Legislature(2019 - 2020)DAVIS 106
03/05/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Presentation: Addressing Gaps in the Crisis Psychiatric Response System | |
| HB86 | |
| HB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 183 | TELECONFERENCED | |
| += | HB 86 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 183-ALASKA PSYCHIATRIC INSTITUTE
4:32:19 PM
CHAIR ZULKOSKY announced that the final order of business would
be HOUSE BILL NO. 183, "An Act relating to the duties of the
Department of Health and Social Services; relating to the duties
of the Department of Labor and Workforce Development; and
relating to staffing and wage standards for the Alaska
Psychiatric Institute."
4:32:29 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt the proposed committee
substitute (CS) for HB 183, Version 31-LS1211\S, Marx, 3/3/20,
as the working draft.
4:32:44 PM
CHAIR ZULKOSKY objected for the purpose of discussion.
4:32:55 PM
REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, as prime
sponsor of HB 183, gave a PowerPoint presentation. Referencing
slide 2 of the PowerPoint, he explained that HB 183 would
address staffing and capacity issues in order to provide safe
conditions at the Alaska Psychiatric Institute (API). The
proposed legislation would also address the need in the
community for public safety and a cost-effective healthcare
system by addressing staff retention and correcting wage
disparities that currently exist. A low, but necessary, floor
had been set for maintaining bed counts, according to
Representative Fields. Bed count statistics were included in
slides 3 and 4 of the presentation. He said HB 183 would also
require an annual report by the Department of Health and Social
Services (DHSS) on related activities, including staffing
standards. In terms of bed counts, Representative Fields said
even 80 beds would be a lower amount than several decades ago.
At lower bed counts, API was full or almost full most of the
time, he related. Moving on to slide 4, he pointed out that the
bed count in the Adolescents Acute Care level was zero, which
was a big problem for public safety in the broader community as
well as for Alaskans who needed safe treatment.
4:35:26 PM
REPRESENTATIVE FIELDS said he had heard from health care
providers how dangerous it was when a lack of capacity at API
forced hospitals to hold psychiatric patients in the ER, often
for days, if not weeks. When that happened, he related, the
patients required one-on-one guards, which was not safe for
medical providers or Alaskans headed to the emergency room (ER)
for different issues. The costs were then passed on directly to
private health insurance payers including the state itself, he
added. He said providers were not only unable to get reimbursed
for these costs, but the administration was passing on more
costs to private payers, in this case the state. Situations
that created uncompensated care got passed directly back to the
state, he explained, which put pressure on premium cost growth
and made it more difficult to find sustainable fiscal solutions.
REPRESENTATIVE FIELDS, directing attention to slides 6 through
9, addressed the problem of ER holds for psychiatric patients, a
result of inadequate capacity at API, which was a problem in
Southcentral, Southeast, and the Interior. He highlighted the
importance of adequate staffing and related the story of assault
on an aide in 2019. He said the state department recognized the
lack of adequate staff when it issued a very large fine.
According to Representative Fields, the problems of violence
continued to grow.
4:38:20 PM
REPRESENTATIVE FIELDS said there was a disconnect between staff
inadequacies not being addressed and belief in the mission of
API among the same staff. In this way staff were making a
sacrifice to work at API as they put themselves in harm's way,
he related. According to slide 10, staff left API because of
bad management and mishandling of safety concerns, and staff
were also concerned about constant changing of management
including CEOs and doctors. He said the least employees
deserved was fair compensation as they would be safer working
elsewhere where they would be paid fairly. Referencing slide
11, he said HB 183, in its attempt to deal with staffing and
capacity issues, was consistent with the 2019 Ombudsman's report
and the 2017 feasibility study. He noted that staffing issues
had been addressed in the past, but, echoing what Mr. Metcalfe
had said, they were not addressed in such a way that sufficed to
meet the real needs at API.
4:39:57 PM
REPRESENTATIVE TARR asked about the prevailing rate of wages for
similar work and, since there was only one state-run facility,
whether North Star Behavioral Health System ("North Star") was
the comparison. She asked whether there was potential to limit
the ability of the union to negotiate for something better or
whether it was "not less than" language.
REPRESENTATIVE FIELDS replied it would be a new policy to
establish a prevailing wage; however, prevailing wages were
nothing new. He confirmed "not less than" language ensured a
prevailing wage floor was consistent with collective bargaining
agreements, and if the state and unions wanted to set wages
higher for comparable positions due to API's challenging work
environment, then that would be the state's and union's
prerogative. In terms of comparable positions, the prevailing
wage language was based on comparable positions in other
sectors. He added that other prevailing wages in the broader
market should be looked at, not just North Star and API.
4:42:11 PM
REPRESENTATIVE SPOHNHOLZ pointed out the disparity for wages,
referencing psychiatric nurses at Providence Health & Services
being paid $12 per hour more than those at API. She asked how
the number of 55 beds was reached, as 50 beds were currently
operational, but the facility had capacity for 80 beds.
REPRESENTATIVE FIELDS answered that the lowest and most
conservative number was decided upon based on a look back at the
need for occupied beds. He questioned whether a higher number
would be safer for the community and said the lower number was
chosen in order to determine the number of patients who would be
able to be treated at API instead of at less appropriate
facilities.
REPRESENTATIVE SPOHNHOLZ opined that the staffing ratios should
be appropriate, and she indicated that forcing slots to be open
when there was no capacity to fill them was what led to the
current staffing issue. She added that API needed to work
toward functioning at its full capacity, as there used to be 160
inpatient beds; considering population growth, anything less
than full capacity could not be justified.
REPRESENTATIVE FIELDS said that he would be supportive and defer
to the will of the committee regarding the correct number of
beds. Addressing Representative Tarr's question, he said DHSS
had contended prevailing wages would conflict with collective
bargaining agreements, and that unions that represent employees
have stated that was not their view.
4:45:22 PM
REPRESENTATIVE TARR commented things become more expensive when
they were not done right the first time. She indicated that
this is a time for not being "penny wise, ... pound-foolish"
when there is a choice to have a high-functioning facility with
adequate staffing.
4:45:58 PM
BESSE ODOM, Staff, Representative Zack Fields, Alaska State
Legislature, on behalf of Representative Fields, prime sponsor,
presented the Sectional Analysis for HB 183, beginning with AS
18.05.020, the statute regarding submission of an annual report
by DHSS to the legislature. Under HB 183, the report must
include: the number of employees who vacated positions during
the reporting period; the number of funded positions that are
vacant; a description of efforts made to recruit and retain
employees; the number and cost of additional positions if
additional positions are deemed necessary; and the amount and
purpose of additional funding if additional funding is deemed
necessary.
MS. ODOM related that Section 2 amended AS 23.10.055(b), the
statute regarding employee compensation rate, with conforming
language that reflected Section 3 of HB 183. Version S would
amend the language to "hospital employee" rather than "health
care provider", she explained. Section 3 amends AS 47.30.660 to
increase and maintain bed counts, implement staffing standards,
and establish wages as determined by the Department of Labor and
Workforce Development (DLWD). Section 4 would define
applicability of HB 183 to contracts entered, amended, extended,
or renewed on or after the effective date.
4:47:36 PM
CHAIR ZULKOSKY removed her objection to the motion to adopt the
proposed committee substitute (CS) for HB 183, Version 31-
LS1211\S, Marx, 3/3/20, as the working draft. There being no
further objection, Version S was before the committee.
4:47:50 PM
MARK REGAN, Legal Director, Disability Law Center of Alaska
(DLC), said DLC was the plaintiff in one of the lawsuits that
led to the requirement there be a plan for fixing problems in
the civil commitment evaluation system. He informed the
committee he was there to testify as to API's role regarding the
decision whether folks needed longer-term commitments. For
DLC, the problem got bad in Fall 2018 when there was the report
of working conditions at API followed by a collapse in the
capacity of the facility, which had been up around 80 and
included 70 civil beds and 10 forensic beds and had gone down to
about half of that very quickly amid a myriad of problems. Mr.
Regan related one of the problems was that word had gone out
from API and from DHSS what would need to happen was when
someone potentially dangerous to self or to others was picked
up, that person, if in Southcentral Alaska, would typically be
taken to API for evaluation - but that API had been at capacity
and not taking people. Then word went out from API that some
people that fit the above description would have their liberties
taken away from them and would have to stay either in a
correctional facility such as the Anchorage Correctional Complex
or even in jail with people who had been accused of crimes until
a place opened at API and they could be evaluated there.
MR. REGAN stated there was no problem in transferring the
patients; there was a real problem with API being unable to
evaluate them and they were forced to sit in a hospital ER. The
lawsuit was regarding what the law said should be done with
people experiencing these types of problems. He said DLC
thought it was the responsibility of the state government, and
principally DHSS, to care for and minimize the length of time
people would be required to stay in jails and ERs.
4:52:40 PM
MR. REGAN stated what would happen with HB 183 was there would
be a requirement that staffing would be at 55 civil beds, for a
total of 65 with the 10 forensic beds, which would be better
than what it was now, as only 40 were available for civil
patients at the time of his testimony. The question from DLC's
perspective, according to Mr. Regan, was whether it would be
enough to solve the problem such as the one that arose in the
fall of 2018. He answered it would probably not be and offered
some alternatives for the committee to consider: DLC had
proposed to the court that DHSS send evaluators to locations
people were to determine whether they would need civil
commitment. He also mentioned, as an alternative, an off-site
Crisis Now facility, which would enable a place that was not API
to conduct evaluations in a non-institutional setting. Together
with a rebuilding of capacity at API, DLC believed that the
problem of people being stuck in jail or in hospital emergency
rooms could be reduced. Mr. Regan added that according to the
way the law was written, evaluation was supposed to take place
immediately. He added that the problem did not start in Fall
2018 but had been happening sporadically for many years.
4:56:08 PM
CHAIR ZULKOSKY said the committee would return to invited
testimony on HB 183 at its next meeting.
CHAIR ZULKOSKY announced that HB 183 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Fiscal Summary for Settlement of 3AN-18-09814CI.pdf |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Crisis Psychiatric Response System |
| Addressing Gaps in the Crisis Psychiatric Response System--2 page overview.pdf |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Crisis Psychiatric Response System |
| HB183 ver M Supporting Document Combined Letters of Support 3.3.2020.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |
| HB 183 v.S.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |
| CSHB 86 ver U Letters of Support 3.28.19.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 86 |
| Addressing Gaps in the Crisis Psychiatric Response System.PDF |
HHSS 3/5/2020 3:00:00 PM |
Addressing Gaps in the Psychiatric Response System |
| HB 86 Version U Amendment 1.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 86 |
| HB 183 Version S Amendment 1.pdf |
HHSS 3/5/2020 3:00:00 PM |
HB 183 |