Legislature(2019 - 2020)DAVIS 106
03/10/2020 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB86 | |
| HB183 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 86 | TELECONFERENCED | |
| += | HB 183 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 183-ALASKA PSYCHIATRIC INSTITUTE
3:46:08 PM
CHAIR ZULKOSKY announced the next 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." [Before the committee was the proposed
committee substitute (CS) for HB 183, Version 31-LS1211\S, Marx,
3/3/20, adopted as work draft on 3/5/20.]
3:46:19 PM
REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, relayed
that Version S would address capacity and workforce issues that
were intimately related to the safety of both patients and
employees. He stated he had heard from providers that when the
Alaska Psychiatric Institute (API) had inadequate capacity and
people were held one-on-one in emergency departments, it was
expensive and dangerous for [psychiatric] patients, other
patients in the hospital, and employees. The proposed
legislation would help to remedy that situation by providing
adequate capacity at API.
3:47:21 PM
CHAIR ZULKOSKY opened public testimony on HB 183.
3:47:34 PM
FAITH MYERS, Mental Health Advocate, testified that she
supported HB 183. She said matching staff salary at API with
the private sector and improving staff safety would help to
create a stable workforce. She stated that in 2017, there were
over 500 patient complaints at API; 116 patients were injured,
90 needing medical care or hospitalization. She relayed the
Alaska State Legislature had not given the disabled the right to
file a formal appeal for grievances one of the few states that
had not. In 1992, the legislature knew psychiatric patients
would have problems receiving treatment in psychiatric
facilities or units. Patients were given the right to bring
grievances to an impartial body under AS 47.30.847, but the law
was poorly crafted, and patients did not have access to an
impartial body. She concluded by saying that a trained and
stable workforce, [indisc.] state laws, and hospital policies
are all essential for patient recovery.
3:49:46 PM
MICHAEL CAMPBELL, Clinical Social Worker, stated he worked at
API from 1988 to 1995 and for a short period in 2002. He stated
he supports HB 183. He said API was one part of a large mental
health system; what impacted one part of the system rippled
through the whole system, and problems with API were felt by
community mental health centers. There had been an issue with
API maintaining adequate staff to operate the hospital at full
capacity; that put pressure on API to discharge patients rapidly
and often before they were ready to be discharged; that in turn
placed an additional burden on community mental health centers
which weren't equipped to adequately manage people who were
still acutely disturbed and in need of intense services. The
community mental health centers had substantial caseloads;
therefore, when one of the newly discharged clients had severe
needs, it took time away from other clients. He stated having a
fully staffed hospital as well as salaries that are commensurate
or at a premium with other providers would help attract and
retain staff. He offered that in addition to salary, adequate
staff training, and support would encourage staff retention. He
said from the very beginning, the hospital was built for much
less capacity than was needed; the inadequate capacity further
burdened the system and did a disservice to the people who
desperately needed it. He offered his support for HB 183 to
raise salaries and increase the census at API.
3:54:09 PM
The committee took a brief at-ease.
3:54:39 PM
CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony.
3:54:58 PM
REPRESENTATIVE PRUITT moved to adopt Amendment 1, labeled 31-
LS1211\S.1, Marx, 3/5/20, which read:
Page 2, line 4:
Delete "and"
Page 2, line 6, following "funding":
Insert "; and
(6) the number of allegations, and the
results of all substantiated incidents, of
(A) violence toward a patient;
(B) inappropriate seclusion or restraint of
a patient;
(C) maltreatment of a patient; and
(D) neglect of a patient"
REPRESENTATIVE SPOHNHOLZ objected for discussion purposes.
3:55:05 PM
REPRESENTATIVE PRUITT offered the proposed legislation called
for a report on activities specifically related to employees,
but nothing related to patients. The proposed amendment would
include the type of information the legislature received through
the Ombudsman. He reviewed the additional requirements for the
report under Amendment 1 and maintained they would provide
information on how services were delivered to patients
particularly the items of concern brought forward by the
Ombudsman.
3:56:25 PM
REPRESENTATIVE FIELDS said he did not object to the intent of
the proposed amendment and suggested adding "or staff" after
"violence toward a patient" in subparagraph (A), [line 8], of
Amendment 1.
3:57:26 PM
The committee took an at-ease from 3:57 p.m. to 3:59 p.m.
3:59:48 PM
REPRESENTATIVE CLAMAN asked whether the addition of the items
specified under Amendment 1 to the activity report would raise
any issues for the state regarding tort liability or other
liabilities that may arise should the report be published on an
annual basis.
4:01:21 PM
STACIE KRALY, Chief Assistant Attorney General; Statewide
Section Supervisor, Human Services Section, Administrative
Services Division, Department of Law (DOL), replied it could
likely lead to increased litigation or other tort violations.
REPRESENTATIVE CLAMAN asked whether providing the information in
a public report would raise any Health Insurance Portability and
Accountability Act [of 1996] (HIPPA) violation issues.
MS. KRALY answered it would depend how the information was being
disclosed: if disclosed as deidentified aggregate data with no
way to identify an individual, there would be no HIPPA or
confidentiality issues. She added the same would hold true for
tort liability.
4:03:12 PM
REPRESENTATIVE CLAMAN asked whether adding the language in
Amendment 1 would have a significant potential of exposing the
state to tort liability of an unknown amount.
MS. KRALY expressed her belief that the language would not
present significant risk of liability, but it would increase the
risk of potential liability.
4:03:48 PM
REPRESENTATIVE CLAMAN offered that Amendment 1 would be an
invitation to lawsuits. He stressed the importance of
monitoring how well services were being provided at API,
however, did not support publishing a report that served as an
"open book" for more investigations costing the state more
money. He opined there may be ways to provide that information,
but Amendment 1 would not serve that purpose. He stated he did
not support the proposed amendment.
4:04:32 PM
REPRESENTATIVE SPOHNHOLZ stated she opposed the proposed
amendment. She offered the intent was to ensure API was a safe
and secure facility; however, she did not believe that would be
achieved through Amendment 1. She mentioned she was concerned
with potential liability. She mentioned her work with the API
governance board on legislation regarding an oversight board;
one requirement of the oversight board would be an annual report
to the legislature that consisted of a high-level look at the
functionality of API in meeting its public mission.
4:05:27 PM
REPRESENTATIVE SPOHNHOLZ maintained her objection.
REPRESENTATIVE PRUITT highlighted that the four items in
Amendment 1 were in the Ombudsman report. He maintained that
what increased liability was that the violations were occurring,
and the state was not fixing them. He said at some point, the
legislature must become aware of the violations as they occurred
and take action to correct them.
4:06:18 PM
REPRESENTATIVE TARR stated she had been provided information
from constituents about the rights of mental health patients and
deficiencies in the current system. She stated Alaska statutes
required a grievance procedure, that patients be notified of the
procedure, and that there be an impartial body. She mentioned
the governance board procedures and the Ombudsman report. She
offered her understanding that information was communicated
using inconsistent language and through different avenues; she
expressed skepticism that the information gathered through the
implementation of Amendment 1 would provide the answers she
wanted. She said she was interested in the information but only
if coordinated for consistency.
4:08:11 PM
A roll call vote was taken. Representative Pruitt voted in
favor of Amendment 1. Representatives Spohnholz, Tarr,
Drummond, Claman, and Zulkosky voted against it. Therefore,
Amendment 1 failed to be adopted by a vote of 1-5.
4:08:49 PM
REPRESENTATIVE SPOHNHOLZ moved to adopt Amendment 2, labeled 31-
LS1211\M.1, Marx, 3/6/20, which read:
Page 2, lines 21 - 22:
Delete "at least 55 beds in an adult civil unit"
Insert "at least
(A) 60 beds in an adult civil unit; and
(B) 10 beds in a youth civil unit"
CHAIR ZULKOSKY objected for discussion purposes.
REPRESENTATIVE SPOHNHOLZ offered Amendment 2 would call for 60
beds instead of 55 beds. She stated there were 120 young people
in facilities outside of Alaska; they required a level of care
that could not be provided by the private providers in Alaska.
She mentioned the "Bring the Kids Home" initiative, returning
1,100 young people to Alaska, and cited the importance of
trauma-informed care and keeping young people close to their
families. She stated Amendment 2 would require that API reopen
the Chilkat Youth Civil Unit [Haines].
4:09:59 PM
CHAIR ZULKOSKY removed her objection.
4:10:09 PM
REPRESENTATIVE TARR expressed her concern as to whether the 10-
bed youth civil unit under Amendment 2 could be achieved. She
cited the difficulty in securing professional staff and opening
the 10-bed unit from nothing. She asked whether the timeline
should be modified.
4:11:03 PM
CHAIR ZULKOSKY maintained her objection.
4:11:17 PM
CLINTON LASLEY, Deputy Commissioner, Department of Health and
Social Services (DHSS), responded API was gradually increasing
its census; it was currently 50; 80 was optimal. He said the
primary challenge was staffing; API competed with other health
care organizations vying for a small number of health care
workers. He relayed the Chilkat unit was one of the options
DHSS was considering; it must be done safely and with staff "on
board."
4:13:44 PM
REPRESENTATIVE CLAMAN asked how long it would take to achieve
the 60-bed requirement.
MR. LASLEY answered he was not comfortable giving a date; it was
a matter of safely "getting to the next step." In the past
year, API had gone from a low census - in the 20s - to the
current census of 50, through incremental increases. Until
there was enough staffing, the department was not comfortable
moving to the next phase.
4:14:48 PM
REPRESENTATIVE TARR cited Section 4 of Version S, [page 3, lines
4-6], which read:
APPLICABILITY. AS23.10.055(b), as amended by sec. 2 of
this Act, and AS 47.30.660(c)(3), enacted by sec. 3 of
this Act, apply to contracts entered into, amended,
extended, or renewed on or after the effective date of
this Act.
REPRESENTATIVE TARR stated since the proposed legislation did
not have an effective date, 90 days after signature was the
point at which any contracts entered into would be required to
meet the standards under Version S. She asked whether the 10-
bed unit could be achieved under the timeline.
4:15:34 PM
MR. LASLEY replied that as deputy commissioner, he would not
tell the hospital what it could safely achieve; the leadership
and governing board of API would make the decision on the next
step. He reiterated the timeline depended on getting enough
qualified trained staff in place. The department evaluated the
issue daily.
4:16:09 PM
REPRESENTATIVE SPOHNHOLZ asked for a description of the efforts
being taken by the department to recruit personnel.
MR. LASLEY reviewed a couple efforts: use of Wellpath's
consulting service, which worked with the state recruitment
office, and internal efforts through publishing positions
online. He stated approximately 12 new staff members would be
coming onboard in March [2020].
4:17:23 PM
REPRESENTATIVE SPOHNHOLZ asked whether there had been staff
turnover at API in the past nine months.
MR. LASLEY offered to provide the requested information.
REPRESENTATIVE SPOHNHOLZ asked whether the staffing levels were
moving in the right direction for a fully operational API. She
asked for a rough estimate of the progress.
MR. LASLEY responded API had been able to achieve a census of 50
and maintain that level for about 6 weeks. The next phase
looked positive with additional staff. He mentioned the
atmosphere at API was much better than previously; there were
smiles on people's faces. He maintained he could not give
specific dates but attested to the department doing everything
it could to recruit staff and move to the next phase - the goal
being a census of 80.
4:19:24 PM
REPRESENTATIVE CLAMAN asked about the current status of the
Wellpath contract.
MR. LASLEY answered the Wellpath contract ended March 31 [2020];
the department had looked at options for extending the contract
for a short period as it built the leadership team at API. He
offered the department would have a final answer in the next few
days; it was reviewing its options.
REPRESENTATIVE CLAMAN asked Mr. Lasley to notify the chair of
the [HSS] committee as to the decision whether the contract
was extended, for how long, and the cost of the extension.
MR. LASLEY agreed to do so.
4:20:59 PM
CHAIR ZULKOSKY referred to Section 3 of Version S and mentioned
the primary focus of the proposed legislation was providing
resources to promote the recruitment and retention of employees
at API in order to meet the standards and care. She asked the
sponsor to comment on the intent behind Section 3(c)(1), [page
2, lines 21-22, of Version S].
REPRESENTATIVE FIELDS relayed that when he drafted the proposed
legislation, the census at API was in the 30s. He stated that
he tried to pick an achievable goal. He mentioned he supported
Amendment 2 because it reflected the progress in the interim and
a new achievable goal. He stated API employees had indicated to
him over the past year staff at API were underpaid relative to
similar positions in the Anchorage job market, and Wellpath had
not been recruiting as aggressively as necessary. He maintained
the intent behind Section 3 was to ensure adequate staffing and
capacity through a prevailing wage standard. He maintained the
state was familiar with the system of prevailing wages. Given
the job market in Anchorage, the system made sense to ensure pay
and benefits were adequate to avoid a high rate of turnover of
staff.
4:23:24 PM
REPRESENTATIVE CLAMAN relayed he was broadly supportive of
establishing targets in statute but was concerned with the
effective date. He mentioned the possibility of a conceptual
amendment to establish an effective date of July 1, 2021 the
beginning of fiscal year 2022 (FY 22).
CHAIR ZULKOSKY agreed with the intent of the language as
expressed by Representative Fields yet acknowledged the
testimony of Mr. Lasley that staffing, recruitment, and
retention of employees was dynamic.
4:24:33 PM
REPRESENTATIVE TARR expressed her concern with building the
youth unit from nothing and non-compliance with the law
prompting a lawsuit.
REPRESENTATIVE TARR moved to adopt Conceptual Amendment 1 to
Amendment 2, adding an effective date of July 1, 2021, under the
"APPLICABILITY" section, for the requirement of a 10-bed youth
civil unit.
4:25:55 PM
The committee took an at-ease from 4:25 p.m. to 4:28 p.m.
4:28:00 PM
REPRESENTATIVE TARR withdrew her motion to adopt Conceptual
Amendment 1 to Amendment 2.
4:28:16 PM
CHAIR ZULKOSKY removed her objection to Amendment 2. There
being no further objection, it was so ordered.
4:28:33 PM
REPRESENTATIVE TARR moved to adopt Conceptual Amendment 3 to
include effective dates for the two provisions adopted under
Amendment 2. The effective date for subparagraph (A) - "60 beds
in an adult civil unit" - would be January 1, 2021; the
effective date for subparagraph (B) - "10 beds in a youth civil
unit" - would be July 1, 2021. Conceptual Amendment 3 would
amend the APPLICABILITY section under Version S to specify that
AS 47.30.660(c)(1)(A) would take effect January 1, 2021, and AS
47.30.660(c)(1)(B) would take effect July 1, 2021. There being
no objection, Conceptual Amendment 3 was adopted.
4:29:39 PM
The committee took an at-ease from 4:29 p.m. to 4:30 p.m.
4:30:51 PM
CHAIR ZULKOSKY opened public testimony on HB 183.
4:31:06 PM
ANDREE MCLEOD testified as a family member of someone who needed
API services. She stated she would have preferred the proposed
legislation specify 80 beds, since that was the capacity and
there was a need to utilize 80 beds. She expressed her
conviction the state should operate API; when the government
took away the rights and liberties of a person, that government
entity should be held directly accountable, inspected, and
regulated. She maintained the state should be directly
accountable to the person; the responsibility cannot be ceded to
a private enterprise who has alternative objectives one being
profit.
MS. MCLEOD expressed her amazement the legislature must codify
the provisions under HB 183; her expectation was that good
government would require all the positions to be filled and the
mission of DHSS and API executed. She agreed years of neglect
and lack of funding brought API to its low point; she maintained
it should be just as easy to "make it right again." She said,
"Just do your jobs and listen to the people who complain about
what's going on at API and not dismiss them and put the money
forward." She relayed a story: When she worked for the Alaska
Department of Fish and Game (ADF&G) in the 1980s, the top three
jobs were statistician, actuary, and other jobs related to
statistics. Statisticians were hard to come by and forecasting
fish runs became increasingly difficult. The simple solution
was for the Department of Administration (DOA) to reclassify
certain positions with appropriate salaries; no statutory
changes were needed; the departments worked together. The
problem was solved, and the fish forecasts have been excellent.
She offered, "We seem to care more about fish than we do
people." Even with the Alaska Mental Health Trust (AMHTA),
technology, and money, "family members are scared to do what
they have to do when they give away the liberties of their
family members to the state." She concluded by saying, "Lets
care more about people than we do fish."
4:35:03 PM
CHAIR ZULKOSKY, after ascertaining that there was no one else
who wished to testify, closed public testimony.
4:35:17 PM
REPRESENTATIVE SPOHNHOLZ moved to report CSHB 183, Version 31-
LS1211\S, Marx, 3/3/20, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
4:35:42 PM
REPRESENTATIVE PRUITT objected. He expressed his concern that
the proposed legislation was reactionary to a "snapshot" in
time. He maintained that whenever the legislature put into
statute the mechanism for compensation it made being competitive
more difficult for the state. He offered that by the time the
state collected the information, did the analysis, and decided
on a wage, the private sector, without the same procurement
rules, would adjust its wages quickly. He said it would be a
never-ending battle in which the state would never be able to
compete. He suggested instead of putting such mechanisms in
statute, the legislature should be eliminating provisions that
limited the states ability to manage and attract people; in the
attempt to remain competitive, "we bind our hands so that we
can't." He maintained his objection.
4:38:00 PM
REPRESENTATIVE SPOHNHOLZ expressed her appreciation for the
proposed legislation; for increasing the standard; and for the
prevailing wage provision that required wages at API be
competitive. She stated the legislature had worked hard to fund
additional staffing positions, to fund salary increases, and to
give the department the tools to increase salaries. She
maintained the prevailing wage provision gave the department the
structure by which to ensure people at API were appropriately
compensated for what was arguably the toughest job in the State
of Alaska. She offered work at API represented public service
at its absolute finest and deserves appropriate compensation.
4:39:46 PM
A roll call vote was taken. Representatives Spohnholz, Tarr,
Claman, Drummond, and Zulkosky voted in favor of reporting CSHB
183, Version 31-LS1211\S, Marx, 3/3/20, as amended, out of
committee with individual recommendations and the accompanying
fiscal notes. Representative Pruitt voted against it.
Therefore, CSHB 183(HSS) was moved from the House Health and
Social Services Standing Committee by a vote of 5-1.
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