Legislature(2013 - 2014)CAPITOL 106
02/12/2014 08:00 AM House EDUCATION
| Audio | Topic |
|---|---|
| Start | |
| HB210 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 210 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 220 | TELECONFERENCED | |
HB 210-STUDENT RESTRAINT, SECLUSION, PSYC DRUGS
8:03:27 AM
CHAIR GATTIS announced that the first order of business would be
HOUSE BILL NO. 210, "An Act relating to the administration of
psychiatric medication to a student; relating to crisis
intervention training for school personnel; and relating to
restraint, escort, and seclusion of students in public and
private schools."
8:04:01 AM
VASILIOS (AKIS) GIALOPSOS, Staff, Representative Charisse
Millett, Alaska State Legislature, said the purpose of HB 210 is
to rectify an absence that exists regarding a statewide policy
addressing restraint and seclusion, of a student, in a school
setting. Many districts in Alaska have taken independent
measures to establish methods and training programs for
personnel, including adoption of definitions and parental
notification procedures. He pointed out that due to a lack of
state statute and standards, a student transferring between
districts could be confronted with a patchwork of efforts based
on a variety of inconsistent approaches to training and defining
what constitutes restraint or seclusion.
8:05:19 AM
REPRESENTATIVE DRUMMOND moved to adopt the committee substitute
(CS) for HB 210, labeled 28-LS0852\I, Mischel, 2/11/14. Without
objection, Version I was adopted as the working draft.
8:05:53 AM
MR. GIALOPSOS continued, explaining that the first provision
requires the establishment definitions for allowable forms of
restraint and seclusion. Secondly, the Department of Education
and Early Development (EED) is required to approve adequate,
comprehensive, training plans for implementation by school
districts regarding acceptable de-escalation techniques and the
use of positive behavioral reinforcements. The department would
also compile detailed restraint and seclusion incident reports,
from all schools. In essence this bill will codify what many
larger districts are already accomplishing and ensure uniformity
of practices across the state, he finished.
8:07:35 AM
KATE BURKHART, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, Statewide Suicide
Prevention Council, said the changes in the CS are intended to
ensure students access to their medication in a safe and
appropriate manner, taking into consideration that the majority
of districts do not have school nurses or other licensed health
care professionals on staff. She directed attention to the bill
page 1, paragraph (2), which establishes a hierarchy for the
administration of medication as described in the subsequent
three subparagraphs. The preference would be for a health care
professional such as a school nurse. Lacking that possibility a
delegation for administration could be authorized pursuant to
the Board of Nursing regulations. The third option would allow
a school district employee, trained by a licensed health care
professional to administer the medication, acting under a health
plan specific to the student, as adopted in consultation with
the student's parents/guardian and the school administrator.
The committee took an at-ease from 8:08 a.m. to 8:54 a.m.
8:54:51 AM
CHAIR GATTIS called the meeting back to order.
REPRESENTATIVE DRUMMOND moved to adopt the committee substitute
(CS) for HB 210, labeled 28-LS0852\I, Mischel, 2/11/14. Without
objection, Version I was adopted as the working draft.
8:55:28 AM
MR. GIALOPSOS recapped his opening statement.
8:57:11 AM
MS. BURKHART reiterated her opening comments, adding that the
intent is to restrict the administration of psychiatric
medication to an appropriately approved person. Access to
prescribed drugs will ensure that students are able to be at
school safely and productively.
CHAIR GATTIS clarified that none of these prescriptions could be
administered by school personnel without parental consent.
9:00:50 AM
REPRESENTATIVE P. WILSON reflected on her career as a school
nurse and the specific training that she provided to aides.
Citing the dominantly rural landscape of Alaska, and hence an
absence of health care providers, she asked how the aides will
be trained.
MS. BURKHART said that the current medication administration
policy, when a school nurse is not available, requires the
school administrator and parent to consult with the prescribing
health care professional and other local health care
professionals to develop and implement a health plan for the
student. Training for the school staff would be provided by the
health care professional. In remote situations, options could
include the school counselor, special education teacher, or
principal, consulting with the parent and prescribing health
care professional to assure that the health plan accurately
reflects the medication regimen. She said there is no intent to
require a district to bring a health care professional into a
remote village.
REPRESENTATIVE P. WILSON noted that current statute expressly
stipulates a local health care provider and asked how the
situation will be handled in the absence of such an individual.
MR. GIALOPSOS interjected that, because this is a matter of
routine medication administration, the consultation can occur
telephonically with the prescribing authority.
REPRESENTATIVE P. WILSON opined that the language in the bill
should reflect these specific points.
MR. GIALOPSOS referred to page 2, subparagraph (C), to indicate
that the broad language allows for the contingency when a health
care professional is not available. He emphasized that the
language stating "(C) trained by a licensed health care
professional to administer the medication to the student ..."
allows training to occur via any feasible means. The training
is not anticipated to be an intensive course, but rather a brief
consultation of how and when the medication should be delivered
on a routine basis, and include cautionary concerns.
9:07:06 AM
REPRESENTATIVE SEATON directed attention to page 1, subparagraph
(B), to read the language, which states:
(B) acting under a delegation to assist with
administration of medication from a licensed nurse ...
REPRESENTATIVE SEATON said the language implies assistance being
provided in the presence of a nurse, differentiating it from the
[language in subsection (C)], which appears to designate a
person who is trained and acting independently.
MR. GIALOPSOS explained that the Board of Nursing is allowed to
promulgate regulations that allow for the delegation of
authority to personnel who aren't licensed health care
practitioners. A concern must be addressed for imposing
provisions which may prove too restrictive in a rural community
setting. He reiterated the content of the previously discussed
three subparagraphs and said there is a convergence in this
language, which is intended to be as expansive as possible in
order to allow students the appropriate access to routine
medications.
REPRESENTATIVE SEATON maintained that subparagraph (B) doesn't
specify training, and offered his interpretation that it
describes a licensed health care professional performing a duty
as an assistant to help complete a task. He asked whether the
language is meant to identify a staffer to act as nurse, rather
than assistant, for administering medications temporally after
being granted the authority through delegation that includes
training.
MR. GIALOPSOS confirmed the members understanding.
9:10:12 AM
REPRESENTATIVE DRUMMOND suggested it would be interesting to
know what training a parent receives to administer the same
medication to the child on a year-around basis.
9:10:39 AM
REPRESENTATIVE P. WILSON directed attention to page 1, line 8,
to read the language, which states:
(1) if the medication is administered as prescribed;
(2) if the employee is
(A) a licensed health care professional acting
within the health care professional's scope of
practice;
REPRESENTATIVE P. WILSON suggested amending the language to read
"... practice; or" to allow flexibility and align with the
language in the subparagraph that follows. Additionally, she
said an additional subparagraph, (D), could be inserted to
include the possibility of a parent or other person
administering the medication at school.
MR. GIALOPSOS said the "or" is used for drafting purposes to
compound the three subparagraphs, only appearing after the final
phrase but it is implied in the preceding phrases. He offered
to clarify this assumed implication for the final draft to
ensure the intent is appropriately reflected. Further, he
offered that there is no language that would preclude a
parent/guardian from administering the medication in the school
setting.
9:12:40 AM
REPRESENTATIVE DRUMMOND assumed that if the student resides in a
village small enough to not have a health aide in residence, the
parent probably lives in close proximity to the school. She
asked what concern precipitated the drafting of the bill.
MR. GIALOPSOS said motivation for HB 210 arose from concern that
children were being restrained without parental notification.
He reported that, on a national level, some restraints included
archaic provisions allowing the use of Thorazine shots for
chemical restraint or using the student's medicine in a non-
prescribed manner to induce sedation. He acknowledged that the
bill primarily addresses physical restraint options.
REPRESENTATIVE DRUMMOND noted that the types of medication has
not yet been addressed, and asked whether Thorazine is normally
prescribed or on hand for emergency use.
9:14:21 AM
MS. BURKHART said the medications that are contemplated would be
those prescribed for patients with diagnosis of severe emotional
disturbances: mood disorders, anxiety, and attention deficit
disorders. She pointed out that HB 210 includes language that
dis-allows school personnel to administer a chemical for
restraint purposes. The intent of the bill is to ensure
appropriate routine administration of a prescribed drug to a
patient who has returned home from a residential psychiatric
treatment center and is assimilating into the mainstream school
setting.
9:15:54 AM
MR. GIALOPSOS directed attention to page 4, lines 18-21, to
highlight the language which prohibits restraint that could
restrict a student's breathing, or placing a student on their
back or stomach in a manner that restricts breathing. The
requirement does not prohibit an educator or school professional
from placing an arm around a student's shoulders for the purpose
of providing a reasonable physical escort. The prone position
is understood to cause death and is, thus not allowed. Any
other form of restraint that the drafter's have not conjured
that would still have the same outcome for loss of breathing, is
likewise not allowed.
9:18:00 AM
REPRESENTATIVE P. WILSON inquired what type of physical
restraint might be allowed.
MR. GIALOPSOS deferred.
9:19:31 AM
KENDRA STEA, Director of Client Services, Crisis Prevention
Institute (CPI) said that standing restraint positions are
commonly taught, which helps avoid the high risk of asphyxia
that may occur using a prone position. She described restraint
as a method of intervention for ensuring safety in a given
situation and disengagement should happen as soon as possible.
REPRESENTATIVE P. WILSON recalled a situation of a child with
convulsive attacks, and, as the school nurse, she would
administer the intravenous medication, to interrupt the seizure
while the student was on the ground. She asked what is
recommended in a situation where a student cannot remain in, or
be brought back to, a standing position.
MS. STEA clarified that the described seizure scenario
represents a medical restraint, and CPI focuses training for
behavioral restraint. To a follow-up question, she said if a
student assumes a fetal position, such action would not pose a
physical threat to anyone, and not require restraint.
9:25:16 AM
PAMELA LLOYD, Occupational Therapist, Anchorage School District,
reported that the Anchorage School District uses CPI and said
that restraint is typically a final measure, and added that when
a student acts out it affects everyone present. Some facilities
have crisis intervention coaches, trained in CPI, to intervene
when a student becomes violent. She described how a student
might be directed away from the group, herded to a quiet area,
and calmness restored. If there is jeopardy of self-injury, or
to others, and a crisis coach encounters resistance, physical
removal may be resorted to and is performed by a two person
team; one at the feet and one at the shoulders to perform a safe
carry. To a member's question, she said that the Mandt System
is another technique for accomplishing a similar end, used in
some settings.
9:27:55 AM
MR. GIALOPSOS referred to the committee handout titled,
"Sectional Analysis-House Bill 210/Version I," to read the
language, which states:
Sec 2: Would amend AS 14.13.120(a), the requirement
for school districts to have a written school
disciplinary and safety program, by requiring that it
be made available to students, parents and the public.
Section 2 also adds a new subsection (9), which
requires that the program include the policies and
procedures consistent with 14.33.125, a new section
that would be added by Section 4 of the bill.
Sec 3: Would repeal the current language in
14.33.120(b) which have the Department of Education
and Early Development define the requirements of
reporting an incident, and replaced with a new
requirement that, after an incident resulting in a
student being restrained or secluded, the student's
school must notify the parent or legal guardian of the
student within 24 hours.
MR. GIALOPSOS pointed out that the requirement for timely notice
to the parent was the impetus for bringing this bill forward.
REPRESENTATIVE SEATON asked the definition being used for notice
to the parent.
MR. GIALOPSOS directed attention to page 3, line 14, to read the
language, which states:
(b) A school shall, not later than 24 hours after the
incident, report to the parent or legal guardian of an
affected student information relating to an incident
involving disruptive or violent behavior by a student
that resulted in restraint or seclusion of a student
by school personnel.
MR. GIALOPSOS offered that the requirement may be fulfilled via
e-mail, telephonically, or in-person. The parent would need to
acknowledge receipt of the timely notification.
CHAIR GATTIS suggested that the key word maybe received; hence a
letter in the mail would not suffice.
REPRESENTATIVE SEATON asked to have schools respond to the
notification question, due to the varied circumstances and
setting of the teaching facilities. He cautioned having a legal
consequence tied to this requirement, pointing out that a school
employee could make every effort to notify a parent and not have
the receipt acknowledged.
CHAIR GATTIS concurred.
9:33:08 AM
REPRESENTATIVE P. WILSON offered that a village setting provides
a unique situation, apart from the urban schools, and having a
statute encompassing the entire state is a challenge in this
regard. She conjectured that the regulations might address the
requirement at the local level for ensuring receipt of the
notification.
9:34:39 AM
MR. GIALOPSOS established that the intent of the language is to
allow the State Board of Regulation the ability to promulgate
regulations around local considerations and contingencies. He
stressed the importance to have a hard 24 hour rule, to which
facilities must adhere, stating that notification schemes would
need to be in place and fully exhausted to ensure compliance.
The State Board of Education is the authoritative body that
would define the mechanisms to be employed.
REPRESENTATIVE SEATON pointed out that the parent or legal
guardian may not be present in the area where the student
attends school; a variable that would need to be addressed. He
cautioned that justifying a statute requiring verification of
receipt may not be possible considering all the variables;
despite any proviso generating a panoply of options for given
situations.
9:36:53 AM
REPRESENTATIVE DRUMMOND directed attention to page 1, line 3, to
note that the bill title, and language throughout the sections,
encompasses private schools and asked how oversight for these
facilities would be handled.
MR. GIALOPSOS responded that the EED would be required to take
up the task.
REPRESENTATIVE DRUMMOND asked if EED has other oversight
responsibilities in regards to private schools.
MR. GIALOPSOS deferred.
9:38:42 AM
REPRESENTATIVE LEDOUX provided a scenario of a student in a
private facility, and lacking a health care professional on
site, asked if the parent would be required to return to the
private facility to administrator the drug.
MR. GIALOPSOS drew attention to page 1, line 12, and the
language stipulating the requirement for a consultation with a
health care professional to occur, resulting in the delegation
of authority for administering purposes.
REPRESENTATIVE LEDOUX asked whether a school would need to have
a conversation with a health care professional.
MR. GIALOPSOS responded, yes.
REPRESENTATIVE LEDOUX pointed out that having a conversation
with a doctor often involves a lengthy process.
MR. GIALOPSOS explained that this aspect of the legislation
applies only psychiatric drugs and situations that would require
an initial consultation to establish a routine for
administration of a medication. He alluded to the scenario
presented earlier of a student returning from a psychiatric
facility to re-enter a mainstream school setting, and clarified
that this would be part of the transitional plan for the
student.
9:43:04 AM
CHAIR GATTIS said that the pharmacist often acts as a consultant
regarding administration of medication, particularly when
receiving a refill. She asked whether a pharmacist would be
considered a health care professional for the purpose of this
requirement.
MR. GIALOPSOS answered, no.
9:44:11 AM
REPRESENTATIVE SEATON turned to page 2, line 13, to read the
language, which states:
(a) Each governing body shall adopt a written school
disciplinary and safety program. The program required
under this subsection must be made available to
students, parents, and the public ...
REPRESENTATIVE SEATON noted that this requirement is being
imposed on private facilities, and said it could be challenging
to craft policy for private schools to adopt if they aren't
governed under state regulations.
9:45:44 AM
CHAIR GATTIS asked about the department's involvement for
overseeing compliance of state statute in a private school
setting.
MIKE HANLEY, Commissioner, Office of the Commissioner,
Department of Education and Early Development (EED), responded
that there is no mechanism in the bill suggesting the department
follow-up or monitor data received from private schools.
Referring to page 5, subsection (f), he paraphrased the
language, which states:
Each school district shall annually report to the
department the total number of incidents involving the
restraint or seclusion of a student.
COMMISSIONER HANLEY said there is no requirement for the
department to utilize the data in any way other than to make it
a public document; no expectation is written in the bill. Also,
the department is only aware of the private schools that
register. The language could be clarified and the
responsibility of the law could be extended to known private
schools. He underscored that the proposed departmental
responsibilities, as well as the ability for monitoring, are not
clear for following-up on the compliance issues addressed in the
legislation.
9:48:12 AM
REPRESENTATIVE SEATON asked if the department currently receives
mandated reports from private schools.
COMMISSIONER HANLEY responded that there are no reports mandated
by the state for private schools to file, although such
facilities are allowed access to the performance scholarship, if
criteria are met.
REPRESENTATIVE SEATON inquired about current departmental
approval for crisis intervention training programs, and
extending the same to private facilities.
COMMISSIONER HANLEY responded that nothing is in place at this
time for private or public schools, and added that it would be
an added responsibility and require a fiscal note.
REPRESENTATIVE SEATON said the bill indicates [page 6,
subsection (a)] "The department shall approve crisis
intervention training programs for schools," implying that all
schools will be included in the scope of this section. He
presumed that the public schools will have a standard of
training established and asked if the department would
anticipate the same standards being implemented for private
schools.
COMMISSIONER HANLEY responded that it is not clear and currently
EED authority does not reach into private facilities.
9:50:13 AM
REPRESENTATIVE P. WILSON referred to and re-read the same
language [page 6, subsection (a)] to inquire if statute
currently exists and if it would be up to the department to
establish an appropriate program for implementation.
COMMISSIONER HANLEY said the department would anticipate vetting
a list of programs that meet the criteria, and making it
available for school districts to access. The language doesn't
indicate that follow-up would be required on behalf of the
department.
REPRESENTATIVE P. WILSON asked about associated costs.
COMMISSIONER HANLEY indicated that a component exists of about
$14,000.
9:52:08 AM
REPRESENTATIVE LEDOUX inquired about current rules governing the
administration of none psychiatric drugs, in the public schools,
and whether state law affects private schools.
COMMISSIONER HANLEY deferred.
REPRESENTATIVE LEDOUX said it would be helpful to understand the
school policy for administering medications in general and how
the requirement for providing psychiatric drugs differs.
9:53:33 AM
STARR MARSETT, Parent, stated support for HB 210. She began her
testimony indicating representation of her adopted grandson,
Cody, then continued, paraphrasing from a prepared statement
which read as follows [original punctuation provided]:
Cody is currently in 9th grade. He attended Mt.
Iliamna from 1st grade through the middle of 5th
grade. Mt. Iliamna is a day school offering Intensive
Behavior Support Services. Restraint and seclusion
was written into Cody's Individual Education Plan.
Although I expressed my concerns that placement in the
safe room could traumatize Cody further as he was
neglected as an infant and he was, and is, very
fearful of being left alone; we still have to sit by
Cody's bedside every night for him to go to sleep. My
concerns were not addressed. At that time, I was
never notified of when Cody was placed in seclusion or
restrained, nor was there ever any discussion or
meeting to talk about amending his Individual
Education Plan to keep him out of the safe room;
except for the annual [review] of the Individual
Education Plan.
Cody was transitioned to his neighborhood school the
middle of his 5th grade year. He was placed in a
classroom with 31 or more students with a teacher's
assistant who was not trained. I was shown a bookroom
that might be used for any quiet time that Cody might
need.
As the second half of the school year progressed Cody
became more anxious, started having nightmares, and
urinating in his pants. He would beg me not to leave
him there; he would say they were mean to him. The
last month of the school year, I found out by accident
that Cody was being placed in a cleaned out janitorial
closet with no furniture and a cold tile floor, a
narrow window, and the door locked so he could not
leave. This was all done without my knowledge or
approval and was not part of his Individual Education
Plan. I removed Cody from the school immediately.
During investigation, we were told one reason he was
placed in the room was because he wouldn't take a
break.
Cody attended a different neighborhood school for 6th
grade. He flourished. The staff was trained, no
seclusion, he had a full-time trained teacher
assistant with him throughout his day, and he
participated in after school activities, showing that
Cody could be successful in the right environment with
trained staff.
Even in today's environment when we think we have
advanced so far, there are still untrained school
staff that think locking a child in a room is OK.
We need this bill to keep all children safe. As a
parent, I still look back to those days that Cody
begged me not to leave him and how I failed him. I
hope today in some small way I have convinced you to
support this bill.
I would like to address the question about disbursing
medication. Cody does get medication, during the day
at school. It is a controlled medication. Even
though it is prescribed, it must be picked up in
person. The school district has a form that we fill
out and the doctor signs, with instructions for
administering the drug at school.
9:57:56 AM
JESSIE HILL, Student, stated his intent to address the section
of the bill dealing with restraint. Speaking from his
experience, as an Anchorage School District student, he said as
a kindergartener he experienced restraint in the classroom. He
testified that, when he acted up, the class teacher used duct
tape to bind his hands to the table and feet to the chair, as
well as covering his face. He recalled being restrained for
most of one school day in this manner. Reporting the action to
his parents, they were reluctant to believe what he was
describing, but did call the school for verification and
received an official denial of the incident. Years later, he
said his parents came to realize that he was not fabricating the
story and eventually believed him. He stressed the importance
that school restraint should be reported to parents, and said
the experience has had a lasting effect on his life.
9:59:50 AM
CHAIR GATTIS announced HB 210 was held over.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB0210A.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| CSHB 210-R Version.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| CSHB 210-Explanation of Changes.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| HB 210 Sponsor Statement Version.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| HB 210 fiscalNote.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| J G-C letter.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| CS HB 220.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 220 |
| Explanation of changes CS HB220.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 220 |
| CSHB 210 I Version-Explanation of Changes.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| CSHB 210 I Version-Sectional Analysis.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |
| CSHB210-I Version.pdf |
HEDC 2/12/2014 8:00:00 AM |
HB 210 |