first responders.
She clarified that the legislation would not interfere with a
police officer's authority, change the statutory authority to
administer medication, change the statutory authority for who
can order an involuntary commitment, or reduce the rights of an
adult or juvenile in crisis.
MR. WILLIAMS explained the graphic on slide 13, illustrating the
"current flow" for involuntary commitment. He noted that law
enforcement is currently the default response to an emergency
call. At this point, the choices for law enforcement for these
individuals are a hospital emergency room, jail, or emergency
hold. He explained that an emergency hold entails putting the
individual in handcuffs in the back of a police vehicle until an
appropriate place for the individual is found. He stated that
none of these options are productive. He expressed confidence
that the proposed legislation would redesign the system. He
clarified that law enforcement and EMS would not be taken out of
the system, but they would not be the default. He suggested
that the implementation of the system would not have to be
linear, as the resources in communities would be diverse.
4:11:26 PM
MR. WILLIAMS moved to slide 15 which outlines the flow for the
statutory changes. He reiterated that law enforcement and EMS
would still be part of the equation, but these resources would
not be the default. He stated that the goal would be to take
the individual to the appropriate care to resolve the crisis in
a way that is less restrictive.
MS. CARPENTER spoke to the changes made in the committee
substitute in the last committee of referral [exhibited on slide
16]. She said a key change had been made to the definition of
"peace officer," aligning it with current definitions found
elsewhere in the statutes. The language removed from this
definition has been used to create a new definition for a
"health officer". She listed some of the other changes which
include: the length of stay at a short-term crisis residential
center would change from five to seven days; concerning patient
rights, the 72-hour clock would start when an individual enters
any crisis center; the court would be required to notify any
guardian if a patient had a hearing; the seven-day hold would
begin at the time of initial retainment, no matter the facility;
and DHSS and AMHTA would collect data and issue reports on
patient harm, restraint, and resolution. She added that these
reports would bring together a group of diverse stakeholders to
investigate and discuss the topic and the process in Alaska and
other states. The group would propose needed changes to
regulations and statute. She said a key part of this process
would include robust public comment. She stated that, once the
legislation is signed into law, there would be one year to come
back to legislature with recommendations and an action plan
forward.
4:15:54 PM
CO-CHAIR ZULKOSKY asked committee members to exercise some
restraint with questions, as three invited testimonies were yet
to be heard.
4:16:22 PM
REPRESENTATIVE SPOHNHOLZ expressed enthusiasm for the
legislation. While the committee's focus has been the
stabilization centers, she questioned how the crisis call
centers and mobile crisis teams would fit into the funding
stream with the 1115 waiver.
4:17:57 PM
GENNIFER MOREAU-JOHNSON, Director, Division of Behavioral
Health, Department of Health and Social Services, stated that
the 1115 waiver reimbursement would currently be for the mobile
crisis response and both types of crisis centers but not for the
call center. She indicated that work needs be done to
understand the access to the Medicaid administration funding for
the call center. She affirmed that the call center would not be
funded.
4:19:34 PM
REPRESENTATIVE KURKA expressed concern about taking freedom from
someone who is having a mental crisis. He expressed interest in
the comparison of due process rights proposed in the legislation
with the due process rights in the criminal justice system.
4:20:52 PM
STACIE KRALY, Director, Civil Division, Department of Law,
explained that she does not practice law in the civil justice
system, and a more concrete answer on an "apples to apples"
comparison between civil commitment for the Crisis Now model and
the criminal justice system would need to be supplied after the
hearing. She stated that the civil commitment process is a
constitutional exercise of the federal government to empower the
police at the state and federal level. Due process is provided
at all different levels within this system. In the proposed
legislation due process would include the right to an attorney
and a court hearing. She suggested that the similarities would
be, at the time of admission, counsel would be appointed, and a
judicial review of the decisions would be made. In addition,
the individual would receive a list of entitled rights, and the
guardian or parents would be notified. She continued that due
process protections would be added and included in this system,
as they exist under Title 47 of the Alaska Statutes. She stated
that it is important to note one major difference: an attorney
would always be appointed, present, and available in the civil
commitment arena, while in the criminal arena it would be based
on indigency, and some individuals may not be eligible for court
appointed counsel.
4:23:27 PM
REPRESENTATIVE MCCARTY, addressing slide 13, questioned whether
currently an ex parte order would be needed to move an
individual from a [23-hour and 59-minute] hold to the next level
of care.
MR. WILLIAMS answered in the affirmative.
REPRESENTATIVE MCCARTY addressed slide 15 and the timeframe. He
voiced the understanding that, if needed, an individual would be
put on a 72-hour hold, but he/she must leave the crisis
stabilization center within the 23-hour and 59-minute limit. He
questioned the location of the individual before he/she would be
evaluated for the 7-day hold.
MR. WILLIAMS clarified that the 23-hour and 59-minute hold would
be a part of the 72-hour timeframe. The 72-hour time limit
would begin with a notice for a scheduled hearing. If at any
point the individual no longer meets the criteria to be held,
then he/she would be released.
REPRESENTATIVE MCCARTY, with a follow-up question, stated that
his understanding is a judge must determine the status of the
individual.
MS. KRALY confirmed that Mr. Williams is correct. The 72 hours
would be a timing mechanism. She stated that upon admission, a
clock would start, and a hearing must be held within 72 hours.
She added that weekends and holidays would not be included in
the timeframe. She stated that the 72-hour timeframe would not
be a benchmark. If an individual stabilizes, based on a
clinical determination, he/she could be released, and a judge
would not be involved. A judge would be required only if,
within 72 hours, it is determined the individual needs more care
on an involuntarily basis.
CO-CHAIR ZULKOSKY reminded committee members that the
legislation will come back before the committee, and she moved
to invited testimony.
4:28:53 PM
MARK REGAN, Legal Director, Disability Law Center of Alaska,
spoke to Representative Kurka's previous question concerning due
process. He related that the Alaska Supreme Court holds that
the current civil commitment process is "based on a probable
cause finding at the start that you are gravely disabled or
because of a mental illness, likely to harm yourself or others."
He stated that this is the standard. He continued that, per the
proposed legislation, an ex parte order would hold the
individual in place for 72 hours. The Alaska Supreme Court
issues that this is constitutional only because there would be a
right to a prompt hearing within 72 hours. He supplied that the
burden would be on the state to have the individual held any
longer. The difference in the criminal system would be that a
person could be arrested and taken into custody before any
involvement with a judge. He stated that the systems would work
in the same way, but HB 172 would allow for the prompt
appointment for an attorney and a prompt hearing before a judge.
4:32:24 PM
MR. REGAN, concerning the aforementioned lawsuit, stated that
the Disability Law Center and public defenders brought the
lawsuit because individuals had been deprived of liberty under
the old system. He expressed the belief that it would be
tempting to blame API, but he explained that API did not have
the capacity to routinely take people for civil commitment
evaluations for the 72-hour period; therefore, individuals ended
in jail or hospital emergency rooms. He continued that API was
only one part of a stressed system. During the breakdown of API
in the winter of 2018 and 2019, individuals had been held at the
Anchorage correctional complex. He stated that a video tour of
the complex from intake to evaluation shows "it is a grim
system." He added that home videos can sometimes come across
dark, but the complex was "a sterile, stark place and not
therapeutic at all." He added that other individuals in the
state were being held in emergency rooms awaiting transportation
to API. He maintained that the key point is these are not
therapeutic, psychiatric-oriented places which could help an
individual resolve a short-term crisis. He said, "If you are
greatly disabled or likely to harm yourself, you ought to be at
a place that is better able to help you." He articulated that
this is the reason the lawsuit endorsed the idea of Crisis Now
facilities, so people could get short-term treatment without
waiting in jails and hospitals. He stated that the law center
supports HB 172 because "people have a basic right to ... a
happier, friendlier place that does more to treat you." He
suggested that the problems at API had affected hundreds of
Alaskans, and there should be a better system.
4:37:39 PM
REPRESENTATIVE SPOHNHOLZ asked for a description of the
appointment of the guardian, as well as the attorney, to
advocate on behalf of the patient.
MR. REGAN explained he cannot speak to guardianship, as the law
center is not responsible for this piece of the legislation, but
he can speak to the appointment of the attorney. He referenced
past issues concerning assigned attorneys, which left patients
"stuck" in emergency rooms or jails, with the sense that no one
would be looking out for them. If an individual is in acute
mental crisis, the need for a lawyer may not be evident to this
individual. He stated that a lawyer would give the individual a
sense of an upcoming resolution, especially for the first 72-
hour hearing. At that time, a decision would be made whether to
hold the individual longer at a crisis residential center.
MR. REGAN, in response to a follow-up question, apologized, but
reiterated that he could not speak on the appointment of a
guardian or guardianship.
4:40:58 PM
HELEN ADAMS, MD, Emergency Medical Physician, Alaska Chapter of
Emergency Physicians, testified in support of CSHB 172(JUD).
She expressed the opinion that, as in the entire nation, Alaska
is experiencing a mental health crisis, and the state does not
have the capacity to care for the increase in mental health
emergency room visits. She explained that the open-door model
would be helpful because, in her experience, the majority of
these people are desperate for help. She stated that within the
four years of working in Anchorage, she only had one upset
patient who requested an attorney. She voiced her opinion that
many emergency care rooms are equipped to deal with a variety of
crises, as Anchorage has an appropriate seven-bed unit for
mentally ill patients. But she added that when patients are
moved into the general emergency room area, there is very little
control over the noise and exposure to other patients. Patients
are able to [easily escape from emergency rooms], which in the
end involves security staff. She maintained that this is not
the best place to care for these patients.
4:43:24 PM
DR. ADAMS continued that a more appropriate clinical environment
would be better support for these patients. The evidence from
other states is that an individual in crisis would deescalate
more quickly in the appropriate environment. Plus, this type of
environment would require less intervention, and there would be
less stress on the patient, and all involved. She stated that a
23-hour and 59-minute stabilization system is practical because
when an individual comes in, often he/she is very intoxicated
and should not be alone. The individual needs to be in an
environment where he/she can become sober and be assessed. She
stated that the majority of those patients want to leave once
they are sober. She emphasized that the patients who are
required to transfer to residential crisis centers are the
minority, and HB 172 would be a good opportunity to expand care
for these patients, otherwise the problem will be ongoing.
4:45:08 PM
DR. ADAMS, in response to Co-Chair Zulkosky, voiced her opinion
that the proposed legislation would provide for actual physical
places in Alaska where care for these patients could be
provided. She referenced her experience in Anchorage, where the
backlog had been so extreme, some patients were held for hours
in the back of a police vehicle in the hospital parking lot.
She indicated that she would physically go to the parking lot
and assess the patient to make sure the patient was physically
safe. She voiced the opinion that this is a major problem, as
ideally a patient would be admitted immediately and put into a
room with a padded bed on the floor with no potential harmful
hardware in the room. The individual would be seen quickly by a
mental health clinician, and a recommendation would be made.
She acknowledged that unfortunately this ideal standard of care
is more often seen only in the minority of cases. Instead,
individuals are placed in a room with equipment which has to be
moved, and a technician has to sit and monitor the person, as
he/she cannot be left alone. This process limits the resources
and the overall ability for the emergency room situation to run
efficiently. The technicians normally assist nurses, so nurses
end up stressed. She stated that, overall, the system does not
work effectively, and medical patients are not getting the care
they need, and this contributes to overburdening of the health
system as a whole. She stated that HB 172 would allow for a
more appropriate and concentrated use of mental health services.
4:48:55 PM
JAMES COCKRELL, Commissioner, Department of Public Safety (DPS),
offered the support of CSHB 172(JUD) personally and
professionally. He added that DPS fully supports the proposed
legislation. He stated that "we've got to do better" for
individuals who are suffering from mental health issues. He
spoke briefly about his personal experience and a family member
who went to jail after a "mental collapse." He insisted that
individuals should not be sent to the emergency rooms, as
hospitals are understaffed. He spoke about instances of
policemen driving around for hours with handcuffed individuals
in the back of their vehicles, because there was nowhere to take
a person in a mental health crisis. He reiterated that "we just
need to do it."
4:52:18 PM
REPRESENTATIVE MCCARTY shared his personal experience working on
a crisis mobile team. In Kodiak he experienced an individual
who was in crisis that did not receive timely transportation to
API. He stated that the individual eventually received
services, but their rights had been infringed upon, and the
courts became involved. He voiced approval for the proposed
legislation but offered that he did not understand the flow, in
regard to the clock-start time, [as exemplified on slide 5]. He
expressed the opinion that a person in crisis could be lost in
the system, which would result in the infringement of rights.
4:55:41 PM
MS. KRALY explained that, upon admission to a crisis
stabilization center, there would be a notice of arrival which
triggers the 72-hour clock. The notice of arrival would go to
the court, and an attorney would be appointed. The court would
set a hearing and provide the guardian with that information.
She stated that every 24 hours the court would be notified as to
the status of an individual in the facility and of any transport
[to another facility]. A court hearing would be held if the
individual objects to being held or has any questions. She
stated that this would be the importance of appointing an
attorney and guardian early, because additional judicial review
could be requested. She stated that in this process, or flow,
the court would issue the ex parte hold for the admission to the
crisis residential center, so the court would be involved
immediately. She reviewed that when an individual stays more
than the 23-hour and 59-minutes in the crisis stabilization
center, the court would become involved, evidence would be
presented, and a recommendation would be made. Upon admission
to the crisis residential facility, she stated, a notice of
arrival or notice of rights would be reported to the attorney
and guardian. She asserted that this would be the process to
make sure no one is lost in the system.
4:58:19 PM
MS. KRALY, in response to a follow-up question, affirmed
Representative McCarty's understanding of the process. In
response to Co-Chair Zulkosky, she agreed that there is a
natural tension in the current system between the mental health
treatment component of a civil commitment and the role law
enforcement plays. She stated that the proposed legislation
would not take law enforcement out of the process, but it would
radically minimize the involvement law enforcement has in the
psychiatric mental health system. She continued that "all of us
agree, get that criminal law enforcement component out of the
psychiatric level of care." She stated that the legislation
would change a multiple hour drive for law enforcement into a
10-minute drop off at a center, where the individual would be
treated by mental health professionals. She suggested that
tension between law enforcement and the mental health system
would be mitigated and reduced.
5:03:00 PM
MS. KRALY, in response to Representative Spohnholz, explained
that guardianship is a legal process outlined in Title 13 of the
Alaska Statutes. She stated that guardians are appointed by a
judge, and it is a formal legal process. She said that there
are two types of guardianships, public and private. The Office
of Public Advocacy would appoint public guardians. She stated
that in the last committee of referral it was determined that an
individual who has suffered a behavioral crisis most likely
would already have a guardian, public or private. She said that
guardians have a unique role, as they assume the same
responsibilities as a parent. A guardian with a ward has the
ability to advocate and communicate with the healthcare provider
in the mental health system to facilitate treatment, voluntary
or otherwise. While the guardian does not have the right to
administer medication for their ward, he/she could testify in
support of treatment with psychotropic medication. She said
that a guardian would facilitate communication with a ward, and
it would be "like having a parent on your side." In response to
a follow-up question, she deferred to Ms. Carpenter.
MS. CARPENTER, in response, explained that in the proposed
legislation the main change would be the strengthened
communication level [with the guardian]. She said that
currently there is no requirement that guardians be notified by
the court; the proposed legislation would require the guardian
be notified of the time and place of a hearing. In response to
a follow-up question, she affirmed that a patient's rights would
be strengthened with this notification.
5:06:38 PM
REPRESENTATIVE KURKA recalled that, in the last committee of
referral, there had been concern about how to contact the
guardian. He questioned whether the court would keep a list of
guardians.
MS. CARPENER responded that the court has the only list of all
public and private guardianships.
5:07:19 PM
CO-CHAIR ZULKOSKY announced that HB 172 was held over.
5:08:04 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:08 p.m.