Legislature(2023 - 2024)DAVIS 106
03/14/2024 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Board of Direct Entry Midwives | |
| HB363 | |
| HB187 | |
| HB205 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 187 | TELECONFERENCED | |
| *+ | HB 363 | TELECONFERENCED | |
| *+ | HB 205 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 363-FOSTER CHILDREN PSYCHIATRIC TREATMENT
3:21:11 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 363, "An Act relating to the placement of foster
children in psychiatric hospitals."
REPRESENTATIVE ANDREW GRAY, Alaska State Legislature, as prime
sponsor, introduced HB 363. He encouraged the committee to
adopt the proposed committee substitute.
3:23:08 PM
REPRESENTATIVE RUFFRIDGE moved to adopt the proposed committee
substitute (CS) for HB 363, Version 33-LS1049\S, Bergerud,
3/13/24, as the working document.
REPRESENTATIVE SADDLER objected for the purpose of discussion.
3:23:45 PM
MATTHEW TURNER, Staff, Representative Andrew Gray, Alaska State
Legislature, on behalf of Representative Gray, prime sponsor of
HB 363, explained the summary of changes from the original bill
version to Version S {included in the committee packet], which
read as follows [original punctuation provided]:
Title Change
Add: and amending Rule 12.1(b), Alaska Child in Need
of Aid Rules Procedure
Eliminate Section
Eliminate section 1 from version A.
Section 1
Amends AS 47.10.087(b) to conform to subsequent
changes.
Section 2
Adds two definitions to this section: "acute
psychiatric hospital" and "contemporaneous two-way
video conference".
Section 3
Adds new rules specifically for how the Department of
Family and Youth Services may place a child into an
acute psychiatric hospital, how the Department must
immediately begin search for a less restrictive
placement for when the child is released from the
acute psychiatric hospital, rules for assuring a
timely initial court hearing to review the placement
of the child, and for establishing regular ongoing
hearings to assure the child does not remain in the
acute psychiatric hospital for longer than necessary.
3:25:10 PM
The committee took a brief at-ease at 3:25 p.m.
3:25:36 PM
REPRESENTATIVE GRAY gave the sponsor statement for Version S of
HB 363 [included in the committee packet]. He explained that HB
363 aims to require children in the custody of the Office of
Children's Services (OCS), also known as foster children, to
receive a hearing in front of a judge in a timely manner to
ensure that they meet the criteria to be placed under the care
of a psychiatric hospital. He cited Native Village of Quinhagak
vs State of Alaska, heard in the Alaska Supreme Court, and
highlighted the judge's opinion that "there is no doubt that
children in OCS custody are at substantial risk of being
hospitalized for longer than they need" and the statement made
that "clarifying the legal protections for a vulnerable
population of children in state custody is of utmost public
importance." He said the Alaska Supreme Court determined that
the current 46-day wait between a child's first admission and
court hearing is far too long to satisfy due process. When a
young person is hospitalized in a psychiatric institution, that
person has limitations placed on their rights and freedoms that
are not placed onto others. He said the chance that a foster
child's rights could be restricted are much higher than that of
other children. He said that often, one of the greatest traumas
experienced by foster children is the process of admission to a
psychiatric institution; it is akin to a form of incarceration.
He advised that children have suffered from admissions that were
too long and unnecessary, which is what HB 363 Version S aims to
solve. He opined that the priority should not be on the child,
not on making the legal process surrounding foster childcare and
custody more convenient for the adults involved.
3:31:27 PM
MR. TURNER began the associated PowerPoint presentation to HB
363, Version S [hardcopy included in committee packet]. He
started on slide 1, which explained the purpose of HB 363,
Version S, by giving context with an article of the Constitution
of the State of Alaska. He moved through slides 3-4, which gave
context to the reality of the situation faced by acute
psychiatric care facilities across Alaska. He continued to
slide 5, which touched on the Alaska Supreme Court ruling that
OCS children are at risk of being hospitalized longer than is
necessary. He moved forward to slide 6, which explained the
authority that OCS has with regard to the placement of foster
children in psychiatric care. He continued to slide 7, which
showed a graph of OCS youth placements into acute psychiatric
care from 2017-2022. Finally, he moved through slides 8-9,
which explained what HB 363, Version S, would do if put into law
to solve the issues surrounding OCS childcare in Alaska.
3:36:33 PM
MR. TURNER offered the sectional analysis for HB 363, Version S
[included in committee packet], which read as follows [original
punctuation provided]:
Section 1
AS 47.10.087 Placement in secure residential
psychiatric treatment centers.
Amends AS 47.10.087(b) to conform to subsequent
changes.
Section 2
AS 47.10.087(d) Definitions
Adds two definitions to AS 47.10.087(d) and renumbers
the section to conform to these changes.
The first defines an "acute psychiatric hospital" as a
facility that primarily provides diagnosis and short-
term treatment of mental, emotional, and behavioral
disorders.
The second defines a "contemporaneous two-way video
conference".
Section 3
AS 47.10.087 Child in need of aid procedures
Adds new subsections to AS 47.10.087 that do the
following:
(e) Allows OCS to place a child in its custody into an
acute psychiatric hospital if it is the least
restrictive placement available, and the person in
charge of admittance to the facility finds that acute
psychiatric care is the best course of action for the
child.
(f) Within 24 hours after placing a child in an acute
psychiatric hospital under OCS shall notify the court,
the child's parents, and any other parties to an
ongoing child-in-need-of-aid case involving the child
of the placement.
(g) A court shall review a placement made under (e) of
this section within 48 hours after receiving
notification of the child's placement in an acute
psychiatric hospital. The court shall notify the
child, the child's attorney, the child's parents, the
department, and any parties to a child-in-need-of aid
case involving the child of the time and place of the
hearing once the hearing is scheduled.
Additional language defines the 48-hour period to
allow for weekends and holidays, and allows the court
an additional two day continuance if the concerned
parties cannot meet earlier. To make the hearing
easier, it may be held via teleconference.
The hearing will determine whether continued placement
in an acute psychiatric hospital is in the best
interest of the child. If the child remains in the
acute psychiatric hospital, there will be review
hearings held every 30 days or at the request of the
child or another party after showing good cause.
3:39:34 PM
MATEO JAMIE, as a foster child, gave invited testimony on HB
363, Version S. He described his experience being placed in a
psychiatric facility and said when he was admitted, all of his
belongings were taken from him and he was forced to wear medical
scrubs, all of which were distressing. He said he was placed in
a psychiatric facility because there were no available foster
homes, which the doctor at the facility acknowledged was common
practice. He said that during his two-month stay at the
facility, his OCS worker visited him only twice to determine if
the facility was the correct placement or not. He described
situations where staff physically attacked the youth staying at
the facility and police were called in to maintain order, and he
cited these situations as causes for post-traumatic stress
disorder (PTSD). He said that if they didn't obey every
command, children at the psychiatric facility would receive a
chemical sedative via injection, which further contributed to
the trauma and humiliation of being admitted to a psychiatric
institution. He explained that he felt "like a zombie" for the
two months he was admitted to the institution and had no say
over anything in his life. He emphasized that psychiatric care
should not be used as a substitute for proper placement in a
foster home and said that foster youth deserve placement
decisions within three days of admittance to OCS.
3:42:48 PM
REPRESENTATIVE MINA gave her thanks to Mr. Jamie for sharing his
experience in the foster care system in Alaska.
REPRESENTATIVE PRAX speculated that just being at the
psychiatric facility was enough to cause trauma.
MR. JAMIE confirmed that is correct; he still has PTSD attacks
to this day.
3:43:51 PM
SARAH LEWIS, as a foster care child, gave invited testimony on
HB 363, Version S. She described her own experience in the
foster care system, saying she was in the system until she aged
out when she turned 21. She said foster youth are being placed
in psychiatric hospitals even though the public has been made
aware of the fact that these institutions are not the right
place for many of them. She shared a story of her younger
brother and sister's experience in the foster care system, in
which they were made to wait 29 days in a psychiatric facility
after being removed from a previous foster home. She emphasized
how traumatizing this process was for both her and her siblings
and said that the child has no say in their placement of foster
care. She recounted a visit to a psychiatric hospital that her
youngest sister was placed in where a nurse was taunting a
foster child and threatening them with an injected chemical
sedative. She described her visit to her younger sister as
heartbreaking, saying it was as though she was a zombie due to
the heavy volume of sedative medication they were giving her at
the institution. She said that OCS has created this trauma and
done nothing to remedy it, all the while the foster child has no
say in their placements in the system.
3:49:37 PM
REPRESENTATIVE RUFFRIDGE asked Ms. Lewis to expound on why her
role as a placement caregiver in the foster care system wasn't
the first option in a foster youth's journey.
MS. LEWIS said she did not know why OCS chose not to give her
immediate custody of her younger siblings; she only won custody
after she obtained an attorney.
3:52:09 PM
REPRESENTATIVE FIELDS said he was baffled by the accusation
pertaining to NorthStar Psychiatry and asked how those
grievances could have occurred.
NANCY MEADE, General Counsel, Alaska Court System, answered
committee questions relating to HB 363, Version S, deferred the
question to OCS.
REPRESENTATIVE FIELDS asked what mechanism beside making an
appeal would be available if OCS doesn't help in regard to an
alleged abuse at NorthStar Psychiatry.
MS. MEADE answered that she is not aware of litigation
surrounding NorthStar Psychiatry but would investigate it.
3:53:51 PM
KIM SWISHER, Deputy Director, Office of Children's Services,
Department of Family & Community Services, gave invited
testimony on HB 363, Version S. She said she isn't able to
speak to ongoing litigation relating to NorthStar Psychiatry,
but she said that there are very few acute psychiatric hospital
settings in Alaska where OCS is able to give urgent care to
foster youth experiencing urgent mental health needs.
REPRESENTATIVE FIELDS asked what it would take for OCS to find
an alternative to NorthStar Psychiatry after years of documented
abuse.
MS. SWISHER responded that she has seen the number of children
who need to use NorthStar decline and added that OCS is working
with NorthStar to remedy complaints that are put forward.
REPRESENTATIVE FIELDS asked if OCS has worked with nonprofit or
tribal health providers to establish other options for foster
care placement.
MS. SWISHER replied that she would have to get back to
Representative Fields later.
3:56:50 PM
CHAIR PRAX asked how OCS makes the choice for which psychiatric
facility to use and how OCS verifies that the care being
provided is adequate.
MS. SWISHER answered that often, acute care settings are chosen
when OCS is awaiting evaluation of a foster child's evaluation,
which she emphasized is performed by a qualified mental health
professional.
3:58:58 PM
REPRESENTATIVE RUFFRIDGE asked if there is a potential to have a
position within OCS whose sole job is to evaluate foster
children for placement options.
MS. SWISHER answered that OCS utilizes acute care settings when
a foster child meets the criteria for that need. She said that
OCS doesn't have an in-house mental health professional to
evaluate foster children but does partner with outside
providers, and she said she would follow up with more
information later.
4:01:20 PM
REPRESENTATIVE MINA asked Ms. Meade to compare the standard
timelines for court hearings of an adult and a child being
considered for psychiatric facility.
MS. MEADE responded that in the comparable scenario for an
adult, a court hearing is required within 72 hours of a
placement in a psychiatric facility. She said that with regard
to children's psychiatric placement, there is no timeline under
current statute, which is what HB 363, Version S, aims to
address. She said if a court determines that an adult who is
being considered during the 72-hour hearing does not meet the
criteria of acute care, the adult is released; whereas a child
isn't just let go and must be sent somewhere, psychiatric
institutions often being the only least-restricting alternative.
She acknowledged that it does take longer for a child to get a
hearing than an adult because of the number of people and
entities involved in the process. She said that 3 days might be
too short but agreed that anything over 14 days is too long.
She advised that it is up to the legislature to set the adequate
timeline that the courts must follow.
4:07:15 PM
REPRESENTATIVE MINA echoed her understanding that there is
currently no requirement to have a court hearing unless it is
requested by someone.
MS. MEADE answered that the current statute that governs OCS
childcare says a court hearing must be granted within 30 days of
the child being taken into care, and said that statute would be
amended by HB 363, Version S.
4:09:07 PM
CHAIR PRAX asked whether a foster child has an advocate beside
OCS. He clarified the timeline of a foster child's court
hearing and gave a hypothetical scenario of a child under OCS
care to clarify his understanding of how the OCS childcare
system currently functions.
MS. MEADE responded that the intent of HB 363, Version S, is to
shorten the timelines of court case hearings for foster
children. She clarified that HB 363, Version S, would address
foster children who are already in state custody, not children
who are in need of emergency assistance by OCS.
CHAIR PRAX gave another hypothetical scenario to clarify his
understanding of the OCS childcare system.
MS. SWISHER confirmed that Chair Prax' understanding is correct:
a qualified mental health professional evaluates a foster child,
and then OCS works with a care provider to find the least-
restrictive option for the child. In response to a series of
follow-up questions from Representative Prax, said that
sometimes foster children are evaluated and immediately sent
back to lower levels of care but the challenge in Alaska is
locating safe, appropriate step-down care services. She added
that OCS has recently been doing safety checks and takes direct
consultation with foster children.
4:18:09 PM
REPRESENTATIVE GRAY gave context to the proposed 72-hour figure
as written in HB 363, Version S. He said he asked the
Department of Law and spoke with OCS about the proposed 72-hour
figure and acknowledged that the Native Village of Quinhagak vs
State of Alaska, Office of Children's Services case recognizes
that the 72-hour figure might be too tight of a timeline, but
said it is incumbent upon the legislature to select the absolute
[maximum time in which foster child must be placed].
4:19:49 PM
REPRESENTATIVE MINA asked how many court hearings have
teleconference or hybrid hearing capabilities.
MS. MEADE answered that OCS has a robust video presence and
hybrid court options are viable for most who can't make it to
the hearing.
4:22:05 PM
REPRESENTATIVE RUFFRIDGE gave his thanks to Representative Gray
for putting HB 363, Version S, forward and suggested that there
be language added to include an obligation to a child being
released should they not meet the criteria for acute psychiatric
care. He asked Ms. Meade to speak to the burden of proof of the
state, and asked Ms. Swisher whether OCS had noticed any of the
complaints brought forward or taken any action to remedy them.
4:25:57 PM
MS. SWISHER, responding to Representative Ruffridge, said that
she has seen changes with NorthStar Psychiatry in working with
its personnel, and OCS takes these complaints seriously and will
continue to investigate them.
MS. MEADE explained that the standard of evidence for admitting
a foster child to acute psychiatric care is "clear and
convincing" evidence that the child is suffering from a mental
illness. She cited page 3, line 9 of HB 363, Version S, which
clarifies that the court can authorize OCS to continue the
placement into acute psychiatric care, but said the presumption
is to not place them into care if not necessary. She said in
child cases, an individual's will is not as important as in
adult cases. She said the decision is based off of a
consideration of all of the evidence presented by all parties
involved in the case and emphasized that there is a statewide
problem with quality mental health facilities and treatment in
Alaska.
4:29:28 PM
CHAIR PRAX expressed interest in how a decision is considered
between adults and children.
REPRESENTATIVE GRAY, in response to Representative Ruffridge,
said that he believes OCS is doing its best to get foster
children the placements and care they need but is inhibited by a
lack of resources. He emphasized that the moment a foster child
says the words, "I'm going to kill myself," a child must be
taken away from their current placement and reevaluated. Making
a statement is sometimes a method used by children in OCS
custody to escape an unhappy placement, whether true or not.
4:31:59 PM
MS. LEWIS added to Representative Gray's testimony, clarifying
that she was referencing her brother, Jeremy Redmond, who passed
away in October 2020 due to a lack of care by OCS. She said
that the job of OCS is to take care of the children in its
custody, but it didn't follow through with that promise. She
said that OCS chose to wait until there was a crisis in her home
with her brother. She recalled going to court to testify
against her brother's foster home placement and said her calls
had been ignored. She said that after placement in this foster
home, her brother was staying with an adult still under OCS care
that she pleaded with the OCS to be removed but was not. She
said this adult under OCS care provided her little brother
drugs, and it was OCS who notified Ms. Lewis of her little
brother's overdose death, even after her pleas to have the
person removed.
CHAIR PRAX asked why Ms. Lewis was disqualified from custody of
her little brother.
MS. LEWIS said that she was disqualified from foster parenthood
because she could not provide her little brother with the
behavioral health services that he was required to be receiving
under OCS care.
4:37:48 PM
A roll call vote was taken. Representatives McCormick,
Ruffridge, Sumner, Fields, Mina, and Prax voted in favor of
adopting the proposed CS for HB 363, Version 33-LS1049\S,
Bergarud, 3/13/24, as a working document. [Representative
Saddler was absent.] Therefore, by a vote of 6-0, Version S was
before the committee.
4:39:14 PM
REPRESENTATIVE FIELDS commented that one of the reasons
institutions with histories of abuse can still exist is because
of the for-profit motive of psychiatric care facilities. He
urged committee members to guide OCS further because what is
happening currently is outrageous.
REPRESENTATIVE MINA added that the Department of Health (DOH)
and the Department of Family and Community Services (DFCS) have
a draft of a youth behavioral health plan that seeks to address
downstream services of the departments. There is a public
comment period open until March 17.
4:41:02 PM
CHAIR PRAX announced that HB 363, Version S, was held over.