Legislature(2019 - 2020)BUTROVICH 205

03/11/2020 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
02:03:42 PM Start
02:04:06 PM SB238
03:00:44 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 179 NURSING: LICENSURE; MULTISTATE COMPACT TELECONFERENCED
<Bill Hearing Canceled>
*+ SB 238 INVOLUNTARY COMMITMENT;PROTECTIVE CUSTODY TELECONFERENCED
Heard & Held
-Invited Testimony Followed by Public Testimony-
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 11, 2020                                                                                         
                           2:03 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Mike Shower                                                                                                             
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 238                                                                                                             
"An Act  relating to involuntary commitment  procedures; relating                                                               
to  protective  custody  at  a  correctional  facility  or  jail;                                                               
relating to  transportation of  individuals held  for involuntary                                                               
admission  for  mental health  treatment;  and  providing for  an                                                               
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 179                                                                                                             
"An Act relating to the licensure of nursing professionals;                                                                     
relating to a multistate nurse licensure compact; and providing                                                                 
for an effective date."                                                                                                         
                                                                                                                                
     - BILL HEARING CANCELED                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 238                                                                                                                  
SHORT TITLE: INVOLUNTARY COMMITMENT;PROTECTIVE CUSTODY                                                                          
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
02/28/20       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/28/20       (S)       HSS, JUD                                                                                               
03/11/20       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
ALBERT WALL, Deputy Commissioner                                                                                                
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Presented an overview of SB 238.                                                                          
                                                                                                                                
STEVEN BOOKMAN, Assistant Attorney General                                                                                      
Civil Division                                                                                                                  
Human Services Section                                                                                                          
Department of Law                                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the  hearing on SB                                                             
238.                                                                                                                            
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
2:03:42 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 2:03 p.m.  Present at the                                                               
call  to  order  were  Senators Giessel,  von  Imhof,  and  Chair                                                               
Wilson. Senators Shower and Begich arrived shortly thereafter.                                                                  
                                                                                                                                
        SB 238-INVOLUNTARY COMMITMENT;PROTECTIVE CUSTODY                                                                    
                                                                                                                                
2:04:06 PM                                                                                                                    
CHAIR WILSON announced the consideration  of SENATE BILL NO. 238,                                                               
"An Act  relating to involuntary commitment  procedures; relating                                                               
to  protective  custody  at  a  correctional  facility  or  jail;                                                               
relating to  transportation of  individuals held  for involuntary                                                               
admission  for  mental health  treatment;  and  providing for  an                                                               
effective date."                                                                                                                
                                                                                                                                
CHAIR  WILSON stated  his intention  to hear  an overview  of the                                                               
bill and take public testimony.                                                                                                 
                                                                                                                                
2:04:46 PM                                                                                                                    
ALBERT  WALL,  Deputy  Commissioner,  Department  of  Health  and                                                               
Social Services (DHSS), Anchorage,  Alaska, said SB 238 addresses                                                               
existing gaps  in civil commitment law  in four ways: 1.  It will                                                               
make clear that  a person can be held in  protective custody in a                                                               
correctional facility or jail only  when absolutely necessary and                                                               
for the absolute  minimum amount of time; 2. It  will outline the                                                               
responsibilities of  DHSS, the  Department of  Corrections (DOC),                                                               
and the  Alaska Court System, such  that when a person  is placed                                                               
in  emergency protective  custody,  the  individual's health  and                                                               
safety  is  protected and  the  person  is reevaluated  every  48                                                               
hours.  And the  person will  automatically have  a court  review                                                               
hearing  within  96  hours;  3.  The  proposed  legislation  will                                                               
protect Alaskans  privacy  and civil rights by  ensuring a person                                                               
receives the full 72 hour  period of evaluation before the person                                                               
can  be  involuntarily  committed  for  30  days.  It  will  also                                                               
prohibit  creating  a  record  indicating  that  the  person  was                                                               
arrested or charged with a crime;  and 4. It more clearly defines                                                               
when DHSS has custody of a  person and requires the department to                                                               
provide transportation  for the person. It  will create efficient                                                               
chains of  communications through  the requirement that  DOC must                                                               
notify DHSS  and DHSS  must file the  necessary reports  with the                                                               
courts.                                                                                                                         
                                                                                                                                
MR. WALL said the bill is  designed to reduce instances of people                                                               
awaiting treatment  in DOC  and provide  a process  of systemwide                                                               
accountability to  protect an individual's rights.  DHSS recently                                                               
submitted a report to the  court addressing gaps in the inpatient                                                               
psychiatric system.  The department committed to  ongoing efforts                                                               
to identify  and improve  gaps in the  system of  care, including                                                               
legal gaps. SB 238 is an important part of that plan.                                                                           
                                                                                                                                
2:07:28 PM                                                                                                                    
MR. WALL presented the sectional analysis for SB 238:                                                                           
                                                                                                                                
     Section 1: Removes  the reference when a  person can be                                                                    
     held in  protective custody  (now addressed  in section                                                                    
     2) and adds "emergency"  to state "emergency protective                                                                    
     custody under  this section  may not  include placement                                                                    
     of a minor in a jail or secure facility."                                                                                  
                                                                                                                                
     Section 2:  Creates AS 17.30.706"Protective  custody at                                                                    
     a correctional  facility or jail. The  new statute only                                                                    
     allows  placement  at  a correctional  facility  if  no                                                                    
     designated  treatment  or evaluation  facility,  crisis                                                                    
     stabilization center,  or health care facility  has the                                                                    
     "capacity  to   safely  admit   the  person   within  a                                                                    
     reasonable amount  of time."  Once the person  is under                                                                    
     protective custody,  they can only be  held there while                                                                    
     transport  arrangements  are   made.  The  correctional                                                                    
     facility/jail must notify the  Department of Health and                                                                    
     Social Services  (DHSS) as soon as  practicable if they                                                                    
     have a person in protective  custody, and then the DHSS                                                                    
     makes  arrangements for  transport and  admission to  a                                                                    
     designated  treatment or  evaluation  facility. If  the                                                                    
     person remains  in protective custody for  more than 48                                                                    
     hours without a  plan in place to  transport within the                                                                    
     next  12  hours, the  DHSS  will  provide an  evaluator                                                                    
     every 48 hours  to determine if the  person still meets                                                                    
     the criteria for probable cause  for the ex parte hold.                                                                    
     The  DHSS  will  notify  the court  if  the  person  is                                                                    
     released or  if the person  is being held and  what the                                                                    
     transfer plan  is. The court  is required to  conduct a                                                                    
     review hearing no later than  96 hours after the person                                                                    
     is  placed  in  protective  custody.  The  correctional                                                                    
     facility/jail is  required to take reasonable  steps to                                                                    
     protect  the   person's  health   and  safety   and  is                                                                    
     permitted to  take reasonable  steps for  protection of                                                                    
     others. Finally, the statute  prohibits making a record                                                                    
     that the  person has  been arrested  or charged  with a                                                                    
     crime.                                                                                                                     
                                                                                                                                
     Section 3 (AS 47.30.715),  Section 4 (AS 47.30.725(b)),                                                                    
     and Section  5 (AS 47.30.725(f)): Amend  current law to                                                                    
     clarify   timelines  for   a  commitment   hearing  and                                                                    
     evaluation.  The purpose  is to  ensure the  evaluation                                                                    
     facility has  the full 72-hour  period to  evaluate the                                                                    
     respondent before a hearing is held.                                                                                       
                                                                                                                                
     Section  6:   Creates  AS  47.30.727  Custody   of  the                                                                    
     department to  clearly delineate when DHSS  has custody                                                                    
     of a  person during the civil  commitment process. DHSS                                                                    
     only  has custody  during the  time  it takes  physical                                                                    
     control in  order to  provide transportation,  and when                                                                    
     the person is at the state hospital.                                                                                       
                                                                                                                                
     Section  7:  Amends   AS  47.30.870  Transportation  to                                                                    
     clarify that  before DHSS takes custody  of the person,                                                                    
     DHSS shall  arrange and  pay for  transportation. Also,                                                                    
     DHSS must  arrange transportation  when the  DHSS takes                                                                    
     custody of the person.                                                                                                     
                                                                                                                                
     Section 8: Amends  AS 47.30.915 to add  a definition of                                                                    
     "crisis stabilization center."                                                                                             
                                                                                                                                
     Section 9: The law applies  to those taken into custody                                                                    
     on or after the effective  date of the Act, which takes                                                                    
     effect immediately.                                                                                                        
                                                                                                                                
2:11:54 PM                                                                                                                    
SENATOR  GIESSEL  referred  to  Section   6.  She  asked  if  the                                                               
Department of Corrections  (DOC) is responsible when  a person is                                                               
in  jail  and  waiting  to  be  admitted  to  Alaska  Psychiatric                                                               
Institute (API), for example, but there is no bed available.                                                                    
                                                                                                                                
MR.  WALL replied  that  is  exactly what  Section  6 intends  to                                                               
clarify. He deferred further comment to Mr. Bookman.                                                                            
                                                                                                                                
2:12:55 PM                                                                                                                    
STEVEN  BOOKMAN,  Assistant  Attorney  General,  Civil  Division,                                                               
Human  Services Section,  Department of  Law, Anchorage,  Alaska,                                                               
agreed  that Section  6  intends  to clarify  that  law. He  said                                                               
Section  6  also would  cover  someone  who  is at  a  community-                                                               
referring hospital before being  transported by the department to                                                               
an evaluation facility.                                                                                                         
                                                                                                                                
SENATOR  GIESSEL questioned  the  notion that  the Department  of                                                               
Corrections would  assume responsibility for the  cost of housing                                                               
and treatment for  these individuals. She noted that  this is not                                                               
insignificant when someone's condition  is serious enough to need                                                               
services from API.                                                                                                              
                                                                                                                                
MR. BOOKMAN  replied that is the  idea, although there would   be                                                               
limits on  what DOC  could provide for  someone. The  statutes do                                                               
not  permit an  involuntary  medication order,  for example,  but                                                               
some  treatment  could  be  given   on  a  voluntary  basis.  The                                                               
department  seeks   to  limit  the  incarceration   time  at  DOC                                                               
facilities or jails for individuals who need treatment.                                                                         
                                                                                                                                
SENATOR GIESSEL  responded, "I'm wondering how  the Department of                                                               
Corrections feels about that."                                                                                                  
                                                                                                                                
MR.  BOOKMAN related  his understanding  that DHSS  met with  the                                                               
Department of Corrections on this matter.                                                                                       
                                                                                                                                
MR. WALL added  that he did not envision many  instances in which                                                               
an  individual would  be  incarcerated in  a  DOC facility  while                                                               
awaiting  an  API  bed  but  the  bill  clearly  defines  who  is                                                               
responsible  for  individuals who  are  awaiting  transport to  a                                                               
psychiatric hospital.                                                                                                           
                                                                                                                                
CHAIR  WILSON related  his understanding  that a  person in  that                                                               
sort of  crisis who  is in an  emergency room would  be put  on a                                                               
one-to-one status  or 15-minute observation. He  asked if someone                                                               
would be given  upgraded observational status while  they were in                                                               
a DOC facility awaiting transport to a psychiatric hospital.                                                                    
                                                                                                                                
MR. WALL  replied each facility  has its own  protocols depending                                                               
on  whether  it   is  a  contract  jail  or   a  state  facility.                                                               
Observation and oversight  would be worked out  on a case-by-case                                                               
basis, he said.                                                                                                                 
                                                                                                                                
MR.  BOOKMAN  added  that  a   majority  of  people  who  are  in                                                               
correctional  facilities awaiting  admittance to  API or  the DET                                                               
[Designated Evaluation and Treatment  Program] are housed at Mike                                                               
Mod in the  Anchorage jail. That facility is spatially  set up so                                                               
that all the cells are visible from a central location.                                                                         
                                                                                                                                
MR. WALL clarified that Mike Mod is a treatment area within DOC.                                                                
                                                                                                                                
CHAIR WILSON  expressed interest in  having the same  standard in                                                               
DOC facilities and contract facilities.  He wondered if DOC could                                                               
address  that issue  and other  questions the  committee has.  He                                                               
noted that the state has  not yet addressed compliance with PREA,                                                               
the Prisoner  Rape Elimination Act. He  said he does not  want to                                                               
create  another burden,  but part  of  this bill  is designed  to                                                               
respond to lawsuits related to  consistency issues on a statewide                                                               
basis. One concern has been  housing prisoners with mental health                                                               
needs  without   providing  the  same  standards   of  care  that                                                               
facilities with higher-level care, such  as API provide. He asked                                                               
when interventions  begin to ensure  the safety of  an individual                                                               
and others.                                                                                                                     
                                                                                                                                
MR.  WALL  replied that  DHSS  will  work  with DOC  to  consider                                                               
various scenarios. He pointed out that  this is not a new process                                                               
or population, so  numerous procedures are currently  in place to                                                               
address these  situations. SB 238  merely clarifies  which agency                                                               
has responsibility during the  timeframe individuals are awaiting                                                               
transport to mental health facilities such as API.                                                                              
                                                                                                                                
2:19:16 PM                                                                                                                    
SENATOR BEGICH  said that is  his primary concern with  the bill.                                                               
He  read  an  excerpt  from   an  Anchorage  Daily  News  article                                                               
[entitled  "Judge  orders  state   to  end  practice  of  holding                                                               
psychiatric  patients   in  jails,   ERs,  October   22,  2019"]:                                                               
"Alaska's practice of detaining  people held on civil psychiatric                                                               
holds  in  jails  due  to   the  Alaska  Psychiatric  Institute's                                                               
inability to treat  them causes 'irreparable harm'  and must end,                                                               
an  Anchorage judge  has ruled."  He offered  his view  that this                                                               
bill  will not  address that  issue. Psychiatric  patients should                                                               
not be in correctional facilities.  He said the article describes                                                               
windowless cells  outfitted with concrete slabs  for sleeping. It                                                               
points  out  that  civil  detainees  at  API  are  held  in  very                                                               
different  conditions than  civil  detainees  at DOC  facilities.                                                               
It's a  mistake to  say that  DOC will  be responsible  for these                                                               
individuals  because   DOC  is   not  designed  to   address  the                                                               
psychiatric  population.  He  questioned  how  patients  and  the                                                               
groups who represent them would respond to this provision.                                                                      
                                                                                                                                
2:21:46 PM                                                                                                                    
SENATOR VON IMHOF asked Deputy  Commissioner Wall if he wanted to                                                               
respond to that before she asked her question.                                                                                  
                                                                                                                                
MR. WALL deferred to Mr. Bookman.                                                                                               
                                                                                                                                
MR.  BOOKMAN  responded that  protective  custody  is already  in                                                               
current   law.  The   bill  seeks   to   provide  structure   and                                                               
clarification about when it should  be used and for what purpose.                                                               
He  characterized it  as a  backup plan.  For instance,  the bill                                                               
explains  that  protective  custody  in a  jail  or  correctional                                                               
facility  should  be  used  only  if  a  treatment  facility,  an                                                               
evaluation facility,  a crisis stabilization center,  or a health                                                               
care  facility  is not  available.  The  state should  be  moving                                                               
toward the goal of not  placing people [in protective custody] in                                                               
jail cells or at least for a minimal amount of time.                                                                            
                                                                                                                                
He  reminded  members  that Deputy  Commissioner  Wall  indicated                                                               
there are  places in the  state with  no other option.  This bill                                                               
will require  DOC to  notify DHSS when  someone is  in protective                                                               
custody,  but  it  does  not   eliminate  or  address  protective                                                               
custody.  Currently   DHSS  is   notified  that  someone   is  in                                                               
protective custody  when the court  order is issued,  which could                                                               
take a number of hours. This  bill will speed up the notification                                                               
process so  DHSS can plan  how to  get someone out  of protective                                                               
custody.                                                                                                                        
                                                                                                                                
MR. WALL added  that there must be some mechanism  of last resort                                                               
in place  for those who fall  through the cracks. This  bill will                                                               
put in  place a precise  structure for that last  resort measure,                                                               
including who must notify DHSS  and file reports, and it provides                                                               
a timeline to limit the protective custody period.                                                                              
                                                                                                                                
SENATOR VON IMHOF noted that some  of the gaps in the system that                                                               
Deputy Commissioner Wall referenced  are being addressed with the                                                               
stabilization centers.                                                                                                          
                                                                                                                                
She recalled that  one reason the situation arose  last fall that                                                               
Senator Begich  mentioned was that the  shortage of psychiatrists                                                               
meant no one could perform  the forensic assessments. She further                                                               
recalled that API indicated it hired  more staff so this has been                                                               
addressed.  She  asked if  this  issue  should be  addressed  via                                                               
regulation rather than in statute.  She related her understanding                                                               
that this  issue primarily relates  to the larger  communities of                                                               
Anchorage,  Fairbanks, Juneau,  and the  Mat-Su Valley.  She said                                                               
smaller communities like Haines were a separate issue.                                                                          
                                                                                                                                
2:27:04 PM                                                                                                                    
MR. WALL  deferred the question  about whether the  remedy should                                                               
be addressed in statute or regulation  to Mr. Bookman. He said SB                                                               
238 relates  to the  civil commitment  process, not  the forensic                                                               
process,  which  DHSS   is  working  to  resolve   with  two  new                                                               
evaluators   via   provider   agreements.  The   department   has                                                               
substantially  eliminated  the  backlog  of  evaluations  on  the                                                               
forensic side.                                                                                                                  
                                                                                                                                
He  reported  that  last  February,   DHSS  had  just  under  100                                                               
individuals  awaiting  API beds.  Since  then,  the figures  have                                                               
typically been in  the single digits, and zero at  times. He said                                                               
DHSS  is still  working to  address  issues, but  the process  is                                                               
moving in the right direction.                                                                                                  
                                                                                                                                
MR. WALL said  the department has made tremendous  strides in the                                                               
last year.  The state has  always needed several levels  of care,                                                               
but  the crisis  stabilization  and  partial hospitalization  for                                                               
those  suffering  from mental  illness  has  not been  available.                                                               
Implementing the  [Medicaid] 1115  waiver has helped.  The second                                                               
phase which includes  serious mental illness will  come online at                                                               
the beginning of the next fiscal year.                                                                                          
                                                                                                                                
MR. WALL said  the Alaska Mental Health Trust  Authority has been                                                               
the main  driver for the  Crisis Now model.  Crisis stabilization                                                               
is one of  the keystones of that model. He  offered his view that                                                               
the 1115 waiver  and working with partners has  been a tremendous                                                               
process. He said  DHSS seeks to reach the point  where the safety                                                               
net is never  needed for those in crisis, no  matter whether that                                                               
person  resides in  Haines or  Anchorage. He  said he  hopes this                                                               
will  be  achieved  once  the  stabilization  center  is  running                                                               
properly. This  bill focuses on what  to do for people  in crisis                                                               
in areas without  a stabilization center who have  no other place                                                               
to  go. It  identifies the  responsibilities for  each department                                                               
and the timeframes.                                                                                                             
                                                                                                                                
MR.  BOOKMAN said  placing this  language in  statute reflects  a                                                               
policy choice.  Regulations are   gap fillingand    implement the                                                               
intent of  the statute. Currently,  protective custody  is almost                                                               
phrased in  the negative. It says  a person taken in  custody for                                                               
emergency  evaluation  may  not  be   placed  in  jail  or  other                                                               
correctional facility except for  protective custody purposes and                                                               
only while  awaiting transportation  to a treatment  facility. He                                                               
expressed concern about placing the  structure provided by SB 238                                                               
in  regulation because  the bill  primarily addresses  underlying                                                               
policy issues.                                                                                                                  
                                                                                                                                
MR. WALL said the whole system  of care has needed correction for                                                               
some time. This bill will address one aspect of the process.                                                                    
                                                                                                                                
2:33:01 PM                                                                                                                    
SENATOR  BEGICH  expressed  concern about  inconsistency  in  the                                                               
state's  continuum  of  care.  He  said he  was  unsure  how  the                                                               
continuum of  care is maintained  if Deputy Commissioner  Wall or                                                               
someone else working  on the system of care leaves  next week, if                                                               
the waiver is  changed to a block grant, or  if there are changes                                                               
in  the way  the system  is funded.  While DHSS  acknowledges the                                                               
need for these services, he does  not often see them presented in                                                               
agency budget  documents. He emphasized that  these services must                                                               
be substantiated. He opined that  the state must address the lack                                                               
of capacity  to provide care  for people who  are inappropriately                                                               
placed in DOC but need mental health services.                                                                                  
                                                                                                                                
He commended  DHSS for  maximizing capacity,  enhancing services,                                                               
and reducing the  waiting list at API, which is  the state's only                                                               
institution.  However,  providing  a continuum  costs  money,  he                                                               
said.                                                                                                                           
                                                                                                                                
SENATOR BEGICH  said he would be  more supportive of the  bill if                                                               
he better  understood where  it fits into  the continuum  and the                                                               
administration's commitment to fund the continuum.                                                                              
                                                                                                                                
MR. WALL said  DHSS faces a conundrum because the  system of care                                                               
is  massive.   Presenting  a  comprehensive  omnibus   plan  that                                                               
identifies each piece, including who  is in control, is daunting.                                                               
He acknowledged  that a huge  piece still needs to  be addressed.                                                               
The department seeks  to achieve what can be  done with precision                                                               
and care  rather than building a  new system by using  an omnibus                                                               
approach.                                                                                                                       
                                                                                                                                
He acknowledged  the difficulty in  describing the  complexity of                                                               
the issue. In its presentation  on the 1115 waiver, DHSS compared                                                               
the different  levels of care under  the old system with  the new                                                               
one.  The presentation  described 23  new services  of care,  the                                                               
process  to access  that  care, and  the  funding mechanism.  The                                                               
chart indicates the lowest level of  care and moves to the higher                                                               
acuity.  The  department  can  provide a  visual  of  where  this                                                               
statute would fall on that continuum.                                                                                           
                                                                                                                                
MR. WALL argued that DHSS  has addressed and continues to address                                                               
the capacity issue,  not only in terms of the  continuum of care,                                                               
but specifically for  inpatient psychiatric care. In  the last 14                                                               
months,  Commissioner  Crum  added  more inpatient  beds  to  the                                                               
continuum of  care through partnerships with  providers than what                                                               
has previously  been done in  years. There is an  active movement                                                               
to  address  the  continuum  of  care and  the  capacity  in  the                                                               
continuum   of  care   at  different   levels.  Although   it  is                                                               
frustrating to  him and  others, DHSS had  made more  progress in                                                               
the last  couple of  years than  he has seen  in the  previous 10                                                               
years.                                                                                                                          
                                                                                                                                
2:39:37 PM                                                                                                                    
SENATOR SHOWER  asked for the general  goal for beds in  the Mat-                                                               
Su. He recalled that it was about 37 beds.                                                                                      
                                                                                                                                
MR.  WALL replied  API is  an 80-bed  facility with  50 available                                                               
beds. DHSS's  goal is to  have all of  them available as  fast as                                                               
possible. Most  of the  constraint relates  to staffing.  For the                                                               
overall system  of care,  determining the  number of  needed beds                                                               
includes the beds needed in  regions such as Bethel, Kotzebue, or                                                               
Ketchikan.  DHSS  is  engaged  with  providers  to  solicit  more                                                               
facilities to  be become designated evaluation  and stabilization                                                               
centers or  designated evaluation  treatment centers  or DES/DET.                                                               
Thus, DHSS is requesting incentivization  funding for new DES and                                                               
DET beds.  Providing a  few more  beds in  each region  will mean                                                               
that people  can more quickly  access care. This  would eliminate                                                               
the need  to fly patients  to one  central location for  care. He                                                               
pointed  out  that in  the  Bering  Strait region,  Norton  Sound                                                               
Health  Corporation  (NSHC)  has  improved its  system  of  care,                                                               
including  psychiatric care,  by adding  a wellness  and training                                                               
center in Nome,  which will house its  behavioral health services                                                               
program.  He  said  DHSS  is working  hard  to  assist  hospitals                                                               
interested in more DES and DET beds.                                                                                            
                                                                                                                                
CHAIR WILSON observed  that Norton Sound would love  to have that                                                               
empty youth facility.                                                                                                           
                                                                                                                                
MR. WALL  responded that  DHSS has  been having  some interesting                                                               
discussions with the NSHC.                                                                                                      
                                                                                                                                
SENATOR SHOWER said the state  has been working to include tribal                                                               
entities. Some questions have arisen,  including if it is wise to                                                               
bring  people  from  rural  areas   to  a  different  culture  in                                                               
Anchorage. He  said he hopes  the state will partner  with tribal                                                               
entities. He offered  that Glenallen is trying to  create its own                                                               
regional capacity.                                                                                                              
                                                                                                                                
MR. WALL  reported that  Bethel has four  DES beds  designated as                                                               
tribal.                                                                                                                         
                                                                                                                                
2:43:51 PM                                                                                                                    
CHAIR WILSON  asked when the  72 hours for assessment  starts and                                                               
if it begins when someone is in transit.                                                                                        
                                                                                                                                
MR. WALL deferred to Mr. Bookman.                                                                                               
                                                                                                                                
MR. BOOKMAN answered  that the 72-hour count  starts when someone                                                               
enters a DET or API.                                                                                                            
                                                                                                                                
CHAIR  WILSON expressed  concern  that if  transportation is  not                                                               
established,  a person  could be  in  involuntary commitment  for                                                               
weeks.                                                                                                                          
                                                                                                                                
MR. BOOKMAN  said the bill seeks  to address this by  requiring a                                                               
hearing to  be held no  later than 96  hours after someone  is in                                                               
protective  custody.   This  requirement  is  not   currently  in                                                               
statute.                                                                                                                        
                                                                                                                                
CHAIR WILSON asked the rationale  for increasing the time from 72                                                               
to 96 hours.                                                                                                                    
                                                                                                                                
MR. BOOKMAN answered that currently,  the statutes gives API or a                                                               
DET  72 hours  to evaluate  someone  and file  the petition.  The                                                               
hearing must  take place within  72 hours. However, if  a patient                                                               
needs 72 hours of observation,  the hearing must be held quickly,                                                               
but  the public  defender  agency  may not  have  enough time  to                                                               
adequately prepare  or it  may not give  the court  system enough                                                               
time to  find a judge. Many  people will achieve some  measure of                                                               
stabilization  in   72  hours,   and  these  patients   could  be                                                               
discharged  or   accept  voluntary  treatment  and   work  toward                                                               
discharge. The  clinical perspective  is that  the full  72 hours                                                               
will allow for  stabilization and time for the  patient to engage                                                               
with a  provider, which may  lead to  a better hearing  since the                                                               
clinician  may  have a  better  understanding  of a  respondent's                                                               
condition.                                                                                                                      
                                                                                                                                
CHAIR WILSON described that as a good answer.                                                                                   
                                                                                                                                
2:47:56 PM                                                                                                                    
MR. WALL said one problem  with stabilization evaluations is they                                                               
may  push  people  through  the system  too  fast.  For  example,                                                               
someone who  comes in with a  psychiatric need, who is  also on a                                                               
substance,  has a  co-occurring issue.  If the  person is  pushed                                                               
through the system too fast,  the substance abuse issue cannot be                                                               
addressed. During  the evaluation  of someone  in an  acute state                                                               
with conflicting  problems, it may  not be easy to  identify what                                                               
part of  the crisis is  due to  the substance or  is psychiatric.                                                               
When the  patient is  given more time  to stabilize,  doctors can                                                               
better identify  the patient's  needs, including  whether someone                                                               
has  an acute  psychiatric  need  or if  the  patient needs  more                                                               
outpatient care.  SB 238  delineates the  legal timeline,  but it                                                               
also slows  down the clinical  process to ensure the  patient has                                                               
the best care.                                                                                                                  
                                                                                                                                
SENATOR BEGICH  asked if  DOC is  the best  department to  do the                                                               
evaluation and provide the care.                                                                                                
                                                                                                                                
MR.  WALL  replied DOC  does  not  conduct evaluations,  but  the                                                               
department   can   provide  the   care   if   it  is   necessary.                                                               
Accessibility to care  at the time of need is  important and that                                                               
delineates  who  has  the responsibility  for  that  because  the                                                               
person is with them at the time of need.                                                                                        
                                                                                                                                
2:50:31 PM                                                                                                                    
SENATOR BEGICH asked how many  people would have been affected by                                                               
the bill over the last five years.                                                                                              
                                                                                                                                
MR. WALL deferred to Mr. Bookman.                                                                                               
                                                                                                                                
MR. BOOKMAN asked for clarification of the question.                                                                            
                                                                                                                                
SENATOR BEGICH asked how many people the bill would affect.                                                                     
                                                                                                                                
MR.  WALL asked  if  he was  asking how  many  patients on  civil                                                               
commitment have been in a DOC  facility in the last year awaiting                                                               
transport.                                                                                                                      
                                                                                                                                
SENATOR  BEGICH  said  his question  included  populations  in  a                                                               
contract jail.                                                                                                                  
                                                                                                                                
MR.  WALL  related his  understanding  of  the question  for  Mr.                                                               
Bookman.                                                                                                                        
                                                                                                                                
MR. BOOKMAN answered that the last  person picked up and taken to                                                               
a  correctional  facility  was last  August.  He  estimated  that                                                               
approximately nine patients were  affected since last January. He                                                               
said he would follow up with the figures for the entire year.                                                                   
                                                                                                                                
SENATOR BEGICH pointed out that there  was a lawsuit and it would                                                               
have brought this  practice to an end. He said  he was interested                                                               
in how many people this bill will affect in an average year.                                                                    
                                                                                                                                
CHAIR WILSON requested the figures for the past two years.                                                                      
                                                                                                                                
MR. BOOKMAN agreed to provide the data.                                                                                         
                                                                                                                                
MR. WALL said  one of the ways  an individual can end  up in this                                                               
category is  to be taken  to a DOC  facility on charges  that are                                                               
dropped  while the  individual is  in the  facility. Then  the ex                                                               
parte order  is filed.  SB 238 requires  notification as  soon as                                                               
the  order  is  filed  so  the  process  can  move  forward.  The                                                               
intention is to keep people in  that status for as little time as                                                               
possible.                                                                                                                       
                                                                                                                                
2:54:00 PM                                                                                                                    
CHAIR WILSON opened public testimony  and after first determining                                                               
no one wished to testify, closed public testimony on SB 238.                                                                    
                                                                                                                                
SENATOR SHOWER asked if the  bill will artificially constrain the                                                               
time needed to evaluate someone  and whether a longer time period                                                               
for evaluation might be needed.                                                                                                 
                                                                                                                                
MR.  WALL  explained  that  that  there  are  generally  accepted                                                               
guidelines  and practices  for psychiatric  care. The  evaluation                                                               
process is prescriptive with a  timeline. Evaluators are required                                                               
to see patients  within timeframes to re-evaluate  them because a                                                               
patient's   condition   changes   over  time,   especially   with                                                               
psychiatric needs. Patients who have  a substance in their system                                                               
need  time   to  detox.  Clinicians  and   doctors  follow  those                                                               
guidelines  for  observation.  He  deferred  to  Mr.  Bookman  to                                                               
address the legal aspects.                                                                                                      
                                                                                                                                
MR. BOOKMAN  said state requirements  vary as to how  long people                                                               
can be held  at a health care facility prior  to a court hearing.                                                               
Alaska requires  72 hours  of evaluation,  but some  states allow                                                               
five or  seven days. He  did not  think there was  anything magic                                                               
about 72  or 96 hours, which  is not established by  the state or                                                               
federal constitution. Legislators could  consider a longer period                                                               
of time, which  could fit into legal parameters, but  there are a                                                               
lot of things to consider.                                                                                                      
                                                                                                                                
SENATOR GIESSEL  expressed appreciation that  Deputy Commissioner                                                               
Wall  brought this  forward  as a  statute  since the  department                                                               
cannot write  regulations without  the statutory authority  to do                                                               
so. More importantly, he heard  the concerns and the interests of                                                               
the  committee. When  an agency  writes regulations,  legislators                                                               
have no say unless the  legislators enter into the public comment                                                               
period.                                                                                                                         
                                                                                                                                
CHAIR  WILSON reiterated  his request  for follow  up information                                                               
from DHSS and DOC's view of the legislation.                                                                                    
                                                                                                                                
SENATOR BEGICH requested information about the locations where                                                                  
people were being held.                                                                                                         
                                                                                                                                
3:00:01 PM                                                                                                                    
CHAIR WILSON held SB 238 in committee.                                                                                          
                                                                                                                                
3:00:44 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Standing Committee at 3:00 p.m.                                                                                                 
                                                                                                                                

Document Name Date/Time Subjects
SB 238 Version A.pdf SHSS 3/11/2020 1:30:00 PM
SB 238
SB 238 Transmittal Letter 2.27.20.pdf SHSS 3/11/2020 1:30:00 PM
SB 238
SB 238 Sectional Analysis Version A.pdf SHSS 3/11/2020 1:30:00 PM
SB 238
SB 238 Fiscal Note DOC 2.27.20.pdf SHSS 3/11/2020 1:30:00 PM
SB 238
SB 238 Fiscal Note DHSS 2.24.20.pdf SHSS 3/11/2020 1:30:00 PM
SB 238
SB 179 Public Input 3.10.20.pdf SHSS 3/11/2020 1:30:00 PM
SB 179
SB 179 DCCED response 3.10.20.pdf SHSS 3/11/2020 1:30:00 PM
SB 179