Legislature(2023 - 2024)DAVIS 106
04/27/2023 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| HB80 | |
| Start | |
| HB80 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 80 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
HB 80-INCOMPETENCY; CIVIL COMMITMENT
[Contains discussion of SB 53.]
3:07:59 PM
CHAIR PRAX announced that the only order of business would be
HOUSE BILL NO. 80, "An Act relating to competency to stand
trial; relating to commitment based on a finding of
incompetency; relating to administration of psychotropic
medication; and relating to victims' rights during certain civil
commitment proceedings."
CHAIR PRAX noted that this is the bill's second hearing and that
a committee substitute (CS) has been prepared.
3:09:20 PM
RILEY NYE, Staff, Representative Mike Prax, Alaska State
Legislature, presented the proposed committee substitute (CS)
for HB 80, labeled 33-LS0224\S, Marx/Dunmire, 4/25/23, (Version
S). He explained that Version S was drafted by using SB 53,
Version P, as the basis and then adding crimes to nine sections
[and subsections]. He stated that the added crimes are: AS
11.41, all crimes against a person, including misdemeanors; AS
11.46.400-11.46.427, arson crimes, matching Senator Claman's
bill; AS 11.61.140, cruelty to animals; and 11.61.190-11.61.210,
misconduct involving weapons. He further stated that the
sections in which the statutes are added within Senator Claman's
bill, SB 53, Version P, are: Section 3(j), Section 4(b),
Section 5(g), Section 6(a), Section 6(d), Section 8(g), Section
9(b)(2), Section 9(b)(3), and Section 11(c).
3:11:12 PM
REPRESENTATIVE ANDY JOSEPHSON, Alaska State Legislature, as
prime sponsor of HB 80, spoke to the proposed CS, Version S. He
explained that Version S pays homage to the Senate version, SB
53, by entirely embedding SB 53 into HB 80. The difference, he
continued, is that Version S adds two additional felonies (out
of over 100 felonies in the code) that he believes the Alaska
Court System and later the Alaska Psychiatric Institute (API)
need to look at and have somewhat less discretion. The court
would still have discretion at day 90 after the charge, he
added, but at a couple stage gates in the process the
prosecutors shall, under Version S, file petitions for
involuntary commitment which would begin with an evaluation for
those crimes, although the timing is a bit different than in SB
53. He allowed that both SB 53 and Version S will impact
resources, but offered his belief that in the category of
assault in the fourth-degree special attention is needed if
there are questions of competency because the act is so
irrational. Representative Josephson said the reason for
embedding this in the bill is the case of Corey Ahkivgak, who
physically assaulted several victims over a period of years
before stabbing another victim, Ms. Harris. He advocated that
the system needs to look at the mentally ill person, the
criminal defendant, when that person is presenting facts that
they could escalate, and this is embedded in the proposed CS.
3:15:47 PM
REPRESENTATIVE SADDLER inquired about the section of statute
regarding assault in the fourth degree ("Assault 4").
REPRESENTATIVE JOSEPHSON replied that an Assault 4 is the most
benign form of assault. If two people get into a fight who know
one another and the behavior is criminal and uncivil but
explainable based on the nature of the event or intoxication or
the context, the issue of competency doesn't arise. There are
three ways to commit the crime of assault in the fourth degree:
1) a person recklessly causes physical injury to another person,
with physical injury defined as any amount of pain; 2) a person
causes physical injury to another person by means of a dangerous
instrument; and 3) by words or other conduct a person recklessly
places another person in fear of physical injury.
REPRESENTATIVE SADDLER inquired about the specific section of
statute that lists assaults in the fourth degree.
REPRESENTATIVE JOSEPHSON responded that it is AS 11.41.230.
1:43:25 PM
CHAIR PRAX noted that Assault 4 is the lowest level of assault.
He offered his understanding that [Version S] would not deal
with all cases of assault 4, only those where there is an
incompetence plea, and the case is dismissed because the
defendant is found to be incompetent.
REPRESENTATIVE JOSEPHSON confirmed that that is correct. He
related that as written Version S would require that within the
first 90 days following the event the court look at restoring
the person if the facts suggest the act was so irrational that
competency was at issue, but at day 90 the court begins to have
discretion to say, "We're not going to do this anymore." He
pointed out that misdemeanors are limited to a one-year sentence
that is inviolable, it cannot be one year and a day, and there
is an understanding that for public safety pivoting a civil
system must start to be considered because if an incompetency
cannot be restored then the case would be dismissed. So, he
continued, [under the bill] the system would intervene at that
stage by moving to a three-day evaluation upon a petition, and
during that juncture the criminal case would remain pending, but
the parties would know there would be an almost imminent
dismissal of the case if the individual couldn't be restored
with competency. There is no perfect way to be safe in society,
he stressed, but the bill as written would give the victim a
better chance of not having interaction, which is again
imperfect because the standards must be looked at. He said the
question would be how long would the courts try to restore Mr.
Ahkivgak and if a civil commitment effort were made, how long
would Mr. Ahkivgak be committed? He allowed that it may not be
as long as required to keep the public safe and advised that
this is going to remain imperfect but feels he is duty bound to
try to do something.
1:43:38 PM
REPRESENTATIVE JOSEPHSON further related that [the bill] adds
the felonies of cruelty to animals and misconduct involving
weapons. He explained that this is because committing a forgery
is a felony but typically the person committing a forgery
wouldn't be incompetent in doing that and while forgery could
damage someone's property interests and be disruptive, no one is
going to die from a forgery. So, he continued, the bill tries
to capture the crimes that matter and that need a longer
sustained look on the issue of restoration to competency. He
noted that terroristic threatening making phone calls that
frighten communities is the kind of thing that an incompetent
person might do and suggested that the committee could look at a
crime like that. There is criminal mischief, he added. He
cited a shooting at the [Trans-Alaska] pipeline that occurred on
the haul road and said he thinks that was done by someone who
was competent, so that would probably be criminal mischief in
the first degree, which speaks specifically about oil property.
He stated he can offer recommendations about other crimes
besides the two crimes he has offered the committee.
3:23:52 PM
REPRESENTATIVE FIELDS inquired about how many of Mr. Ahkivgak's
incidents were misdemeanors.
REPRESENTATIVE JOSEPHSON answered that all were misdemeanors.
1:43:49 PM
CHAIR PRAX asked whether it is exceptional that someone would
commit a significant number of misdemeanor cases that lead to
more serious offenses.
REPRESENTATIVE JOSEPHSON replied that when he was a prosecutor
he saw people with 30 or more misdemeanors, sometimes along with
a couple felonies as well, and that is not atypical. He stated
that in the cases of Mr. [Clayton] Charlie who killed an
Anchorage Zoo [groundskeeper in November 2018] and Mr. Ahkivgak,
sirens should have gone off. To the credit of the system, he
continued, sirens did sound but the system either lacks
resources or needs toughening up so that there is another set of
eyes and ears looking at a potentially dangerous person. He
said he believes the system does lack resources, but that
problem won't be solved this spring.
3:26:18 PM
The committee took a brief at-ease.
3:26:50 PM
REPRESENTATIVE SUMNER moved to adopt the proposed committee
substitute (CS) for HB 80, labeled 33-LS0224\S, Marx/Dunmire,
4/25/23, as the working document. There being no objection,
Version S was before the committee.
3:27:41 PM
MR. NYE provided a sectional analysis of Version S [included in
the committee packet], titled "HB 80 CS Explanation of Changes
Version B to S," which read as follows [original punctuation
provided with some formatting changes]:
Section 1 Page 1, Line 5 12.47.070(a) is amended to
read
Replaced section 1 of HB 80 version B with section 1
of SB 53 version P.
Impact of Change
No changes were made to section 1 of SB 53 version P.
Section 2 Page 2, Line 8 12.47.100(b) is amended to
read
Replaced section 1 of HB 80 version B with section 1
of SB 53 version P.
Impact of Change
No changes were made to section 1 of SB 53 version P.
Section 3 Page 2, Line 26 12.47.100 is amended by
adding new subsections
Replaced section 3 of HB 80 version B with section 3
of SB 53 version P. The following crimes were added to
subsection (j): AS 11.41 (all crimes against a person,
including misdemeanors), AS 11.46.400-11.46.27 (arson
crimes, just felonies), AS 11.61.140 (cruelty to
animals), and AS 11.61.190-11.61.210 (misconduct
involving weapons)
Impact of Change
SB 53 version P limits offenses of concern to felony
offenses against a person (AS 11.41) and felony arson.
The additional offenses that were added in subsection
(j) broadens the offenses of concern that a defendant
may be evaluated for in order to determine if they
meet the standards for involuntary commitment.
Section 4 Page 3, Line 16 AS 12.47.110(a) is amended
to read
Replaced section 4 of HB 80 version B with section 3
of that same version B.
Delete "crime listed in (f) of this section" refers to
"(f)" in HB 80 version B
Insert "crime listed in (h) of this section" refers to
"(h)" in HB 80 CS version S
Impact of Change
The changes made here narrow the scope of crimes that
are listed. Crimes listed in (f) of version B that are
not listed in (h) of version S are the following: AS
11.46.430 (criminally negligent burning in the second
degree), AS 11.51.100, AS 11.61.118, and AS 11.61.22
Section 5 Page 3, Line 28 AS 12.47.110 (b) is
amended to read
Replaced section 5 of HB 80 version B with section 4
of SB 53 version P. Felonies against a person under AS
11.41 and felony arsony were already listed in
subsection (b). We added the crimes AS 11.46.400 -
11.46.427, AS 11.61.140(h), or 11.61.190 11.61.200
Impact of Change
For the crimes that we added to subsection (b), the
court may extend the period of commitment for
additional 18 months.
Section 6 Page 4, Line 22 AS 12.47.110 is amended by
adding new subsections
Section 6 of HB 80 version B is replaced with section
5 of SB 53 version P. Felonies against a person under
AS 11.41 and felony arsony were already listed in
subsection (g). We added the crimes AS 11.46.400 -
11.46.427, AS 11.61.140, or 11.61.190 11.61.210
Impact of Change
By adding these crimes to this subsection, it ensures
that a defendant charged with one of these crimes will
be subject to the process detailed in this subsection.
Meaning that if they remain incompetent at the
expiration of the additional 18 month period, they
will remain subject to the next steps in the
prosecutorial process.
Section 7 Page 5, Line 23 AS 47.30 is amended by
adding new section 47.30.706
Section 7 of HB 80 version B is replaced with section
6 of SB 53 version P. Felonies against a person under
AS 11.41 and felony arsony were already listed in
subsection (a) and (d). To both of those subsections,
we added the crimes AS 11.46.400 - 11.46.427, AS
11.61.140, or 11.61.190 11.61.210
Impact of Change
If a person charged with an offense under the statutes
we added has been found incompetent to proceed under
AS 12.47, subsection (a) ensures that an attorney with
the department of law file a petition with the court
to have delivered to the nearest facility for an
evaluation under AS 47.30.710.
Adding these statutes to subsection (d) has the
[effect] that a defendant charged with an offense
under them is rebuttably presumed mentally ill and to
present serious harm to self or others. And it says
the court may consider as recent behavior "the conduct
with which the. defendant was originally charged.
Section 8 Page 6, Line 23 AS 47.30.710(a) is amended
to read
Replace section 8 of HB 80 version B with section 7 of
SB 53 version P. No other changes made to this
section.
Section 9 Page 6, Line 29 AS 47.30.725 is amended by
adding new subsections
Section 9 of HB 80 version B is replaced with section
8 of SB 53 version P. Felonies against a person under
AS 11.41 and felony arsony were already listed in
subsection (g). To that subsection, we added the
crimes AS 11.46.400 - 11.46.427, AS 11.61.140, or
11.61.190 11.61.210
Impact of Change
This section details that a victim of a crime shall be
notified when the criminal case is dismissed. That
statutes we added in this section ensures that the
victims of these additional crimes will be notified as
well.
Section 10 Page 7, Line 10 AS 47.30 is amended by
adding a new section
Replaces section 10 of HB 80 version B with section 9
of SB 53 version P. Felonies against a person under AS
11.41 and felony arsony were already listed in
subsection (b)(2) and (b)(3). To those two
subsections, we added the crimes AS 11.46.400 -
11.46.427, AS 11.61.140, or 11.61.190 11.61.210
Impact of Change
(b)(2) and (b)(3) broadens the scope of offenses that
may be considered when determining a 5 year commitment
period.
Section 11 Page 8 Line 17 AS 47.30.780(a) is amended
to read
Replaced section 11 of HB 80 version B with section 10
of SB 53 version P. No additional changes were made to
this section.
Section 12 Page 8, Line 23 AS 47.30.780 is amended
by adding subsections
We took section 11 of SB 53 version P and made it
Section 12 in this CS. Felonies against a person under
AS 11.41 and felony arsony were already listed in
subsection (c). To subsection (c), we added the crimes
AS 11.46.400 - 11.46.427, AS 11.61.140, or 11.61.190
11.61.210
Impact of Change
By adding these offenses listed in these statutes to
subsection (a), we have broadened the scope of
offenses so that the professional person in charge may
not discharge these additional respondents under (a)
of this section unless the court officially terminates
the involuntary commitment.
Section 13 Page 9, Line 13, AS 47.30.805(a) is
amended to read
We took section 12 of SB 53 version P and made it
section 13 of this CS. We didn't make any additional
changes to this section.
3:47:38 PM
CHAIR PRAX requested Ms. Baldwin-Johnson to provide her invited
testimony.
3:48:31 PM
KATIE BALDWIN-JOHNSON, Chief Operating Officer, Alaska Mental
Health Trust Authority, provided invited testimony on HB 80.
She stated that the Alaska Mental Health Trust Authority
("Trust") is glad for the dialogue that has occurred around the
need to balance public and community safety with due process
rights, given the potential for a Trust beneficiary to be
institutionalized for up to five years without being convicted
of a crime. The Trust recognizes the severity of recent events
and incidents, she said, but most individuals who experience
mental illness are no more likely to be violent than anyone
else. She advised that mental illness and other behavioral
health challenges, are best treated in a community setting when
possible versus in an institution. Ms. Baldwin-Johnson further
advised that investing resources to stabilize behavioral health
services in communities is a critical approach to better serve
individuals, ensure the availability of treatment,
interventions, and supports, and establish greater opportunities
to address the needs of the individual with chronic or
exacerbated mental health conditions. Greater investment in
services, she continued, increases community safety by better
meeting the needs of individuals who require more support paired
with the right treatment and, in some circumstances, more
structured support and supervision.
MS. BALDWIN-JOHNSON related that disability justice has been an
established focus area for the Trust since 2005. She stated
that Trust beneficiaries are at increased risk and involvement
with the criminal justice system as victims and as defendants.
She said this can be due to the person's disability and/or
behavior health conditions and because there are deficiencies in
treatment and support systems at all levels. The Trust's work
in this area, she specified, includes diversion programs such as
crisis stabilization and therapeutic courts, providing
behavioral health services for incarcerated persons, re-entry
services for returning citizens, and supporting organizations to
expand and build out needed services in communities.
1:44:13 PM
MS. BALDWIN-JOHNSON requested that the committee consider some
of her thoughts as it moves forward: Is enough known about the
broader impacts on the system? What will be the impact on the
API's ability to serve the entire state, as well as impacts to
Alaskan communities if beds at API are occupied for extended
periods of time, potentially years? What is the impact on
Alaskans experiencing an acute mental health crisis if the
ability to access needed care is further reduced because
individuals are institutionalized for longer periods of time?
She pointed out that there are already access challenges due to
hospital capacity and individuals can be boarded in hospitals
for extended periods because there is not an available bed at
API to admit them. She noted that API has been operating almost
at full capacity for many months now.
MS. BALDWIN-JOHNSON, in conclusion, encouraged the committee to
consider limited restoration capacity currently at API, long
wait lists, and what efforts have been implemented towards
expanding capacity. She maintained that moving legislation
forward would create increased demand without addressing the
additional capacity needed. She said addressing the system's
needs upstream will help improve both community and beneficiary
safety. She urged that the legislature work collaboratively
with the department to ensure that a plan is in place for
addressing infrastructure and capacity limitations in Alaska
prior to enacting legislation.
3:53:53 PM
CHAIR PRAX opened public testimony on HB 80.
3:56:03 PM
JOHN SKIDMORE, Deputy Attorney General, Criminal Division,
Central Office, Department of Law, noted that [Version S] is
attempting to address gaps in Alaska's laws. He further noted
that [Version S] is also attempting to address the aspect that,
currently, individuals charged with a crime and then found
incompetent are not automatically referred or have petitions
filed even in cases where it may be appropriate for them to be
evaluated for a civil commitment. Several different concepts
have been discussed about how that could be accomplished, he
added. As well, he stated, [Version S] is attempting to address
civil commitments, which the Criminal Division does not handle.
Therefore, he continued, he cannot answer questions about that,
but he can answer questions about criminal incompetence or about
what happens during that process.
3:57:23 PM
REPRESENTATIVE RUFFRIDGE surmised the current process of having
two qualified [psychiatrists or psychologists] ensures that one
person is not granted authority over another without a backup.
He asked whether this process has been working well in
determining incompetence in criminal cases.
MR. SKIDMORE replied that the requirement of two individuals is
a challenge because regularly only one individual is seen
conducting evaluations. He pointed out that the requirement of
certification by a particular board within the country is also a
challenge since Alaska currently does not have any folks with
that certification and hasn't for several years. He related
that for several years, various reports have consistently
recommended that only one individual be required to provide that
opinion and that certification by that board not be required.
Mr. Skidmore further advised that if either the state or the
defense has concerns about the opinion that is offered, either
party is at liberty to hire their own expert to conduct their
own evaluation to provide further information.
3:59:22 PM
REPRESENTATIVE RUFFRIDGE offered his understanding that there is
no one employed by the State of Alaska or within the state who
is certified by the [American Board of Forensic Psychology].
MR. SKIDMORE responded that there are individuals in the state
who practice in that area and do so effectively, but he is
unsure that they have received certification from the [American
Board of Forensic Psychology]. In his experience, Department of
Law prosecutors have routinely not been able to find individuals
with those certifications in the state.
4:00:16 PM
REPRESENTATIVE RUFFRIDGE read aloud from page 3, lines 8-12,
Version S, which state: "If the defendant is charged with an
offense under AS 11.41, AS 11.46.400-11.46.427, AS 11.61.140, or
11.61.190-11.61.210, a qualified psychiatrist or psychologist
conducting an examination under (b) of this section may, at the
same time, evaluate the defendant to determine whether the
defendant meets the standards for involuntary commitment under
AS 47.30.700 - 47.30.915." He inquired about the reason why
they would be given the option to do that.
MR. SKIDMORE answered that when an individual is first evaluated
for competency, the system allows for the attempt to restore the
individual if he or she is found incompetent. That restoration,
he said, is broken into three phases 90 days, 90 days, and six
months none of which are required; those are discretionary
times. What the law requires, he explained, is that the court
find that there is a possibility that the person could be
restored. If restoration is not likely in that period, the
"may" in this provision would allow a medical professional
evaluating the person for competency to also evaluate, if the
professional thinks it appropriate, whether the individual
should be civilly committed. He stressed that the use of the
word "may" means it is at the discretion of the medical provider
conducting the initial evaluation for incompetency. It's a
separate evaluation to determine if the person should be civilly
committed, he added.
4:02:28 PM
REPRESENTATIVE SADDLER asked whether there is any risk or
downtick to having parallel evaluations for competency to stand
trial and potentially for involuntary commitment. He noted that
other provisions in the bill would allow the examining
psychologist or psychiatrist to use previous evaluations, which
it appears that the law does not now allow.
MR. SKIDMORE replied that having parallel evaluations is not a
problem legally. Conducting both evaluations is more resource
intensive, he stated, and that could be problematic from a
logistics perspective given that resources are limited to begin
with. Regarding the value of a civil commitment evaluation at
the time that a competency evaluation is done, he explained that
if restoration is attempted and it's for 90 days, or another 90
days, or the final 180 days, the period of elapsed time from
when the first evaluation was done until the case would
ultimately be at the point of being dismissed assuming the
person is still incompetent, may have made that civil commitment
evaluation stale, requiring yet another evaluation. He
reiterated that the term "may" makes it at the discretion of the
medical provider to determine if that would be effective and
helpful at that time and whether they have the resources to do
it.
4:04:23 PM
REPRESENTATIVE SADDLER inquired about the statistics under the
current system for how often those found to be incompetent are
restored.
MR. SKIDMORE responded that he doesn't have a percentage off the
top of his head for how frequently it occurs. He deferred to
Dr. Becker to provide that answer. He related that during his
25 years as a prosecutor he has handled cases in which a person
was deemed incompetent, was restored, and the prosecution
proceeded, as well as cases where somebody was not able to be
restored and the case had to be dismissed.
4:05:49 PM
REPRESENTATIVE SADDLER asked whether the bill would impose an
excessive burden on the Department of Law's Criminal Division.
MR. SKIDMORE confirmed the bill would have some impact on the
Criminal Division but stated he doesn't know whether the impact
on the Criminal Division is the same that it might be on, say,
API or the Civil Division of the Department of Law. He said one
additional responsibility imposed upon the Criminal Division
would be to file petitions when somebody is found incompetent
under the types of crimes described in the bill, so not every
time a person is found incompetent. An additional
responsibility that would be imposed upon the Criminal Division,
he continued, would be the requirement to notify victims in
crimes where the person has been found incompetent and then
potentially ends up in civil proceedings to determine whether
there should be a civil commitment and, if committed, what is
happening throughout that course. He said the Criminal Division
has submitted a fiscal note given additional resources would be
needed for the division to be able to accomplish those two
things, but he doesn't consider the burden great.
4:07:28 PM
MR. SKIDMOR, responding to Representative Mina, confirmed that
the requirement to notify the victim is included in Version S,
Section 9, pages 6-7. He explained that it is a new subsection
that is added, with the three different types of notification
found on page 7.
4:08:29 PM
REPRESENTATIVE RUFFRIDGE observed that page 6, line 16, Version
S, states: "In evaluating whether a defendant is likely to
cause serious harm, the court may consider as recent behavior
the conduct with which the defendant was originally charged."
Given that a person is innocent until proven guilty, he asked
whether it is a problem legally if someone is originally charged
with something and those charges are dismissed, and then those
alleged behaviors are used as reason to civilly commit someone.
MR. SKIDMORE answered that he doesn't believe it poses a problem
but allowed that others may disagree with him. His reason why,
he explained, is that the initial probable cause statement which
is filed in criminal charges is reviewed by the court, and that
probable cause statement would not be moving forward without the
court's agreement that there is probable cause to believe that
the individual committed those crimes. When evaluating this
initial portion, he stated, what is being talked about is
whether there should be a petition for the person to be
evaluated and whether the court is able to consider the conduct
that occurred. Without that language, he continued, there can
be up to a year's time from the date of the incident or the date
of the charging until restoration is attempted to be completed
and then civil commitment is being evaluated. What is typically
looked for in civil commitments, he said, is conduct that causes
folks to believe that the individual is a danger now. He noted
that sometimes it is heard that that conduct is now stale and
why is it thought that what the person did a year ago makes him
a danger now? This [language], Mr. Skidmore advised, is an
attempt to direct the court and others to evaluate the conduct
the individual engaged in to begin with, the conduct found in
the probable cause statement, to evaluate whether the person is
a danger. It's not that the person is convicted, it's not proof
beyond a reasonable doubt, it's a lower standard for these
evaluations, it's a preponderance of the evidence, and being
able to consider the information there is appropriate, he
further advised. That does not mean that it is considered in a
vacuum, other information can be provided, he added, and that is
why that language is written the way in which it is.
4:11:52 PM
KRISTY BECKER, PhD, Chief of Clinical Services, Alaska
Psychiatric Institute, stated she is a forensic psychologist by
training, so a criminal psychologist. She said she is before
the committee to talk about the needs of the institution and
some of the potential implications that HB 80 may have on API.
She agreed with Ms. Baldwin-Johnson that there are potential
capacity issues that this bill could cause for the facility in
terms of who fills its beds, what nature of patients fill its
beds, and where those patients are from, potentially filling
more beds with individuals who have a history of criminal
behavior or who have recently engaged in criminal behavior
rather than vulnerable community members who need API's care.
DR. BECKER related that API is revising a fiscal note for HB 80.
She advised that with the two-year commitment period, the
additional evaluative process, and the three-day holds included
in HB 80, there will be a burden on the hospital to conduct
evaluations and to house patients in a way that API isn't
currently doing. She reminded committee members that Alaska has
10 beds dedicated for competency restoration for the entire
population of Alaska. Those 10 beds represent the lowest per
capita number of beds for competency restoration of any state in
the nation, she continued, so API is currently operating at far
below what would be ideal bed space for its patients, not just
for this purpose but for all purposes.
4:14:54 PM
REPRESENTATIVE FIELDS offered his opinion that API's under
capacity is a separate issue than the need for this bill. He
stated that API's under capacity has posed a public safety risk
to Anchorage and throughout the state for a long time. He asked
whether Dr. Becker would agree that trying to expand API's
capacity should be done regardless of whether HB 80 is passed.
DR. BECKER replied that there is clear cause, both civil and
criminal through Title 47 and Title 12, to indicate that API
does need expansion and that the expansion of community services
and transitional care environments, upstream and downstream, are
deeply needed by the state of Alaska.
4:15:43 PM
REPRESENTATIVE SUMNER inquired about the number of new beds that
would be needed to go from the lowest per capita fence to a
fence in the middle of the pack.
DR. BECKER responded that she doesn't have that number. She
related that API has 30-35 individuals, on average, sitting on
its waitlist in jail settings awaiting a bed in API's competency
restoration unit. She further related that it currently takes
between 120 and 130 days for an individual to get from the
competency order issued by the court to a bed at API. Regarding
the restoration periods of 90 days, 90 days, and then an
additional 180 days, she pointed out that everyone is already in
their second commitment period when they arrive at API's door.
4:16:50 PM
REPRESENTATIVE SADDLER asked about the effectiveness of the
entire process of trying to restore somebody charged with a
crime to competency to stand trial.
DR. BECKER answered that it is a complicated and nuanced area of
the law and of psychological practice. She said, nationwide,
about 60 percent of defendants referred for restoration are
successfully restored, but in the state of Alaska, competency
restoration is much less effective. She stated that there are
significant problems in Alaska with getting people into
restoration services in a timely manner as well as with the
ability to access and provide involuntary medication to these
patients once they are in services. She explained that if API's
patients don't wish to take medication in the process of
competency restoration, a separate procedure is necessary to
involuntarily provide those medications to API's patients. The
procedure is a very high legal standard that is hard to reach,
she continued, and because it isn't codified in Alaska statute
API relies on federal statute to attempt to do this. Dr. Becker
said that leaves API to the whims of different jurisdictions and
judges' interpretations of this federal guideline to determine
who it can or cannot provide involuntary medication to. The
shortened period of time that API is given access to the patient
and able to provide the services, along with the incredible
limitations on API's ability to provide medication against those
patients' will, prevents API's ability to restore them and
restoration rates are far below the national average.
4:19:07 PM
REPRESENTATIVE SADDLER asked whether Alaska has more people
committing crimes who are possibly mentally incompetent than
other states.
DR. BECKER replied, "Not to my knowledge." She said Alaska has
higher rates of certain types of crimes and certain types of
behavior than other states, and the rate of sexual assault in
Alaska is above national averages. Nationwide, she specified,
competency restoration and the pressure to manage incompetent
defendants through state hospital systems is problematic and
there is an exponential growth rate of the referrals and number
of people who are referred for competency restoration orders for
competency evaluation and thereby hospitalized. She noted that
information is available about how other states are either
managing it well or are failing to manage or struggling to
manage it.
4:20:13 PM
REPRESENTATIVE SADDLER inquired about the reasons for why there
are this many people being incompetent and committing crimes.
DR. BECKER responded that from a data driven perspective it
would be difficult for her to fully answer that, but she
believes there is a historical timeline that can be followed.
She stated that since the occurrence of deinstitutionalization
during and shortly prior to Ronald Reagan's administration, many
individuals who had spent their lives inside psychiatric
hospitals were released into communities with the intent to
provide community services for them and have them live in
communities and be supported. From a clinician's perspective,
she said, the nation did not provide those community resources,
nor were these folks shored up in communities in a way that was
safe. An insurgence of nuisance crimes was seen, behaviors
related to mental health, she continued. A person with a mental
illness, Dr. Becker continued, is much more likely to have legal
exposure than an average individual. She said it holds to
reason that part of the exponential increase in the concerns
about competency and the number of orders for evaluation and
thereby restoration is related to these folks being out in
communities more. Through the course of time, she added, this
has exacerbated and grown along with the problem with folks who
are unhoused and the general inability of communities nationwide
to manage these populations effectively.
4:22:00 PM
REPRESENTATIVE RUFFRIDGE inquired about the number of forensic
psychologists at API in addition to Dr. Becker.
DR. BECKER answered that besides herself, there is a chief
forensic psychologist who manages the 10-bed unit in question, a
forensic psychologist who recently joined API from Washington
state, and another forensic psychologist whom she recently
hired. She said API also currently has four contractors who
support the hospital through telehealth and conduct some
competency evaluations via telehealth mechanisms like Zoom where
they can interface with the defendants and provide API with a
report for competency.
REPRESENTATIVE RUFFRIDGE noted that Alaska doesn't have a place
to train forensic psychologists. He asked where Dr. Becker was
trained and how long she has been doing this.
DR. BECKER replied that she has worked in criminal justice and
mental health since she was 18 years old, starting her career as
a psychiatric technician at Western State Hospital. She went on
to work in a maximum-security prison, she said, then went to
undergraduate school in Idaho and received her master's degree
at Teachers College at Columbia University in New York. She
went to Sam Houston State University in Texas, she continued,
one of the top five brick and mortar colleges that produce
forensic psychologists. There are not many forensic
psychologists in Alaska, she noted. She explained that a
forensic psychologist has the same training as a clinical
psychologist, and that psychiatrists are medical doctors who
give medications, while psychologists are not medical doctors
and don't give medications but do reports and conduct
evaluations. She related that she came to Alaska on her
internship to work at API for one year and she chose to stay.
She noted that API can train a clinical psychologist to have
forensic skills, but it takes time and practice with oversight,
so it isn't something that someone straight out of graduate
school can just start doing.
REPRESENTATIVE RUFFRIDGE inquired about the number of other
states Dr. Becker has been in. He further asked whether other
states have this same problem, whether they have solved it, and,
if so, whether the approach was the same [as proposed in HB 80].
DR. BECKER confirmed other states have this problem and she
would say resoundingly that they have not solved it. Different
approaches have been taken by other states, she said. For
example, she continued, Washington, Oregon, and Colorado are all
under some sort of consent decree or legal action where suits
have been brought forward indicating that civil liberties of
defendants are being violated because they are being held in
jail for far too long prior to receiving competency restoration
services. Those consent decrees, she explained, have created
edicts in which there are certain timelines that revoke the
evaluative process and the amount of time that is allowed before
a defendant can be admitted to the hospital. She noted that
they've also created quite short timelines of 7-14 days on
average for the defendant to be hospitalized after a finding of
incompetence so the restoration process can begin quickly. She
specified that those states, however, are generally not always
able to comply with those consent decrees, and often find
themselves being fined because of their inability to comply.
DR. BECKER continued her response. She related that states have
also attempted to address this problem by using outpatient
competency restoration and jail-based competency restoration.
She advised that she has made efforts to institute both of those
programs in Alaska, with the support of her administration. She
said API has had consultants evaluate Alaska's ability to
initiate an outpatient competency restoration pilot and API will
try to do that starting August 2023 with 10 people who are
misdemeanants that have no crimes of force involving a person.
Jail-based programs, she continued, function in a variety of
ways in which restoration services can be provided while the
defendants are still in custody prior to being hospitalized.
How this might look in Alaska, she said, is that the very lowest
level criminal defendants might be able to bailed out, placed on
bail conditions, and then restored in the community; the mid-
level defendants with a variety of illnesses who are able to
cooperate with medication provision in a custodial setting in
jail could receive services in jail; and the most acute and most
severely ill individuals could be placed in API's 10-bed unit.
That could reduce the pressure, she advised, but even if both
those programs were opened today [API] would have a wait list
with five or six people on it.
4:27:26 PM
REPRESENTATIVE RUFFRIDGE, should the bill be passed in its
current form, asked whether the state would be at the same risk
of liability for those same issues of holding people in jail for
too long because the state doesn't have this expanded capacity.
DR. BECKER deferred to an attorney or someone better able to
answer that question. However, she suggested, it is reasonable
to say that, given the current wait lists, there is already
potential jeopardy for that outcome and probably has been for
some time. So, she continued, additional pressure, additional
capacity issues, and an inability to move people off waitlists
is likely to exacerbate that problem along with the capacity
issues that API is currently facing.
4:28:46 PM
REPRESENTATIVE MINA surmised that HB 80 would result in a higher
number of civil commitments for people with a history of
violence. She inquired about the current safety standards for
nonviolent patients also housed at API.
DR. BECKER answered that those populations are already mixed to
some extent. She explained that because of the commonality and
frequency of criminal exposure or legal exposure for individuals
with mental illness, and the current state of the nation, there
are a lot of defendants or patients who move between the
competency restoration unit and the civil unit on a routine
basis. She posed a hypothetical scenario where Mr. Smith comes
into API because he is gravely disabled and unable to care for
himself in the community, he is placed on meds and returned to
the community, he steals a car, he comes to API for competency
restoration, API isn't able to restore him, he leaves again
after some time with medication, then he behaves in a
threatening way at a local grocery store, is found to be
dangerous to others, and is returned to the civil side of API.
Dr. Becker said it's uncommon that API has an individual who is
just a competency defendant or just a civilly committed patient,
rather it is more common that there is mobility between those
two states and those two legal states.
DR. BECKER continued her response to Representative Mina. She
said API's safety precautions designed in the hospital address
the awareness of individuals residing on API's regular civil
adult units who then may also reside on the forensic unit. The
safety precautions in place, she explained, are adequate
staffing, patient monitoring, and a minimum of 15-minute checks
on every patient. She noted that if there is any incidence of
threat, violence, or sexual impropriety between patients, API
will investigate, appropriately separate the patients, and
report to the ombudsman and other related agencies such as adult
protective services.
4:31:27 PM
REPRESENTATIVE MINA asked whether, for patient and staff safety,
there should be more focus on improving the safety components of
adequate staffing and patient monitoring should there be an
increase in people who have a history of violence.
DR. BECKER replied yes, [API] must be conscientious about how it
staffs patients who are exhibiting dangerousness to others and
whether it increases the need for higher staffing ratios and for
one-to-one staffing to ensure safety of all patients at API.
She advised that if API does move toward a more forensic
population where the hospital has more individuals with legal
involvement and criminal histories, it will rub up against API's
ability to maintain accreditation. It can be difficult, Dr.
Becker explained, because of the nature of management of large
groups of individuals with criminal histories and the rules and
guidelines necessary to maintain a safe environment that meets
guidelines for the regulatory bodies. So, she continued, there
will be many questions drawn about safety and other issues if
the hospital does become more forensic in nature.
4:33:08 PM
REPRESENTATIVE MINA asked if there would be workforce issues
with hiring for more positions and expanding that capacity.
DR. BECKER confirmed that there would be workforce issues. She
advised that API currently has significant workforce issues and
difficultly hiring and is staffing many of its nursing positions
with traveling nurses. She acknowledged that the committee has
heard from a variety of people about the difficulties that API
experiences in finding both nursing staff and higher-level
professional staff, including psychologists and psychiatrists at
the API facility.
4:34:03 PM
CHAIR PRAX noted that only a small part of the total population
of people with mental illnesses find themselves before a court
for committing some sort of crime. He asked whether the right
strategy is being chosen, or whether there is a better strategy
that would intercept in a positive way more people.
DR. BECKER acknowledged that the incident prompting this
attention is a tragedy and allowed that there are community
safety concerns brought about by some individuals whom she
treats. She offered her appreciation for use of the word
"intercept" because when looking at models within criminal
justice and mental health care, the talk is about intercepts and
when intervention can occur. There are multiple points of
intervention, she explained, and the interventions being talked
about today are interventions after everything has in some way
failed and an individual is in a circumstance of having
inflicted harm upon another person and is now in legal trouble
and facing the consequence of incarceration or long-term
hospitalization because of their inability to be safe in the
community. Dr. Becker stated that her preference as a clinician
and a practitioner is to create intercepts as early as possible
because the earlier the intervention from when an individual
first develops a mental illness, the better the outcome. If the
outcome is better, she said, an individual may be prevented from
becoming dangerous. Treatment, safe and secure housing, and
compliance with long term outpatient care reduces the risk of
the patient harming others, she added. It's an imperfect
system, she advised, and predicting risk is very challenging
even for people trained to do it and oftentimes those people
will be wrong.
4:37:52 PM
NANCY MEADE, General Counsel, Alaska Court System, first
qualified that the court is neutral on HB 80. She stated that
the issue of capacity is something for the committee to bear in
mind. She further pointed out four things for committee members
to think about with HB 80 in terms of policy: 1) How long
should the restoration period be in a criminal case when
somebody is found incompetent and HB 80 changes that? 2) When a
case is dismissed because the person is not competent in that
criminal case, what groups of cases must be segued directly into
the civil commitment process? 3) Should there be a long-term
civil commitment process for those individuals who are segued
after being found incompetent to stand trial? 4) How long can
that hold be? Ms. Meade related that Version S of HB 80 is
workable from the court's point of view, but she is uncertain
whether it's practically workable and will accomplish everything
the committee wants it to accomplish. However, she advised, it
is a step forward for doing something with the individuals whose
cases get dismissed and there is a sense that they have some
threat to public safety and therefore something else needs to be
done with them other than letting them go.
4:39:58 PM
CHAIR PRAX inquired about the number of cases in the Anchorage
courts.
MS. MEADE answered that statewide data isn't complete because it
isn't the court system's role to collect that data and determine
what is going on, but there is decent data for Anchorage. She
said she will therefore stick with the criminal cases, Title 47,
where a person is found incompetent to stand trial. Statewide
[in 2022], she related, there were 404 requests for evaluations
for competency in a criminal case. About 240 of those were in
Anchorage where the court found that examination was justified.
Out of those 240 cases, she continued, about 140 had felony
charges and in 78 of those cases the defendant was found
competent after evaluation. The Alaska Court System, Ms. Meade
advised, does not perceive that the capacity issues at API would
affect these evaluations that are ordered because they happen in
a fairly timely manner of two-three weeks, or a bit longer if
the defendant is not in jail and must be located. So, she said,
out of 240 orders, a third were found competent, meaning that
two-thirds of the people, about 160, were found incompetent by
API. Most of those cases, she specified, get dismissed because
API's wait list to get in for restoration is 120-150 days and if
the person is facing less time than that in jail, for example,
or if there is no substantial likelihood that the person is
going to be restored, the court or the prosecutor dismisses the
case. Out of all those, she continued, 12 people ended up going
to API for restoration and six of them got restored to
competency and six were found non-restorable. While these
numbers are for just one year, Ms. Meade stated, it would mean
that under this bill the six cases of those found non-restorable
plus the cases that were dismissed would be segued by a petition
into a civil evaluation, which takes three days, to determine if
full mental commitment proceedings should be filed and continued
from there, and then it is in Title 47.
4:43:23 PM
CHAIR PRAX calculated that roughly 120 of these cases a year are
found incompetent to stand trial but should be evaluated for
civil commitment.
MS. MEADE replied that it's more like a couple hundred for the
whole state, not just the numbers for Anchorage. She qualified
that she doesn't have exact data with what those persons were
charged with but said most of them will have been charged with
an AS 11.41 crime against a person. If someone is charged with
a lesser crime the case is often dismissed earlier than the
finding of incompetency and the first 90 days passes. This bill
would move only the people with the finding of incompetency. It
is generally the cases of crimes against a person that are held
onto a bit longer to see if the person can be restored or to get
the person into the civil commitment.
4:45:41 PM
MARK REGAN, Legal Director, Disability Law Center of Alaska,
relative to Dr. Becker's testimony about the pressures on the
system and on API, stated that inadequate competency restoration
and inadequate capacity for competency restoration is a long-
standing problem in Alaska. He referenced a 2019 study and
noted that in Alaska the lengths of waiting lists and people
being held in jail awaiting competency restoration are about the
same now as they were in 2019. He further noted that there are
different ways to do competency restoration, but the 2019 study
recommended that 25 more beds be added to the 10 beds currently
in API's unit for competency restoration. Despite much
discussion, he added, nothing has been agreed upon and the state
has not committed to providing those additional 25 beds and that
additional capacity.
MR. REGAN addressed alternatives mentioned by Dr. Becker and
others, such as the possibility for some people to go through
competency restoration as outpatients. Expanding capacity by
allowing for more outpatient commitment is a good idea, he
counseled, but neither Version S nor any of the amendments [in
the committee packet] adopts the Senate bill's encouragement of
outpatient commitment processes and bail conditions that would
steer people into the outpatient commitment opportunity. In the
other direction, he said, are jail-based competency restoration
programs that respond to the unfortunate situation that when
there is a waiting list and a delay of 120-150 days or more,
people are going to be sitting in jail not getting help and not
getting restoration. So, Mr. Regan advised, even though this is
the wrong setting for people to be going through competency
restoration, it may be a better setting than the person not
getting services at all. He stated that regardless of whether
the committee does or doesn't take the opportunity to expand
jail based and outpatient competency restoration, legislation
like HB 80 will put many more people in competency restoration
which will lead to somewhat more people going through the civil
commitment process on competency restoration at API.
MR. REGAN asserted it is wrong for people to sit in jail for
half a year waiting to get into API for competency restoration.
As was pointed out, he recounted, there have been lawsuits in
Washington state, in particular the Trueblood case which imposed
very tight time limits on how soon a person can get into a state
hospital once found incompetent. The problem there, he advised,
is that if these time limits get enforced, they are typically
enforced by fines, rather than by people getting out, getting no
restoration, getting no help. The fines have not gone to the
benefit of the lawyers or clients who brought the cases, Mr.
Regan further advised, the fines have typically gone back into
the system, so lawyers have not been taking resources away from
competency restoration by bringing those lawsuits. He stated
that Dr. Becker is precisely right, the lawsuits have led to
orders that are unenforceable as a practical matter, and so he
is not sure the legal exposure of the state and lawsuits are
going to do much good.
MR. REGAN suggested that having more resources available for
competency restoration would be good. He said a study could be
done to look at whether a practical way would be, for example,
to have a separate facility or to have an expansion at API so
more beds could be devoted to competency restoration. He stated
that it would be good if the legislation before the committee
leads to an expansion of capacity that helps people, reduces
waiting times, and keeps people out of jail and in a more
therapeutic setting. He expressed his concern that two things
are going on one is putting more people through the competency
restoration system and the other is finding the resources to
treat them. He urged the committee to not put more people in
the system without immediately supplying the resources for
treating them as that would make the existing problem worse.
4:53:08 PM
CHAIR PRAX inquired about what way, in Mr. Regan's view, the
problem would be made worse.
MR. REGAN responded that the problem, as he has tried to define
it, is too many people waiting for competency restoration. A
typical place for someone to wait for competency restoration is
in jail, he pointed out. He related that in a case decided by
the Court of Appeals in 2020 [or thereabout], a person with
severe mental illness was charged with a misdemeanor and spent
eight months in jail waiting for competency restoration services
because there were no open beds. The person's lawyer filed
suit, he said, and the Court of Appeals dismissed the charges
because someone with a misdemeanor cannot serve more than a year
and this person was close to that amount of time. The Court of
Appeals, he continued, said it was a due process violation to
hold this person for 300 or 330 days without treatment, without
competency restoration. It's going to make the problem worse,
he said, if there are more people with misdemeanors waiting in
jail for extended competency restoration.
MR. REGAN discussed civil commitments. He stated that the
Senate bill which has been merged into Version S provides for
extended civil commitment periods of up to five years. However,
there are several problems with the technical way this is done,
he advised, one being that no standards are included in the bill
for a judge to use for figuring out whether it is 18 months,
three years, five years. Another is related to things that are
necessary to protect the public, he said. Based on what people
have told him, not personal observation, there are eight to ten
people in the more general population at API who are there on a
series of 180-day commitments, he stated. They're not getting
better necessarily, he conveyed, they are there because their
cases come up every 180 days and commitments are renewed.
That's the alternative to this five-year commitment process, he
stated. His organization's position, Mr. Regan related, is that
the five-year commitment process has constitutional problems as
a matter of equal protection, as a matter of discrimination
against people with disabilities. But, he continued, if the
180-day renewable process is sufficient, then extending it to a
five-year system isn't needed because the people currently in
API going through these repeated civil commitment processes show
that that works.
4:57:38 PM
MR. REGAN addressed the case of Ms. Harris and the man who
assaulted her [Mr. Ahkivgak]. He said he doesn't know why Mr.
Ahkivgak didn't get into the civil commitment process as someone
who was dangerous and a danger to others. Had somebody
initiated the civil commitment process at the time of Mr.
Ahkivgak's last criminal involvement before the stabbing at the
Loussac [Library], Mr. Regan continued, then presumably Mr.
Ahkivgak would have been committed, presumably his commitments
would have gone up through the 180-day period, and he would
probably be there today and not have committed the crime. What
went badly wrong with the existing system, he advised, was that
nobody filed for civil commitment. This bill and all the bills
pending in the legislature, he said, would require that a civil
commitment petition be filed, and once that's done the person
would be in a system that is renewable, and which would protect
the public. The problem is not that a five-year system is
needed, he stated, the problem is that the system needs to get
on with its process of holding people and providing treatment to
them for up to a 180-day period. People can be protected with
the 180-day system if only it would get started, he continued,
so that's why the Disability Law Center of Alaska thinks that a
five-year civil commitment is not needed.
4:59:43 PM
REPRESENTATIVE FIELDS stated that he introduced a bill a couple
years ago to force expansion of API, but in the last 30 minutes
it seems two problems have been identified one is a lack of
capacity at API and the other is the problem addressed in HB 80.
He said he doesn't want the fact that there are two problems to
delay or prevent the committee from addressing the problem being
dealt with in HB 80. He requested that the committee consider
amendments and pass the bill as expeditiously as possible.
5:00:24 PM
REPRESENTATIVE MINA, regarding the five years and the renewal
period of 180 days, offered her understanding that Section 4 of
the original version of HB 80 had the 180-day renewal period.
She asked whether that previous 180-day window could be a
potential way to change Version S.
MR. REGAN answered that he believes there is an amendment [in
the committee packet] which would remove the five-year idea. He
advised that if the up to five years commitment was dispensed,
it would still be necessary for there to be a civil commitment
petition filed when certain charges are dismissed or when
competency cannot be restored, as he is sure the bill proponents
would not want that taken out. He stated that the original bill
version didn't have the five-year system, but the committee
could revert to the original bill and take some of the
improvements from SB 53 and get to the same result.
5:02:13 PM
The committee took a brief at-ease.
5:02:43 PM
REPRESENTATIVE JOSEPHSON stated that to the extent he doesn't
respond to some of Mr. Regan's concerns, [members] could take
something suggested from that. He clarified that Section 3 and
Section 6 of [Version S] do talk about outpatient clinics and
that Version S really is Senator Claman's bill plus a few
things. Regarding Mr. Regan's concern with housing improperly
the wrong people, Representative Josephson stated that currently
under law, attempts to restore a misdemeanant can last 12 months
and he thinks that that is on all misdemeanors. Version S, he
continued, would reduce all misdemeanor restoration attempts
other than the assault fours that he talked about and includes
all the AS 11.41 offenses against people. The bill reduces that
12-month period down to six, he added, but efforts at restoring
misdemeanants would be reduced under Version S.
5:04:59 PM
ALEXANDER SCHROEDER, Staff, Representative Andy Josephson,
Alaska State Legislature, spoke on behalf of Representative
Josephson, prime sponsor of HB 80. He explained that currently
a misdemeanor charge can put a person into restoration for up to
12 months if the person meets the criteria of crime against a
person. Under [Version S], he pointed out, it's only felony
charges in AS 11.41 - felony arson, felony cruelty to animals,
and felony misconduct involving weapons. The maximum amount of
time that a misdemeanant could spend in restoration under
[Version S] is six months, he stated.
REPRESENTATIVE JOSEPHSON confirmed that it is six months. He
said the misdemeanor assaults about which he spoke would get a
continuing look through the civil commitment process; it's six
months.
5:05:59 PM
The committee took an at-ease from 5:05 p.m. to 5:06 p.m.
5:06:52 PM
CHAIR PRAX inquired about the committee's will regarding HB 80.
REPRESENTATIVE FIELDS suggested moving the bill now in the
interest of getting the bill passed this year.
5:07:22 PM
The committee took an at-ease from 5:07 p.m. to 5:09 p.m.
5:09:45 PM
REPRESENTATIVE RUFFRIDGE moved to report CSHB 80, labeled 33-
LS0224\S, Marx/Dunmire, 4/25/23, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, CSHB 80(HSS) was reported out of the
House Health & Social Services Standing Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 80 CS Version S.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.1.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.3.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.4.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.5.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.6.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.12.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.12.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Amendment S.14.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 Potential Committee Substitute Changes.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 version B to S Explanation of Changes.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| Disability Law Center House HSS comments on HB 80 and proposed CSHB 80 4 27 23.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |
| HB 80 SB 53 Research Forensic Psychiatric Hospital Feasibility Study Draft Phase 1.pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 SB 53 |
| HB 80 JK v State(1).pdf |
HHSS 4/27/2023 3:00:00 PM |
HB 80 |