Legislature(2025 - 2026)BUTROVICH 205
01/28/2025 03:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB45 | |
| SB44 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | SB 44 | TELECONFERENCED | |
| *+ | SB 45 | TELECONFERENCED | |
SB 44-MINORS & PSYCHIATRIC HOSPITALS
4:30:52 PM
CHAIR DUNBAR reconvened the meeting and announced the
consideration of SENATE BILL NO. 44 "An Act relating to the
rights of minors undergoing evaluation or inpatient treatment at
psychiatric hospitals; relating to the use of seclusion or
restraint of minors at psychiatric hospitals; relating to a
report published by the Department of Health; relating to
inspections by the Department of Health of certain psychiatric
hospitals; and providing for an effective date."
4:31:33 PM
SENATOR MATT CLAMAN speaking as sponsor of SB 44 stated that in
2022, the United States Department of Justice (DOJ) investigated
Alaska's behavioral health care system for youth and found an
overreliance on institutionalization to treat minors with
behavioral health disabilities. In response to the DOJ's
findings, the Department of Health launched the Behavioral
Health Roadmap project for Alaska youth in the fall of 2023. He
acknowledged and appreciated the efforts made by the department,
behavioral health providers, and stakeholders who contributed to
regional meetings and the drafting of the report. He expressed
hope that through continued collaboration, meaningful progress
could be made to provide care for Alaska's youth in the most
appropriate settings along a full continuum of care.
4:32:22 PM
SENATOR CLAMAN emphasized the urgent need for transparency and
increased parent or guardian involvement at psychiatric
hospitals that serve Alaskan youth with behavioral health needs.
He explained that Senate Bill 44 aims to enhance and protect the
rights of these young patients and outlined its four main
objectives. First, the bill ensures youth patients have access
to at least one hour of communication with a parent or legal
guardian each week. Second, it requires the Department of Health
to conduct biannual, unannounced inspections of facilities
providing residential psychiatric treatment for youth, during
which 50 percent of all youth patients must be interviewed about
their experiences. Third, the bill mandates that any use of
seclusion or restraint on a youth patient must be reported
within 24 hours to both the Department of Health and the
patient's parent or guardian. Fourth, it enhances transparency
by requiring the Department of Health to publish an annual
report on minors in psychiatric hospitals and make it publicly
accessible.
4:33:40 PM
BREANNA KAKARUK, Staff, Senator Matt Claman, Alaska State
Legislature, Juneau, Alaska, provided the sectional analysis for
SB 44:
[Original punctuation provided.]
Senate Bill 44
Sectional Analysis Version A
Section 1
AS 47.30.840 Right to privacy and personal
possessions; other rights. Adds a new section to
ensure a minor undergoing evaluation or inpatient
treatment at a psychiatric hospital has the right,
unless otherwise prohibited by law or court order, to
have confidential video communication at least once
each week for at least one hour with the minor's
parent or legal guardian, which will be facilitated by
the psychiatric hospital.
Section 2
AS 47.32.030 Powers of the Department of Health and
the Department of Family and Community Services;
delegation to municipality. Adds a new subsection (e)
and (f). Subsection (e) requires the Department of
Health to prepare an annual report regarding minors in
psychiatric hospitals, to publish the report on the
department's website, submit to the Senate Secretary
and Chief Clerk of the House of Representative, and
notify the Legislature of its availability. Subsection
(f) requires the Department of Family and Community
Services to collect data on minors who receive
residential psychiatric care at psychiatric hospitals
and to submit it to Department of Health for their
report.
Section 3
AS 47.32.110 Right of access and inspection. Amends
subsection (c) to authorize the officer or employee of
a department with licensing authority to enter for any
purposes described in new subsection (d).
Section 4
AS 47.32.110 Right of access and inspection. Adds a
new subsection (d) to require a designated agent or
employee of the Department of Health to conduct, at
least twice a year, unannounced inspections of each
psychiatric hospital where minors undergo evaluation
or inpatient treatment in which a minor has spent more
than three nights in the preceding year. At these
inspections, the designated agent or employee must
interview at least 50 percent of the patients.
Section 5
AS 47.32.200 Notice required of entities. Adds a new
subsection (g) to require a psychiatric hospital to
send written notification of each use of seclusion or
restraint on a minor, including the use of a chemical,
mechanical, or physical restraint, to the Department
of Health and the minor's parent or guardian within
one business day after the use of seclusion or
restraint.
Section 6
Sets the effective date of July 1, 2025
4:36:00 PM
SENATOR TOBIN asked a question regarding the definition of
"physician" in SB 44, page 2, line 1, which mentions the
overseeing physician. She said she was unclear whether this
definition includes clinical psychologists or advanced nurse
practitioners with psychiatric training who may be responsible
for overseeing care in these facilities. She asked whether the
definition is inclusive of those professionals who might also be
involved in monitoring the treatment of youth patients.
4:36:53 PM
SENATOR CLAMAN asked for clarification of the question. He
stated the question asked is not specifically about the
definition of "physician" itself, but rather about the meaning
of the term "overseeing physician" as modified by the word
"overseeing." He sought to confirm whether the question was
focused on that modifier and its implications for who qualifies
as overseeing care.
SENATOR TOBIN clarified her question by referencing the phrase
"approved by the overseeing physician" in SB 44. She asked what
is meant by "overseeing physician" and what the definition
includes. She wanted to know whether it is inclusive of all
professionals who might be identified as overseeing care in
treatment facilities, such as a clinical psychologist who may be
responsible for treatment oversight. She noted that such
individuals are not necessarily licensed under the State Medical
Board but may instead be licensed under the State Board of
Psychologists and Psychological Associate Examiners. She asked
whether those individuals are included in the definition.
4:37:43 PM
SENATOR CLAMAN responded that this may be an area where further
discussion is needed. He explained that, as currently drafted,
the term "overseeing physician" in the bill likely refers to the
physician in charge of medical care at the facility level,
rather than the individual overseeing the care of a specific
patient. For example, at the Alaska Psychiatric Hospitalone of
the facilities to which this legislation would applythe
overseeing medical professional has historically been a
physician. He clarified that while clinical psychologists or
other providers may be responsible for direct care of individual
patients, the bill appears to require that any decision to
restrict a youth's communication with their parent would need to
be approved by the physician overseeing the facility's
operations, not just the provider managing day-to-day care. He
added that if there is interest from the committee in allowing a
mid-level clinical provider who supervises a specific patient's
care to make that determination, it would be a reasonable
consideration. However, as drafted, the bill assigns that
authority to the physician in charge of the facility.
4:39:21 PM
SENATOR TOBIN explained that she raised the question because SB
44, page 1, line 11, the language states that the "overseeing
physician" may determine whether communication with a parent is
"therapeutically unadvisable." In her interpretation, that
decision would likely come from someone directly overseeing the
child's caresomeone with firsthand insight into the therapeutic
needs of the patient. She noted that this person might not
necessarily hold an MD degree but could hold another other
degrees.
4:39:53 PM
SENATOR GIESSEL noted that about four or five years ago, the
state expanded the types of clinicians authorized to provide
care in psychiatric hospitals to include physician assistants
and advanced nurse practitioners. She suggested reviewing the
definition of "physician" in SB 44, and if the intent is to
limit it to physicians only, an amendment could be offered.
SENATOR CLAMAN stated that he would look into the definition
issue further. He emphasized that while he is not committed to
requiring approval from the physician overseeing the entire
facility, he supports having a higher-level sign-off when a
treatment provider deems parental contact therapeutically
inadvisable. He noted this would serve as a check and balance,
ensuring such decisions are not made routinely or without
thorough consideration.
4:41:32 PM
SENATOR HUGHES questioned the rationale for limiting youth
communication with parents or guardians to no more than four
occasions per week in SB 44. She asked whether this restriction
would prevent more frequent contact, such as daily video
communication, if recommended by the supervising provider. She
sought clarification on the intent behind the statutory limit.
SENATOR CLAMAN clarified that the language in SB 44 sets a
minimum standard for youth communication with parents or
guardians, not a maximum. He stated that care providers could
allow more frequent contact if appropriate. The intention is to
ensure that youth receive at least the minimum required contact.
SENATOR HUGHES said she understands that the one-hour
requirement is intended as a minimum but expressed concern that
the phrase "over not more than four occasions" imposes a limit.
She questioned whether this language would prevent a clinician
from allowing more frequent contact, such as daily
communication. She suggested that the limiting phrase be removed
to avoid unintended restrictions.
4:43:01 PM
SENATOR DUNBAR said he may be misinterpreting the language, but
noted that on line 10 the SB 44 grants the minor "the right,"
which he interpreted as a minimum or floor. He stated that, as
written, the bill gives the minor the right to at least one hour
or four occasions but does not prevent the facility from
allowing more contact. He asked if Senator Claman has the same
interpretation.
SENATOR CLAMAN replied he was in exact agreement but
acknowledged it was worth further discussion offline. He stated
that everyone seemed aligned on the intent. He agreed with
Senator Hughes that the language should not imply a maximum
number of visits or establish a ceiling for communication
allowed by the facility.
4:43:45 PM
SENATOR HUGHES asked about the practicality of the requirement
in Section Four, page three, for unannounced inspectors from the
Department of Health to interview at least 50 percent of minor
patients. She noted the value of the information that could be
gathered but questioned whether some youth, particularly those
who are severely traumatized, would be in a condition to
participate in interviews. She asked if providers had been
consulted and whether meeting this requirement would be
reasonable.
SENATOR CLAMAN said that in developing the SB 44 similar laws in
other states were reviewed and providers were consulted. He
stated that interviewing 50 percent of current patients appears
reasonable, emphasizing that the requirement applies only to
those in the facility and not those in the facility over the
course of the year. He noted it is unlikely that a majority of
youth in a facility would be in such an acute psychiatric state
that they could not communicate at all. He acknowledged that
some may have communication challenges but said it is rare for
50 percent to be entirely unable to participate.
4:45:31 PM
SENATOR HUGHES said it would be helpful to hear from someone
with direct experience working in a psychiatric hospital on the
practicality of interviewing patients. She referred to Section 5
and noted the sponsor's statement cited 261 incidents of
restraint within three months, which she described as startling.
She acknowledged the concern families may have and the
importance of ensuring restraints are only used when
appropriate. She asked whether current procedures require video
documentation during such incidents, whether parents have a
right to view that footage, and whether video access could help
confirm that restraints were used appropriately and not
abusively.
SENATOR CLAMAN said further research is needed to determine the
current use of video monitoring during restraints. He noted that
in psychiatric treatment environments, constant camera
surveillance could pose clinical concerns, particularly for
patients experiencing paranoia. He acknowledged the potential
complications and stated interest in hearing directly from
providers on the issue. He agreed to follow up with more
information.
4:47:55 PM
SENATOR TOBIN referenced earlier testimony related to the Indian
Child Welfare Act (ICWA) and tribal children in psychiatric
systems. She highlighted language in SB 44 on page two, line
one, regarding "other adults" and asked whether the bill ensures
that, in cases involving unaccompanied minors who are tribal
members, a tribal representative or designated tribal authority
would have access to the child. She requested clarification on
whether ICWA responsibilities are reflected in the bill.
4:48:29 PM
SENATOR CLAMAN expressed willingness to talk more about the
concern.
4:48:52 PM
CHAIR DUNBAR announced invited testimony on SB 44.
4:49:12 PM
AMANDA METIVIER, Co-founder, Facing Foster Care in Alaska,
Anchorage, Alaska, testified by invitation on SB 44. She stated
that Facing Foster Care in Alaska, a youth-led nonprofit,
supports SB 44 and that the bill addresses long-standing issues
faced by minors in residential psychiatric treatment. She
explained that many foster youth, particularly Alaska Native and
American Indian children under the Indian Child Welfare Act
(ICWA), are impacted by psychiatric placement, often far from
their communities and with limited external communication. She
emphasized that access to phone contact can be restricted as
punishment or incentive, and that chemical and physical
restraints, including sedation, are commonly reported.
4:54:31 PM
MS. METIVIER supported SB 44's transparency measuresincluding
inspection requirements and communication rightsas a critical
step toward reform and urged the committee to pass the bill.
4:56:03 PM
CAROLINE BROWN, representing self, Fairbanks, Alaska, testified
by invitation on SB 44. She expressed strong support for SB 44
and shared her personal experience as a foster and adoptive
parent of a child with significant behavioral health needs. She
described the challenges of navigating psychiatric care,
including residential treatment, and emphasized the critical
role of regular communication between children and their
families during hospitalization. She noted that while her family
has generally maintained contact with their son, this access
often required intense advocacy, which not all families can
provide. She highlighted the bill's provision for timely
notification of seclusion or restraint, underscoring how
important it is for parents to be informed in order to help
their children process those experiences.
4:59:21 PM
SENATOR DUNBAR concluded invited testimony on SB 44 and [held SB
44 in committee.]