Legislature(2019 - 2020)ADAMS 519

03/21/2020 09:00 AM House FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to a Call of the Chair --
-- Continued from 3/20/20 --
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved SB 137 Out of Committee
-- Public Testimony --
Moved CSSB 120(HSS) Out of Committee
-- Public Testimony --
Moved CSHB 290(JUD) Out of Committee
-- Public Testimony --
Moved CSHB 247(FSH) Out of Committee
-- Public Testimony --
                  HOUSE FINANCE COMMITTEE                                                                                       
                      March 21, 2020                                                                                            
                         9:05 a.m.                                                                                              
9:05:44 AM                                                                                                                    
[Note: continuation  of the 3/20/20  1:30 p.m.  meeting, see                                                                    
separate minutes for detail.]                                                                                                   
CALL TO ORDER                                                                                                                 
Co-Chair  Johnston   called  the  House   Finance  Committee                                                                    
meeting to order at 9:05 a.m.                                                                                                   
MEMBERS PRESENT                                                                                                               
Representative Neal Foster, Co-Chair                                                                                            
Representative Jennifer Johnston, Co-Chair                                                                                      
Representative Dan Ortiz, Vice-Chair                                                                                            
Representative Ben Carpenter                                                                                                    
Representative Andy Josephson                                                                                                   
Representative Gary Knopp                                                                                                       
Representative Bart LeBon                                                                                                       
Representative Colleen Sullivan-Leonard                                                                                         
Representative Cathy Tilton                                                                                                     
Representative Adam Wool                                                                                                        
MEMBERS ABSENT                                                                                                                
Representative Kelly Merrick                                                                                                    
ALSO PRESENT                                                                                                                  
Senator  Peter Micciche,  Sponsor;  Michael Willis,  Intern,                                                                    
Senator  Peter Micciche;  Kris Curtis,  Legislative Auditor,                                                                    
Alaska Division  of Legislative  Audit; Jane  Conway, Staff,                                                                    
Senator Cathy Giessel;  Representative Matt Claman, Sponsor.                                                                    
Cynthia Montgomery,  Nurse Practitioner,  Alaska Psychiatric                                                                    
PRESENT VIA TELECONFERENCE                                                                                                    
Andree  McLeod, Self,  Anchorage;  Carrie Doyle,  President,                                                                    
Alaska  Advanced  Practice  of Registered  Nurses  Alliance,                                                                    
Anchorage;  Marieke Heatwole,  Self, Anchorage;  Sara Kozup,                                                                    
Certified  Psychiatric Nurse  Practitioner, Alaska  Advanced                                                                    
Practice of  Registered Nurses Alliance,  Anchorage; Michael                                                                    
Alexander,  MD, Director  of Psychiatry,  Alaska Psychiatric                                                                    
Institute,   Anchorage;   Carrie  Doyle,   Alaska   Advanced                                                                    
Practice of  Registered Nurses  Alliance; Tom  Taube, Deputy                                                                    
Director, Division  of Sport  Fisheries, Department  of Fish                                                                    
and   Game;  David   Rutz,  Director,   Division  of   Sport                                                                    
Fisheries, Department of Fish and Game.                                                                                         
HB 247    SPORT FISHING ENHANCEMENT SURCHARGE                                                                                   
          CSHB 247(FSH)  was REPORTED out of  committee with                                                                    
          seven  "do  pass"  recommendations and  three  "no                                                                    
          recommendation" recommendations  and with  one new                                                                    
          fiscal  impact note  from the  Department of  Fish                                                                    
          and Game.                                                                                                             
HB 290    ALTERNATIVE TO ARREST: MENTAL HEALTH CTR.                                                                             
          CSHB 290(JUD)  was REPORTED  out of  committee out                                                                    
          of committee  with six "do  pass" recommendations,                                                                    
          three  "no  recommendation"  recommendations,  and                                                                    
          one  "do not  pass" recommendation;  and with  one                                                                    
          previously published zero  impact note: FN1 (LAW);                                                                    
          one previously  published indeterminant  note: FN2                                                                    
          (DPS); and two  previously published fiscal impact                                                                    
          notes: FN3 (DHS) and FN4 (DHS).                                                                                       
CSSB 120(HSS)                                                                                                                   
          ADMINISTRATION OF PSYCHOTROPIC MEDICATION                                                                             
          CSSB 120(HSS)  was REPORTED out of  committee with                                                                    
          a   "do   pass"   recommendation  and   with   two                                                                    
          previously published zero  fiscal notes: FN1 (DHS)                                                                    
          and FN 2 (DHS).                                                                                                       
SB 137    EXTEND BOARD OF PAROLE                                                                                                
          SB 137  was REPORTED out  of committee with  a "do                                                                    
          pass"  recommendation  and   with  one  previously                                                                    
         published fiscal impact note: FN1 (COR).                                                                               
Co-Chair Johnston reviewed the meeting agenda.                                                                                  
SENATE BILL NO. 137                                                                                                           
     "An Act extending the termination date of the Board of                                                                     
     Parole; and providing for an effective date."                                                                              
9:06:41 AM                                                                                                                    
Co-Chair Johnston OPENED and CLOSED public testimony.                                                                           
Co-Chair Johnston  asked for a  brief reintroduction  of the                                                                    
SENATOR PETER  MICCICHE, SPONSOR, the bill  would extend the                                                                    
Board  of  Parole from  2020  to  2025. He  highlighted  the                                                                    
importance  of the  bill,  given  the need  for  a Board  of                                                                    
Parole. He asked his staff to provide additional detail.                                                                        
MICHAEL WILLIS, INTERN, SENATOR  PETER MICCICHE, shared that                                                                    
the  bill would  extend the  Board of  Parole from  June 30,                                                                    
2020  to June  30,  2025.  He detailed  that  the board  was                                                                    
serving  the  public's  interest by  effectively  evaluating                                                                    
prisoners' likelihood  of recidivism and whether  a prisoner                                                                    
poses a  threat to the  public. He relayed that  Kris Curtis                                                                    
with  the Division  of Legislative  Audit was  available for                                                                    
additional questions.                                                                                                           
9:08:42 AM                                                                                                                    
Representative  Knopp asked  if  the fiscal  note showed  an                                                                    
increased or decreased cost from prior fiscal notes.                                                                            
Mr. Willis answered  that he had not looked  at prior fiscal                                                                    
notes. He deferred the question to the legislative auditor.                                                                     
Senator Micciche answered that  he had reviewed prior fiscal                                                                    
notes.  He highlighted  that the  auditor's report  (copy on                                                                    
file)  showed that  the  cost had  increased  because SB  91                                                                    
[crime  reform legislation  passed in  2016] had  added five                                                                    
positions.  He  believed  there may  be  an  opportunity  to                                                                    
reduce the members on the  board the following year once the                                                                    
impacts of HB  49 [crime reform legislation  passed in 2019]                                                                    
were  understood. He  explained  that a  reduction in  board                                                                    
members would bring the cost down somewhat.                                                                                     
Representative   Carpenter  directed   a  question   to  the                                                                    
legislative auditor.  He asked about the  board's ability to                                                                    
effectively evaluate the likelihood  of recidivism. He asked                                                                    
if  it was  something the  audit was  able to  evaluate with                                                                    
statistics the  Department of Corrections  or board  kept on                                                                    
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE  AUDIT,  replied  that  what  the  sunset  audit                                                                    
reviewed was  dictated by statute  (the 11  various statutes                                                                    
were  included in  the appendix  of the  audit report).  The                                                                    
audit did not look at the  quality of a board's decisions in                                                                    
terms of whether  they were making the  right decisions. The                                                                    
background information  sections of the audit  explained how                                                                    
a board went  about making decisions and the  tools it used.                                                                    
When  Legislative Audit  did  its testing,  it  made sure  a                                                                    
board was  using the tools  described in regulation,  but it                                                                    
did not reaffirm a board's decision.                                                                                            
9:11:04 AM                                                                                                                    
Representative Wool  stated that  the renewal date  had been                                                                    
pushed back  due to  HB 49. He  thought the  board extension                                                                    
had been reduced  from eight to five years. He  asked if the                                                                    
extension was too long considering that  SB 91 and HB 49 had                                                                    
taken place during a short  timeframe. He knew that numerous                                                                    
staff had  been added  as a  result of SB  91. He  thought a                                                                    
reduction may occur sooner than five years.                                                                                     
Ms. Curtis answered  that HB 49 had not  been considered [in                                                                    
the audit].  She elaborated that  when the audit  report had                                                                    
been   written,  Legislative   Audit  did   not  know   what                                                                    
legislation  would pass;  therefore, she  had recommended  a                                                                    
five-year  extension.  The  last  time the  board  had  been                                                                    
extended  was three  years earlier.  At that  time, she  had                                                                    
recommended a  six-year extension,  which had been  cut down                                                                    
to  three  years  due  to uncertainty.  The  length  of  the                                                                    
extension was solely up to  policy makers. She reported that                                                                    
the  Board of  Parole  was very  well run  and  had done  an                                                                    
amazing job with the change they had gone through.                                                                              
Senator  Micciche  answered that  there  would  be a  parole                                                                    
board whether or  not the extension was  made. He elaborated                                                                    
that whether  the board was extended  for 3, 5, or  8 years,                                                                    
the  things  the  legislature  would  have  to  adjust  were                                                                    
independent of the  board extension. He noted he  was on the                                                                    
Department   of   Corrections   finance   subcommittee.   He                                                                    
referenced  exhibit  3   on  page  2  [of   the  audit]  and                                                                    
considered whether the legislature  had over capitalized the                                                                    
board  with  positions  now  that  there  was  no  longer  a                                                                    
requirement for a  Board of Parole hearing.  He believed the                                                                    
legislature  would have  to work  through the  issue in  the                                                                    
budget  process. He  explained  that the  board would  still                                                                    
need to  be extended and  he did not  see the five  years as                                                                    
being a factor  in how the legislature  adjusted the board's                                                                    
budget in the next five years.                                                                                                  
9:13:30 AM                                                                                                                    
Co-Chair  Foster MOVED  to REPORT  SB 137  out of  committee                                                                    
with individual recommendations  and the accompanying fiscal                                                                    
note. There being NO OBJECTION, it was so ordered.                                                                              
SB  137 was  REPORTED  out  of committee  with  a "do  pass"                                                                    
recommendation  and  with  one previously  published  fiscal                                                                    
impact note: FN1 (COR).                                                                                                         
CS FOR SENATE BILL NO. 120(HSS)                                                                                               
     "An Act relating to administration of psychotropic                                                                         
     medication to a patient without the patient's informed                                                                     
     consent; and providing for an effective date."                                                                             
9:13:55 AM                                                                                                                    
Co-Chair Johnston OPENED public testimony.                                                                                      
ANDREE   MCLEOD,  SELF,   ANCHORAGE  (via   teleconference),                                                                    
strongly opposed  the legislation. She found  it stunning to                                                                    
hear  that  involuntary  medications had  been  administered                                                                    
without  a  physician's   determination  and  authority  for                                                                    
nearly ten years at the  Alaska Psychiatric Institute (API).                                                                    
She  was intimately  aware of  many aspects  of the  current                                                                    
mental health system  in Alaska because of  a family member.                                                                    
She stated that the current  system was broken and needed to                                                                    
be fixed. She thought the legislation was ill conceived.                                                                        
Ms. McLeod  relayed that one  full-time and  three part-time                                                                    
psychiatrists worked  at API according to  the Department of                                                                    
Health  and  Social   Services  (DHSS)  Deputy  Commissioner                                                                    
[Albert] Wall. She believed testimony  the past Thursday had                                                                    
created more questions  and raised flags. She  asked why Dr.                                                                    
Alexander  was   so  overworked   and  why   more  full-time                                                                    
psychiatrists had  not been  hired. She  did not  believe it                                                                    
was an  acceptable answer  to say that  it was  difficult to                                                                    
hire psychiatrists.  She believed API had  been given plenty                                                                    
of time  and resources  to hire adequate  staff and  ramp up                                                                    
bed capacity. She asked what the hold up was.                                                                                   
Ms. McLeod  shared that  she had worked  for the  state long                                                                    
enough to know  that if an administration  was serious about                                                                    
fixing  a problem,  the red  tape easily  disintegrated. She                                                                    
highlighted  that  the  emergency declaration  that  brought                                                                    
Wellpath to  manage API came  with substantial  funding. She                                                                    
asked  what  had   happened  to  the  money   and  why  more                                                                    
psychiatrists had not been hired  to help Dr. Alexander. She                                                                    
asked  what  had  caused  the   increase  in  assaults.  She                                                                    
questioned  whether  there  had  been  more  reports  or  if                                                                    
assaults had  actually increased. She stated  there had been                                                                    
optimism the  previous year when  Kevin Huckshorn  came from                                                                    
Wellpath to  API because of  her expertise  in de-escalating                                                                    
situations. She  asked whether  Ms. Huckshorn's  methods had                                                                    
been implemented thoroughly.                                                                                                    
Ms. McLeod  stated that the  crux of the legislation  was to                                                                    
allow physician  assistants (PAs) and  advanced practitioner                                                                    
registered nurses (APRNs) to  have parity with psychiatrists                                                                    
and physicians.  She stressed  there was  a disparity  for a                                                                    
reason. She underscored  that PAs and APRNs were  not of the                                                                    
same caliber,  had not  had the same  training, and  did not                                                                    
have  the  same  depth  and  breadth  as  psychiatrists  and                                                                    
physicians.  From the  perspective  of a  family member  who                                                                    
often  had  to  give  up  her  family  member's  rights  and                                                                    
liberties to  the state, it  was incumbent to trust  who her                                                                    
family member  was treated  by and where  they went  at API.                                                                    
She emphasized  that the  trust had  been breached  when she                                                                    
found there had been malpractice  for ten years at API where                                                                    
PAs  had  been  able  to  authorize  involuntary  medication                                                                    
Ms.  McLeod hoped  the  committee would  not  move the  bill                                                                    
forward. She  wanted physicians and psychiatrists  to be the                                                                    
ones  to determine  whether psychotropic  medications should                                                                    
be administered without consent.  She implored the committee                                                                    
to not move the bill forward.                                                                                                   
9:19:51 AM                                                                                                                    
Representative   Josephson  thanked   Ms.  McLeod   for  her                                                                    
testimony.  He  recognized  that   she  had  a  passion  and                                                                    
expertise and good governance on  the topic. He noticed that                                                                    
the bill would delete a  section that specified a registered                                                                    
nurse  could  make  the   initial  determination  about  the                                                                    
administration  of  a  psychotropic drug.  He  believed  the                                                                    
world functioned because there  were registered nurses (RNs)                                                                    
and  he clarified  he did  not  mean any  disrespect to  the                                                                    
profession. He  believed it seemed inarguable  that the bill                                                                    
would ratchet up  the level of training and  would no longer                                                                    
allow an  RN to potentially  administer the drugs.  He noted                                                                    
that the bill specified the person  would be an APRN, PA, or                                                                    
doctor. He asked if the  change made the situation better in                                                                    
Ms. McLeod's eyes.                                                                                                              
Ms. McLeod replied in the  negative. She had dealt with many                                                                    
APRNs and  PAs inside  and outside of  API. She  stated that                                                                    
they  had made  mistakes.  She elaborated  that one  current                                                                    
member  of the  API management  team had  previously been  a                                                                    
health provider  at API and  had treated her  family member.                                                                    
She discussed  that the provider  had made  serious mistakes                                                                    
and when questioned about it,  Ms. McLeod found the person's                                                                    
response shocking.  She reported that  incorrect medications                                                                    
had  been  prescribed to  her  family  member. She  recalled                                                                    
being  yelled at  by  the individual.  She  did not  believe                                                                    
APRNs had the  demeanor to make the  decisions when tensions                                                                    
ran high.  She stated that  doctors and physicians  had been                                                                    
trained. She did not believe they were the same caliber.                                                                        
9:23:28 AM                                                                                                                    
CARRIE  DOYLE,   PRESIDENT,  ALASKA  ADVANCED   PRACTICE  OF                                                                    
REGISTERED NURSES ALLIANCE,  ANCHORAGE (via teleconference),                                                                    
spoke in  strong support of the  bill on behalf of  the APRN                                                                    
Alliance. She  shared that  she had  a doctorate  in nursing                                                                    
practice  and  is   an  APRN.  She  read   from  a  prepared                                                                    
     The APRN  Alliance wholeheartedly  supports SB  120, as                                                                    
     passed  by  the Senate.  We  discussed  the bill  at  a                                                                    
     recent  board meeting  where  all  four disciplines  of                                                                    
     advanced   practice    nursing   -    certified   nurse                                                                    
     specialists,    certified   nurse    anesthesiologists,                                                                    
     certified   nurse   midwives,   and   certified   nurse                                                                    
     practitioners  -  participated  in the  discussion.  We                                                                    
     note  that there  have been  some strong  statements of                                                                    
     support in  favor of this  bill as  written. Providence                                                                    
     Hospital  supports the  bill as  passed by  the Senate.                                                                    
     API,  who does  know a  few things  about the  subject,                                                                    
     supports the  bill as passed  by the Senate.  The State                                                                    
     Medical Association supports the  bill as passed by the                                                                    
     Senate.  There  is a  lot  of  knowledge and  expertise                                                                    
     there  and yet,  based on  a few  minutes of  committee                                                                    
     discussion  in the  final days  of session,  it appears                                                                    
     there  is  an  effort  to limit  an  advanced  practice                                                                    
     nurse's  ability   to  practice.  We   applaud  Senator                                                                    
     Giessel in trying to remove barriers to practice.                                                                          
     In 2010, the Institute  of Medicine's Future of Nursing                                                                    
     Report  and  more  recently,  the  executive  order  on                                                                    
     protecting  and  improving  Medicare for  our  nation's                                                                    
     seniors,  both  recognize that  burdensome  supervision                                                                    
     requirements  and  licensure  requirements  that  limit                                                                    
     professionals  from  practicing  to the  top  of  their                                                                    
     licensure  and education.  We  are  concerned that  the                                                                    
     amendment to  this bill  will introduce  burdensome and                                                                    
     unnecessary   restrictions  to   practice.  APRNs   are                                                                    
     educated  and trained  to administer  these medications                                                                    
     and we  are ready to do  so if this bill  is passed and                                                                    
     signed into law.                                                                                                           
     Madam Chair,  nurse practitioners throughout  the state                                                                    
     are on  the front lines  of a global  pandemic, working                                                                    
     for you  and the  citizens of the  State of  Alaska. We                                                                    
     ask  that you  do  the same  for us.  I'd  be happy  to                                                                    
     answer any  questions, but I'd  like to  emphasize that                                                                    
     we do support  the bill as passed by  the Senate. Thank                                                                    
Representative Wool believed that one  of the issues at hand                                                                    
was  not  about  the  medical   knowledge  of  an  APRN.  He                                                                    
highlighted  that  the  bill  pertained  to  an  involuntary                                                                    
medication, which  was a constitutional issue  where someone                                                                    
was forced to do something  they did not necessarily want to                                                                    
do. He  believed it was the  crux of the issue.  He believed                                                                    
the  issue went  a bit  beyond medical.  He stated  that the                                                                    
committee had  been told that  API had one  psychiatrist for                                                                    
50  or  more patients,  albeit  they  had heard  conflicting                                                                    
evidence. He asked if Ms. Doyle found it cause for concern.                                                                     
Ms. Doyle  replied that nationwide  there was a  shortage in                                                                    
psychiatrists  and psychiatric  APRNs and  in resources  for                                                                    
mental health needs.  The bill would help  alleviate some of                                                                    
the burdens.                                                                                                                    
Representative Wool  asked if there  was a  psychiatric APRN                                                                    
credential within  the State  of Alaska.  He noted  that Ms.                                                                    
Doyle  had listed  the  four  kinds of  APRNs  on the  [APRN                                                                    
Alliance]  board.   He  observed   she  had  not   listed  a                                                                    
psychiatric  APRN.  He understood  that  some  states had  a                                                                    
credentialed psychiatric APRN.                                                                                                  
Ms.  Doyle responded  that there  were four  types of  APRNs                                                                    
including nurse practitioners. Within  the groups there were                                                                    
six   population   foci,   which  included   mental   health                                                                    
psychiatric care. She relayed that it was a certification.                                                                      
Representative Wool  asked if all  of the APRNs at  API were                                                                    
psychiatric   APRNs.  Alternatively,   he   wondered  if   a                                                                    
different subdiscipline could work  at API. He observed that                                                                    
the bill did not require psychiatric APRNs specifically.                                                                        
Ms.  Doyle  answered  that state  statutes  and  regulations                                                                    
prohibited   nurses   from    working   outside   of   their                                                                    
certification. She  could not  speak about  API and  who the                                                                    
facility   had  on   staff,  but   she  assumed   they  were                                                                    
psychiatric nurse practitioners.                                                                                                
Co-Chair  Johnston noted  there  were  individuals from  API                                                                    
available to answer the question after public testimony.                                                                        
9:28:54 AM                                                                                                                    
MARIEKE  HEATWOLE,  SELF,  ANCHORAGE  (via  teleconference),                                                                    
shared that she  is a registered nurse.  She urged unanimous                                                                    
support  and passage  of SB  120.  She shared  that she  had                                                                    
worked  as a  nurse at  API in  2016 and  she was  currently                                                                    
studying  to  become  a   psychiatric  mental  health  nurse                                                                    
practitioner.  She  stated  that  with all  due  respect  to                                                                    
earlier  testimony, her  experience  with  the patients  and                                                                    
medical   professionals  at   API  was   top  quality.   She                                                                    
elaborated that the  bill provided a necessary  tool for the                                                                    
smooth operation  of inpatient  psychiatric care  and mostly                                                                    
for the  safety and comfort  of patients. She  was available                                                                    
for any questions.                                                                                                              
9:30:12 AM                                                                                                                    
Representative   Josephson  asked   if  in   Ms.  Heatwole's                                                                    
experience  people  at  API  complied   with  the  law  that                                                                    
required    documenting    the    maximum    frequency    of                                                                    
administration   and   specific   conditions   under   which                                                                    
medication  would be  given. Additionally,  when the  crisis                                                                    
finished  there was  a requirement  to have  and document  a                                                                    
discussion with  the patient about precursors  to the crisis                                                                    
and ways  to avoid future  crises. He asked if  Ms. Heatwole                                                                    
recalled compliance at API with  other parts of the existing                                                                    
Ms. Heatwole answered  that she could not  stress enough the                                                                    
importance of  documentation. She shared  that documentation                                                                    
was one  of the  nurses' primary  jobs. She  emphasized that                                                                    
all staff members  at API were trained  in de-escalation and                                                                    
it had  always been  the first  attempt. She  detailed there                                                                    
had  always  been  an attempt  to  verbally  deescalate  and                                                                    
employees  were taught  how  to  physically deescalate.  She                                                                    
relayed  that crisis  medication was  always a  last resort.                                                                    
She underscored  that she had never  felt uncomfortable when                                                                    
the situation  arose because she knew  the attending medical                                                                    
provider  and patient.  Staff  were licensed,  credentialed,                                                                    
and qualified and there had always been full documentation.                                                                     
Representative Wool  gathered that  Ms. Heatwole  had worked                                                                    
at API. He referenced Ms.  Heatwole's testimony that she was                                                                    
currently  studying to  obtain a  psychiatric mental  health                                                                    
nurse practitioner  certification. He asked if  she had been                                                                    
an RN or APRN when she had  worked at API. He asked for some                                                                    
history of her work experience at API.                                                                                          
Ms. Heatwole answered  that in 2016 she had worked  as an RN                                                                    
at  API. She  shared that  she  was currently  in a  program                                                                    
pursuing  psychiatric   mental  health   nurse  practitioner                                                                    
licensure. As  Ms. Doyle  had stated, she  would be  an APRN                                                                    
with  specific credentialing  in  psychiatric mental  health                                                                    
care across  the lifespan.  She appreciated  the opportunity                                                                    
to point out the  credentialing required 650 direct clinical                                                                    
hours, not  with an employer  but with a mentor  licensed in                                                                    
the  same field.  She noted  it was  considerably more  than                                                                    
what  a physician  would require  in  a general  psychiatric                                                                    
Representative Wool  asked about her experience  at API when                                                                    
situations required  an emergency chemical  intervention and                                                                    
the  appropriate licensed  people were  called. He  asked if                                                                    
the person called had typically  been a psychiatrist or a PA                                                                    
or APRN.                                                                                                                        
Ms. Heatwole  replied that  at the  time, she  believed that                                                                    
every  unit  had  been  open, and  the  units  were  staffed                                                                    
perhaps   equally  by   APRNs  maybe   even  more   so  than                                                                    
psychiatrists.  She did  not know  the  precise answer.  She                                                                    
deferred to Dr. Alexander with API for further detail.                                                                          
Representative  Wool  asked  if   having  the  licensure  of                                                                    
psychiatric  mental health  nurse practitioner  should be  a                                                                    
prerequisite   of  the   type   of   APRN  responsible   for                                                                    
administering psychotropic intervention.                                                                                        
Ms. Heatwole  asked if Representative Wool  was referring to                                                                    
the  fact   that  a  physician,  not   a  psychiatrist,  was                                                                    
Representative Wool  answered in the negative.  He explained                                                                    
that  the  bill  referenced  APRN   but  did  not  delineate                                                                    
psychiatric mental health nurse practitioner.                                                                                   
Ms. Heatwole agreed and noted  the bill did not use specific                                                                    
language  for  a physician  either.  She  stated that  if  a                                                                    
change in  bill language was  considered she would  defer to                                                                    
the bill  sponsor. She  would be  surprised to  learn anyone                                                                    
would hire someone to serve  the specific population without                                                                    
the  credentialing. She  believed  Ms.  Doyle had  addressed                                                                    
some state  requirements in her  testimony. She  deferred to                                                                    
someone with  more intimate knowledge  of the issue  for any                                                                    
additional detail.                                                                                                              
9:36:12 AM                                                                                                                    
Representative Carpenter  asked if changes in  the bill were                                                                    
bringing the law in line with current practice.                                                                                 
Co-Chair Johnston  noted the question  could be  answered by                                                                    
individuals available online after public testimony.                                                                            
Ms. Heatwole  agreed wholeheartedly. She shared  that Alaska                                                                    
had   one   of   the  fullest   licensure   and   credential                                                                    
recognitions  of  APRNs.  She  elaborated  that  APRNs  were                                                                    
already  working with  the medications.  She added  that the                                                                    
treatment  in a  crisis situation  was the  difference of  a                                                                    
combination and dose of  medication that nurse practitioners                                                                    
and  PAs were  already working  with. Furthermore,  it would                                                                    
fall  to   these  professionals  to  manage   patients  with                                                                    
complete  follow up  care, which  was already  happening and                                                                    
within their scope of practice.                                                                                                 
9:37:54 AM                                                                                                                    
AT EASE                                                                                                                         
9:38:42 AM                                                                                                                    
Representative Knopp  addressed Ms. Heatwole. He  noted that                                                                    
Ms. Heatwole  had stated she  had previously worked  for API                                                                    
and that  she had  administered [psychotropic]  drugs. Under                                                                    
the old statute, Ms. Heatwole  had administered the drugs at                                                                    
the  recommendation   or  approval  of  a   physician  after                                                                    
consultation.  He   thought  the  underlying   question  was                                                                    
whether, in  order to  administer the  drugs, PAs  and APRNs                                                                    
should be going through the  same training that Ms. Heatwole                                                                    
was currently undertaking.                                                                                                      
Ms. Heatwole believed they did  [receive the same training],                                                                    
and she  would let others  speak to that. She  also believed                                                                    
the issue  may be regulated  in statute as mentioned  by Ms.                                                                    
9:40:23 AM                                                                                                                    
SARA  KOZUP,   CERTIFIED  PSYCHIATRIC   NURSE  PRACTITIONER,                                                                    
ALASKA  ADVANCED  PRACTICE  OF REGISTERED  NURSES  ALLIANCE,                                                                    
ANCHORAGE (via  teleconference), spoke in support  of SB 120                                                                    
as  passed  by   the  Senate.  She  read   from  a  prepared                                                                    
     I  appreciated  Senator  Giessel in  trying  to  remove                                                                    
     barriers  to practice.  I  understand  that there  have                                                                    
     been concerns  raised about the ability  of psychiatric                                                                    
     nurse practitioners  to order  psychotropic medications                                                                    
     during  an emergency.  Mastering  the few  psychotropic                                                                    
     medications  used   in  emergency  mental   health  and                                                                    
     knowing what risks to monitor  for is a straightforward                                                                    
     part of  our job. Advanced practice  nurses order these                                                                    
     medications and  monitor for their  effectiveness every                                                                    
     day.  Choosing to  forcibly  administer a  psychotropic                                                                    
     medication is  also an ethical  and a  system decision.                                                                    
     In my  undergraduate nursing program,  I took  the same                                                                    
     ethics  course  as the  medical  students.  I then  had                                                                    
     additional ethical education in my graduate program.                                                                       
     As a  former registered  nurse, I have  participated in                                                                    
     forcibly  administering  medications and  am  therefore                                                                    
     more  aware of  emotional  and physical  risks to  both                                                                    
     patients  and staff.  Nurses are  also  the people  who                                                                    
     manage the system of the  hospital. A forced medication                                                                    
     event pulls  caregivers from  other units  and disrupts                                                                    
     the flow of  care hospital wide. Not only  am I capable                                                                    
     of  ordering  emergency  psychotropic  medications,  my                                                                    
     education and background make me  the perfect person to                                                                    
     make this clinical  decision. I would be  very happy to                                                                    
     answer  any questions,  but I  would like  to emphasize                                                                    
     that I support the bill  as passed by the Senate. Thank                                                                    
9:42:24 AM                                                                                                                    
Co-Chair  Johnston thanked  the  testifiers  for taking  the                                                                    
time to call in. She CLOSED public testimony.                                                                                   
Co-Chair Johnston  asked for a  brief reintroduction  of the                                                                    
JANE CONWAY, STAFF, SENATOR CATHY  GIESSEL, relayed that the                                                                    
bill  was   designed  to  help  treatment   facilities  with                                                                    
existing staff shortages throughout  the state and to ensure                                                                    
safety  for  the   patients  and  staff  who   work  in  the                                                                    
facilities.  She   clarified  that   the  bill   could  help                                                                    
additional  facilities   beyond  API,   including  Fairbanks                                                                    
Memorial,   Mat-Su,   Bartlett    Regional   Hospital,   and                                                                    
Representative  Wool  noted that  the  bill  sponsor or  her                                                                    
staff [in  a previous hearing  on the bill] had  stated that                                                                    
many  of  the APRNs  had  ten  years  of experience  at  the                                                                    
facility.  He   shared  that  he   had  worked   in  "these"                                                                    
facilities  and had  been  involved  in forcible  medication                                                                    
situations  in the  past. He  understood the  intent of  the                                                                    
legislation.  He  remarked  that a  previous  testifier  had                                                                    
highlighted  that the  practitioners knew  the patients  and                                                                    
their history -  it was comforting when  a practitioner knew                                                                    
a  patient well  and  understood their  behaviors. He  asked                                                                    
about  a situation  where a  temporary or  new APRN  did not                                                                    
have  the  ten  years'  experience  and  did  not  have  the                                                                    
psychiatric mental  health nurse practitioner  licensure. He                                                                    
asked  if  all  of  the   APRNs  at  API  were  licensed  in                                                                    
psychiatric health.  He recalled  that the  APRN designation                                                                    
had been  changed in  statute recently. He  asked if  all of                                                                    
the  APRNs envisioned  in the  bill were  psychiatric mental                                                                    
health nurse practitioners.                                                                                                     
MICHAEL  ALEXANDER,  MD,   DIRECTOR  OF  PSYCHIATRY,  ALASKA                                                                    
PSYCHIATRIC   INSTITUTE,  ANCHORAGE   (via  teleconference),                                                                    
replied in  the affirmative.  He relayed  that at  API there                                                                    
were a  number of  different nurse  practitioners, including                                                                    
three APRNs working in  psychiatry, one physician assistant,                                                                    
and two  physician assistants who worked  in family practice                                                                    
medicine. He  stressed that  the medical  officer who  was a                                                                    
family  practice doctor  or the  other physician  assistants                                                                    
did not  have the specific  training or experience  and were                                                                    
never  contacted  regarding   the  issue  [of  administering                                                                    
psychotropic   drugs].  He   stated   it   was  always   the                                                                    
psychiatric  APRN  or  the  psychiatric   PA  who  would  be                                                                    
contacted regarding crisis medications.                                                                                         
9:47:02 AM                                                                                                                    
Representative  Wool asked  if  the PAs  at  API were  under                                                                    
licensure of the psychiatrists also at the facility.                                                                            
Mr. Alexander replied affirmatively.  He had a collaborative                                                                    
association with his PA who  worked in psychiatry. The other                                                                    
two  PAs  were  under   the  collaboration  of  the  medical                                                                    
Representative Wool referenced  testimony that Dr. Alexander                                                                    
was  the  one full-time  psychiatrist  at  API. He  noted  a                                                                    
testifier   had    stated   there   were    also   part-time                                                                    
psychiatrists.  He asked  if that  was the  case. If  so, he                                                                    
surmised  that Dr.  Alexander was  not the  psychiatrist for                                                                    
all of the current API residents.                                                                                               
Mr. Alexander answered that he  was the only psychiatrist at                                                                    
API who worked  for the State of Alaska.  He elaborated that                                                                    
apart   from   his   position   there   were   three   nurse                                                                    
practitioners  and  one  PA.   Additionally,  API  tried  to                                                                    
utilize a  temporary contract employee as  well as utilizing                                                                    
locum tenens. There was currently  one contract employee and                                                                    
one  locum  tenens doctor  temporarily  working  at API.  He                                                                    
believed there were six open  psychiatrist positions at API.                                                                    
He  had been  working hard  to  try to  fill them;  however,                                                                    
getting  psychiatrists  up  to  Alaska  was  extraordinarily                                                                    
Representative Josephson thought there  were key two issues.                                                                    
The  first  was  the  practice   of  making  a  decision  to                                                                    
administer a psychotropic drug  vicariously through the eyes                                                                    
and ears  of information telephonically. He  stated that the                                                                    
current  law  allowed  the  practice  for  doctors  but  not                                                                    
others.  He  asked  for  verification   that  a  doctor  was                                                                    
responsible  for making  those types  of decisions  over the                                                                    
phone based on what people  told them. For example, a doctor                                                                    
could  receive a  call while  they were  shopping or  having                                                                    
Mr. Alexander responded affirmatively.                                                                                          
Representative  Josephson  surmised  that the  bill  was  an                                                                    
expansion of  the current law.  He remarked that  the second                                                                    
key issue was  whether there was confidence in  the APRN and                                                                    
PA community.  He noted that  Dr. Alexander's  testimony was                                                                    
that he had  confidence in the ability of the  APRNs and PAs                                                                    
because   most  of   the   institutions   would  only   hire                                                                    
individuals with the appropriate training and experience.                                                                       
Dr.  Alexander replied  in  the  affirmative. He  elaborated                                                                    
that the  individuals were  specifically trained  to provide                                                                    
psychiatric care.                                                                                                               
9:50:48 AM                                                                                                                    
Representative  Sullivan-Leonard asked  if the  Alaska State                                                                    
Medical Board had weighed in on the legislation.                                                                                
Ms. Conway responded that there  had not been correspondence                                                                    
from the  State Medical  Board. She  believed the  board was                                                                    
currently in a state of  flux, which she speculated could be                                                                    
the reason  the bill had  not received a letter  of support.                                                                    
She did  not know for sure.  She relayed there was  a letter                                                                    
from the Alaska State Medical Association.                                                                                      
Representative  Sullivan-Leonard  requested  a copy  of  any                                                                    
letters of support.                                                                                                             
Ms. Conway  agreed. She  had thought  the committee  had the                                                                    
Representative Sullivan-Leonard  still had concern  that the                                                                    
bill  was being  considered by  the House  Finance Committee                                                                    
instead  of  the  House Health  and  Social  Services  (HSS)                                                                    
Committee. She  noted that the  HSS Committee  typically dug                                                                    
deeply  into  the potential  ramifications  of  a change  in                                                                    
licensure,    especially    with   a    psychotropic    drug                                                                    
administration.  She   stressed  the  medication   was  very                                                                    
intensive and  meant to be administered  against a patient's                                                                    
will  or approval.  She  stated that  she  had big  concerns                                                                    
about the bill and thought it needed additional scrutiny.                                                                       
9:52:33 AM                                                                                                                    
Co-Chair   Johnston  asked   Ms.  Conway   to  share   which                                                                    
committees heard the bill in the Senate.                                                                                        
Ms.  Conway responded  that  the bill  had  received an  HSS                                                                    
referral [in the Senate].                                                                                                       
Co-Chair  Johnston asked  for verification  that the  Senate                                                                    
HSS Committee had thoroughly reviewed the bill.                                                                                 
Ms. Conway answered affirmatively.                                                                                              
9:53:12 AM                                                                                                                    
Representative  Carpenter shared  that  he  was hesitant  to                                                                    
pass a  bill that he  did not fully understand.  He wondered                                                                    
how many  types of  medications had to  be prescribed  in an                                                                    
effort  to alleviate  a mental  health crisis  situation. He                                                                    
asked if  the same medication  was used across the  board or                                                                    
if  the  type  of  medication   used  was  specific  to  the                                                                    
Mr. Alexander responded that the  number of medications used                                                                    
varied  by state  and  over time  as  more medications  were                                                                    
developed. However,  a combination of medications  was often                                                                    
used.  He elaborated  that sometimes  an antipsychotic  drug                                                                    
like Olanzapine  could be  used alone in  a liquid  form. He                                                                    
noted that sometimes  Olanzapine was not enough  on its own.                                                                    
He shared that  in his training they had  used a combination                                                                    
of  Haloperidol,   Cogentin,  or   Benadryl  along   with  a                                                                    
Benzodiazepine  valium type  of medication.  He shared  that                                                                    
multiple  hospitals throughout  the United  States used  the                                                                    
different combinations  - the  combinations were  not unique                                                                    
to  Alaska.  The medications  used  on  a particular  person                                                                    
depended on  whether there  was an  allergy list  or whether                                                                    
something had been effective in the past.                                                                                       
Mr. Alexander shared  that API looked to  the most effective                                                                    
and least amount  of dosing possible. He  explained that the                                                                    
nurse who  would be calling  for a crisis situation  had the                                                                    
information  in a  patient's medical  record. He  summarized                                                                    
that       API       typically       used       Haloperidol,                                                                    
Chlorpromazine/Thorazine,                Zyprexa/Olanzapine,                                                                    
Benadryl/Diphenhydramine   for    side   effects,    and   a                                                                    
benzodiazepine  such as  Ativan. He  stated it  was a  small                                                                    
grouping   of   medications;   there   were   not   numerous                                                                    
medications available  in an immediate release  liquid form,                                                                    
which was  the reason  the specific medications  listed were                                                                    
9:56:14 AM                                                                                                                    
Representative Carpenter  remarked on the complexity  of the                                                                    
issue. He  asked Dr. Alexander  to provide  more information                                                                    
on  API's process  for determining  which doctors  or others                                                                    
were  authorized to  administer medications.  Alternatively,                                                                    
he  asked  if a  specific  certification  was all  a  person                                                                    
Mr. Alexander  replied that  it was  a standard  training as                                                                    
part  of  a  medical  residency. He  clarified  it  was  not                                                                    
something   unique,  it   was  a   regular  occurrence   for                                                                    
psychiatrists  that began  at the  start of  a residency  or                                                                    
when working in any facility.                                                                                                   
Representative   Carpenter  asked   if  Dr.   Alexander  was                                                                    
speaking  about  medical  doctors  only.  Alternatively,  he                                                                    
wondered if APRNs were included.                                                                                                
Mr.   Alexander  explained   that   he   was  referring   to                                                                    
psychiatrists.  He added  that  often  times emergency  room                                                                    
physicians   and   nurse    practitioners   prescribed   the                                                                    
medications. His  prior answer applied to  psychiatrists and                                                                    
psychiatric nurse  practitioners at API -  both received the                                                                    
training   and  had   experience   working  in   psychiatric                                                                    
facilities. The medicines used in  a psychiatric crisis were                                                                    
the same  medications used on  a daily basis  for resolution                                                                    
of psychotic symptoms or otherwise.                                                                                             
9:58:40 AM                                                                                                                    
Representative  Wool   asked  for  clarity.  He   asked  for                                                                    
verification  that   an  APRN  or  PA   could  prescribe  an                                                                    
antipsychotic medication like Thorazine on a daily basis.                                                                       
Dr. Alexander responded affirmatively.                                                                                          
Representative Wool  provided a hypothetical  scenario where                                                                    
a  PA,  APRN,  or  someone in  the  facility  determined  an                                                                    
emergency  intervention  was  required  for  a  patient.  He                                                                    
stated  that current  law required  the medical  provider to                                                                    
call a  doctor in the  situation. He asked  for verification                                                                    
that the bill  would enable a PA or APRN  at the facility to                                                                    
decide to use the medications.                                                                                                  
Dr. Alexander replied, "Of course."                                                                                             
Representative Wool  stated his understanding that  the APRN                                                                    
or  PA  could  prescribe  emergency  medications  against  a                                                                    
patient's will  and after the crisis  situation was resolved                                                                    
the patient would  take their medicine as  prescribed by the                                                                    
same individual.  He wondered about  the 24-72  hour period.                                                                    
He referenced  line 11, page  10 of the  legislation related                                                                    
to  the quantity  of an  authorized dose  and the  method of                                                                    
administering  that dose.  He  asked if  a  doctor would  be                                                                    
called in  an emergency  intervention even if  a PA  or APRN                                                                    
prescribed the medication without the doctor.                                                                                   
Dr. Alexander  responded in the negative.  He explained that                                                                    
the PA  or APRN  was considered an  independent practitioner                                                                    
and the doctor would not be  called. The PA or APRN would be                                                                    
managing  the  different  calls and  issues  throughout  the                                                                    
24-hour period they were on call.                                                                                               
Representative Wool  thought that after a  certain point the                                                                    
PA or  APRN would  inform the  doctor about  an intervention                                                                    
that took place.                                                                                                                
Dr. Alexander agreed  that if the patient  was the doctor's,                                                                    
the PA or  APRN would notify the doctor; however,  if it was                                                                    
their  own patient,  the PA  or APRN  would be  managing the                                                                    
medication anyway.                                                                                                              
Representative Wool thanked the  doctor for highlighting the                                                                    
10:01:53 AM                                                                                                                   
Representative  Carpenter MOVED  to ADOPT  Amendment 1,  31-                                                                    
LS0866\K.1 (Marx, 3/19/20) (copy on file):                                                                                      
     Page 1, lines 12-13:                                                                                                       
          Delete ", physician assistant, [OR A REGISTERED]                                                                      
          or advanced practice registered nurse"                                                                                
          Insert "[OR A REGISTERED OR ADVANCED PRACTICE                                                                         
          REGISTERED NURSE]"                                                                                                    
     Page 2, lines 4 -5:                                                                                                        
          Delete",   physician    assistant,   or   advanced                                                                    
          practice registered nurse"                                                                                            
     Page 2, following line 21:                                                                                                 
          Insert a new bill section to read:                                                                                    
          "* Sec. 2. AS 47.30.838 is amended by adding new                                                                      
          subsections to read:                                                                                                  
                    (e)A  physician  assistant  or  advanced                                                                    
               practice   registered   nurse  may   make   a                                                                    
               determination  under (a)(l)  of this  section                                                                    
               or order or renew  medication under (a)(2) of                                                                    
               this section only  if the evaluation facility                                                                    
               or   designated    treatment   facility   has                                                                    
               designated   the   physician   assistant   or                                                                    
               advanced  practice  registered   nurse  as  a                                                                    
               person  who may  make  a determination  under                                                                    
               (a)(  I) of  this section  or order  or renew                                                                    
               medication under (a)(2) of this section.                                                                         
                    (f)Each    evaluation    facility    and                                                                    
               designated    treatment     facility    shall                                                                    
               establish  criteria  for its  designation  of                                                                    
               the   physician   assistants   and   advanced                                                                    
               practice  registered nurses  who  may make  a                                                                    
               determination under  (a)( I) of  this section                                                                    
               or order or renew  medication under (a}(2} of                                                                    
               this section."                                                                                                   
     Renumber the following bill sections accordingly.                                                                          
     Page 2, line 28:                                                                                                           
          Delete "Section 2"                                                                                                    
          Insert "Section 3"                                                                                                    
Co-Chair Johnston OBJECTED for discussion.                                                                                      
Representative Carpenter  explained that the  amendment made                                                                    
him more comfortable with the  oversight and risk management                                                                    
of the  bill. He  expressed discomfort  at the  limited time                                                                    
the committee  had spent  on the bill.  He believed  that if                                                                    
PAs  and   APRNs  were  given  the   ability  to  administer                                                                    
[psychotropic]  medication in  an  emergency situation,  the                                                                    
facility  should share  in  the risk  of  the decision.  The                                                                    
amendment   would  require   the   evaluation  facility   to                                                                    
establish  criteria for  its own  use, ensuring  that people                                                                    
were properly trained and authorized to make decisions.                                                                         
10:03:10 AM                                                                                                                   
Representative  Knopp   spoke  against  the   amendment.  He                                                                    
thought  the question  was whether  there was  confidence in                                                                    
the  ability of  trained and  experienced APRNs  and PAs  to                                                                    
administer  a drug  in a  crisis intervention  situation. He                                                                    
had complete confidence in the  ability of the nursing staff                                                                    
to  administer   the  drugs.   He  explained   that  medical                                                                    
professionals  who lived  and breathed  the work  daily were                                                                    
qualified  to  make  the decisions.  He  believed  the  bill                                                                    
helped remove  unnecessary regulation.  He remarked  that it                                                                    
was not  that long ago there  had not been PAs  and numerous                                                                    
other  types  of  healthcare   providers.  He  believed  the                                                                    
individuals were uniquely skilled and qualified.                                                                                
Co-Chair  Johnston asked  one of  the testifiers  to address                                                                    
the  risk associated  with the  current  bill proposal.  She                                                                    
asked if  nurse practitioners carried their  own malpractice                                                                    
insurance.  She  also  wanted  to  understand  the  risk  or                                                                    
malpractice carried by API.                                                                                                     
CYNTHIA MONTGOMERY,  NURSE PRACTITIONER,  ALASKA PSYCHIATRIC                                                                    
INSTITUTE, responded  that as a  state entity,  the facility                                                                    
was covered  by a state provided  malpractice insurance. She                                                                    
added  that when  she practiced  in the  community, she  was                                                                    
either covered by a facility's  malpractice insurance or her                                                                    
own malpractice insurance when working independently.                                                                           
10:05:59 AM                                                                                                                   
Co-Chair  Johnston  asked  Ms.   Doyle  to  respond  to  her                                                                    
question as well.                                                                                                               
CARRIE DOYLE, ALASKA ADVANCED  PRACTICE OF REGISTERED NURSES                                                                    
ALLIANCE (via  teleconference), replied that it  depended on                                                                    
whether  it  was a  private  practice.  She elaborated  that                                                                    
occasionally  APRNs  were  covered by  a  facility  provided                                                                    
malpractice  insurance. She  relayed  that  most APRNs  also                                                                    
carried their own malpractice insurance.                                                                                        
10:06:31 AM                                                                                                                   
Representative Wool read from  the amendment. He thought the                                                                    
designation  or criteria  sounded like  an APRN  could be  a                                                                    
psychiatric mental  health nurse practitioner and/or  that a                                                                    
PA  would work  under  a psychiatrist  at  the facility.  He                                                                    
believed it was something that  was already taking place. He                                                                    
asked if he was correct.                                                                                                        
Mr.  Alexander  responded that  he  did  not understand  the                                                                    
Representative  Wool asked  if  Dr. Alexander  had seen  the                                                                    
Dr. Alexander responded affirmatively.                                                                                          
Representative  Wool clarified  that  Amendment 1  specified                                                                    
that  a  facility may  make  a  determination and  establish                                                                    
criteria.  He  asked  if  a  facility  could  establish  the                                                                    
criteria specifying  that an APRN [working  at the facility]                                                                    
was a psychiatric mental health nurse practitioner.                                                                             
Dr. Alexander believed the determination  that an APRN or PA                                                                    
could  provide the  service, should  be innate  within their                                                                    
duties and not determined by individual facilities.                                                                             
10:08:39 AM                                                                                                                   
AT EASE                                                                                                                         
10:17:04 AM                                                                                                                   
Representative  Carpenter  appreciated  the  discussion.  He                                                                    
WITHDREW Amendment 1.                                                                                                           
Representative   Sullivan-Leonard  highlighted   the  bill's                                                                    
reference  to   an  evaluation  facility  or   a  designated                                                                    
treatment facility.  She asked for additional  detail on the                                                                    
evaluation facility. She wondered,  for example, if a prison                                                                    
could  be considered  an  evaluation  facility for  patients                                                                    
with psychiatric issues.                                                                                                        
Ms.  Conway did  not believe  a  prison would  be under  the                                                                    
purview of the legislation. She deferred the question.                                                                          
10:18:24 AM                                                                                                                   
Co-Chair  Johnston noted  that API  had a  relationship with                                                                    
the state's correctional system.  She asked Dr. Alexander if                                                                    
the bill would apply to a correctional facility.                                                                                
Dr.  Alexander answered  that he  did not  know whether  the                                                                    
bill  would apply  to a  correctional facility.  He was  not                                                                    
certain how correctional  facilities mandated medications to                                                                    
be given to patients or in a crisis situation.                                                                                  
Representative  Sullivan-Leonard  considered that  the  bill                                                                    
would  broaden the  scope for  a  PA or  APRN to  administer                                                                    
psychotropic   medications.   She   reasoned  that   if   an                                                                    
evaluation facility was considered  within the parameter for                                                                    
a correctional facility,  correctional facilities would have                                                                    
the  same  authority  as  API.   She  highlighted  that  the                                                                    
conversation  had been  around behavior  health and  the API                                                                    
facility;  however,  the  bill  may  be  used  in  different                                                                    
facilities. She wondered if her thoughts were accurate.                                                                         
Ms.  Conway  believed  the  bill   implied  that  the  terms                                                                    
evaluation   facility  or   designated  treatment   facility                                                                    
pertained  to psychiatry.  She did  not know  that a  prison                                                                    
would be  considered a facility for  psychiatric evaluation.                                                                    
She  remarked   that  [deputy]  Commissioner   Wall  [deputy                                                                    
commissioner for  Medicaid & Health Care  Policy, Department                                                                    
of  Health  and Social  Services]  could  have answered  the                                                                    
question if he had been available.                                                                                              
10:20:37 AM                                                                                                                   
AT EASE                                                                                                                         
10:25:09 AM                                                                                                                   
Ms. Conway  relayed that AS  47.30.670 defined  a designated                                                                    
treatment  facility  as  a  hospital,  clinic,  institution,                                                                    
center,  or   other  healthcare   facility  that   has  been                                                                    
designated    by   the    department   for    treatment   or                                                                    
rehabilitation of  mentally ill persons. She  noted that the                                                                    
list   did  not   include   correctional  institutions.   an                                                                    
evaluation  facility was  defined as  a healthcare  facility                                                                    
that  has  been  designated  or   is  in  operation  by  the                                                                    
department  to  perform  the  evaluations  described  in  AS                                                                    
47.30.660 or a  medical facility licensed under  AS 47.32 or                                                                    
operated by the federal government.                                                                                             
10:26:30 AM                                                                                                                   
AT EASE                                                                                                                         
10:27:15 AM                                                                                                                   
Co-Chair  Foster  MOVED  to  REPORT  CSSB  120(HSS)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
Representative  Carpenter  OBJECTED.   He  found  supporting                                                                    
documentation that did  not include a letter  from the State                                                                    
Medical Board.  He believed passing the  legislation without                                                                    
a recommendation from the board  was ill advised. He did not                                                                    
support passing the bill.                                                                                                       
A roll call vote was taken on the motion.                                                                                       
IN FAVOR: LeBon,  Ortiz, Wool,  Josephson, Knopp,  Johnston,                                                                    
OPPOSED: Sullivan-Leonard, Tilton, Carpenter                                                                                    
The MOTION  PASSED (7/3). There being  NO further OBJECTION,                                                                    
it was so ordered.                                                                                                              
CSSB 120(HSS)  was REPORTED  out of  committee with  six "do                                                                    
pass"   recommendations   and   four   "no   recommendation"                                                                    
recommendations  and  with  two  previously  published  zero                                                                    
fiscal notes: FN1 (DHS) and FN2 (DHS).                                                                                          
HOUSE BILL NO. 290                                                                                                            
     "An   Act  establishing   an   alternative  to   arrest                                                                    
     procedure  for  persons  in acute  episodes  of  mental                                                                    
     illness;  relating to  emergency  detention for  mental                                                                    
     health evaluation; and relating  to licensure of crisis                                                                    
     stabilization centers."                                                                                                    
10:29:38 AM                                                                                                                   
Co-Chair Johnston OPENED Public Testimony.                                                                                      
ANDREE MCLEOD,  SELF, ANCHORAGE (via  teleconference), spoke                                                                    
in  opposition  to  the bill.  She  stated  the  legislation                                                                    
impacted   people    who   experience    acute   psychiatric                                                                    
emergencies and the development  of organizations with staff                                                                    
and it  had not  been vetted through  the Health  and Social                                                                    
Services Committee or the Labor  and Commerce Committee. She                                                                    
stated that  "we're all  aware and  we're all  desperate for                                                                    
easy  fixes to  our  broken mental  healthcare system."  She                                                                    
believed there was  a tendency to grasp for  almost any fix.                                                                    
She thought  the bill  was ill  conceived. She  stressed the                                                                    
need for a  comprehensive package to fix  the broken system.                                                                    
She  pointed out  that  the  bills all  had  impacts on  the                                                                    
system. She opined  that bills should not  move forward when                                                                    
they were not  vetted by the right  committees. She appealed                                                                    
to members  to vote against  the bill  and to include  it in                                                                    
part of a comprehensive package in the future.                                                                                  
Ms.  McLeod   stated  that  the  bill   criminalized  mental                                                                    
illness. She  stressed that the  arrest followed  the person                                                                    
who  had an  acute psychiatric  emergency, which  had severe                                                                    
ramifications  for  the person  going  forward.  She used  a                                                                    
hypothetical scenario  where a  person was  arrested because                                                                    
they lashed out and hit  someone while having a heart attack                                                                    
or  some  kind  of  extreme  emergency  due  to  high  blood                                                                    
pressure. She  asked members to  consider that  the symptoms                                                                    
of a  person's illness could  create a criminal  record. She                                                                    
mentioned  HB 312  sponsored by  Representative Matt  Claman                                                                    
that had passed  several years earlier. She  believed it had                                                                    
criminalized mental  illness. She stated that  people in API                                                                    
or any medical  facility who exhibit symptoms  that could be                                                                    
deemed threatening could be arrested  and taken to jail. She                                                                    
emphasized that  the court  record followed  the individuals                                                                    
and impacted  their jobs and  future living  situations. She                                                                    
reiterated  her desire  to see  HB 290  brought back  in the                                                                    
future as part of a comprehensive package.                                                                                      
Co-Chair  Johnston   CLOSED  Public  Testimony.   She  asked                                                                    
Representative  Claman to  provide a  reintroduction of  the                                                                    
10:33:40 AM                                                                                                                   
REPRESENTATIVE MATT CLAMAN,  SPONSOR, highlighted that there                                                                    
had been questions at the  last hearing about the definition                                                                    
of acute  behavioral health crisis.  He read  the definition                                                                    
included  in an  email  from the  Department  of Health  and                                                                    
Social  Services:  a  situation  in  which  an  individual's                                                                    
behavior or  state of mind  puts that individual at  risk of                                                                    
hurting  themselves or  others or  prevents them  from being                                                                    
able  to  care for  themselves  or  function safely  in  the                                                                    
community  as a  result of  a mental  health diagnosis  or a                                                                    
substance  abuse disorder.  He explained  that the  bill did                                                                    
not include the definition because  it was common in the law                                                                    
for the courts  to look at what they refer  to as the "plain                                                                    
meaning rule."  He elaborated that  from the  perspective of                                                                    
the Department  of Law's Civil  Division, the  plain meaning                                                                    
rule would  take the definition  of acute  behavioral health                                                                    
crisis and  recognize that it included  both substance abuse                                                                    
and  behavioral health  issues.  The  division believed  the                                                                    
bill was  inclusive of the broad  terms and there was  not a                                                                    
need for a  more specific definition in  statute. He offered                                                                    
to provide a longer introduction and/or answer questions.                                                                       
Co-Chair  Johnston asked  Representative  Claman to  address                                                                    
the  concerns raised  in public  testimony. She  stated that                                                                    
the  bill was  more  about  keeping people  out  of jail  as                                                                    
opposed to putting them in jail.                                                                                                
Representative Claman  agreed. The  purpose of the  bill was                                                                    
to  divert individuals  who were  appropriate for  treatment                                                                    
away  from  a  repeat  cycle where  they  were  not  getting                                                                    
successful treatment in  jail. He detailed that  many of the                                                                    
individuals could be  stabilized in a short  period of time.                                                                    
He  shared that  states  that used  the crisis  intervention                                                                    
model had much better results  and police officers found the                                                                    
method in  the bill  was a  better way  to work  with repeat                                                                    
offenders  in  the community.  He  explained  that they  had                                                                    
actually been  able to reduce criminal  behavior and achieve                                                                    
savings  in  terms of  psychiatric  care  and public  safety                                                                    
10:36:28 AM                                                                                                                   
Co-Chair  Foster  MOVED  to  REPORT  CSHB  290(JUD)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes.                                                                                                      
Representative Carpenter OBJECTED.                                                                                              
A roll call vote was taken on the motion.                                                                                       
IN  FAVOR: Ortiz,  Wool,  Josephson,  Knopp, LeBon,  Foster,                                                                    
OPPOSED: Sullivan-Leonard, Tilton, Carpenter                                                                                    
The MOTION  PASSED (7/3). There being  NO further OBJECTION,                                                                    
it was so ordered.                                                                                                              
CSHB 290(JUD)  was REPORTED  out of  committee with  six "do                                                                    
pass"    recommendations,    three    "no    recommendation"                                                                    
recommendations, and  one "do not pass"  recommendation; and                                                                    
with one  previously published zero impact  note: FN1 (LAW);                                                                    
one previously published indeterminant  note: FN2 (DPS); and                                                                    
two previously published fiscal  impact notes: FN3 (DHS) and                                                                    
FN4 (DHS).                                                                                                                      
HOUSE BILL NO. 247                                                                                                            
     "An   Act  relating   to  the   fish  and   game  fund;                                                                    
     establishing the  sport fishing  enhancement surcharge;                                                                    
     relating to  the repeal of  the sport  fishing facility                                                                    
     surcharge; providing for an  effective date by amending                                                                    
     the effective  date of sec.  21, ch. 18, SLA  2016; and                                                                    
     providing for an effective date."                                                                                          
10:37:25 AM                                                                                                                   
Co-Chair Johnston OPENED Public Testimony.                                                                                      
Co-Chair Johnston CLOSED Public Testimony.                                                                                      
Co-Chair Johnston  asked for a  brief reintroduction  to the                                                                    
TOM  TAUBE, DEPUTY  DIRECTOR, DIVISION  OF SPORT  FISHERIES,                                                                    
DEPARTMENT OF  FISH AND  GAME (via  teleconference), relayed                                                                    
that the  bill would allow  the Department of Fish  and Game                                                                    
(DFG)  to  continue  to  collect  a  reduced  sport  fishing                                                                    
license surcharge beyond the date  it was set to expire. The                                                                    
sport fishing  surcharge was collected  in order to  pay off                                                                    
the bonds  issued to construct  the Ruth Burnett  Sport Fish                                                                    
Hatchery in  Fairbanks and the William  Jack Hernandez Sport                                                                    
Fish  Hatchery  in  Anchorage.  The  surcharge  also  funded                                                                    
Chinook  and Coho  salmon  production  in Southeast  Alaska,                                                                    
which would be  lost when the surcharge  sunset. The statute                                                                    
authorizing  the   bonds  and  surcharge  would   sunset  on                                                                    
January 1  of the calendar  year following the  repayment of                                                                    
the bond obligations (at the end of the current year).                                                                          
Mr. Taube elaborated that the  bill would retain the statute                                                                    
authorizing DFG to  collect the surcharge, but  at a reduced                                                                    
rate.  The revenue  from  the surcharge  would  be used  for                                                                    
ongoing  maintenance   and  repairs  at  state   sport  fish                                                                    
hatchery  facilities as  well  as  continued enhancement  of                                                                    
sport fisheries in Southeast.                                                                                                   
10:39:27 AM                                                                                                                   
Representative  Wool  asked  if there  had  been  discussion                                                                    
about  not reducing  the surcharge.  He understood  the bond                                                                    
had  been paid  off. He  noted testimony  from the  previous                                                                    
hearing on  the bill  that a  reduced number  of nonresident                                                                    
licenses was  projected, especially in the  current year. He                                                                    
cited Mr.  Taube's testimony  that the  money would  be used                                                                    
for  other  maintenance projects  and  not  for the  initial                                                                    
hatcheries  that were  built.  He asked  if  there had  been                                                                    
discussion about leaving the fee at the current rate.                                                                           
Mr. Taube responded that at  the time the surcharge had been                                                                    
implemented,  DFG had  made  commitments  to discontinue  it                                                                    
after  the bonds  were paid  off. He  relayed that  when the                                                                    
bill  had  been  conceived,  DFG  had  realized  there  were                                                                    
components of  the Fairbanks  and Anchorage  hatcheries that                                                                    
were  not  completed at  the  time  of construction  due  to                                                                    
rising construction costs in the  mid-2000s. He referenced a                                                                    
backup  well at  the  Fairbanks hatchery  and some  effluent                                                                    
filtering at the Anchorage hatchery  as examples. Due to the                                                                    
high  cost   of  the  investment  of   the  hatcheries,  the                                                                    
department had  decided to go  with a reduced amount  to try                                                                    
to partially remain with the  commitment made when the bonds                                                                    
were first created.                                                                                                             
Co-Chair Johnston  remarked that in the  past the department                                                                    
had  been asked  if  any  of the  funds  had  been used  for                                                                    
Mr.  Taube  replied  that  the  entire  surcharge  had  been                                                                    
directed to  paying off the bonds  themselves. The component                                                                    
of the  bill would be  used for covering  maintenance staff,                                                                    
replacing  hatchery  vehicles,  and for  components  of  the                                                                    
hatcheries  that  had  not  been   put  in  place  when  the                                                                    
hatcheries   were  constructed.   He  reported   that  daily                                                                    
operations were currently being  covered by [federal] Dingle                                                                    
Johnson funds.                                                                                                                  
10:42:25 AM                                                                                                                   
Representative  Carpenter  asked  if   there  had  been  any                                                                    
discussion about  revenue alternatives in light  of the fact                                                                    
that  the fee  was scheduled  to sunset  and the  bill would                                                                    
extend the  fee and  use the funds  for a  different purpose                                                                    
than   originally  intended.   He   asked   if  there   were                                                                    
alternatives  about how  to  continue  with maintenance  and                                                                    
repairs at the hatcheries.                                                                                                      
Mr. Taube  replied that DFG  would be continuing to  pay for                                                                    
the  operations  as it  did  via  Dingle Johnson  funds.  He                                                                    
elaborated  that for  larger  components,  DFG would  likely                                                                    
come  to the  legislature  for  capital improvement  project                                                                    
funds to  make necessary upgrades  to allow the  hatchery to                                                                    
continue functioning.                                                                                                           
Representative  Carpenter  opined   that  the  conversations                                                                    
should continue  to take place  in an operational  sense. He                                                                    
stated that the people had paid  a tax via a license fee. He                                                                    
stated  that  the purpose  for  the  fee  was gone  and  the                                                                    
people's money should be returned  to them. He believed that                                                                    
if  the   legislature  needed   to  fund   maintenance,  the                                                                    
conversation should take place.                                                                                                 
10:44:22 AM                                                                                                                   
DAVID   RUTZ,  DIRECTOR,   DIVISION   OF  SPORT   FISHERIES,                                                                    
DEPARTMENT OF  FISH AND GAME (via  teleconference), provided                                                                    
a brief narrative about items that  had been left out of the                                                                    
bill  and  items  included  in  members'  bill  packets.  He                                                                    
stressed  that the  hatcheries were  stocking 270  locations                                                                    
throughout Alaska  and they supported hundreds  of thousands                                                                    
of angler-days,  a sport fishing effort  that generated over                                                                    
$5,000 to  the Alaskan economy.  He elaborated that  most of                                                                    
the stocking areas  were baren lakes that were  once void of                                                                    
fish population  - there had  been no  fishing opportunities                                                                    
in those areas previously. The  vast majority of the angling                                                                    
efforts on  stocks were  Alaskan residents  and most  of the                                                                    
stocking  locations were  within  close  proximity of  major                                                                    
population  centers  where  anglers could  access  excellent                                                                    
fishing for  minimal out of pocket  cost. He noted it  was a                                                                    
great benefit. The stocking efforts  also reduced effects on                                                                    
wild  fish  populations,  many of  which  were  experiencing                                                                    
times  of low  production.  He underscored  it  was a  great                                                                    
driver  for reducing  the division's  dependence on  General                                                                    
Fund monies  and would help the  department with anticipated                                                                    
shortfalls  caused  by  reduced  non-resident  license  fees                                                                    
resulting from  COVID-19. He reported that  the division was                                                                    
fully supportive of the legislation.                                                                                            
10:46:02 AM                                                                                                                   
Co-Chair  Foster  MOVED to  REPORT  CSHB  247 (FSH)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal note.                                                                                                       
There being NO OBJECTION, it was so ordered.                                                                                    
CSHB 247(FSH) was  REPORTED out of committee  with seven "do                                                                    
pass"   recommendations   and  three   "no   recommendation"                                                                    
recommendations  and with  one new  fiscal impact  note from                                                                    
the Department of Fish and Game.                                                                                                
10:46:42 AM                                                                                                                   
Representative  Tilton  MOVED to  bring  back  HB 259  [2020                                                                    
legislation  proposed   by  the  governor  to   pay  a  2019                                                                    
supplemental   Permanent  Fund   Dividend]  for   additional                                                                    
discussion. She  relayed that  the bill  would pay  the past                                                                    
Permanent Fund Dividend (PFD) back to the people.                                                                               
10:47:07 AM                                                                                                                   
AT EASE                                                                                                                         
10:48:00 AM                                                                                                                   
Co-Chair Johnston OBJECTED.                                                                                                     
Representative Tilton believed it  would be prudent to bring                                                                    
HB  259 back  before the  committee because  the legislature                                                                    
was looking at a  long-term economic stabilization plan. She                                                                    
highlighted  that the  committee heard  from businesses  the                                                                    
previous day  that talked  about the need  for an  influx of                                                                    
cash  into   communities.  She  elaborated   that  committee                                                                    
members  had also  heard from  individuals. She  shared that                                                                    
she  had received  numerous emails  with concerns  about how                                                                    
they would  deal with  daily living  expenses. Additionally,                                                                    
the   governor   had   come   forward   with   an   economic                                                                    
stabilization plan that  included HB 259. She  stated it was                                                                    
dependent  on  the  legislature to  make  decisions  on  the                                                                    
issues. She thought  the bill could be used as  a vehicle to                                                                    
consider and discuss the stabilization of the economy.                                                                          
10:49:16 AM                                                                                                                   
Representative      Sullivan-Leonard     concurred      with                                                                    
Representative  Tilton. She  stated that  the committee  was                                                                    
finally not  hearing something related to  health and social                                                                    
services  and was  having a  discussion about  fiscal policy                                                                    
and the  budget. She elaborated  that legislators  had heard                                                                    
loud and  clear from  across the  state that  many residents                                                                    
were looking for back PFD  funds for support. She recognized                                                                    
there  had  been discussion  with  regard  to federal  funds                                                                    
coming through, but  she believed the quickest  route to get                                                                    
funds  to the  public  was through  the  PFD. She  supported                                                                    
Representative Tilton's motion.                                                                                                 
Co-Chair Johnston MAINTAINED her OBJECTION.                                                                                     
10:50:04 AM                                                                                                                   
AT EASE                                                                                                                         
10:50:24 AM                                                                                                                   
Co-Chair Johnston  discussed her objection. She  stated that                                                                    
while she appreciated the  comments by Representative Tilton                                                                    
and  Representative Sullivan-Leonard,  she objected  because                                                                    
she  believed   the  legislature  would  be   looking  at  a                                                                    
comprehensive relief  bill that  was currently  being worked                                                                    
on. She stated  that the subject in HB 259  could be part of                                                                    
that  legislation, but  she did  not yet  know. She  did not                                                                    
believe a supplemental PFD was  the only part of relief. She                                                                    
had  concerns about  what  kind of  relief  the state  would                                                                    
provide because it  was not an issue of a  month's time. She                                                                    
stated it could  be an issue of 18 months  to two years. She                                                                    
wanted  to make  certain the  state  had the  funds and  the                                                                    
tools to  accommodate it. She  emphasized the  importance of                                                                    
cash for the  state's daily needs. She  elaborated that most                                                                    
of  the  state's  retail   and  service  organizations  were                                                                    
currently  closed. She  was concerned  about their  economic                                                                    
stability going  forward and she  wanted to ensure  that any                                                                    
funding provided  by the state  went to  Alaskan businesses,                                                                    
and residents in the most need.                                                                                                 
Representative  Josephson associated  himself with  Co-Chair                                                                    
Johnston's remarks.  He understood  the importance  of cash;                                                                    
however, the numbers were still  the numbers. He appreciated                                                                    
Co-Chair Johnston's thoughtful comments.                                                                                        
10:52:19 AM                                                                                                                   
Representative   Tilton   appreciated  Co-Chair   Johnston's                                                                    
comments  as well  and  agreed on  the  importance of  being                                                                    
thoughtful  in  developing   a  comprehensive  package.  She                                                                    
highlighted that  the legislature  had a  stabilization plan                                                                    
for consideration, and she had  not seen something come from                                                                    
the legislature  itself. She remarked  that bringing  HB 259                                                                    
back was not  necessarily about the dividend  itself, but it                                                                    
could  be used  as a  vehicle  to have  the discussion.  She                                                                    
highlighted that the committee  had heard testimony from the                                                                    
business  community  the  previous   day  and  had  received                                                                    
testimony  from  the public  indicating  a  strong need  for                                                                    
cash. She  reasoned that businesses would  not remain stable                                                                    
or open  even with innovative  ways to alter  their business                                                                    
style. She pointed  out that if people did not  have cash in                                                                    
their  pockets,  businesses  would not  be  stabilized.  Her                                                                    
overall  concern   was  for   the  state's   residents.  She                                                                    
underscored  the need  to look  at how  the state  would get                                                                    
money out to the economy during an unprecedented time.                                                                          
Co-Chair  Johnston  thanked  Representative Tilton  for  her                                                                    
remarks. She stated that everyone  on the committee was very                                                                    
concerned  about  everyone  in Alaska.  She  MAINTAINED  her                                                                    
A roll  call vote was  taken on the  motion to bring  HB 259                                                                    
before the committee.                                                                                                           
IN FAVOR: Sullivan-Leonard, Tilton, Carpenter,                                                                                  
OPPOSED:  Wool,  Josephson, Knopp,  LeBon, Ortiz,  Johnston,                                                                    
The MOTION FAILED (3/7).                                                                                                        
Co-Chair Johnston  indicated the  meeting would  be Recessed                                                                    
to a Call of the  Chair. [See separate minutes dated 3/23/20                                                                    
11:33 A.M.]                                                                                                                     
10:55:03 AM                                                                                                                   

Document Name Date/Time Subjects
SB 120 ver. K Amendment 1 3.19.20.pdf HFIN 3/21/2020 9:00:00 AM
SB 120
HB 120 Testimony Letters 032120.pdf HFIN 3/21/2020 9:00:00 AM
HB 120