Legislature(2023 - 2024)DAVIS 106

04/20/2023 03:00 PM House HEALTH & SOCIAL SERVICES

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SJR 10 MEDICARE REIMBURSEMENT TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 80 INCOMPETENCY; CIVIL COMMITMENT TELECONFERENCED
Heard & Held
**Streamed live on AKL.tv**
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         April 20, 2023                                                                                         
                           3:02 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mike Prax, Chair                                                                                                 
Representative Justin Ruffridge, Vice Chair                                                                                     
Representative CJ McCormick                                                                                                     
Representative Zack Fields                                                                                                      
Representative Genevieve Mina                                                                                                   
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Dan Saddler                                                                                                      
Representative Jesse Sumner                                                                                                     
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE JOINT RESOLUTION NO. 10                                                                                                  
Encouraging Alaska's Congressional delegation and the federal                                                                   
government to raise Medicare reimbursement rates to meet the                                                                    
actual cost of care for the state's senior citizens.                                                                            
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 80                                                                                                               
"An  Act  relating to  competency  to  stand trial;  relating  to                                                               
commitment  based  on  a finding  of  incompetency;  relating  to                                                               
administration  of  psychotropic   medication;  and  relating  to                                                               
victims' rights during certain civil commitment proceedings."                                                                   
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SJR 10                                                                                                                  
SHORT TITLE: MEDICARE REIMBURSEMENT                                                                                             
SPONSOR(s): SENATOR(s) GIESSEL                                                                                                  
                                                                                                                                
03/13/23       (S)       READ THE FIRST TIME - REFERRALS                                                                        
03/13/23       (S)       HSS                                                                                                    
03/30/23       (S)       HSS AT 3:30 PM BUTROVICH 205                                                                           
03/30/23       (S)       Moved SJR 10 Out of Committee                                                                          
03/30/23       (S)       MINUTE(HSS)                                                                                            
03/31/23       (S)       HSS RPT 4DP 1NR                                                                                        
03/31/23       (S)       DP: WILSON, TOBIN, DUNBAR, GIESSEL                                                                     
03/31/23       (S)       NR: KAUFMAN                                                                                            
04/11/23       (S)       TRANSMITTED TO (H)                                                                                     
04/11/23       (S)       VERSION: SJR 10                                                                                        
04/12/23       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/12/23       (H)       HSS                                                                                                    
04/20/23       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
                                                                                                                                
BILL: HB  80                                                                                                                  
SHORT TITLE: INCOMPETENCY; CIVIL COMMITMENT                                                                                     
SPONSOR(s): REPRESENTATIVE(s) JOSEPHSON                                                                                         
                                                                                                                                
02/22/23       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/23       (H)       HSS, STA, JUD                                                                                          
03/14/23       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
03/14/23       (H)       Heard & Held                                                                                           
03/14/23       (H)       MINUTE(HSS)                                                                                            
04/20/23       (H)       HSS AT 3:00 PM DAVIS 106                                                                               
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR CATHY GIESSEL                                                                                                           
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As the prime sponsor, introduced SJR 10.                                                                 
                                                                                                                                
ERIC GURLEY                                                                                                                     
Executive Director                                                                                                              
Access Alaska Inc.                                                                                                              
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided invited testimony in support of                                                                 
SJR 10.                                                                                                                         
                                                                                                                                
ELIZABETH RIPLEY, President, CEO                                                                                                
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION STATEMENT:  Testified in support of SJR 10.                                                                          
                                                                                                                                
JEROME GEORGE, representing self                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SJR 10.                                                                           
                                                                                                                                
ANGELA HARRIS, representing self                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Provided invited testimony in support of HB
80.                                                                                                                             
                                                                                                                                
EMMA POTTER, Staff                                                                                                              
Senator Matt Claman                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  on HB  80,  answered                                                             
questions on behalf of Senator Claman, prime sponsor of SB 53.                                                                  
                                                                                                                                
REPRESENTATIVE ANDY JOSEPHSON                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As the  prime sponsor, answered questions on                                                             
HB 80.                                                                                                                          
                                                                                                                                
ALEXANDER SCHROEDER, Staff                                                                                                      
Representative Andy Josephson                                                                                                   
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:    On behalf  of  Representative  Josephson,                                                             
prime sponsor of  HB 80, discussed the differences  between HB 80                                                               
and SB 53.                                                                                                                      
                                                                                                                                
SENATOR MATT CLAMAN                                                                                                             
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As the prime  sponsor of SB 53, testified on                                                             
HB 80.                                                                                                                          
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:02:55 PM                                                                                                                    
                                                                                                                                
CHAIR  MIKE PRAX  called  the House  Health  and Social  Services                                                             
Standing   Committee    meeting   to    order   at    3:02   p.m.                                                               
Representatives  Ruffridge,  McCormick,  Fields, Mina,  and  Prax                                                               
were present at the call to order.                                                                                              
                                                                                                                                
                 SJR 10-MEDICARE REIMBURSEMENT                                                                              
                                                                                                                                
3:04:06 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that the  first order of business  would be                                                               
SENATE   JOINT   RESOLUTION    NO.   10,   Encouraging   Alaska's                                                               
Congressional  delegation and  the  federal  government to  raise                                                               
Medicare reimbursement rates to meet  the actual cost of care for                                                               
the state's senior citizens.                                                                                                    
                                                                                                                                
3:04:43 PM                                                                                                                    
                                                                                                                                
SENATOR  CATHY GIESSEL,  Alaska  State Legislature  as the  prime                                                               
sponsor,  introduced  SJR   10.    She  explained   that  SJR  10                                                               
encourages  Alaska's  Congressional  delegation and  the  federal                                                               
government to raise Medicare's  inadequate reimbursement rates to                                                               
meet the  actual cost of care.   The inspiration for  SJR 10, she                                                               
said, was the  closure of a senior Medicare  clinic in Anchorage,                                                               
which left hundreds of seniors rushing  to find a new health care                                                               
provider.                                                                                                                       
                                                                                                                                
SENATOR GIESSEL  pointed out that  Alaska's senior  population is                                                               
the fastest  growing in the nation,  and at the same  time Alaska                                                               
has the  highest health care  costs in  the nation, and  the U.S.                                                               
has  the highest  healthcare costs  in the  world.   This "senior                                                               
tsunami," she  said, coupled with  inadequate Medicare  rates, is                                                               
resulting in the  shutdown of many senior care  clinics, or these                                                               
clinics  have  stopped accepting  new  Medicare  patients.   This                                                               
leaves Medicare seniors going to  emergency rooms and urgent care                                                               
centers, she stated.                                                                                                            
                                                                                                                                
SENATOR  GIESSEL  related  that   the  federal  Medicare  Payment                                                               
Advisory Commission's  annual meeting  occurred after SJR  10 was                                                               
written.   The  commission's  [2023] annual  report  to the  U.S.                                                               
Congress, she  continued, stated  that Medicare spending  in 2022                                                               
grew by  7.5 percent, mainly  driven by the increasing  number of                                                               
beneficiaries  across  the country.    This  report, she  further                                                               
related,  recognized that  cost increases  will be  difficult for                                                               
clinicians  to  absorb,  with   primary  care  physicians  versus                                                               
specialists being  the hardest  hit by  inadequate reimbursement.                                                               
The repricing  for clinical  services, she  advised, needs  to be                                                               
targeted particularly  at primary care.   She stated that  SJR 10                                                               
is meant to send a  strong message to Alaska's congressional team                                                               
and the federal government that this  is a huge problem in Alaska                                                               
and is detrimental to Alaska's clinicians and seniors.                                                                          
                                                                                                                                
3:08:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE  commented that the  steadily increasing                                                               
rate of Medicare costs is also  tied to an increase in the actual                                                               
cost of  care.  He  inquired about  these increases.   He further                                                               
inquired about  whether people might  be getting wealthy  off the                                                               
Medicare "dime" given that many  insurance companies are creeping                                                               
into the top 10 Fortune 500 companies.                                                                                          
                                                                                                                                
SENATOR  GIESSEL replied  that  the  [Medicare] Payment  Advisory                                                               
Commission identified the  growth of the cost at  7.5 percent and                                                               
projected a  cost of care growth  of 6 percent to  7 percent next                                                               
year.  She expressed uncertainty  about where this falls in terms                                                               
of insurance companies.                                                                                                         
                                                                                                                                
3:10:37 PM                                                                                                                    
                                                                                                                                
ERIC  GURLEY, Executive  Director, Access  Alaska Inc.,  provided                                                               
invited  testimony   in  support  of   SJR  10.     He  expressed                                                               
uncertainty  concerning Representative  Ruffridge's question,  as                                                               
he only  has information for  the people served by  Access Alaska                                                               
through  the  [Medicare]  waiver,  Veterans  Directed  Care,  and                                                               
private  pay.   He explained  that his  service supports  in-home                                                               
medical care needs versus an assisted  living model.  He noted he                                                               
is  a constituent  of Senator  Giessel's and  works with  Senator                                                               
Tobin and Representative Fields  because Access Alaska is located                                                               
in their districts.                                                                                                             
                                                                                                                                
MR.  GURLEY  pointed  out  that Access  Alaska  and  Centers  for                                                               
Independent Living  are in different  parts of the state  and are                                                               
not the  same.  He related  that while doing research  to support                                                               
SJR  10, he  found that  the number  of Alaskans  who are  65 and                                                               
older are  expected to increase by  30 percent per the  June 2022                                                               
report, "Alaska Population  Projections 2021-2050," [published by                                                               
the  Alaska  Department  of  Labor  and  Workforce  Development].                                                               
Current Medicare reimbursement rates,  he further related, do not                                                               
support seniors'  need for access  to health care providers.   He                                                               
added that the workforce shortages,  clinic closures, and primary                                                               
care delays all  create more significant needs.   He advised that                                                               
a senior waiting  for service and for primary care  often must go                                                               
to the emergency room to receive adequate support.                                                                              
                                                                                                                                
MR. GURLEY  urged that SJR 10  be moved forward because  it is an                                                               
absolute need.   He further noted that the  penalties for seniors                                                               
who  are late  in enrolling  for  Medicare result  in a  lifelong                                                               
penalty which has few, if any, remedies for getting fixed.                                                                      
                                                                                                                                
3:15:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MINA  inquired  about the  percentage  of  Access                                                               
Alaska's  population  who  are eligible  for  both  Medicaid  and                                                               
Medicare.                                                                                                                       
                                                                                                                                
MR. GURLEY replied that in  this population, Access Alaska serves                                                               
about 248 [individuals]  across Alaska.  He added that  this is a                                                               
little less than  half of the total served by  Access Alaska with                                                               
long-term type supports.                                                                                                        
                                                                                                                                
REPRESENTATIVE  MINA inquired  about  the  number of  individuals                                                               
served by  Access Alaska who  are dual-eligible for  Medicaid and                                                               
Medicare or whether they all are dual-eligible.                                                                                 
                                                                                                                                
MR. GURLEY responded  that [they all are]  not necessarily [dual-                                                               
eligible].   For example, he explained,  somebody experiencing an                                                               
intellectual   developmental  disability   might  have   been  on                                                               
Medicaid  for life  and then  upon reaching  eligibility switches                                                               
over to Medicare.   He said this is a  much smaller percentage of                                                               
the population supported by Access Alaska.                                                                                      
                                                                                                                                
3:17:38 PM                                                                                                                    
                                                                                                                                
ELIZABETH  RIPLEY,  President,   CEO,  Mat-Su  Health  Foundation                                                               
(MSHF) testified in support  of SJR 10.  She noted  that she is a                                                               
co-owner of the  Mat-Su Regional Medical Center  [in Palmer], and                                                               
MSHF invests  its share of  the hospital's profits back  into the                                                               
community through grants,  scholarships, and systems-change work.                                                               
She said that MSHF supports  SJR 10 because the Matanuska-Susitna                                                               
(Mat-Su)   Valley  has   one  of   the  fastest   growing  senior                                                               
populations in  Alaska.  From  2015-2020 the  valley's population                                                               
of residents  65-plus increased 47.3  percent, she  reported, and                                                               
it will continue to accelerate over the next 10 years.                                                                          
                                                                                                                                
MS. RIPLEY  pointed out that  this population is spread  across a                                                               
vast  geography that  is medically  underserved according  to the                                                               
[federal]  Health Resources  and Services  Administration (HRSA).                                                               
She continued that  data from the U.S. Census shows  that in 2015                                                               
the Mat-Su  had 8,271  people enrolled in  Medicare, and  by 2021                                                               
the number grew  to 14,527.  She reported that  the average 65 to                                                               
74-year-old only  has one chronic  disease, while the  average 75                                                               
to  84-year-old  has  three.   She  advised  that  this  increase                                                               
mandates  the  need  for  more   medical  care  by  primary  care                                                               
physicians;  however,  because  of Medicare's  low  reimbursement                                                               
rates,  most providers  cap the  percentage of  Medicare patients                                                               
they  receive.    She  related that  providers  report  that  the                                                               
current   Medicare  reimbursement   rates  are   less  than   the                                                               
provider's  cost; therefore,  providers must  make the  difficult                                                               
decision to either limit the  number of Medicare patients allowed                                                               
in their practice or to not accept Medicare patients at all.                                                                    
                                                                                                                                
MS. RIPLEY noted  that a patient with multiple  payer sources has                                                               
less  trouble finding  a physician  than a  patient who  only has                                                               
Medicare,  which is  the case  for over  3,400 Mat-Su  residents.                                                               
These patients,  she continued, often  go without a  primary care                                                               
provider, and  end up in  the emergency room, often  for problems                                                               
which could have  been solved through routine care.   She related                                                               
that according  to the Behavior  Risk Factor  Surveillance System                                                               
Data, in 2021  more than 9 percent of Mat-Su  seniors aged 65 and                                                               
over did  not have a  primary care  provider.  She  further noted                                                               
that only 26.3  percent of women and 39.8 percent  of men over 65                                                               
in  Mat-Su  are  up  to   date  on  receiving  core  preventative                                                               
services.    She  said  the Mat-Su  Health  Foundation  has  made                                                               
significant  investments   in  supporting  senior   services  and                                                               
enhancing workforce  development through  its focus  areas called                                                               
Healthy Aging and Healthy Futures.   But, Ms. Ripley advised, the                                                               
foundation's  efforts  alone  will  not  solve  the  shortage  of                                                               
providers who  accept Medicare  patients.  This  is where  SJR 10                                                               
can help, she  said, and MSHF urges that the  resolution be moved                                                               
out of committee.                                                                                                               
                                                                                                                                
3:21:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA offered her  understanding that the Anchorage                                                               
Neighborhood Health  Center and Providence Alaska  Medical Center                                                               
can  take in  new  patients on  Medicare.   She  asked about  the                                                               
number of facilities in the Mat-Su  that can take new patients on                                                               
Medicare.                                                                                                                       
                                                                                                                                
MS.  RIPLEY answered  that  it is  a  dynamic situation  because,                                                               
within  a  physician's  practice,  people  are  aging  into  this                                                               
category, and Mat-Su is the  only place where the in-migration of                                                               
older adults  is greater than  the out-migration.   She expressed                                                               
the understanding  that the private  primary care  physicians she                                                               
knows  either do  not take  Medicare, or  limit [the  number they                                                               
will  take].   She  stated  that  the three  federally  qualified                                                               
health  centers  (FQHC)  in  the Mat-Su  all  take  Medicare  and                                                               
Medicaid, and to  her knowledge, none of them have  a limit.  She                                                               
noted  that  Mat-Su  Regional  Medical Center  used  to  own  and                                                               
operate a physician practice  specializing in geriatric medicine,                                                               
but it lost this provider about seven years ago.                                                                                
                                                                                                                                
REPRESENTATIVE  MINA inquired  about how  the influx  of Medicare                                                               
patients going into  these FQHCs has impacted the  wait times for                                                               
other patients trying to get appointments.                                                                                      
                                                                                                                                
MS. RIPLEY  expressed uncertainty but  offered to report  back to                                                               
the committee.                                                                                                                  
                                                                                                                                
3:24:54 PM                                                                                                                    
                                                                                                                                
JEROME  GEORGE, representing  self, testified  in support  of SJR
10.  He stated  he is 81 years old and a  retired State of Alaska                                                               
employee.  He expressed the  understanding that the state has the                                                               
lowest  ratio  of  doctors  to population  in  the  country,  and                                                               
Alaska's underperforming  school system discourages  doctors from                                                               
coming to  the state.  He  advised that the University  of Alaska                                                               
[School  of  Nursing]  and  Alaska  Pacific  University  [Nursing                                                               
Program] have  problems with clinics and  hospitals not accepting                                                               
their students  for internships.   He  argued that  without these                                                               
internships,  students   cannot  get  licensed,  yet   Alaska  is                                                               
importing nurses  and paying them  per diem.  Problems  like this                                                               
need to be addressed, he stated.                                                                                                
                                                                                                                                
MR.  GEORGE argued  that besides  Medicare, a  plethora of  other                                                               
problems  plague the  system, and  these problems  are under  the                                                               
control of  the legislature.   For example, he said,  doctors who                                                               
were in the clinic that went  out of business were prevented from                                                               
practicing within seven miles of  the clinic for one year because                                                               
of noncompetitive  clauses.  He expressed  the understanding that                                                               
the clinic said  it did not enforce this, while  the doctors said                                                               
it  did.    When  noncompetitive clauses  are  enforced  in  this                                                               
manner, he argued, it discourages doctors from coming to Alaska.                                                                
                                                                                                                                
MR. GEORGE maintained  that one hospital in  Anchorage is sending                                                               
close to 50  percent of its serious cases to  Seattle because the                                                               
hospital does not have the capacity  to treat these patients.  He                                                               
urged that  this needs to  be investigated.   In addition  to SJR
10, he urged that the  legislature investigate other issues, such                                                               
as the  "blackmail clause"  in Medicare.   Under this  clause, he                                                               
expressed the understanding that if  a clinic accepts a person on                                                               
Medicare  who has  supplemental insurance,  the clinic  must also                                                               
take Medicare  patients who do  not have  supplemental insurance.                                                               
He pointed  out that he  has supplemental insurance;  however, he                                                               
cannot  find a  primary  care physician  clinic  because of  this                                                               
clause.  He  added that the clinic  said it would take  him if he                                                               
paid 100  percent of his  bill.  He  said these things,  plus the                                                               
lower [Medicare]  reimbursement rate,  cannot be  ignored because                                                               
it  discourages  Alaska's  providers  and  clinics  from  serving                                                               
seniors.                                                                                                                        
                                                                                                                                
3:30:51 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX stated  that he imagines the committee  will have some                                                               
more  meetings about  other things  associated with  Medicare and                                                               
Medicaid.                                                                                                                       
                                                                                                                                
3:31:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS  offered his support  for SJR 10.   He said                                                               
his constituents tell him that  they cannot find Medicare primary                                                               
care.   He argued  that seniors  are an  economic benefit  to the                                                               
state, not  a burden,  and senior  care is  an important  part of                                                               
growing  the state's  population.    He shared  a  letter from  a                                                               
constituent  in  which  it was  reported  that  "retired  seniors                                                               
present a  positive economic  ratio of  10 to 1  for money  in to                                                               
cost  out."    Therefore,  he continued,  when  considering  this                                                               
resolution  and  others, committee  members  should  not only  be                                                               
cognizant  of  seniors,  but  of  [the  state's]  economic  self-                                                               
interest as well.                                                                                                               
                                                                                                                                
3:32:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MINA thanked Senator  Giessel for bringing forward                                                               
SJR 10.  She noted that  Medicare Part A is [hospital and skilled                                                               
nursing facilities inpatient  care], Part B is  [doctor and other                                                               
health care providers'  services outpatient care], and  Part D is                                                               
prescriptions.   She asked whether  there is a specific  need for                                                               
just centering on  Medicare Part B or whether there  is a need to                                                               
increase rates for all aspects of Medicare.                                                                                     
                                                                                                                                
SENATOR  GIESSEL expressed  uncertainty  concerning the  specific                                                               
levels,  but   she  does  know   the  cost  of   medications  and                                                               
pharmaceuticals is going up.                                                                                                    
                                                                                                                                
3:33:33 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX announced that SJR 10 was held over.                                                                                 
                                                                                                                                
             HB  80-INCOMPETENCY; CIVIL COMMITMENT                                                                          
                                                                                                                                
3:34:45 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  announced that the  final order of business  would be                                                               
HOUSE  BILL NO.  80,  "An  Act relating  to  competency to  stand                                                               
trial;   relating   to  commitment   based   on   a  finding   of                                                               
incompetency;   relating   to  administration   of   psychotropic                                                               
medication; and relating to victims'  rights during certain civil                                                               
commitment proceedings."                                                                                                        
                                                                                                                                
[Includes discussion of SB 53.]                                                                                                 
                                                                                                                                
3:35:00 PM                                                                                                                    
                                                                                                                                
ANGELA HARRIS,  representing self, provided invited  testimony in                                                               
support of HB 80.  She  shared her experience of being stabbed in                                                               
the spine  at the  Loussac Library  [in Anchorage]  on 2/13/2022.                                                               
Her assailant, Corey Ahkivgak, was  arrested later that day while                                                               
she  was awaiting  emergency surgery.   She  shared that  she was                                                               
left paralyzed from the waist  down along with decreased strength                                                               
and sensation in  her upper extremities.  She  continued that she                                                               
could  not  live  in  her  home  until  it  was  modified  to  be                                                               
handicapped accessible.   Her parents  came to live with  her and                                                               
her   two  youngest   children  for   eight  months,   while  her                                                               
significant  other  had  to  quit  his  job  to  be  the  primary                                                               
caretaker.  Her  long road to recovery, she  stated, has involved                                                               
physical and occupational therapy, as  well as counseling to work                                                               
through the trauma of her assault.                                                                                              
                                                                                                                                
MS. HARRIS reported that in  2018 Mr. Ahkivgak violently attacked                                                               
his mother, and in 2021 he  attacked two other women, after which                                                               
he  was declared  incompetent and  non-restorable.   After  being                                                               
held  for 28  days,  he  was released  back  into  the public  on                                                               
1/6/22.   She  continued  that  on 2/10/22  he  was arrested  for                                                               
trespassing, and after  stabbing her on 2/13/22,  he was declared                                                               
incompetent with  the possibility  of release after  a competency                                                               
hearing next month.   She argued that improvements  are needed to                                                               
the state's mental health  system, particularly regarding violent                                                               
offenders; the loopholes  in current laws which  allow people who                                                               
commit  violent crimes  to be  released back  into the  community                                                               
must  be closed.   She  stressed that  it should  not be  left to                                                               
victims to pursue a civil commitment.                                                                                           
                                                                                                                                
MS. HARRIS  stated that  HB 80  is written  to target  the narrow                                                               
group  of  individuals like  the  man  who  assaulted her.    She                                                               
expressed her belief that jail  is an inappropriate place for Mr.                                                               
Ahkivgak, given  his serious mental  illness, but  that community                                                               
placement  is not  an appropriate  option either.   She  said the                                                               
rights of  the victims to  live safely in their  communities must                                                               
be  prioritized, while  allowing individuals  who need  long term                                                               
care to receive it.  She  expressed the difficulty of living with                                                               
the reality her  assailant could be released at  his next 180-day                                                               
hearing next  month.  She  related that she has  attended several                                                               
hearings and expressed shock that  often individuals are released                                                               
from custody simply  because the waitlist for  restoration is too                                                               
long,  and civil  liberties of  the offender  would be  violated.                                                               
She urged  that the  state appropriate  money for  individuals to                                                               
regain competency  so they  can be  charged criminally  for their                                                               
violent  acts.   She  further  urged that  there  be a  long-term                                                               
placement  option  for  violent  individuals  who  cannot  regain                                                               
competency, rather  than cycling  them through  the system.   For                                                               
example,  she said,  her assailant  has been  in and  out of  the                                                               
state's criminal and mental health system for decades.                                                                          
                                                                                                                                
3:39:12 PM                                                                                                                    
                                                                                                                                
MS. HARRIS  stated that while  continuing to  attend occupational                                                               
and  physical therapy  appointments  to physically  heal, she  is                                                               
sharing  her  story  in  the  hope  of  reducing  the  amount  of                                                               
senseless violent  assaults.   She pointed out  that had  she not                                                               
been on active duty with the U.S.  Coast Guard at the time of her                                                               
assault, she would have very  limited resources.  She argued that                                                               
while her  assailant has more  rights, options, and  resources at                                                               
his disposal  than she does as  his victim.  She  related that in                                                               
May  2022, three  months after  she  was assaulted,  she filed  a                                                               
request  with the  [Violent Crimes]  Compensation Board  and last                                                               
week, one year  later, received her first response  of $3,000 for                                                               
mental health  services.  She  voiced that this amount  of money,                                                               
along with the amount of time is insulting.                                                                                     
                                                                                                                                
MS.  HARRIS said  her  assault  is an  example  of  the need  for                                                               
building  out Alaska's  mental  health  facilities and  [passing]                                                               
state  laws to  provide help  to  violent offenders  and to  keep                                                               
communities safe.   She pointed  out that the  Alaska Psychiatric                                                               
Institute (API) serves  the entire state, yet it  operates on the                                                               
very  limited maximum  capacity of  80  beds, with  only 10  beds                                                               
designated for  restoration.   Alaska's inadequate  mental health                                                               
services  for  violent  offenders   and  their  victims  must  be                                                               
addressed,  she  stated.    She  emphasized  that  the  loopholes                                                               
allowing violent  offenders to  victimize more  innocent Alaskans                                                               
must  be closed.    She  suggested that  the  moment an  offender                                                               
commits a  violent act against  a fellow citizen,  the offender's                                                               
rights should be weighed against the victim's rights for safety.                                                                
                                                                                                                                
MS. HARRIS  requested that committee members  answer any concerns                                                               
about HB  80 with  a solution  to the  problem rather  than empty                                                               
words and opposition.   She argued that HB 80  is a good starting                                                               
point and an opportunity to  make changes that are beneficial for                                                               
all  Alaskans.   She encouraged  the committee  members to  learn                                                               
more  about  the  issues  and  find  solutions  to  prevent  what                                                               
happened to her from happening to others.                                                                                       
                                                                                                                                
3:42:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS inquired about  the status of resolving the                                                               
differences between the  bill's two versions, [HB 80  and SB 53].                                                               
He questioned  whether the committee  should advance HB 80  as it                                                               
is.  He advised that a bill should be passed this year.                                                                         
                                                                                                                                
3:42:48 PM                                                                                                                    
                                                                                                                                
EMMA   POTTER,  Staff,   Senator   Matt   Claman,  Alaska   State                                                               
Legislature, during  the hearing on  HB 80, on behalf  of Senator                                                               
Claman, prime sponsor of SB 53,  responded that she is before the                                                               
committee in  support of  Ms. Harris,  and SB  53 was  drafted in                                                               
response to  Ms. Harris's tragic  experience.  She noted  that SB
53 was  heard the previous  day in the Senate  Finance Committee,                                                               
and it differs from HB 80.                                                                                                      
                                                                                                                                
REPRESENTATIVE  FIELDS  asked  whether the  differences  will  be                                                               
resolved in this committee or in the House Finance Committee.                                                                   
                                                                                                                                
3:44:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDY  JOSEPHSON,  Alaska  State  Legislature,  as                                                               
prime sponsor  of HB  80, responded  that on  3/14/23 he  and his                                                               
staff provided the committee with  an overview of the problem and                                                               
of the bill.   He explained that HB 80 and SB  53 are both trying                                                               
to ensure  that maximum efforts  are made at restoring  people to                                                               
competency, while  identifying those  who cannot be  restored and                                                               
considering civil  liberties where there could  be an involuntary                                                               
commitment.   He pointed out that  another factor taken up  in SB
53 is  AS 12.30 and  bail conditions.   He expressed  the opinion                                                               
that this  is something  the committee  should consider.   People                                                               
are constitutionally entitled  to bail, he stated,  but it should                                                               
be legal and  appropriate for different standards,  if the person                                                               
poses a threat.  He  stressed that misdemeanors should be covered                                                               
which indicate  erratic, random  behavior, such  as the  abuse of                                                               
animals  and random  assaults, as  these behaviors  portend other                                                               
worse behaviors.  For example,  he continued, two or three months                                                               
prior  to  assaulting Ms.  Harris,  her  assailant committed  two                                                               
misdemeanor assaults,  and these portended something  worse could                                                               
come.                                                                                                                           
                                                                                                                                
3:46:41 PM                                                                                                                    
                                                                                                                                
ALEXANDER  SCHROEDER,   Staff,  Representative   Andy  Josephson,                                                               
Alaska State Legislature, on  behalf of Representative Josephson,                                                               
prime sponsor of  HB 80, discussed the differences  between HB 80                                                               
and SB  53, with  the main difference  being the  five-year civil                                                               
commitment  process.   He  explained  that  the civil  commitment                                                               
process  [for  both pieces  of  legislation]  would be  that  the                                                               
person first goes through a three-day  ex parte order; then a 30-                                                               
day; then a 60-,  90-, and 180-day.  If the person  is to be kept                                                               
after the  180 days, it  would be a  recurring 180 days  to prove                                                               
there is still a danger to self  or others.  He stated that under                                                               
SB 53, but not  HB 80, a new option would  be created for someone                                                               
found  incompetent, where  a five-year  civil commitment  process                                                               
would be  filed, and  the person  could be  held for  five years,                                                               
with a yearly petition to be released.                                                                                          
                                                                                                                                
MR. SCHROEDER addressed another difference.   He noted that under                                                               
current statute  the judge "shall"  order restoration  for felony                                                               
charges.   He  offered his  understanding  that SB  53 would  not                                                               
change  this requirement,  but HB  80 would.   He  explained that                                                               
Section 5 of HB 80 would  create a new subsection (f) which lists                                                               
the  crimes the  judge must  consider for  requiring restoration.                                                               
He  said this  change  reflects the  opinion  that currently  the                                                               
resources are being delineated incorrectly.                                                                                     
                                                                                                                                
MR.  SCHROEDER  stated that  SB  53  would, after  the  six-month                                                               
initial  commitment,  require a  new  type  of criteria  to  hold                                                               
someone  for longer,  changing crimes  involving force  against a                                                               
person to  a felony,  under AS  11.41.  He  continued that  HB 80                                                               
would get rid  of the crime involving force against  a person but                                                               
preserve  the substantial  probability.   He  explained that  the                                                               
theory  is  that  someone  undergoing  required  restoration  has                                                               
already   committed  a   crime   which   would  warrant   further                                                               
restoration;  therefore,  this  person  would have  to  meet  the                                                               
substantial probability of further committing a crime.                                                                          
                                                                                                                                
MR. SCHROEDER said  another difference is that  both bills extend                                                               
the restoration period  to two years, but each bill  does it in a                                                               
different way.   He explained  that under HB  80 it would  be 180                                                               
days after the six  months, while under SB 53 it  would be an 18-                                                               
month window.                                                                                                                   
                                                                                                                                
3:51:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   FIELDS  inquired   about  the   longest  legally                                                               
defensible period  that people can  be civilly committed  when it                                                               
is manifestly obvious the person is a danger to society.                                                                        
                                                                                                                                
REPRESENTATIVE  JOSEPHSON answered  that there  are states  which                                                               
have  indefinite  periods, but  the  key  here is  receiving  the                                                               
general   support  from   the   mental   health  and   disability                                                               
communities.   He  pointed out  that  there is  concern with  the                                                               
five-year rule,  as SB 53  is not limited  to five years,  and it                                                               
could be  10 or  15 years.   Furthermore,  he explained  that, as                                                               
currently written,  SB 53  is the  more vetted  and sophisticated                                                               
bill,  as the  burden  would be  shifted from  the  state to  the                                                               
patients to make  their case for removal from custody.   Based on                                                               
the  testimony   received,  he  suggested  that   the  disability                                                               
community is concerned about this;  therefore, it is something to                                                               
be considered.  He advised that SB  53 is "ahead" of HB 80 on the                                                               
seamless   transition  of   moving  people   from  being   deemed                                                               
unrestorable to involuntary commitment.                                                                                         
                                                                                                                                
3:54:10 PM                                                                                                                    
                                                                                                                                
MR.  SCHROEDER stated  that  both bills  deal  with the  petition                                                               
process  of moving  individuals from  the criminal  to the  civil                                                               
side.  He suggested that SB  53 better tackles the intricacies of                                                               
doing  this  between  the  Department  of  Family  and  Community                                                               
Services  (DFCS)  and the  Department  of  Law  (DOL).   In  this                                                               
respect the only  difference between the bills, he  said, is that                                                               
HB 80 makes DFCS file  the petition for civil commitment, because                                                               
currently  this is  vague with  no requirement,  as the  petition                                                               
could be  filed by any  adult.  Under SB  53, he stated  that the                                                               
prosecutor "shall"  file the  petition and  report the  filing to                                                               
DOL.                                                                                                                            
                                                                                                                                
REPRESENTATIVE JOSEPHSON added  that under SB 53  there would not                                                               
be  an  instant  dismissal  the  moment a  person  is  found  not                                                               
competent;  there would  be an  intervening, short  period, where                                                               
DOL could file  a petition.  He expressed  the understanding from                                                               
the  court system  that it  does  not want  to appear  to be  the                                                               
petitioner  because this  is  not the  role of  the  court.   The                                                               
issue,  he continued,  would  be  to avoid  a  situation where  a                                                               
dismissal of a  case based on incompetency  allowed a potentially                                                               
dangerous  person  out  on his/her  recognizance,  and  then  the                                                               
person is brought back to civil commitment.                                                                                     
                                                                                                                                
MR.  SCHROEDER further  explained that  under HB  80 the  charges                                                               
must be  dismissed, and  then a petition  is filed;  however, the                                                               
problem is  the person's location  between these two events.   He                                                               
said  that  SB  53  would  move the  discharge  until  after  the                                                               
petition  is filed.    The  petition, he  continued,  would be  a                                                               
three-day ex  parte order  at which that  person would  undergo a                                                               
civil  commitment proceeding,  and this  would determine  whether                                                               
the person goes through the  30-day civil commitment process.  He                                                               
pointed out  that this would  create a seamless process  in which                                                               
the person is not let back out, and the statute is not changed.                                                                 
                                                                                                                                
3:57:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE FIELDS observed that  there are four committees of                                                               
referral for HB 80, with this  committee being the first one.  He                                                               
surmised that  a leadership  discussion is needed  to get  a bill                                                               
passed  this year.   He  said  he would  leave it  to [the  prime                                                               
sponsors of the bills] to figure  out the best way to merge these                                                               
concepts.                                                                                                                       
                                                                                                                                
CHAIR PRAX  responded that he  is working on  this.  He  said the                                                               
challenge will  be figuring  out how  to vet  and glean  the best                                                               
parts of both bills, and then come out with a finished product.                                                                 
                                                                                                                                
3:59:52 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOSEPHSON  related  that  there  is  interest  in                                                               
having  an upstream  committee  referral  removed, leaving  three                                                               
committees  including  this one.    He  said  he is  inclined  to                                                               
encourage  the  committee to  adopt  SB  53.    He stated  he  is                                                               
personally wedded  to ensuring  that misdemeanants  who act  in a                                                               
particularly erratic  and dangerous  way and whose  competency is                                                               
questioned  are part  of  this  bill, so  he  would like  further                                                               
opportunity to  come before this  committee to convey  what needs                                                               
strengthening.   He  advised, however,  that  SB 53  is the  more                                                               
sophisticated and  vetted bill,  and he encouraged  the committee                                                               
to adopt a committee substitute (CS) which this.                                                                                
                                                                                                                                
4:01:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE  opined  that  this  is  an  incredibly                                                               
important issue, and it should  be addressed during this session.                                                               
He thanked Representative Josephson  and Senator Claman for their                                                               
work and urged that the  committee do everything possible to move                                                               
things along.                                                                                                                   
                                                                                                                                
4:02:27 PM                                                                                                                    
                                                                                                                                
CHAIR  PRAX  asked whether  a  similar  bill  has been  filed  in                                                               
previous sessions.                                                                                                              
                                                                                                                                
REPRESENTATIVE  JOSEPHSON responded  that two  terms ago  Senator                                                               
Claman  worked  with  Senator  Giessel   on  a  short  bill  that                                                               
concerned the melding  of public safety and health  issues.  This                                                               
had looked to a new venue  where people with mental health issues                                                               
would be  treated instead of going  to prison.  He  said this was                                                               
followed up with House Bill  172 [passed during the Thirty-Second                                                               
Alaska State  Legislature], with  the Crisis  Now provision.   He                                                               
stated  that   these  are  only   forerunners  to   the  proposed                                                               
legislation, and  not the same.   He expressed  the understanding                                                               
that in  2008 a  bill by  Senator Liesl  McGuire was  designed to                                                               
deal with this,  and though it was  a good effort, it  did not do                                                               
it.                                                                                                                             
                                                                                                                                
4:04:40 PM                                                                                                                    
                                                                                                                                
SENATOR MATT  CLAMAN, Alaska State Legislature,  testified as the                                                               
prime sponsor  of SB 53.   He  concurred that the  specific issue                                                               
addressed  in  the proposed  bills  was  not addressed  by  prior                                                               
legislation.   He stated that  this is addressing people  who are                                                               
incompetent  under  Title  12,  and,   based  on  some  level  of                                                               
dangerousness   defined   in   statute,  these   individuals   be                                                               
immediately put into an involuntary commitment process.                                                                         
                                                                                                                                
CHAIR PRAX asked  whether anything comes to mind  from House Bill                                                               
172, as  there were  similar civil rights  concerns.   He further                                                               
asked  whether   the  committee  could  be   given  documentation                                                               
concerning this.                                                                                                                
                                                                                                                                
SENATOR  CLAMAN  answered  that  House  Bill  172  dealt  with  a                                                               
different  timeframe  and course  of  action  in the  process  of                                                               
dealing with  mental illness.   He advised  that the  due process                                                               
concerns  raised by  House  Bill  172 are  not  an  issue in  his                                                               
proposed bill.   He stated he  is available to meet  with members                                                               
of the committee and staff to talk about the proposed bill.                                                                     
                                                                                                                                
4:06:51 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE RUFFRIDGE offered his  understanding that the goal                                                               
of SB  53 and HB  80 would be to  fix a loophole  concerning what                                                               
happens  when  someone  is deemed  incompetent  to  stand  trial.                                                               
Under  the current  mechanism,  he  continued, individuals  would                                                               
have  their charges  dismissed; however,  after this  there is  a                                                               
question  mark of  what happens  next, and  the goal  here is  to                                                               
remove this  question mark.   He requested affirmation  that this                                                               
would  not destroy  people's rights  or incarcerate  them against                                                               
their will;  rather, it  would create  a public  safety mechanism                                                               
for both the public and "the patient."                                                                                          
                                                                                                                                
SENATOR  CLAMAN responded  in  the affirmative.    He added  that                                                               
under current  statute the loophole  is when the  individuals are                                                               
deemed incompetent,  there is no  basis to hold  them; therefore,                                                               
charges are  dismissed.   From this point  the Civil  Division of                                                               
DOL, or another party, has  to initiate an involuntary commitment                                                               
proceeding, which  sometimes happens.   He stated in the  case of                                                               
Ms. Harris this did not happen.   He explained that the structure                                                               
proposed by  the Senate  is, prior to  dismissal of  the criminal                                                               
case  for  people who  meet  a  certain statutory  definition  of                                                               
"dangerousness,"  the prosecutor  would file  a civil  commitment                                                               
petition, which would  create a new civil case;  the person would                                                               
be held,  the civil  commitment process  would be  initiated, and                                                               
the Civil Division would continue forward with the civil case.                                                                  
                                                                                                                                
4:09:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  RUFFRIDGE,  in the  case  of  a crime  where  the                                                               
charges   are  dismissed,   asked  whether   it  is   solely  the                                                               
responsibility of the Civil Division  to file for incompetency or                                                               
civil commitment.   He surmised that  in the case of  Ms. Harris,                                                               
an  individual  cannot  apply  for   the  person  to  be  civilly                                                               
committed.                                                                                                                      
                                                                                                                                
SENATOR CLAMAN  replied that more  research would be  needed into                                                               
whether  Ms.  Harris could  have  filed  a petition  against  the                                                               
person who attacked her.  He  said that, per current statute, the                                                               
"medical person  in charge" can  file a petition  for involuntary                                                               
commitment  based on  what  is apparent.    He acknowledged  that                                                               
these procedural aspects were touched  on in House Bill 17, which                                                               
is what  is in place  for having someone involuntarily  held, and                                                               
the authority  to do so.   A police  officer, he noted,  can also                                                               
file an involuntary commitment proceeding.                                                                                      
                                                                                                                                
4:11:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOSEPHSON advised  that under  current state  law                                                               
anyone can  file such a petition.   He expressed the  belief that                                                               
the  benefit  of HB  80  and  SB 53  would  be  to specify  these                                                               
individuals.   He said that  several experts have  cautioned that                                                               
for this  to work  properly, more  personnel and  more facilities                                                               
would be needed.                                                                                                                
                                                                                                                                
SENATOR CLAMAN  clarified that  there are  many court  forms, and                                                               
often  these forms  will dictate  more  than anything  else.   He                                                               
related  that the  current  form for  filing  a 48-hour  petition                                                               
lists a psychiatrist,  physician, psychologist, registered nurse,                                                               
therapist,    family    member,   counselor,    social    worker,                                                               
psychological  associate, other  mental health  professional, and                                                               
other  interested person  who must  state his/her  interest.   He                                                               
expressed   the  opinion   that  this   clarifies  Representative                                                               
Josephson's response.   The  answer is that  anyone can  file, he                                                               
continued, and the  only requirement is a statement of  why he or                                                               
she has an interest in the person.                                                                                              
                                                                                                                                
4:13:52 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  clarified that the  situation would involve  a person                                                               
who is  picked up for  an incident and declared  incompetent, and                                                               
then  the   court  dismisses   the  case.     He   expressed  the                                                               
understanding that  the objective to the  proposed legislation is                                                               
that a state employee would be  required to file and follow up on                                                               
the individual.                                                                                                                 
                                                                                                                                
SENATOR  CLAMAN  answered that  in  SB  53,  before the  case  is                                                               
dismissed,  the prosecutor  would file  the civil  petition under                                                               
Title 47.   He explained that  in statute it would  be recognized                                                               
that  before there  is a  motion to  dismiss the  prosecutor must                                                               
prepare the paperwork.   He expressed the  expectation that there                                                               
will be a court form, and  the prosecutor would ask that the case                                                               
be held while  the form is completed.  Once  the prosecutor files                                                               
the civil petition form, the process would start.                                                                               
                                                                                                                                
4:15:52 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX asked  whether the civil rights  limitations have been                                                               
considered.                                                                                                                     
                                                                                                                                
SENATOR CLAMAN replied that once  the form is filed, the existing                                                               
30-day commitment  process would start  with all these  rights in                                                               
place.  He  pointed out that SB  53 would remove the  step in the                                                               
process called  the 48-hour exam.   This exam entails  the police                                                               
officer filing the petition to  bring in the individual, and then                                                               
the hospital would  determine whether to file a  petition to hold                                                               
the individual.   Under SB  53, he  explained, the person  can be                                                               
held  for the  existing 72-hour  hold procedure  and at  72 hours                                                               
there must be  a contested hearing where the  defense attorney is                                                               
present.  The attorney from  the Attorney General's office on the                                                               
civil  side would  be present,  he continued,  and this  attorney                                                               
would  determine  how to  go  forward.    These are  the  current                                                               
existing  rights, he  noted, where  once an  order is  placed the                                                               
person  gets 72  hours, and  then there  is a  hearing, at  which                                                               
point the  normal civil  commitment process  goes forward.   What                                                               
the proposed  legislation would  ensure, Senator  Claman advised,                                                               
is that  a person  who meets  the "dangerousness"  criteria would                                                               
not be released for the first 72 hours.                                                                                         
                                                                                                                                
4:18:07 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX questioned the potential  number of cases.  He offered                                                               
his  understanding that  this is  referring  to misdemeanors  and                                                               
whether  there are  legitimate reasons  in these  cases, such  as                                                               
cruelty  to animals,  which would  deserve further  evaluation on                                                               
whether the person is competent to stand trial.                                                                                 
                                                                                                                                
REPRESENTATIVE  JOSEPHSON  expressed  the belief  that  a  person                                                               
committing cruelty to his/her own  pet is chargeable, but because                                                               
the person  has a relationship  with the  pet, this would  not be                                                               
reason  for a  competency hearing  or an  involuntary commitment.                                                               
What portends  concern for  him, he continued,  is when  a person                                                               
burns down  a building and  does not recall  doing it or  why, or                                                               
when a  person attacks someone's  dog for  no reason.   He stated                                                               
that this is what is included in [HB 80].                                                                                       
                                                                                                                                
4:20:46 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  opined that some good  could be done for  a person by                                                               
going  through   the  involuntary  civil   commitment  procedure;                                                               
however, there  is some  point where the  state may  be exceeding                                                               
the  bounds   of  the   rights  of   the  individual.     Another                                                               
consideration,  he stated,  is that  with an  overload of  cases,                                                               
there may not be sufficient attention to details.                                                                               
                                                                                                                                
REPRESENTATIVE JOSEPHSON answered that  the committee may want to                                                               
hear from the court system concerning  its data.  He related that                                                               
many hundreds of cases are heard  per year, but many of these are                                                               
deemed competent, and  these cases proceed as  any other criminal                                                               
case.  This leaves a  relatively small number of individual cases                                                               
which should  not be  dismissed because  the individuals  are not                                                               
well enough  for trial.  He  asserted that, in relation  to these                                                               
cases, there  is currently no  secondary system to  ensure public                                                               
safety.                                                                                                                         
                                                                                                                                
4:23:22 PM                                                                                                                    
                                                                                                                                
SENATOR CLAMAN  added that the  court system reported it  had 176                                                               
cases  in the  last  calendar year  which  involved questions  of                                                               
competency.   Some percentage  of these 176  cases will  be found                                                               
competent to stand trial and subject  to the criminal system.  He                                                               
specified  that  HB  80's  approach  is  the  inclusion  of  some                                                               
misdemeanors  which  would  trigger the  mandatory  petition  for                                                               
involuntary commitment if the person  were found incompetent.  He                                                               
continued  that SB  53 does  not include  misdemeanors.   It only                                                               
includes felony offenses against a  person and arson.  One reason                                                               
for this difference,  he explained, is because,  in a misdemeanor                                                               
offense the  maximum sentence is  one year, and per  due process,                                                               
the person who is being held  for restoration could be held for a                                                               
period longer  than the potential  sentence served  if convicted.                                                               
This  becomes  an issue,  he  further  explained, if  the  person                                                               
spends time  in jail for  restoration to competence,  but because                                                               
of a  lack of the  resources to  bring the person  to competence,                                                               
the  extended  time in  jail  becomes  a  factor in  due  process                                                               
analysis.   He advised that  this is not  a simple analysis.   He                                                               
added that SB  53 has an option of up  to a five-year involuntary                                                               
commitment on the civil side.   He explained that SB 53 only uses                                                               
felony offenses  because there  would be  the potential  of being                                                               
held for up to a  five-year involuntary commitment.  He expressed                                                               
the  opinion that  one  version  is not  better  than the  other;                                                               
however, there are some detailed policy questions.                                                                              
                                                                                                                                
REPRESENTATIVE  JOSEPHSON  stated  he  is  working  with  Senator                                                               
Claman on  this, and he will  give this more thought.   He voiced                                                               
the concern  that in the case  of Mr. Ahkivgak, who  prior to his                                                               
assault on Ms.  Harris had not committed a felony,  rather he had                                                               
committed  some very  "bizarre" misdemeanors.   He  expressed the                                                               
belief  this  is  an  indication that  misdemeanors  need  to  be                                                               
investigated.                                                                                                                   
                                                                                                                                
4:26:47 PM                                                                                                                    
                                                                                                                                
CHAIR PRAX  noted that  the question  of protecting  both society                                                               
and individual rights  has been a topic for decades,  and it will                                                               
take thought.   He opined that, if possible, the  issue should be                                                               
addressed  this  year, and  with  more  thought, more  discussion                                                               
could happen  next year.   He said  the committee will  meet with                                                               
four department representatives where questions can be asked.                                                                   
                                                                                                                                
[HB 80 was held over.]                                                                                                          
                                                                                                                                
4:28:54 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:28 p.m.                                                                                                          
                                                                                                                                

Document Name Date/Time Subjects
SJR 10 Support Redacted.pdf HHSS 4/20/2023 3:00:00 PM
SJR 10
SJR10 Fiscal Note LEG-SESS.pdf HHSS 4/20/2023 3:00:00 PM
SJR 10
SJR10 Sponsor Statement 03.22.23.pdf HHSS 4/20/2023 3:00:00 PM
SJR 10
SJR10 Support Document ADN 01.23.23.pdf HHSS 4/20/2023 3:00:00 PM
SJR 10
SJR10 Version 33-LS0490A.PDF HHSS 4/20/2023 3:00:00 PM
SJR 10
SJR10 Support AMA Letter to Congress 03.15.23.pdf HHSS 4/20/2023 3:00:00 PM
SJR 10