Legislature(2017 - 2018)GRUENBERG 120
02/05/2018 01:30 PM House JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| HB312 | |
| HB129 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 312 | TELECONFERENCED | |
| += | HB 129 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 312-CRIMES AGAINST MEDICAL PROFESSIONALS
1:31:26 PM
CHAIR CLAMAN announced that the first order of business would be
HOUSE BILL NO. 312, "An Act relating to arrest without a warrant
for assault in the fourth degree at a health care facility; and
relating to an aggravating factor at sentencing for a felony
offense against a medical professional at a health care
facility."
1:32:15 PM
REPRESENTATIVE KOPP noted that it had been a privilege to work
with Chair Claman on this legislation over the interim. The
background, he related, is that over the last ten years,
nationally and statewide, there has been a rising tide of
workplace violence occurring at health care facilities. He
related that throughout his years in law enforcement he escorted
a number of people to emergency rooms, stayed with them while
they were being treated, and once they were stable, he escorted
them to whatever facility they were going to next It is
interesting, he commented, how things have changed both in the
health care environment and in public safety, with a primary
drivers being the sheer numbers of people showing up in
emergency rooms with severe behavioral health, alcohol, and
substance abuse issues, that contribute to violent behavior. In
the event an assault occurs on a fire fighter or a police
officer outside of the emergency room doors, the charge is
assault. Although, somehow after entering the emergency room,
the culture has become that "you get a free pass on the health
care worker." He explained that currently, misdemeanor assault
has an exception for obtaining an arrest warrant only for
domestic violence. Therefore, on a domestic violence
misdemeanor level of an assault, an officer can make an arrest
if they determine who was the principal aggressor and they can
also consider other factors in making that determination.
Except, he pointed out, in the event it is a misdemeanor level
assault in an environment, such as a health care facility or an
emergency room, an arrest warrant is required unless the health
care provider is willing to place the person under arrest for
assault and sign an affidavit as to everything that occurred.
Consequently, he said, it is difficult for that arrest to take
place.
1:34:41 PM
REPRESENTATIVE KOPP advised that this piece of legislation looks
at the health care facility as an environment the legislature
must protect and keep safe because the state considers keeping
people safe in a home to be a sacred duty. This bill recognizes
that health care facilities also rise to that level of a sacred
place wherein the patients who are already admitted, the people
that work there, and the people coming in, need to know that
they are in a safe place. In the event violence occurs and the
police are summoned, at their discretion, they can make an
arrest if probable cause is present to charge a person for an
assault that occurred in the health care work environment.
Further, he advised, if the assault is at a felony level of
assault where serious physical injury had occurred, this bill
allows that it is an aggravator at sentencing if the assault
occurred on a medical health professional during the course of
their duties, and that the person knowingly carried out the
assault for that purpose. In summary, he explained, this bill
addresses a real need to protect workers in their workplace, and
that Alaska's health care facilities, above all facilities,
represents health care providers and honors them in the same
manner in which the legislature would any other person because
"there is no free pass for assaults in a workplace." This
legislation balances the need for accountability with the need
for patient protection by requiring that "the health care
professional state that they are stable for discharge before
they go out the door."
1:36:47 PM
LIZZIE KUBITZ, Staff, Representative Matt Claman, Alaska State
Legislature, paraphrased the sectional analysis as follows:
Section 1
AS 12.25.030(b) - Grounds for arrest by private person
or peace officer without a warrant.
Establishes that a peace officer may arrest a person
without a warrant when the peace officer has probable
cause for believing that the person has committed an
assault in the fourth degree at a health care facility
and the person was not seeking medical treatment at
the facility or was stable for discharge.
The term "stable for discharge" comes from the federal
Emergency Medical Treatment and Labor Act, also known
as EMTALA. EMTALA requires anyone coming to an
emergency department be stabilized and treated,
regardless of their insurance status or ability to
pay. The federal government has published guidelines
that describes the responsibilities of hospitals in
emergency cases.
The guidelines provide: "a patient is considered
stable for discharge?when, within reasonable clinical
confidence, it is determined that the patient has
reached the point where his/her continued care,
including diagnostic work-up and/or treatment, could
be reasonably performed as an outpatient or later as
an inpatient, provided the patient is given a plan for
appropriate follow-up care with the discharge
instructions." In addition, "? 'Stable for discharge'
does not require the final resolution of the emergency
medical condition."
Section 2
AS 12.25.030 - Grounds for arrest by private person or
peace officer without a warrant.
Establishes that the definition for "health care
facility" has the meaning given in AS 18.07.111.
Section 3
AS 12.55.155(c) - Factors in aggravation and
mitigation.
Adds an aggravator to Alaska's felony assault statute
when a defendant committed the offense at a health
care facility and knowingly directed the conduct
constituting the offense at a medical professional
during or because of the medical professional's
exercise of professional duties.
Section 4
Uncodified law
This section contains applicability provisions.
1:39:56 PM
REPRESENTATIVE LEDOUX stated that she likes the idea of the bill
but was unsure about the exception here and noted that if
someone was dying of a heart attack, it probably would not be a
good idea to arrest the person at that time. There is the
exception that if that is going to cause death or severe bodily
damage, to rather not have those exceptions.
MS. KUBITZ explained that in creating those two separate
incidents of the person not seeking medical treatment or the
person who was stable for discharge, it attempts to capture
anyone who comes into that facility, whether a patient or a
family member of a patient. She advised that they worked
closely with Legislative Legal and Research Services to create
as much clarification as possible.
1:41:30 PM
REPRESENTATIVE LEDOUX advised that she was not following Ms.
Kubitz' explanation.
REPRESENTATIVE KOPP explained that many of the assaults that
occur in a health care facility are "visitors on health care
givers." In other words, the person may be accompanying a
family member or a spouse, and situations can be volatile for a
variety of reasons, such as a lack of understanding as to why a
health care procedure was given or there was an unmet
expectation. He related that violence can and does occur, and
he referred to letters contained in the committee packet, as
follows: Jim Lynch, CEO of Fairbanks Memorial which advised
that just this last year it had over 100 assaults on its own
staff; and there was a letter from Julie Taylor, Anchorage
Regional Hospital. He expressed that [the problem] is not just
the patients who come into the hospital, it can also be the
person that accompanies them.
1:42:36 PM
REPRESENTATIVE LEDOUX agreed that Representative Kopp was
correct in that it is not just the patients going into the
hospital. Except, to the extent it is a patient, why would the
sponsor not let the patient be arrested as long as the arrest
would not cause death or severe bodily injury.
CHAIR CLAMAN explained that concerns were raised, and he used
the example of someone suffering from an unstitched bleeding leg
wound that continued to bleed, thereby, causing a risk to that
person's health. In this scenario, the arresting police officer
who started transporting the person to jail is now put in an
untenable position because the jail would say that it could not
sew up the wound and the offender needs to go to the emergency
room. Yet, the police officer is left there saying that they
just left the emergency room. Therefore, the reason for
definition, "stable for discharge" essentially relates to the
patients and the police officer would wait to arrest the person
until after the doctor in the emergency room advised that the
person was stable for discharge, stable enough to take to the
jail. He explained that law enforcement does not want to be in
a place in which the health care professionals release an
unstable for discharge person to a police officer, and the
police officer is left asking, "What do I do now?"
1:44:12 PM
REPRESENTATIVE EASTMAN asked what establishes whether someone is
seeking medical treatment at the facility. He related that
sometimes paramedics find people who do want medical treatment
but are compelled into treatment for their own good and asked
whether that person was seeking medical treatment at a facility.
On the other hand, he related that someone decides to slug a
doctor and has a bruised hand, and says, "help my hand," whether
that person was seeking medical treatment.
MS. KUBITZ answered that she was unsure it mattered either way
simply because the legislation does capture everyone. In the
event a doctor presumes a person was seeking medical treatment
and it was the reason they came to the hospital, then the person
falls under the "stable for discharge" language. In the event
the doctor assumed the person was not seeking medical treatment
and was accompanying someone with a wound, the person could fall
under the first category of not seeking medical treatment. She
reiterated that she was unsure that specification really
mattered in that she would hope the health care professionals
would realize who was, and was not, a patient and who needed
care.
1:45:41 PM
CHAIR CLAMAN opened public testimony on HB 312.
1:46:05 PM
ANNE ZINC, Emergency Medicine Physician, Matanuska-Susitna
Regional Hospital, advised that she is the past president of the
Alaska College of Emergency Medicine Physicians. She noted that
as an emergency medical provider, this bill reads "cleanly and
we're doing this on a regular basis every single day" when
deciding whether someone is stable for discharge, stable for
jail, stable for transport, and it fits in nicely with (audio
difficulties) and will be easy to follow through in practice.
She related that she hopes HB 312 passes quickly and cleanly,
and as mentioned previously there has been "a huge increase" in
patients being served with behavioral health needs. During the
last three years, at the Matanuska-Susitna Regional Hospital,
there has been a four-fold increase, and oftentimes the patients
are held anywhere from two days to ten days in its emergency
department. These patients are oftentimes medically clear, but
the hospital is awaiting some sort of behavioral health
evaluation, and many of these patients will act out violently
because they are in an unpredictable and chaotic environment for
a long period of time. Unfortunately, she pointed out, in the
emergency department it has become the norm to be threatened or
attacked and many physicians or nurses have been threatened or
personally attacked. She stated that it makes it hard to care
for other patients when "I received a black eye in the emergency
department and was held up against the wall while trying to care
for a six-month old who was really struggling to breathe." She
related that being able to get these patients to a safer, calmer
place outside of the emergency departments allows the staff to
care for all of the other patients in the emergency department
who need them at that time. She expressed hope that this bill
is passed quickly and cleanly, not only for the benefit of
health care workers and the other patients, but that it will
benefit the violent patients because they are often stuck in a
chaotic uncontrolled environment and they do better in a more
controlled environment, such as jail while waiting for
psychiatric treatment.
1:48:07 PM
JULIE TAYLOR, CEO, Alaska Regional Hospital, advised that she
has been a nurse over 30 years, and has seen the evolution of
what is being dealt with today, including the spike in the last
couple of years, because she has had a front row seat. She
offered concern that people may not want to be in the nursing
profession any longer due to the nurses feeling unprotected,
wherein, it is typical for nurses to be kicked and spit at with
no consequences. She pointed out that when there is really no
follow-up to the issues she had identified when asking for
support, the nurses are getting used to it and becoming numb,
which is "really a problem." There were 80 separate events in a
short time just last year, she advised, and those events
continue to escalate because there are not strong enough
consequences or clear lines as to how these patients need to be
managed. Without question, she pointed out, nurses are
compassionate, and they want people to receive the health care
they require and become stable to be discharged. She expressed
that Dr. Anne Zinc "nailed it on the head" because when people
are held for a long period of time when simply waiting for
placement, they act out. She said she has had patients threaten
her nurses by stating, "I'll figure out where you live," so my
nurses have only their first names on their name badges because
they are afraid to have their full name listed, but they are
concerned about their first name being listed also. The milieu
is not good for anyone and there must be a way to send a message
stating that, "the health care environment needs to be
protected." In response to Representative LeDoux's comment, she
said, "To me, these are people that are putting themselves out
there (audio difficulties) health care workers and supporting
the community." She related that the state needs to have a high
bar in keeping health care workers safe because if a staff
member is distracted, another patient is not receiving the
attention they deserve. She said that she echoes everything Dr.
Zinc testified to and added that this legislation is for the
health and welfare of everyone.
1:50:49 PM
BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing
Home Association, advised that she represents the Alaska State
Hospital and Nursing Home Association and offered its strong
support for HB 312. This legislation gives law enforcement "and
the judicials" new tools to address workplace violence in health
care facilities. As Representative Kopp noted, hospitals are
sacred places to help people at some of their most joyful and
most difficult times in their lives, and they should be safe
places where people can receive help in an emergency. She
related that hospitals are also a reflection of the community at
large, and unfortunately due to a variety of factors, Alaska has
seen workplace violence escalate in hospital settings. Health
care staff report that they feel unsafe in the workplace because
far too often they are kicked, punched, spit on, or verbally
threatened. Violence should not be an acceptable workplace
hazard, she said, except, for many nurses and physicians, CNAs,
and other caregivers, this has become the new norm. As
employers, hospitals have a responsibility to address any
workplace violence, and she said she wanted to assure the
committee that "we are doing our part" and working to ensure
there are plans in place to prevent, identify, and de-escalate
violence before it gets to the point where law enforcement
becomes involved. She advised that, "We're sharing best
practices" on preventing and responding to violence, but when
law enforcement is called, usually the situation is serious and
sometimes the individual must be arrested and removed from the
facility. She commented that there is an attitude that violence
is just part of the job in health care, and she opined that that
is one of the things "we are working to address" through this
legislation. Hospitals simply cannot bear the burden of
violence much longer, "we are doing our part, but we need help.
Our caregivers need help." While there are many things that can
be done as hospitals in addressing workplace violence, health
care workers need the support and engagement of the legislature
and the criminal justice system, as well. She said she wanted
to reassure the committee that hospitals address violence daily,
and they understand the needs of vulnerable patients with
behavioral health or substance abuse issues. The intent of this
legislation is not to penalize those who need those treatment
services. In fact, she advised, it was carefully designed not
to do that, but it is intended to give law enforcement and the
judicial system new tools to help address the epidemic of
workplace violence in Alaska's hospitals. She urged quick
consideration and passage of this bill as written.
1:53:27 PM
REPRESENTATIVE REINBOLD commented that "it says only fourth
degree here," and asked whether there was a reason it was
limited to fourth degree and whether to expand the definition.
CHAIR CLAMAN advised that a person can be arrested for a felony
without a warrant, so there is no need to change it for a felony
assault because law enforcement already has that authority.
1:53:56 PM
REPRESENTATIVE REINBOLD surmised that the committee needs to
keep the definition limited to what it is in the bill.
CHAIR CLAMAN advised that the only issue for law enforcement was
fourth degree assault, it does not have issue with first,
second, and third-degree assaults.
1:54:20 PM
CHUCK BILL, CEO, Bartlett Regional Hospital, advised that
Bartlett Regional Hospital provides health care services to the
residents of Juneau, visitors to Juneau, and the surrounding
communities. He acknowledged that Bartlett Regional Hospital
has seen almost the exact same increase in violence in its
facility as was heard from the Fairbanks and the Matanuska-
Susitna hospitals. Weekly, he said, the staff is punched,
kicked, spit on, and that is not okay. The most dramatic
incident, he stressed, was when a patient removed their IV
tubing and tried to strangle one of his nurses. This is an
important bill and he encouraged the committee to move it
forward, while emphasizing that the hospital believes this
legislation is only a part of the solution to the ongoing
problem. Bartlett Regional Hospital implemented a number of
programs to really start doing what it can to reduce those
issues. Most importantly, he related is the training for all
staff members, which includes: escalation; how to avoid
dangerous situations; and so forth. In addition, he advised,
Bartlett Regional Hospital implemented a software system, that
has been implemented in the emergency departments throughout the
state, that flags patients and sends the hospital a heads up
when there is a patient with a prior history, so the hospital
can be prepared. This year, he remarked, the hospital
introduced "duress buttons" wherein the staff in its emergency
room and mental health facility can push a button if they feel
they are in a threatened position, and that button will send
help from all over the organization. Finally, he said, this
year the hospital doubled its security force, which is not
something it did lightly because obviously, it takes away from
its ability to hire nurses and other staff. Except, he said, it
was an important commitment for the hospital to make for the
safety of its workers.
1:56:29 PM
REPRESENTATIVE REINBOLD referred to the increase in incidents
and asked whether he had an inkling as to why the increase.
MR. BILL opined that, partially it is the pervasiveness of the
meth problem, and partially it is in response to the changes in
the law that made it harder to "put people in" for misdemeanors.
While the timing is suspicious, he commented, he could not say
that for a fact, but he was pretty comfortable that issue had
input into the problem.
1:57:19 PM
JOAN CLOOTIER, RN, Alaska Native Hospital Emergency Room,
advised that she was assaulted last September by a patient, she
was punched twice in the face, kicked up against a wall,
repeatedly kicked until security and a behavioral health person
came to her aide. It was actually a patient that dragged her
free after suffering multiple injuries, bruises, loss of a tooth
and, she pointed out, this is "just one of these things that
just seems to be increasing rampantly, nationwide assault
against health care workers and nurses in particular." The
emergency room is a hotbed, she described, because people are
seen at their worst in all phases of strife and stress, and "we
are" certainly one of the first people to get nailed when it
comes to assaults. She opined that one of the big cause for
assaults is that people are not held accountable for their
actions. Speaking as an emergency room nurse of 27-years, she
advised the committee that this was probably the 12th or 15th
time she had been assaulted as a health care worker. Assaults
on health care workers are horribly on the rise and she noted
that she has been assaulted twice in the last six months.
Clearly, drugs and alcohol are increasing but, she stressed, the
lack of accountability has also increased in this country and
people are not receiving consequences for their actions. Be
that as it may, she said, the person who assaulted her last fall
served 90-days, "she tried to get out going through the mental
health part of it." Ms. Clootier related that she was
persistent because it required her being persistent, while
unfortunately, not all of her co-workers are persistent.
Something must be done to stop the assaults against the nurses,
she expressed.
1:59:37 PM
REPRESENTATIVE REINBOLD asked whether 90 days was enough time to
serve for what the offender did to her.
MS. CLOOTIER responded that she absolutely did not believe [that
was justice] because she is still recovering from the attack and
has to pay $1,000 out of her own pocket to have a tooth
replaced.
REPRESENTATIVE KREISS-TOMKINS advised Ms. Clootier that the
Victims' Crime Compensation Board might be something to look
into in terms of the $1,000 tooth replacement.
2:00:43 PM
REGENA DECK, RN, Emergency Room, Bartlett Regional Hospital,
offered testimony as follows:
I've lived in Juneau for three years and have worked
on the East Coast in a variety of emergency room
situations, including inner city. And, I've not seen
the amount of violence that we have here in Alaska
against health care professionals. In Pennsylvania,
one of the emergency rooms that I have worked in, it
is already a felony assault, there is no question
about it, and when you say, "What's the difference?" I
look at my co-workers and we have conversations on a
daily basis, whether it is the security guard, whether
it's a fellow nurse, we come out of a room and we say,
"Wow, that person really scared me, they threatened to
kill me, they know my cousin, they know where I live."
And, those are the kinds of things that if this was
raised to a felony, it would take that piece of us
having to enforce it ourselves out of it. As people
who are kind and caring, it is our job to try to heal
and figure out, 'why was he angry with me.' We're
almost in an abusive life situation, where instead of
saying, 'Wow, I just got punched in the face, we look
at it as 'what did I do, what did he really need from
me?' And, it is unacceptable. I was a victim, I
moved to Juneau and three months after, I was
strangled in the emergency department ... I feel that
I've ... that gentleman has since been prosecuted, but
not after a lot of work on our behalf. That gentleman
is now serving three years in prison, but much of the
trial process was him trying to get the three felony
counts in addition to his misdemeanor (audio
difficulties) to a misdemeanor. His people, speaking
on his behalf, including mental health professionals,
said 'Well, ER nurses have to expect it, it's your
job, it's what you do.' To which I say, 'I doubt it,
I definitely won't say to my family, Hey, I need to go
to work as a nurse today, I hope I don't die.' That's
not what I do for work. In Juneau, we see more and
more of a prevalence, not only of drug addiction,
homelessness, things that drive people to desperation,
but also a disregard for the repercussions. We have
people that come in with knives and guns on them, and
anecdotally, they just say, 'Oh yeah, I guess you want
to hold this while I go to x-ray.' As a nurse, that's
unnerving. I get you might be a hunter, you might be
qualified to carry that, but I work in an environment
where not only am I now being strangled by my own
equipment and being left with the ramifications of
that, as have my fellow staff and my husband. But,
now I have to worry that every patient is out to get
me and that is not the kind of care I give. I also
happen to be a professor who is teaching the next
group of nursing students here in Juneau, and it's a
fine road to hoe to take away the fantasy of, I'm
going to go forth and help people and make them
better. But, I have to be worried that they don't
kill me first. So, I'm hoping that this bill ... in
this gentleman's case, he had been reported to the
police and reported to security on numerous occasions
before this happened. And that anecdotal information
didn't come out until after my event. So, had it been
a felony, he wouldn't have had the opportunity to have
37 crimes listed on his rap sheet before strangling
me.
2:04:17 PM
[CHAIR CLAMAN and Representative Reinbold discussed criminal
justice reform.]
REPRESENTATIVE REINBOLD asked whether Ms. Deck believes that
three years was justice for the event, that includes all of the
time and energy she has had to put in on it and the trauma on
her life.
2:05:25 PM
MS. DECK responded as follows:
The reality was, or my misunderstanding watching too
much t.v. was, he was given his sentence and then
walked out. He walked out of the courtroom and was
going to be free on appeal. He went back into prison
only by his own choice because he didn't have any
place else to live. So, he chose to go back into
prison, but after having been convicted, after being
in court with his family, who can now identify me and
made a point of staring at me in the courtroom, he
then was let walk. And, that's the part for me that
was the most scary. Three years ... I don't have a
number that will make it go away, it'll be a lifetime
for myself and the follow workers who were there. As
well as my husband who has to deal with the idea that
he can't protect his wife while she's at work. And,
of course, I think somebody mentioned that our
inclination is then to say, 'Don't work there.' Okay,
well, I'm sure that many of you having an emergency or
a trauma would be appreciative of nurses with
experience, but I think we're scaring them out the
door. So, I don't know how much would have been
enough, but three years doesn't seem enough.
2:06:30 PM
REPRESENTATIVE KOPP referred to the person who strangled her and
asked what charge the person received.
MS. DECK remarked that originally, he had four charges. He was
charged with a class A misdemeanor for negligent injury with a
weapon; and he was also then charged with class C felony for the
cause of fear, cause of death, and attempt to harm with a
dangerous weapon.
2:07:22 PM
HAROLD SUNKEL, RN, Emergency Nurses Association, Alaska Native
Medical Center, [audio difficulties throughout Mr. Sunkel's
testimony.] described an attack he suffered when a lady came
into the hospital crying from abdominal pain. (Audio
difficulties) already verbally abusing, was uncooperative, and
would not let anyone take her vitals while yelling profanities
at the staff. She was given a private room, so the staff could
close the door and not disturb anyone else. The woman called
out slurs toward the staff, so Mr. Sunken took over her care.
After several attempts to calm her down, she called him "the N-
word" with homosexual slurs. (Audio difficulties.) After
refusing to accept medication she began yelling that the staff
was not helping her. After several requests for the woman to
take her medication, he closed the door and walked out. The
woman came out of the room and spit in his face, he was shocked
and put his hand over his head (audio difficulties) and she hit
the back of his head twice. As he was taught, he then put her
hand behind her, pushed her up against the wall, and pushed her
face so she could not continue spitting at him of which she was
attempting, and finally he received help. He said that security
put her in a room to watch her, the police were called, and his
shift ended four hours later. The police officer told him that
his hands were tied because there was no visible bruising, and
no charges were pressed (audio difficulties). The woman's
consequence was a ride home from the police officer, and her
defense was that Mr. Sunkel hit her and slapped her, even though
he never laid a hand on her except to keep himself safe. He
stressed that these people have no consequences, and when the
staff tells them they will be arrested, they laugh in the
staffs' face.
2:10:20 PM
AUDREY BUMA, RN, Bartlett Regional Hospital Emergency Room,
advised she has been a nurse for 12-years and that not even once
in nursing school did they teach the nursing students how to
defend themselves. She advised that during the last 4.5 years
at Bartlett Regional Hospital "we have been assaulted verbally,"
physically assaulted, kicked at, spit at, things thrown at the
staff, and oxygen tanks have become weapons. Whereas now, the
staff has to take most things out of a lot of the rooms just to
be safe. These offenders know there are no consequences and it
happens daily for most people, especially the verbal abuse and,
it is okay. She related that she believes this legislation will
help protect staff a little bit because there has to be
consequences for their actions. Nurses did not go into the
profession of nursing to be abused, she pointed out, and it is
difficult to go to work knowing something could happen. She
referred to Regina Deck's testimony wherein it took two years of
a terrible trial to go through to then see some consequences,
yet this person would still come back on a weekly basis, which
is difficult. She asked the committee to please pass this bill
to help the health care workers.
2:11:46 PM
REPRESENTATIVE KREISS-TOMKINS asked Ms. Buma to describe the
verbally abusive people being treated at Bartlett Regional
Hospital, and what injuries or conditions they have when coming
through the emergency room door.
MS. BUMA answered that most of the people come in due to being
intoxicated with drugs, sometimes they may be hurt, but a lot of
the time they were taken to the hospital for medical clearance
before going to "sleep off," or to jail. Some of the people are
hurt, some of the people come to the emergency room for help,
but many times drugs and alcohol are involved.
2:12:29 PM
REPRESENTATIVE KREISS-TOMKINS referred to the majority of the
people that go to the hospital due to drugs and alcohol and
asked whether there would be an active medical danger at hand if
the person was not at an emergency room, such that they may die
or suffer some type of injury.
MS. BUMA remarked that she was sure if the person was too
intoxicated that "they worry" about them, or with drugs. The
hospital has to be able to clear these people and sometimes it
is hard to even access them because they get mad if a nurse
wakes them up from sleeping; or if they are not getting the pain
medicine they requested; or is making them leave when they have
been discharged.
2:13:15 PM
REPRESENTATIVE KREISS-TOMKINS commented that he understands that
the people who are heavily intoxicated should go to the
emergency room, especially if other issues may arise. In the
event the emergency room was being used as a place for people to
sleep off a high or sleep off being incredibly drunk, that
appears to be a misuse of the facility. He asked Ms. Buma to
speak to the people she encounters who are verbally abusive, and
whether there would be any medical harm if they were to go
someplace else that was more secure with appropriately trained
people.
MS. BUMA remarked that that is a hard question to answer.
2:14:07 PM
REPRESENTATIVE REINBOLD asked whether Ms. Buma had seen an
increase [in workplace abuse] or whether it has been steady over
the last 4.5 years.
MS. BUMA replied that it has probably increased over the last
4.5 years, and that she came from Washington and Colorado where
it was a felony for assaulting a health care worker. She opined
that that made a difference because people knew that health care
workers could warn them that if they assaulted a health care
worker something would happen, and people would "sort of" back
down. She estimated that over the last two years there has been
an increase in health care worker assaults.
2:15:25 PM
AMBER MICHAEL, Alaska Nurses Association, [audio difficulties
throughout Ms. Michael's testimony.] (audio difficulties) in
support of HB 312. (Audio difficulties) on health care workers
a very real and troubling (audio difficulties) all areas of the
hospital, not just the emergency department. This includes:
(audio difficulties) progressive care, medical/surgical units,
and ICUs. On a daily basis workers experience violence in all
forms, including: spitting; hitting; kicking; pushing; verbal
abuse; and in some circumstances gun violence. All (audio
difficulties). The lack of (audio difficulties) situations is
unacceptable. A police officer should be equipped with the
legal authority to arrest someone who is a threat to those
around them and remove them from the premises. The danger
(audio difficulties) when an altercation occurs in a health care
facility anyone present is in harm's way. Health care
facilities, for example, (Audio difficulties) increased anger
and even great joy. (Audio difficulties) and that is not
including those who are intoxicated. Nurses, doctors, medical
assistants, and other personnel can easily become targets of
violence in these situations. (Audio difficulties) having to
protect ourselves under (audio difficulties) care. The added
(audio difficulties) health care worker (audio difficulties) and
the hope that it is (audio difficulties) in health care
facilities. She strongly urged the committee to support this
legislation.
2:17:25 PM
WENDY SHACKELFORD, [Audio difficulties throughout Ms.
Shackelford's testimony.] offered her belief that health care
workers who want a job should absolutely be protected from
physical injury while on the job, and abuse is never respectable
behavior from patients or their visitors. This is also to avoid
(audio difficulties) clients with behavioral health or trauma
driven behavior. This state has worked hard to decriminalize
the institutionalized (audio difficulties) criminal justice
costs. She suggested that the resources may be better spent in
beefing up community based behavioral health services so people
have quicker access. She then offered examples (audio
difficulties) actual data regarding physical arrests, physically
removing the person from the hospital property to the Department
of Corrections for assault in the fourth degree on health care
workers. She asked the actual data regarding summons arrests,
for example, the person left on the property and issued a court
date is actually an arrest for assault in the fourth degree on
health care workers. She opined that police agencies also have
policies and procedures that may dictate whether they issue a
summons or make a physical arrest based on bail schedules set by
courts and circumstances (audio difficulties) boundaries, not
necessarily whether someone wants to press charges. She
encouraged the legislature to involve law enforcement (audio
difficulties) they may also all be actual data in this area.
She offered concern that there is not enough information to
implement new legislation and encouraged the cultivation of
actual data (audio difficulties) that still keeps health care
workers safe.
2:20:20 PM
KATIE BALDWIN-JOHNSON, Senior Program Officer, Alaska Mental
Trust Health Authority, advised that the Alaska Mental Trust
Health Authority is in place to advocate on behalf of trust
beneficiaries, and prioritize policy practices and funding
toward strategies that help improve the lives of beneficiaries.
She explained that beneficiaries include individuals with mental
illness, chronic alcoholism, substance abuse, intellectual and
developmental disabilities, Alzheimer's disease and related
dementias, and traumatic brain injury. She advised that her
comments are specifically focused on the impact on mental health
trust beneficiaries, and that the trust recognizes there are
legitimate concerns about hospital workplace violence, and the
safety of health care providers and patients seeking care,
requiring the implementation of a number of targeted solutions.
She advised that the trust has made long-term investments in the
areas of disability, justice, and criminal justice reform with
the focus on finding solutions with the fact that mental health
trust beneficiaries are over-represented in the criminal justice
system. Approximately 40 percent of incarcerations annually are
beneficiaries and their stays at both pre-trial and sentencing
are longer than non-trust beneficiaries. She described that
trust beneficiaries languish in correctional care for a variety
reasons, one reason is that some beneficiaries are higher
utilizers of emergency services and it is difficult to find
adequate solutions in the current system of (audio difficulties)
treat their needs. The trust is concerned that the unintended
consequences of this legislation will result in additional trust
beneficiaries being incarcerated, she said. Much of what the
trust focuses on is targeted toward preventing the following:
identification of community-based solutions that better serve
and prevent the incarceration of trust beneficiaries; enhancing
access to necessary substance abuse and mental health treatment
services; supporting opportunities for training and practices
for providers to work effectively with complex behaviors;
investing in housing solutions; employment opportunities; and
together with the trust's partners, it addresses the gaps in the
community continuum of care that shifts reliance on hospital
settings and unnecessary incarceration, she explained. The
trust would support, and is interested in, seeing some of the
data hospitals are collecting and its analysis of the data,
thereby, assisting the trust in understanding how beneficiaries
inter-relate with the incidents that are taking place because
the trust and its partners can help to be part of that solution.
2:23:00 PM
REPRESENTATIVE REINBOLD asked whether Ms. Baldwin-Johnson was
opposed to this bill.
MS. BALDWIN-JOHNSON responded that the Alaska Mental Trust
Health Authority was neutral, but it would be difficult to say
that the trust supports this legislation without knowing more
about its impact on its mental health trust beneficiaries.
2:23:27 PM
REPRESENTATIVE REINBOLD asked whether Alaskans with mental
illness, substance abuse, Alzheimer's disease, traumatic brain
injury are all beneficiaries of the trust.
MS. BALDWIN-JOHNSON responded that it depends upon their level
of functionality because the trust is in place to prevent
beneficiaries from being incarcerated or placed in higher levels
of institutional care. In the event an individual had a history
of drug or alcohol use and was able to function independently in
the community, that individual would not necessarily be deemed a
beneficiary, she said.
2:24:04 PM
REPRESENTATIVE REINBOLD requested the percentage level of
functionality.
CHAIR CLAMAN asked whether Ms. Baldwin-Johnson could offer
statistics as to who is eligible and what kind of population is
being served.
REPRESENTATIVE REINBOLD interjected that "functionality is what
she said it was stated on." She then asked whether it would be
better, "rather than having these people running all over the
place with temptations and alcohol, and everything," to have
them in a confined setting, such as a prison or a treatment
program where their treatments would be more successful. It
would seem, she opined, that Ms. Baldwin-Johnson would support
treatment inside certain facilities.
MS. BALDWIN-JOHNSON referred to the functionality question and
responded that it would be a description of an individual's
ability to live independently and successfully in a community,
and she said she would provide the committee with more
information. Ms. Baldwin-Johnson then referred to the
confinement question and answered that the department would
"absolutely be an advocate of expanded treatment" in services
both within correction settings and certainly community-based
settings. The need there, she explained, is that individuals
need access to their correct treatments in settings that are
appropriate for their needs.
2:25:50 PM
REPRESENTATIVE STUTES surmised that the Mental Health Trust Fund
does not directly help these individuals, but rather it works
through the other agencies that help these individuals.
MS. BALDWIN-JOHNSON replied that the Mental Health Trust Fund
funds through a variety of avenues, and it supports some funding
to state agencies to implement mental health focus services to
enhance those opportunities to better serve its beneficiaries.
The Mental Health Trust Fund also has authority to grant funding
to community organizations that are working directly with its
trust beneficiaries. The trust does have individual grants it
can directly impact its beneficiaries to help them move more
independently in the community, she offered.
REPRESENTATIVE STUTES asked whether Ms. Baldwin-Johnson was
saying that the trust directly supports individuals if the
parameters are appropriate.
MS. BALDWIN-JOHNSON responded that the trust has a mini-grants
program that is appropriate for individuals with behavioral
health issues. In the event an organization applies on behalf
of that individual for a "specific thing" to support that
individual in living independently, or help to improve their
quality of life, the trust can fund an individual's beneficiary
grants, she explained. Although, she added, the funds go
through an organization and not directly to an individual.
2:27:37 PM
REPRESENTATIVE STUTES surmised that all of the trust's grants
and dollars it expends are through a third-party, one way or
another.
MS. BALDWIN-JOHNSON answered in the affirmative.
2:27:55 PM
SARA MARTIN, Nursing Director, Fairbanks Memorial Hospital,
advised that she is the nursing director in the emergency room
and the intensive care unit at Fairbanks Memorial Hospital. As
had been previously testified, she agreed that there has been "a
very, very sharp increase" in patient violence and acts against
health care workers in the last two years.
She pointed out that the Fairbanks Memorial Hospital is there to
help provide better support for its staff and increase their
feelings of security and recognizing that these things are
happening to them in their workplace. She advised that the
Fairbanks Memorial Hospital has put into place many different
additional steps in trying to keep its staff safe because the
administration recognizes that this legislation is not the only
answer to everything the staff has gone through. Ms. Martin
added that this legislation would be a great step in moving the
hospital forward in helping to support its staff and keeping
them safe.
2:29:03 PM
JENNIFER MOORE, Chief Quality Officer, Mat-su Regional Medical
Center, advised that she is speaking on behalf of the Mat-Su
Regional Medical Center, and that the medical center is in
support of HB 312, as it helps to address the serious concern of
workplace violence in health care facilities. Alaska's
hospitals have experienced increased workplace violence over the
past year, including assaults and physical injuries against
caregivers. As a nurse for more than 20-years, she said that
she has personally been punched, spit on, slapped, kicked, and
grabbed so hard the (audio difficulties), as well as countless
verbal threats, all while attempting to treat and care for those
in need of medical attention. Of note, she acknowledged that
she has never been an emergency room nurse, but this abuse not
only impacts that unit because it impacts any and all units
within a hospital. She pointed out that the hospital's nurses
and providers have experienced or witnessed the same workplace
violence or worse, and they are afraid to come to work due to
their fear of assault. Ms. Moore said that she remembers the
day Dr. Zinc was assaulted and the impact it had on the
emergency department and throughout the entire hospital, and its
health care workers need to know they are supported in their
time of need especially when they are always there to support
others in their time of need. Violence, she argued, should not
be an acceptable workplace habit, and yet, for so many nurses,
providers, and others, this has become the new normal. Clearly,
she pointed out, legislation is not the only acceptable solution
to this complex problem and in order to successfully address
this problem, each facility must implement a comprehensive
strategy (audio difficulties). The Mat-Su Medical Center is
working on a comprehensive workplace violence preventative
program that includes a program called, "Handle with Care."
This program teaches the staff how to de-escalate a situation
with specialized safety techniques, such as escape, blocking,
and how to safely (audio difficulties) an aggressive patient.
This program also teaches the staff how to recognize their own
tension triggers and how to reduce personal tension. The Mat-Su
Memorial Hospital continually emphasizes to the staff that their
safety is one of the hospital's top priorities and it will
support them in whatever manner they need. She said that the
Mat-Su Memorial Hospital urges the committee to pass this
legislation, thereby, sending a strong message to nurses,
physicians, and other caregivers, that Alaska takes this issue
seriously.
2:31:15 PM
MATT HALL, Chief Human Resources Officer, Bristol Bay Area
Health Corporation, advised that the Bristol Bay Area Health
Corporation is in support of HB 312, and noted that the Bristol
Bay Area Health Corporation provides all health care services in
the Bristol Bay Region, which includes: medical, dental,
behavioral, and environmental health. He added that its care
includes a number of communities around the region where it also
has 21 clinics. The Bristol Bay Area Health Corporation is
aware that violence is never an acceptable workplace hazard, and
he related that the testimonies he heard today are striking
examples of workplace violence. There are other tribal
organizations in Nome, and the Bristol Bay Area Health
Corporation has medical providers out in the villages in the
clinics, as well. When crimes are committed in an isolated
rural area, the response time sometimes does take a bit longer
with more effort, he remarked. Basically, he offered, being
able to have responders (audio difficulties) fourth degree
assault types of charges and those types of results and having
that opportunity to respond far more quickly and efficiently
would be a "huge thing for us." He noted that legislation is
only one potential solution, but it is a great start and the
Bristol Bay Area Health Corporation welcomes all avenues in
helping its providers become far safer. This region of Alaska
is rural in a land-locked area and assuring that its providers
are safe and can go home safely at night in a small area where
many people know each other professionally and personally, that
type of a safety measure would be a wonderful thing, he
explained.
2:33:28 PM
REPRESENTATIVE LEDOUX asked whether the meaning given to health
care facility encompasses all of the facilities in rural areas.
CHAIR CLAMAN explained that the statute covers all of the
facilities in the rural areas, the only two exempted facilities
under Title 18 are the Pioneer Homes and Alaska Veterans Home.
2:34:45 PM
DAVID SCORDINO, MD, Alaska Regional Hospital, advised that he
supports HB 321 for a variety of reasons. (Audio difficulties.)
He said that a couple of months ago an intoxicated woman came
into the hospital, she did not have a psychiatric (audio
difficulties) exquisite abdominal pain, and she threatened to
kill him, the nurses, security, and our families. (Coughing)
CHAIR CLAMAN interrupted Dr. Sordino to ask whether he was on a
speaker phone, and Dr. Scordino then advised that he was on a
cell phone. (Audio difficulties.)
2:35:48 PM
DR. SCORDINO continued his testimony (audio difficulties)
strike, kick, spit on all members of his staff, but he had a
legal obligation to verify that she did not have an emergency
medical condition. The police were activated but they could not
do anything because he could not discharge her to them and
nothing ended up happening. Ultimately, (audio difficulties)
heard through all of this is a complication (audio
difficulties), he has a legal obligation, (audio difficulties)
obligation because if he missed (audio difficulties) which can
be a cause of bleeding (audio difficulties) caused by acting out
or bad behavior, then he has missed that. And, that legal
obligation to him, in his ability (audio difficulties)
discharging these individuals without a thorough evaluation can
put them in danger and; therefore, the hospital has to keep them
sometimes longer than necessary due to that obligation both from
a legal perspective and a financial perspective for his future.
(Audio difficulties) increased medical health factor (audio
difficulties).
CHAIR CLAMAN asked Dr. Scordino to email his remarks to Chair
Claman's office due to the audio difficulties.
DR. SCORDINO said he would email his remarks.
2:38:53 PM
CHAIR CLAMAN, after ascertaining no one wished to testify,
closed public testimony on HB 321.
2:39:26 PM
REPRESENTATIVE LEDOUX asked why this bill exempts the Pioneer
Homes and the Alaska Veterans Home.
CHAIR CLAMAN responded that the Pioneer Homes and the Alaska
Veterans Home are currently exempted under that definition of
health care facility. He advised that more research is taking
place as to why an existing statute is treated differently than
every other medical facility in the state and noted that the
answer is unknown at this point.
2:40:04 PM
REPRESENTATIVE LEDOUX surmised that under current statute, if a
person commits an offense at a Pioneer Home or the Alaska
Veterans Home, that person can be arrested, and it takes that
person out of presumptive sentencing.
CHAIR CLAMAN responded that HB 321 allows a police officer to
arrest the person who allegedly committed a fourth-degree
assault offense without obtaining a sworn affidavit from the
complainant. In the event it was a felony assault anywhere, the
police officer could arrest the person, he said.
He advised that his office is looking into this issue because
"what is the incidence of fourth degree assaults in the Pioneer
Homes as distinct." For example, the committee has only heard
testimonies regarding issues in emergency rooms and, he noted
that the Pioneer Homes and Alaska Veterans Home are not an
emergency room setting even though the Pioneer Homes provide a
degree of medical care.
2:41:26 PM
REPRESENTATIVE LEDOUX surmised that the bill not only does what
Chair Claman described, but it takes a person out of presumptive
sentencing. She then referred to [HB 321, Sec. 3, AS
12.55.155(c)(36)] page 7, lines 7-14, which read as follows:
(36) the defendant committed the offense at
a health care facility and knowingly directed the
conduct constituting the offense at a medical
professional during or because of the medical
professional's exercise of professional duties; in
this paragraph
(A) "heath care facility" has the
meaning given in AS 18.07.111;
(B) "medical professional has the
meaning given in AS 12.55.135(k).
REPRESENTATIVE LEDOUX advised that it takes a person out of the
presumptive sentencing. The presumptive sentencing guidelines
are at AS 12.55.(c), and it adds something else so that it is
now the 36th reason to get out of presumptive sentencing.
CHAIR CLAMAN advised that those are actually aggravating factors
in a felony that gives the court authority ...
REPRESENTATIVE LEDOUX commented that she realized that, but that
she sees 36 ways in which the judge can go above the presumptive
sentencing, but she did not see, for example, workplace violence
for daycare centers. She then referred to AS 12.55.155(c)(35),
which read as follows:
(35) the defendant knowingly directed the
conduct constituting the offense at a victim because
that person was 65 years of age or older;
REPRESENTATIVE LEDOUX noted that it does not matter if a person
"just slugs a person who is 80," if the reason was not because
the person was 80 years of age, and "someplace else" it says
that a person should know about advanced age. She suggested
that possibly the committee should re-think all of the
exceptions and do something different with presumptive
sentencing. This is a good bill, she described, but she asked
whether it would make more sense to change the presumptive
sentencing guidelines so that they are guidelines, but that a
judge in their discretion may direct a sentence above the
guidelines, period.
2:44:11 PM
CHAIR CLAMAN commented that that is an interesting idea, but the
intent of this legislation was to address the concerns brought
forward by medical providers. While, he related, the
presumptive sentencing structure has been in place in Alaska
since 1980, it could be critiqued in that it has received
different amendments in different ways. Except, he remarked,
the sponsors are not ready to take that on because the goal was
to simply identify a specific need.
2:44:39 PM
REPRESENTATIVE EASTMAN asked that law enforcement help the
committee understand the gap in arrest authority currently, and
what is it about these fourth-degree assault type charges that
causes difficulty in arresting.
2:46:01 PM
DAN LOWDEN, Captain, Alaska State Troopers, responded that
essentially, law enforcement is allowed to arrest for felonies
not committed in the presence of law enforcement if there is
probable cause. However, he added, if law enforcement is
dealing with a misdemeanor offense, that person cannot be
arrested without a warrant if it was not committed in the
presence of law enforcement. As the committee is well aware,
there are exceptions for domestic violence, assaults, DUIs, and
so forth. Therefore, he pointed out, the gap this bill appears
to address is with regard to a misdemeanor offense wherein many
times law enforcement does not witness the offense in the
emergency room and arrives after the fact. This bill would give
law enforcement the authority, as in DUIs, domestic violence,
and assault, to arrest someone for this misdemeanor assault that
was not committed in the presence of law enforcement, he
advised.
2:47:32 PM
REPRESENTATIVE EASTMAN asked whether the ability to arrest in
these types of fourth-degree assaults would be beneficial to law
enforcement outside of a health care setting.
CAPTAIN DAN LOWDEN answered that most law enforcement officers
would appreciate being able to arrest for most misdemeanors at
any time necessary.
2:48:15 PM
REPRESENTATIVE REINBOLD commented that if the intent of this
legislation is to make an assault to a health care worker a
felony, then this bill is unnecessary.
CAPTAIN DAN LOWDEN commented that if the committee made assault
on a health care worker a felony, this bill would not be
necessary to address the issue it is trying to address, but it
is a policy call for the legislature.
2:49:09 PM
REPRESENTATIVE REINBOLD asked the bill sponsors whether they
would accept an amendment allowing for a felony on an assault of
a health care worker because it appeared more logical than
having a bill.
REPRESENTATIVE KOPP responded that a felony assault on a health
care worker can and does occur currently, even without this
bill. He pointed out that the previously described strangling
offense is at least a felony assault, and possibly that assault
should have been charged as attempted murder. On a domestic
violence offense, strangling often is charged as attempted
murder and this bill would not change any of those provisions.
This bill, he explained, amends the law so that on a misdemeanor
assault where there is no serious physical injury, there is
still an injury because there is real fear, which was
articulated to the committee. Those types of assaults now can
be arrested without a warrant, this legislation relates to the
lower level of assaults. He noted that the committee could make
a policy call and make every assault a felony. Although, he
said, when considering that the ultimate goal is to protect
health care workers, accountability, (audio difficulties) want
there to be an immediate consequence. The sponsors are trying
to achieve the right balance wherein the bill simply addresses
the lower level misdemeanor assault wherein an arrest can be
made without a warrant, which leaves the health care environment
safe to continue to work.
REPRESENTATIVE REINBOLD noted that currently, assaults in the
first, second, and third degree are felony assaults, and assault
in the fourth degree is a misdemeanor. This bill basically
allows law enforcement to arrest for fourth degree assaults of
health care workers, which is important, she said.
2:51:27 PM
REPRESENTATIVE KREISS-TOMKINS surmised from the testimonies that
emergency rooms are more of a dumping ground for undesirable
people who are not in a condition to be in society. He
commented that perhaps there is a need for enhanced drunk tanks
for those who are incredibly drunk or high to sleep it off or
let it wear off. While recognizing there has been a recent
increase in drug and alcohol abuse, he asked how the state has
gotten to this point and requested an off-the-record
conversation or further testimony regarding his question.
CHAIR CLAMAN recommended that the folks with thoughts on that
subject to follow up with Representative Kreiss-Tomkins.
CHAIR CLAMAN referred to the indeterminate fiscal note from the
Alaska Psychiatric Institute (API), and noted to Randall Burns,
Division of Behavioral Health, that the fiscal note suggests
this bill would increase the need for competency exams when
allowing for an arrest without a warrant in a health care
facility for fourth-degree assault. He asked how often in the
last five-years has API had to perform a competency evaluation
on someone charged with fourth degree assault in any location.
2:54:19 PM
RANDALL BURNS, Director, Division of Behavioral Health,
Department of Health and Social Services (DHSS), responded that
he was not aware of the number of competency evaluations off the
top of his head. The major concern, he related, is that this
bill may create a situation wherein a significant number of
additional individuals would claim their mental illness was a
contributor to their arrest, thereby, creating a situation where
even more competency evaluations were required. More
importantly, he added, if the individual was found to be
incompetent, then being asked to perform more restoration. He
commented that, obviously, API and its staff completely
understand the injuries and the situations other hospital
nursing staff are under, and he opined that "As long as we're
able to put on the record now that we are concerned about the
potential ramifications on the forensic capabilities of the
department and the division, that we would submit a fiscal note
for now because there obviously is very little data coming from
the hospital to assist us in reaching what might actually be the
results in the next year." He related that that is the reason
for the indeterminate fiscal note, and he believes it would make
sense to submit a zero fiscal with the disclaimer that,
depending on the increase, they may have to then submit
additional budget support in the coming fiscal year.
CHAIR CLAMAN offered concern that the questions are legitimate
but that the actual number of misdemeanor cases in which
competency exams are performed are quite small and, in speaking
with others, most of the competency evaluations involve folks
charged with more serious crimes. This bill does not make any
more serious crimes, it simply gives law enforcement additional
arresting authority, he pointed out.
[The committee treated public testimony on HB 312 as closed.]
[HB 312 was held over.]