Legislature(2003 - 2004)
04/10/2003 03:35 PM Senate STA
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* first hearing in first committee of referral
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= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 159-PAROLE FOR MEDICAL / COGNITIVE DISABILITY
CHAIR GARY STEVENS asked for a motion to adopt the committee
substitute (CS) as the working document.
SENATOR GRETCHEN GUESS made a motion to adopt work draft \D
Luckhaupt 4/9/03 as the working document. There being no
objection, it was so ordered.
SENATOR LYDA GREEN, sponsor of SB 159, paraphrased from the
sponsor statement:
SB 159 gives the Alaska Board of Parole (ABP)
flexibility to grant or deny medical parole to
applicants. Thus the board will be better able to meet
the needs of the prisoners, the department and
communities.
The ABP has a proven track record in their decision-
making abilities. Over the past seven years, the ABP
has granted parole to approximately 45 percent of all
the discretionary parole applicants. Less than eight
percent of these parolees have violated their
conditions (i.e. missed a meeting with a parole
officer) and approximately one percent has committed a
new offense. This number is particularly compelling
when compared to the 77 percent return rate of
mandatory parole violators.
This bill will allow the ABP and the Department of
Corrections to work together to determine an
appropriate and cost effective release plan. The cost
of health care to the Department of Corrections has
significantly increased over the last few years. Some
of the factors causing these increases are:
· The increased population of terminally ill
inmates
· The recent Seward Highway accident on November
19, 2002
· Hospitalization of prisoners for long-term
assisted care
When making a determination for medical parole
the following are considered:
· Department of Correction medical report
· The seriousness of the criminal offense
· Release plan
· Parole officer/DOC recommendation
Passage of this proposed legislation will allow
the ABP to use its endowed power and authority to
make responsible decisions regarding all the
factors mentioned above, while still considering
the safety of the community.
CHAIR GARY STEVENS said he has visited several prisons in
the last several months and has learned that because the
state is fully responsible for the individual while
incarcerated, the state may face enormous medical expenses.
This bill would allow those seriously ill inmates to return
home or move to a facility that provided less expensive
treatment.
SENATOR FRED DYSON noted the original law didn't allow for
parole for someone who was convicted and incarcerated for
sexually abusing a minor. He asked if it was correct that
this bill removed that provision.
SENATOR GREEN said it did; that is what the language on
page 1, line 12 does.
SENATOR DYSON asked for the reasoning for removing the
prohibition for paroles for those guilty of sexual abuse of
a minor.
JACQUELINE TUPOU, staff to Senator Green, explained the
inmates that are considered for medical parole are
physically incapacitated. Also, not all medical parolees
would simply be released; many would move to other secure
facilities.
SENATOR COWDERY asked where these inmates would be placed
and would the type of crime come under consideration.
MS. TUPOU said the bill provides flexibility so each case
would receive individual consideration and the
determinations would be different. Some inmates would move
to another secure facility and others might go home. If
parole would diminish the seriousness of the crime the
inmate would be disqualified from consideration.
CHAIR GARY STEVENS asked the department to come forward.
LARRY JONES, Executive Director of the Alaska Board of
Parole, said the Parole Board sees this as a corrective
bill because the 1995 legislation is overly tight. The
department can't legitimately bring inmates to the board to
implement the decision making process. When a special
medical parole applicant meets the criteria, the board must
act quickly because the person is close to death. Since
1996 they have granted just nine medical paroles and have
considered just 14 cases. Most died within two to three
months of their parole. These inmates are so critically ill
they aren't the same person that committed the crime for
which they were incarcerated.
In his judgment, this bill would not impact public safety.
Every year the board makes hundreds of discretionary
decisions; this would simply provide them increased
flexibility. Medical paroles require that a plan be
established for each parolee; inmates wouldn't be tossed
"into the gutter." These people are still under the
supervision of the Department of Corrections just as any
other parolee would be.
Whether a parole would diminish the seriousness of the
crime is always a consideration and never taken lightly by
the board. The Board of Parole stands as a very strong
proponent of victim's rights. Victims are notified of the
hearings and they may participate.
CHAIR GARY STEVENS asked him for an explanation of who is
on the Parole Board, the associated responsibilities and
the connection with the department.
MR. JONES replied it is complex and he would like to hear
the question posed more frequently. The Alaska Board of
Parole is an autonomous board with five members that report
to the governor. There is a certain judicial requirement so
there is a geographic representation. Ethnicity and gender
are also considerations for appointment. Members serve five
year staggered terms and legislative approval is not
necessary. Members typically serve for more than one term.
The board travels to the hearing sites, which entails
considerable travel. They don't hear mandatory parole
cases, but 96 percent of their hearings are the revocation
hearings for those mandatory paroles. When the board
travels this includes five board members, two staff, the
parolee and attorney, the state parole officer, the victims
and the witnesses.
SENATOR COWDERY asked how many inmates might take advantage
of a special medical parole.
MR. JONES deferred to Mr. Tupou.
LEITONI TUPOU, Special Assistant to the Commissioner of
Corrections, explained the board would review 13
applications if the bill passes.
SENATOR COWDERY asked if that would save $500,000.
MR. TUPOU replied it would.
MR. JONES added the savings would be greater in the long
term.
MR. TUPOU referred to a spreadsheet to show how much the
state currently spends on those inmates. Under current law,
the board would not hear these cases.
SENATOR COWDERY asked if the savings would come from
transferring the inmates from their present location.
MR. JONES said that is correct.
SENATOR COWDERY asked if the $500,000 is a medical savings.
MR. JONES said the impact of this bill is a matter of who
is bearing the cost.
4:00 pm
KEVIN HENDERSON, Eligibility Program Officer for the
Division of Medical Assistance, advised the department is
generally supportive of the bill. Part of the intent is a
cost shift because many of these inmates will be looking
for a way to pay for continuing medical care. The
department sees Medicaid as the likely recipient. At the
state level it makes sense to put these people on Medicaid
and get federal matching money for at least part of the
costs. As long as they are incarcerated the state pays 100
percent of the health care costs.
He pointed to the fiscal notes and cautioned it was likely
only nine of the 13 would qualify for Medicaid. Some would
probably qualify for expensive long-term care and some for
adult public assistance. The bill is a good idea for the
state but it's important to clearly look at careful
discharge planning for each individual to ensure they are
provided for.
SENATOR LYMAN HOFFMAN made reference to the fiscal note
from Health and Social Services and asked if they believe
Medicaid expenditures would grow at just ten percent per
year. If that's true, he asked how that fits with the data
on page 1 of the fiscal note.
MR. HENDERSON replied the fiscal note reliability after two
years is difficult. They made some assumptions that may or
may not be true.
Historically Medicaid costs have been increasing at ten
percent or more per year. That rate has nothing to do with
the 13 Alaska inmates; it's just the rate that health care
is increasing. An assumption was made that the nine inmates
identified as likely to be eligible for Medicaid would
continue to live and that there would be a linear growth of
nine new Medicaid recipients each year thereafter.
Admittedly, those people are medically fragile and probably
wouldn't survive for years, but he was reluctant to project
just how long they would live. They were unsure how many
inmates would be medically paroled every year or the level
of care that might be needed.
SENATOR HOFFMAN noted FY09 costs would be $2.7 million,
which would be $2.2 million over and above the $500,000
savings.
MR. HENDERSON advised him to look at the GF Match line.
SENATOR HOFFMAN observed the breakeven point ends in FY06;
after which it would cost the state.
MR. HENDERSON replied the numbers were probably high and
the Department of Corrections would likely make the case
that all the parolees would not live five years.
SENATOR HOFFMAN rhetorically questioned how many would have
to not live that long for it to make sense.
ROBERT BRIGGS, staff attorney with the Disability Law
Center of Alaska, reported they provide services for
Alaskans with disabilities including those in institutions.
With the closure of the Harborview institution in Valdez,
they now provide protection and advocacy services for
nursing homes, prisons and mental institutions. They
believe the bill makes sense in terms of saving general
fund dollars.
He suggested amending the bill to require discharge
planning that would address the basic life domains of the
prisoner. Because the intended population would be
functionally impaired, a plan needs to be in place before
they are released. Both Montana and Rhode Island require
medical discharge planning in the statute that is parallel
to what this bill would do. Appropriate discharge planning
would also address the safety concerns.
Cost shifting is good because institutional costs are the
highest costs. Some of these individuals are likely to be
eligible for home and community based waivers meaning a
family member could provide care for the individual. Care
coordination could certainly be provided cheaper than
services in a nursing home.
Representative Berkowitz pointed out the language on page
3, line 17 appears to limit the concept of who can be
discharged to those who have a cognitive condition that is
impaired due to irreversible dementia. The medical officer
for the correctional system testified he had no problem
eliminating the phrase "due to irreversible dementia."
Based on his testimony, the House State Affairs Committee
eliminated the phrase.
DR. JOHN ROBERTSON, Medical Director and Health Services
Administrator for the Department of Corrections, advised
the inmates selected for medical parole would be likely to
live less than a year. Although there has been mention of
cost shifting, all ways have not been addressed. For
instance, some inmates would qualify for veteran benefits
if they were out of the state system. While this
legislation would give the department and the parole board
more flexibility, each applicant would be carefully
scrutinized and wouldn't be considered for medical parole
without adequate discharge planning.
SENATOR HOFFMAN asked what he estimated the annual savings
to be if parolees lived between six months and a year after
parole.
DR. ROBERTSON admitted he assisted in drafting the numbers.
When he reviewed actual costs for the last three years he
found the state spent from $20,000 to $500,000 depending on
the medical condition. Statistically medical expenses are
the greatest at the end stage of life and it isn't uncommon
to accrue a $200,000 bill in the last two weeks of life.
Another cost to the department that isn't reflected in the
numbers is that while the inmate is institutionalized there
are associated officer costs. For every day that someone is
in a hospital or nursing home rather than in the
correctional system there would be a salary savings for one
or two officers.
SIDE B
4:25 pm
ANNA FAIRCLOUGH from Anchorage expressed concern that
sexual assault offenders might be considered for medical
parole under SB 159. The proposal is particularly
indefensible with regard to those who committed offenses
against minors. She questioned whether any of the 13
inmates that might be eligible for medical parole had
sexually assaulted a minor.
CHAIR GARY STEVENS called Ms. Tupou forward to address the
question.
SENATOR DYSON asked Ms. Fairclough whether she heard the
response when he asked that question.
MS. FAIRCLOUGH replied she interpreted his question more
globally as confirmation that they were revoking the
inability to release sexual perpetrators. Her question
specifically asked whether there was a sexual perpetrator
in the group of thirteen under discussion.
MS. TUPOU replied one inmate was convicted of a sexual
offense of a minor.
MS. FAIRCLOUGH urged members to be aware that sexual
offenders are high repeaters and even though they are on
their death bed they might still present a danger because
they aren't "hard wired" the same. If they are exposed to
children or have any opportunity they will repeat the
offense. She supported a discharge plan and asked whether
there was a definition in state statute for corrections to
use for "severely medically disabled."
She asked Senator Dyson to pay particular attention to this
bill because it would be a step in the wrong direction to
allow a sex offender back on the street.
CHAIR GARY STEVENS remarked he was certain that was not the
intention of the department.
He asked Ms. Tupou to respond to the proposed amendments.
For discussion purposes he labeled the discharge plan
amendment #1 and the irreversible dementia amendment #2.
MS. TUPOU explained the sponsor has no specific problem
with either amendment. She opined amendment #1 is redundant
since the new regulations became effective on March 29,
2003.
CHAIR GARY STEVENS advised the bill would go to the Finance
Committee and he would be comfortable passing it along in
the present form giving the sponsor the opportunity to
address the amendments there.
SENATOR GUESS stated she would like to hear from the
Disability Law Center whether they were comfortable with
the new regulations. She added Ms. Tupou didn't speak to
amendment #2.
CHAIR GARY STEVENS asked Mr. Briggs to comment on adopting
the amendments or passing the bill in the present form with
the recommendation that the sponsor carefully review them
in the Finance Committee.
MR. BRIGGS had no problem passing the bill without the
amendments. That the new published regulations require
discharge planning, he would take as represented. Further,
the point that Dr. Robertson made that a medical officer be
charged to ensure there is appropriate continuity of
service is reasonable and makes his job easier.
There were no further questions.
CHAIR GARY STEVENS asked for a motion to move the bill
without amendments.
SENATOR DYSON made a motion to move SB 159 from committee
with attached fiscal notes with individual recommendations.
SENATOR GUESS added the points Ms. Fairclough made
regarding sex offenders were valid and she would appreciate
the sponsor's attention on the issue.
There being no objection, SB 159 moved from committee.
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