Legislature(2017 - 2018)CAPITOL 106
04/10/2018 03:00 PM House HEALTH & SOCIAL SERVICES
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| Presentation: Alaska Psychiatric Institute | |
| Adjourn |
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ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 10, 2018
3:03 p.m.
MEMBERS PRESENT
Representative Ivy Spohnholz, Chair
Representative Tiffany Zulkosky, Vice Chair
Representative Sam Kito
Representative Geran Tarr
Representative Jennifer Johnston
Representative Colleen Sullivan-Leonard
MEMBERS ABSENT
Representative David Eastman
Representative Matt Claman (alternate)
Representative Dan Saddler (alternate)
COMMITTEE CALENDAR
PRESENTATION: ALASKA PSYCHIATRIC INSTITUTE
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
RANDALL BURNS, Director
Division of Behavioral Health
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Presented the PowerPoint "The Alaska
Psychiatric Institute.
FAITH MYERS
Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of Alaska
Psychiatric Institute (API).
DORRANCE COLLINS
Mental Health Advocate
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
JAMELIA SAIED
Counselor
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
ANGELIKA FEY MERRIT
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
RICH RADUEGE, Psychiatric Nursing Assistant (PNA)
Alaska Psychiatric Institute (API)
Shop Steward, Alaska State Employees Association Local 52
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
SHEILA LITTLE, Registered Nurse (RN)
Alaska Psychiatric Institute
Shop Steward, Alaska State Employees Association Local 52
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
MUSA KANTEH, Psychiatric Nursing Assistant (PNA)
Alaska Psychiatric Institute
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
JASON LESSARD
NAMI (National Alliance for Mental Illness) Anchorage
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of API.
ALISON KULAS, Executive Director
Alaska Mental Health Board
Division of Behavioral Health
Department of Health and Social Services
Juneau, Alaska
POSITION STATEMENT: Testified during discussion of API.
STEVE WILLIAMS, COO
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Testified during the discussion on API.
ACTION NARRATIVE
3:03:23 PM
CHAIR IVY SPOHNHOLZ called the House Health and Social Services
Standing Committee meeting to order at 3:03 p.m.
Representatives Spohnholz, Johnston, Sullivan-Leonard, and
Zulkosky were present at the call to order. Representatives
Tarr and Kito arrived as the meeting was in progress.
^Presentation: Alaska Psychiatric Institute
Presentation: Alaska Psychiatric Institute
3:04:03 PM
CHAIR SPOHNHOLZ announced that the only order of business would
be a presentation by the Alaska Psychiatric Institute which will
include: an in-depth discussion surrounding the Alaska
Psychiatric Institute (API); the Department of Health and Social
Services, Division of Behavioral Health; a variety of
stakeholders; patient and employee advocates; and organizations
that may be able to offer insight and background as to API's
issues and how to chart a course forward to ensure that patients
and employees are safe and well.
3:05:24 PM
RANDALL BURNS, Director of the Division of Behavioral Health,
Department of Health and Social Services, paraphrased slide 2,
"Alaska Psychiatric Institute: the Basics," as follows [original
punctuation provided]:
API's proposed SFY19 budget is $33,360.0
Only 22% of API's funding is UGF: $7.2 Million
More than half of the remainder of API's budget is
funded by DSH (Disproportionate Share Hospital)
Medicaid Funds: $18.7 Million
The remainder of API's budget comes from Statutory
Designated Program Receipts (SDPR - $7.4 Million),
including Medicare, Medicaid, third party/private
payers, grants, etc.
API is the largest user of the State's DSH funds
DHSS currently uses its other available DSH funds to
pay for the Division's support for Alaska's 3
important designated hospitals providing psychiatric
evaluation and treatment services [Fairbanks Memorial
Hospital (FMH); Providence Alaska Medical Center for
the Providence Psychiatric Emergency Department
(PPED); and Bartlett Regional Hospital (BRH)]
FMH has a 20 bed mental health unit, with 4 acute
beds; BRH has 12 mental health beds;
and the Providence Psychiatric Emergency Department,
which acts as a behavioral health
triage center for the Anchorage area, has 7 beds. All
three have psychiatrists at the head of
their units.
3:07:39 PM
MR. BURNS, paraphrased slide 3, "An 80 Bed Hospital" as follows
[original punctuation provided]:
API is an 80 bed hospital with 5 distinct units:
Two adult acute units: Katmai (24 beds) and Susitna
(26 beds) for a total of 50 adult acute patient beds
One 10 bed unit for adolescent patients (Chilkat)
ages 13 through 17
One 10 bed unit for longer term adult patients
(Denali) with a real mix of diagnoses, from TBI,
autism, dementia, IDD, and all with very difficult and
complex behavioral issues
One 10 bed unit for "forensic" patients (Taku) for
defendants' whose criminal trials are on hold because
of concerns for their mental status (competency to
stand trial)
3:08:00 PM
MR. BURNS advised that slide 4, "Average Length of Stay by Unit
by Year, 2014-2017" is an example of the length of stay over the
last four years of each unit and they have been relatively
stable across these years.
MR. BURNS, paraphrased slide 5, "History: A Range of Bed
Options: From 162 Beds to Just 45 Beds" as follows [original
punctuation provided]:
Beginning in 1986, and over the next 14 years, there
were a variety of scenarios proposed to replace the
aging API
Most of the scenarios ended up being primarily based
on the funding available and did not significantly
rely on the approximately $6 Million in programming
work DHSS had contracted for as it prepared its CON
for the replacement hospital
DHSS issued is preliminary study in February of 1992,
summarizing the work of many of its consultants; this
study targeted the new API as requiring 162 beds: 72
Adult, 18 adolescent, 36 forensic, and 36 elderly
(although a year later, in 1993, a final DHSS study
suggested Alaska would need between 198 and 237 beds)
DHSS' early 1992 report was highly criticized by
advocates and community behavioral health providers
who supported a focus on more community-based services
3:09:38 PM
MR. BURNS, paraphrased slide 6, " History: The 'Alyeska Accord':
Finding Stakeholder Agreement on the Bed Capacity of the New
API," as follows [original punctuation provided]:
The Alaska Mental Health Board held a meeting at
Alyeska of 42 community mental health advocates and
mental health service providers in June 1992 (over 25
years ago)
The results from this weekend meeting became known as
the "Alyeska Accord" and was a set of principles which
were to guide the AMHB's response to DHSS' Certificate
of Need (CON) application for a new API
Agreements reached included the decision that the
central purpose of API was to provide "tertiary" care
and agreement that the new API should be built at 114-
beds, as follows: Adolescents: 18 beds Elderly: 18
beds Adults: 36 beds Swing (complex adults): 18
beds Forensic: 24 beds (not a part of the original
accord, but adopted by the AMHB a month later, in July
of 1992
3:11:00 PM
MR. BURNS, paraphrased slide 7, " History: From 114 beds to 57
to 72 to 80!" as follows [original punctuation provided]:
Based on the Alyeska Accord result, a CON for the 114
beds was submitted in August of 1993 by DHSS
However, this CON and its cost ($64.9 Million) was
DOA. Four years later, in 1997, the DHSS Commissioner
reviewed a report with different five scenarios, based
primarily on funding availability: a 72-bed option, a
63-bed option, two different 54-bed options, and even
a 45-bed option.
Based on this report, the DHSS Commissioner selected
one of the 54-bed options (which included adolescent
beds).
3:11:58 PM
CHAIR SPOHNHOLZ referred to the Certificate of Need for 114 beds
for the roughly $65 million API facility, and asked Mr. Burns to
explain why it was "dead on arrival."
MR. BURNS responded that it was due to the cost. He explained
that there was no support from the legislature for a capitol
budget of which would have been essentially $40 million above
the funding that the department had available at that point in
time.
3:12:50 PM
MR. BURNS continued paraphrasing slide 7, as follows [original
punctuation provided]:
After four more years, in 2001, with over $16 Million
in legislative-approved COP bonds, the re-
appropriation of $19 Million in existing committed
capital funds, and a Trust Authority contribution of
$3 Million, DHSS finally had the funds to procure a
72-bed facility. Another controversy: the construction
proposal was issued as design-build.
Because of concerns for the ability of the 72 beds to
handle API's capacity issues in 2001, DHSS issued API
a CON for 72 beds but did allow for an expansion to 80
beds with proof of a history of needing additional
beds. API opened with 80 beds in 2005.
As a part of this effort to fund a new hospital, DHSS
also applied for and was awarded a SAMHSA grant for $5
Million a year for three years to help fund expanded
community-based treatment to support the downsized-
hospital. These funds primarily were used to support
the development of additional DET capacity, and
training in role recovery, dual diagnosis, cultural
competence, and crisis intervention.
3:15:05 PM
CHAIR SPOHNHOLZ requested the definition of DET.
MR. BURNS answered that it is Designated Evaluation and
Treatment (DET). During the downsizing of API, it was decided
that more regional-based mental health options were necessary.
The Fairbanks Memorial Hospital and the Bartlett Regional
Hospital mental unit are both considered designated evaluation
and treatment facilities, he explained. Those facilities are
also designated to receive a portion of the DSH each year, he
said.
3:15:48 PM
MR. BURNS paraphrased slide 8, "Calendar Year Snap Shot of API
Utilization," and noted that in 1990, API had 160 beds and in
2017, it had 80 beds. He referred to the column titled, "No. of
Unduplicated Admits With Just a Single Stay during the Year" and
pointed out that in 2017 there were 839 unduplicated admits and
of those, 486 were admitted and had never been admitted to API
previously. He described it as one-third of the admissions for
that year, which is typical.
3:17:11 PM
MR. BURNS paraphrased slide 9, "The Current Bed "Capacity"
Issue" as follows [original punctuation provided]:
As members of this Committee are aware, API needs
and has been going through an expensive but very
necessary face-lift, retrofitting every bathroom and
portions of every bedroom to meet revised Joint
Commission safety requirements
Since mid-November of last year, this six-month long,
temporary closure of each of API's five hospital units
for repairs has had a major impact on community
hospital EDs and Alaskans experiencing psychiatric
emergencies: patients with court orders for
hospitalization for evaluation at API have been held
for days not hours sometimes up to a week or more
awaiting transfer to API for evaluation and
treatment [or transfer to one of the two other
hospitals with Designated Evaluation and Treatment
(DET) mental health units]
The API contractor has been working on the last unit
for about a month now (the Susitna Unit);
unfortunately, it is the hospital's largest unit, with
26 adult acute beds, so API's census capacity has been
set at just 54 patients, not 80 (or even 70)
MR. BURNS paraphrased slide 10, "API's Current Estimated Bed
Capacity " as follows [original punctuation provided]:
The construction on the Susitna unit was completed
last week; other off-patient-unit bathrooms were also
being repaired last week (e.g., restrooms off the gym
and dining room); the Susitna Unit is being thoroughly
cleaned and should be ready to open back-up this very
week
However, because of a shortage of nursing staff on
April 11th when API will have completed the
renovation project on time and the contractor is out
of the building at this time, and for at least the
next several months, we believe API will only be able
to run a census of 58 beds, down a total of 22 beds
for the foreseeable future.
We are not going to be able to open up the Denali Unit
(10 beds) and we will be forced to run the Katmai unit
at half of its normal census, or just 12 beds instead
of the normal 24 beds.
Until we are able to hire more RNs (travelers or full-
time positions), or the staff curren,tly out on
various types of leave (whether it be workers' comp or
FMLA) are able to return to work, we are not going to
be able to fully staff the Katmai unit, nor open the
Denali Unit
3:19:30 PM
REPRESENTATIVE SULLIVAN-LEONARD offered concern regarding the
shortage of nurses at API, and asked how Mr. Burns plans to
overcome this challenge. She further asked whether he is
working through the University of Alaska nursing program or
recruiting from out-of-state or out-of-country.
MR. BURNS responded that API's recruitment problems are due
mainly to its salaries, and later in the presentation he will
address that issue.
3:20:34 PM
REPRESENTATIVE TARR referred to slide 7, and its different
scenarios and offered that in addition to the funding issue
there were some challenges in the location. She asked whether
any challenges to the location had influence over the size of
the facility.
MR. BURNS answered that the community in that area has always
been highly supportive of API, and it was not a community
objection to the size. He explained that the acreage API sat on
was considered to be highly valuable and there were many
competing (indisc.), the university, Providence Hospital, and
the Alaska Mental Health Trust and its ability to use part of
that land for profit or for the beneficiaries. The real debate
related to what the footprint of API would look like, and how to
get it onto that property, which is how it ended up back in the
corner of that much larger lot (indisc.), he explained.
3:22:16 PM
REPRESENTATIVE TARR referred to the first paragraph on slide 9,
which read as follows [original punctuation provided]:
As members of this Committee are aware, API needs
and has been going through an expensive but very
necessary face-lift, retrofitting every bathroom and
portions of every bedroom to meet revised Joint
Commission safety requirements
REPRESENTATIVE TARR requested a description of the Joint
Commission, and whether there is a report the legislature would
have received.
MR. BURNS described that the Joint Commission is the entity that
credits all (indisc.) seeking new accreditation so it can bill
for Medicaid clients. The Centers for Medicare & Medicaid (CMS)
has given its authority to the Joint Commission, and the Joint
Commission regularly visits hospitals around the country and
accredits them to make sure they meet the standards jointly
produced by the Joint Commission and CMS.
3:23:28 PM
MR. BURNS paraphrased slide 11, "API's Current Estimated Bed
Capacity " as follows [original punctuation provided]:
We have hired four (4) traveling RNs, but we continue
to run at an RN deficit. The salaries that API is able
to pay for starting RNs is not competitive with
private sector hospitals
DHSS is presently exploring hiring bonuses and other
types of incentive pay in an attempt to make the
positions more attractive to prospective RNs
(incentives used by other departments, like DOC)
We have been meeting with Southcentral Alaska
hospitals and are going to be implementing some
admissions changes that should somewhat help mitigate
the stress on hospital ED's during this perfect storm
of problems affecting API
While we have been pleased with the Certificate of
Need (CON) applications from both Alaska Regional
Hospital and MatSu Regional Medical Center, CONs that
Commissioner Davidson has approved, we are anxious
about the actual dates that these facilities will be
able to open and actually begin accepting behavioral
health patients
Finally, in Governor Walker's capital budget for FY19,
there is a request to remodel the Anchorage Pioneer
Home to add at least six beds for psychiatric patients
needing dementia care.
MR. BURNS, in response to Representative Sullivan-Leonard's
previous question, advised that recently API spent a great deal
of time looking into what the department would need to bring API
fully online. Subsequent to API's research, it determined that
API had approximately 10 RNs out on a variety of leave, with 10
vacancies. Therefore, in order to keep the unit open, API is
seeking 10 new positions to cover those out on leave and five
positions to cover those vacancies. Clearly, he stressed, the
state's nursing salaries are simply not competitive, and 18
years ago in order to solve a similar problem the department
raised all of the nursing salaries by two ranges and it worked.
He said that API is suggesting the state try that same solution
at this time, and fund the 15 new positions as well as increase
the salaries of the existing RNs at API. The total funding, he
explained, would be approximately $2.5 million to have
competitive salaries. For example, he advised, API learned that
a current API nurse also works on the Psychiatric Unit at
Providence Hospital and earns $8.00 more an hour at Providence
Hospital than she does at API. However, he said, API also needs
funding for programing for staff; it is particularly concerned
about the need to increase salaries for physician assistants,
Adult Nurse Practitioners (ANPs), forensic psychologists, and
pharmacists. These issues have been closely reviewed and he
would be happy to provide more details in going forward as to
what API believes its true needs are for its staff.
3:27:36 PM
REPRESENTATIVE ZULKOSKY surmised that over 25 years ago there
was an acknowledgement that the capacity needs of API were well
over what was actually constructed, and asked whether that is,
in part, due to the costs of construction.
MR. BURNS responded that it was a combination of construction
costs but mostly it was (indisc.) around the hospital with the
amount of capitol funds and eventually some bonding that allowed
API to cobble together the funding.
REPRESENTATIVE ZULKOSKY advised that in coming from travel
health recently she understands the challenges around recruiting
needs, the need to operate at capacity, and to provide some
market adjustments to make sure the salaries are competitive.
She asked whether API has found that there is a shortage of
medical professionals nationwide as she knows the shortages
exist for hospitals. She further asked whether the facility is
HIPPA compliant.
MR. BURNS responded that API is compliant with all patient
privacy requirements, and he agrees that there is a national
shortage of RNs and medical staff, so Alaska is not alone in
that regard. Given the shortages, it is an employee market in
the healthcare industry and medical providers can probably
choose where they want to work given their skills set if given
competitive salaries.
3:30:42 PM
REPRESENTATIVE JOHNSTON asked that Mr. Burns repeat the number
of nursing vacancies.
MR. BURNS replied that API has 10 vacant positions and 10
positions that are essentially vacant because the staff is on
some type of leave.
REPRESENTATIVE JOHNSTON surmised that API must have a "pretty
high" vacancy factor.
MR. BURNS answered that it has the normal budget vacancy factor
of 8 percent.
REPRESENTATIVE JOHNSTON related that she is trying to understand
how API can operate as well as it is currently, and asked
whether there are duties an LPN can perform for an RN to relieve
some of the pressure on the RN.
MR. BURNS answered that there are some jobs an LPN can perform
rather than an RN, the API physician descriptions (indisc.) for
them, and these are site nursing positions. As long as API is
meeting the Joint Commission standards for its nursing staff, it
can use LPNs for RNs if they have had the appropriate medical
training, he said.
REPRESENTATIVE JOHNSTON explained that she is trying to
understand how API can transform when it has an RN shortage and
a need, and how some of those duties are transformed in order to
make it all work. She related that with the vacant positions,
API could possibly revise some of its salary structure to be
competitive and review its job descriptions to put "more feet in
the building." She asked whether Mr. Burns had been looking at
those possibilities in API's organizational management to
determine how to work with what it has currently in order to
meet some of these chronic needs.
MR. BURN responded that in using API's existing salary
schedules, it was suggested that it simply take the existing
salary schedule and boost the ranges of those positions in order
to make them more competitive. He reiterated that that approach
was made some time ago and it was successful.
REPRESENTATIVE JOHNSTON asked whether API would be looking at
what its needs are on the floor to determine whether it could
shift some of those needs to an LPN, or another medical
provider, to make it all work.
MR. BURNS replied that API has been looking at a variety of
options to get those positions filled and it will continue to
review options.
REPRESENTATIVE JOHNSTON said that she did not mean a licensed
practical nurse, but other healthcare providers who are not an
RN but have the capability to be effective on the floor.
MR. BURNS advised that those are where the limitations come in
in terms of the Joint Commission standards, there are very
strict standards about the nature of the positions that can work
in a hospital and the duties of those positions. Therefore, API
must make sure it is recruiting and staffing at the appropriate
level of clinical expertise.
3:35:30 PM
CHAIR SPOHNHOLZ noted that Mr. Burns testified that he had a
requested $2.5 million to assist in addressing the staffing
shortage, and asked where that request was located.
MR. BURNS answered that that is not a request API has in any
budget. In the event API could get its staff up and running
again as quickly as possible and assuming it could fund those
positions at a higher level, the cost would be $2.5 million to
fully staff API and empty out the emergency departments across
the state.
CHAIR SPOHNHOLZ surmised that that is both an adjustment of
salaries in order to be more competitive and also an increase in
the number of personnel.
MR. BURNS stated that Chair Spohnholz was exactly correct.
CHAIR SPOHNHOLZ, for context, noted that psychiatric nurses in
API are working in the absolute most complex working environment
in the State of Alaska in terms of the acuity and the complexity
of the patients admitted into API. She stressed that she could
not state strongly enough how important it is to make sure these
salaries are at the correct range to attract and retain the most
qualified personnel possible. The State of Alaska must employ
the best of the best in these positions because the patients
cannot go anywhere else, and they are the most challenging
simply because API is the state's only psychiatric institution.
She stated that she will follow up with Mr. Burns and department
representatives to try to figure out some of the fiscal elements
of these problems. These issues about patient safety and worker
safety cannot continue to be neglected when it is a known
problem and there are clear straight-forward solutions to
resolving these problems. She pointed out that API has been
neglected for "a very, very long time." Chair Spohnholz noted
that she had read API's PowerPoint presentation earlier and read
some of the reports and history, and she was struck that the
legislature has refused to address the known problems directly
and as forthrightly as necessary.
3:38:39 PM
REPRESENTATIVE ZULKOSKY noted that according to the
presentation, currently API is only running 58 beds, and is down
22 beds. She asked Mr. Burns to speak to the total count of
staff necessary for the current number of beds in operation, and
the necessary staff if API operated at full capacity.
MR. BURNS replied that 22 of the 58 beds is based on the
staffing it currently has available, particularly RNs. The API
does have a total of 56 RN positions, but it is down 20 of those
positions due to the vacancies and/or personnel out on a variety
of leave, it is down to 36 beds. He explained that that is the
reason API is currently staffing the hospital at 58 beds rather
than 80 beds.
REPRESENTATIVE ZULKOSKY restated her question and asked the
number of full-time exempt position (travel health), and the
total number of employees necessary to run however many beds are
currently in operation versus how many full-time employees would
be required to run a full-capacity facility.
MR. BURNS answered that API would need 56 nursing positions
filled in order to fully staff the facility, obviously other
staff is needed for every shift. The RNs are particularly
important because if there is not an RN on shift, the unit must
be closed. He related that that is why API looks to the RN in
order to set the capacity of the hospital because it is staffing
24/7 and those units would need all 56 RN positions filled in
order to keep the units open on a 24/7 basis.
REPRESENTATIVE ZULKOSKY surmised that 20 full-time positions.
MR. BURNS responded that API would need an additional 20 full-
time positions, currently 10 positions are vacant because API
cannot fill the positions. The facility is not counting on all
of the staff that are on leave will return, which is why it set
15 as the number "we really are looking to" in order to have the
hospital up and running.
3:42:48 PM
REPRESENTATIVE TARR referred to the $2.5 million figure and said
that when she spreads it out among 20 positions it is
approximately $125,000 per position. She asked how the $2.5
million translates into those positions relative to the private
sector and whether it is necessary to add $125,000 to the
overall compensation package to be competitive with the
positions of the private sector. Previously, Mr. Burns had said
that the $8.00 per hour for a full-time employee is
approximately $16,000 more per year, and she asked Mr. Burns to
explain the numbers.
MR. BURNS apologized for not providing the information in a
format that would be useful. He explained that API took the
existing RN position range of 19, and the $62,000 per year with
benefits equals $108,000, if that range is bumped up two full
ranges to make it more competitive with the private sector, it
becomes $70,800 per year and with benefits it is $120,591.
Thereby, API would be increasing the cost of that position of
$108,000 to $120,000, he explained.
REPRESENTATIVE TARR surmised that the $2.5 million roughly is 10
of those range 21 positions.
MR. BURNS clarified that it is 15 positions plus the addition of
the funding necessary to also bring, not just the 10 vacant
unfilled positions, but bring up the salaries of the other
positions, which is another $500,000.
3:45:57 PM
MR. BURNS paraphrased slide 13, "API and its Forensic
Population," as follows [original punctuation provided]:
There is another population besides adolescents that
pose a particular problem for API.
The Alaska Court System's demand for DHSS's forensic
services has simply outstripped API's ability to
manage the caseload assigned to its staff utilizing
API's 10-bed, medium security unit the Taku Unit
to serve the defendants court-ordered to API for
treatment
API did seek consultation on this issue and Dr.
Patrick K. Fox, a psychiatrist with significant
forensic experience, was hired by the Western
Interstate Commission for Higher Education (WICHE) to
provide API with a report. His report was issued in
November 2016.
The report offered a number of recommendations,
including additional education to API staff,
consideration of a jail-based competency restoration
program, an evidenced-based jail- diversion program,
involvement of more experienced outside forensic
examiners, and training for judges and the legal
community on forensic issues (including the Sell
involuntary medication standard)
The API Forensic Evaluation Team was served with a
notice last month that an Anchorage Mental Health
Court Judge had set April 16th for an "Order to Show
Cause Hearing" as to why API should not be held in
contempt of court for not evaluating a defendant
within the judge's requested time frame. This was
recently resolved, but it shows the level of
frustration.
In partial response to this crisis, and with the
original support of this Committee and the eventual
support of the House Finance Committee, the House of
Representative is seeking Legislative and Alaska
Mental Health Trust Authority support for a
feasibility study to explore the value of establishing
a forensic hospital in Alaska, given the various
demands on API and the general needs of Alaska's
mentally ill correctional population.
MR. BURNS advised that prior to the late 1980s, API's forensic
patients were sent out of state to (indisc.) a hospital in
California. At some point, California decided it was finished
with taking care of another state's patients and returned the
patients to Alaska and then to API. Since that time, API has
worked with this population and the court system has been
unhappy with the delays in API's ability to perform competency
examinations of those people accused of crimes who may not be
competent to stand trial. While API is behind in that issue, it
has only three staff members to handle those numbers and API
feels fortunate in their abilities. In the event the patient is
reviewed and determined to be incompetent but could be restored,
they are admitted to the API 10-bed unit for treatment and
restoration, he offered. Due to the fact that API has so few
beds, a number of those defendants found to be non-restorable
are waiting in the Department of Corrections (DOC) for API to
admit them into the hospital. In order to show the committee
the court system's level of frustration, last month an Anchorage
judge in the mental health court sent API an Order to Show Cause
as to why it shouldn't be held in contempt for not accepting
this particular client within a certain period of time. That
order has since been resolved, he said, and API appreciates the
House Health and Social Services Standing Committee, the House
Finance Committee, and the Mental Health Trust Authority's
support in funding a forensic feasibility study for a forensic
hospital.
3:48:52 PM
MR. BURNS paraphrased slide 14, "Studying Alaska's Need for a
Forensic Hospital," as follows [original punctuation provided]:
The study would look at Alaska's needs for forensic
beds in order to admit, evaluate, and treat criminal
defendant with issues around the insanity defense and
their competency to stand trial (see AS 12.47). The
list of issues is long and complex and would involve
defendants: needing competency evaluations; found
incompetent to stand trial who need treatment to
determine if they can be restored to competency in
order stand trial; found non-restorable and who are
then civilly committed to API (including dangerous
persons who often have committed serious felonies);
found Guilty but Mentally Ill (GMI) and held in
prisons; found Not Guilty by Reason of Insanity
(NGRI) and committed to API's forensic unit; or
found guilty of a variety of crimes where competency
was not raised and who have been incarcerated but who
are experiencing a mental illness and need ongoing
treatment because of the severity of their symptoms
and just as often the severity of their crimes.
MR. BURNS described this as an incredibly complex area with a
long list of needs for this population.
3:49:43 PM
CHAIR SPOHNHOLZ asked how many people have been admitted to API
who were found to be non-restorable and are essentially
committed for an indeterminate amount of time.
MR. BURNS answered that there are 10 patients in the forensic
unit that API is trying to restore, there are currently four
patients on the civil side who were determined non-restorable
and committed to API. He advised that three of those patients
committed very serious crimes.
CHAIR SPOHNHOLZ asked how many are in the Department of
Corrections (DOC) when they should rightly be in API.
MR. BURNS apologized and said he does not have that number off
the top of his head.
CHAIR SPOHNHOLZ asked that Mr. Burns follow up with that number.
MR. BURNS agreed.
3:51:24 PM
MR. BURNS paraphrased slide 15, "So: the Short List of API
Current Challenges:" as follows [original punctuation provided]:
Admissions pressures: Continuing demand for
treatment beds at API from all regions of the state
Long waits for patients (boarding) in hospital EDs for
an evaluation and/or a treatment bed at API because of
API's general lack of an adequate number of treatment
beds
Staffing related budget concerns, including
recruitment, retention, appropriate unit staffing
coverage, quality of care (i.e., need for unit
programming / therapeutic activities for patients in
treatment), and the reliance on overtime to keep the
hospital minimally staffed (Premium Pay)
Concerns for the safety of staff and patients and
staff training to ensure their safety and the safety
of patients when staff are appropriately redirecting
or intervening with challenging patients; ongoing
concerns for the use of seclusion and restraint
Current inadequate local community behavioral health
programming to support patients who are discharged
from API or either Fairbanks Memorial or Bartlett
Regional, including inadequate community-based
medication management services, and an ongoing need
for community mental health (MH) treatment, for
substance use/misuse disorder (SUD) treatment, for a
combination of both MH and SUD (Co-occurring)
treatment, and / or because of a lack of housing or
appropriate living arrangements
In partial response to the clear need for more
community based services, and to address the substance
use / opioid crisis in this state, the Governor has
introduced an FY18 supplemental request for $18
Million to assist in providing greatly needed SUD
treatment programs in local communities, especially
withdrawal management and residential treatment
programs
3:53:02 PM
MR. BURNS paraphrased slide 16, "A Summary of Potential Projects
that Could Significantly Improve API," as follows [original
punctuation provided]:
There are a number of projects presently being
considered by the Legislature that would have a direct
and highly beneficial impact on API's current
crisis:
Support for an expansion of Alaska's DSH Program,
allowing DHSS to explore ways to financially assist
those hospitals highly impacted by the reduction in
treatment bed capacity at API
Support for the $18 Million in additional substance
use/misuse disorder treatment, providing funding for
inpatient and ambulatory withdrawal management
services, residential and intensive outpatient
residential treatment services, sobering center or 72-
hour SUD crisis evaluation services, and housing
assistance and support services
Support for the $318.0 feasibility study to explore
the need for a forensic hospital in Alaska
Support for API's budget and recognition that present
funding is inadequate to meet the dramatic admission,
discharge, and patient and staff safety pressures
facing the hospital
3:54:09 PM
CHAIR SPOHNHOLZ acknowledged Mr. Burn's long service time with
the department, and asked whether he feels the legislature made
the right decision in terms of building API with an 80 bed
capacity, or does he feel the legislature should have built API
out larger in the 1990s proposals.
MR. BURNS answered that part of the appeal in building a smaller
API was that there would be 16 beds of designated evaluation and
treatment directly in Anchorage with the understanding that 80
beds would have been adequate. He related that that particular
portion of the commitment was never followed up on, there was an
attempt but it failed which meant the facility was down 16 beds.
In addition, he opined, there was a real expectation,
particularly by advocates in the communities, that there would
be substantial ongoing support to make sure the communities had
adequate local support for those individuals with mental
health/substances abuse issues. Unfortunately, he said, that
commitment would have required a continuing additional
commitment to those communities which has been hard to maintain.
In a perfect world, if everyone had done what the plans said
they would do, API would probably be okay but that didn't really
take place.
3:57:29 PM
FAITH MYERS, Mental Health Advocate, advised that she volunteers
as a mental health advocate, she has served on numerous API
committees, and is a board member (indisc.). Psychiatric
hospitals and (indisc.) operate in self-interest, "we are not
going to voluntarily improve rights of care for psychiatric
patients." Thereby, leaving the legislature and the court
system to protect psychiatric patients wherein thousands of
individuals are brought into forced psychiatric evaluation or
treatment each year in Alaska at over $1,500 per day. In the
process, 47 percent will experience sexual trauma or harm which
may cause exacerbate post-traumatic stress disorder (PTSD).
Evidence indicates that PTSD is associated with the highest
rates of medical and mental health services, making it one of
the costliest mental disorders. There is a real correlation
between the lack of rights for acute care of psychiatric
patients and the poor system of care, as at API. Among those
rights, psychiatric patients should have the right to have
(indisc.) trauma recognized by the Alaska hospitals and units
and treatment provided. Providing care rights for psychiatric
patients will force the various state departments to develop
proper systems of care that reach best practices in psychiatric
hospitals and units. Best practices for the state, she offered,
would be for the legislature to pass a bill similar to the 2008
Georgia House Bill 535, a summary of which read as follows
[original punctuation provided]:
This legislation repeals current law providing for a
State and a Community Ombudsman for Mental Health,
Mental Retardation, and Substance Abuse, and instead
provides for the Office of Disability Services
Ombudsman (Office). The Ombudsman will serve as chief
officer of the office. The Ombudsman will promote the
safety, well-being, and rights of mental health
consumers; will establish procedures for investigating
and resolving complaints; investigate actions of
service providers; establish a uniform statewide
complaint process; enter and inspect facilities;
access clinical and agency records; promote the
interests of consumers to government agencies; and
report to law enforcement when appropriate. The bill
also includes a separate
clause to cover persons with developmental
disabilities and addictions.
4:00:20 PM
REPRESENTATIVE TARR shared that Legislative Legal and Research
Services is drafting legislation based on Georgia House Bill 535
for the committee's review and study.
4:00:51 PM
DORRANCE COLLINS, Mental Health Advocate, advised that he
volunteers as a mental health advocate. In 2010, he said he
served as a board member on the Alaska Psychiatric Institute
Advisory Board, made a tour of three of the hospital units, and
wrote a four-page report with 16 constructive criticisms. He
described that a patient was lying in a urine soaked bed at 3:00
p.m., and he was informed that the hospital had no policy for
when to change the sheets of the patients. The API and other
hospitals have never voluntarily developed psychiatric patient
policies that properly protect disabled patients and help with
recovery. He referred to the 2008 Georgia House Bill 535, and
advised that 10 years ago, the Georgia legislature determined
that its equivalent of the Department of Health and Services and
the providers of services of psychiatric patients operated in
self-interests. So much so, he said, it was proven that
Georgia's Department of Health and Social Services was incapable
of writing or enforcing fair rules to protect their clients.
(Indisc.) cost of investigating their client's basic rights. A
number of years ago, he said he went to the Ombudsman's Office
and it was determined that Behavior Health had not investigated
patients' complaints in five years as it was not their priority
list to investigate complaints. He noted that as to the
testimony today, his group is totally against practice of the
transfer of criminals into non-criminal units in API and if a
larger hospital was built the rights of the patients would be
improved. Patrons of API and the people who make decisions
believe that the patients have no clear right to fair treatment,
or fair rights, he said.
4:04:13 PM
JAMELIA SAIED, Counselor, advised that she grew up in Fairbanks,
is a professional mental health counselor, has had interactions
with API over 25 years, and has served on the boards for several
mental health organizations. For several years, she said she
offered weekly presentations at API on particular treatment
programs, and worked with her own patients at API. She
applauded the committee for performing this long overdue
investigation and she considers most the employee concerns to be
valid because they often are not adequately trained in best
practices and often work in conditions without supervision or
support. She asked the committee to strongly consider the
impact that the inadequate employee conditions have on patients.
During the time she conducted the presentations at API, numerous
patients were always asking her for help with some kind of
problem, sometimes the issues were easily resolved by a staff
members, and other issues were fundamental problems with their
treatment. For example, there were constant problems with their
medications due to a revolving door of providers, and being told
they were about to be discharged with no plan in place. Working
as a clinician for patients at API, she said she would generally
have difficulty reaching the attending doctor to discuss ongoing
outpatient care, and oftentimes they could not remember the
patient to whom she was inquiring. She described that she had
advocated for a larger institution, API is too small for its
community especially when considering that API not only serves
Anchorage, it serves rural communities statewide. Due to the
constant shortage of beds, many individuals who need help end up
in jail, thereby resulting in the DOC being the largest mental
health provider in the state. Also, she remarked, many API
patients have co-existing substance abuse disorders and opined
that there are only eight de-tox beds available in Anchorage.
The API has serious problems for both employees and patients,
and the other states that have examined these issues have
successfully corrected the problems. It will cost money, she
offered, because nurses and the other medical staff need
competitive wages when the committee considers the additional
stress in working with API patients. She expressed that the
salaries should actually be higher at psychiatric institutions.
The inadequate care the patients are receiving ends up costing
the state more dollars in terms of increased crime,
homelessness, and the substance abuse epidemic Alaska is
experiencing.
4:09:09 PM
CHAIR SPOHNHOLZ commented that she appreciates Ms. Saied drawing
the link between appropriate staffing levels, appropriate
training, and how that translates to appropriate care for
patients.
4:09:30 PM
ANGELIKA FEY MERRIT shared anecdotes about her daughter's
experiences at API. After sharing her daughter's experiences,
she stated that API is not a safe place for the patients or the
staff, it is not a stable environment for her daughter, and no
treatment is provided for the patients other than medications.
She urged the legislature to provide treatment programs for long
term patients, like her daughter, rather than re-traumatizing
the patients.
4:18:54 PM
RICH RADUEGE, Psychiatric Nursing Assistant (PNA), Alaska
Psychiatric Institute, Shop Steward for the Alaska State
Employees Association Local 52, said that API is a dangerous
place to work and he shared his experiences working at API since
1987. In 2018, the Occupational Safety and Health
Administration (OSHA) found API to be a generally unsafe
workplace, and in 2015, Dr. Joshua Dvorkin, forensic
phycologist, law professor at the University of Arizona, was
hired by then CEO Melissa Ring at API to make recommendations
regarding the unsafe workplace issues. He related that Dr.
Dvorkin wrote as follows:
In my opinion, API is significantly and at times
dangerously understaffed. When staff is inadequately
staffed, staff members become fearful of patients and
as a result they may spend too much time in the
nursing station and not enough time interacting with
their patients. Understaffing also reduces the
ability of staff to intervene early in non-
confrontational ways which would allow them to avoid
many of the circumstances which lead to ... end up use
of force."
Dr. Dvorkin also recommended that 24 permanent floor staff be
added and noting that CEO Dr. Ring had previously made that same
recommendation as well. The staffing of permanent experienced
PNAs is inadequate and API recently started a program of filling
the lack of those permanent staff positions with on-call non-
permanent staff. He described that these staff members are
inexperienced, can only work a certain number of hours, and are
supposed to be used as substitutes for the permanent staff on
leave or workmen's compensation. Staff are reluctant to take
the lead in controlling a disruptive patient because every
restraint is likely to result in blame by the lead staff person,
he stressed, the PNA performing the restraint should not be
subject to blame because this prevents open debriefing when
blame occurs and it prevents interventions that would benefit
the other patients, and no standardize policy exists allowing
for the restraint type of intervention. Staff are reluctant to
open up in debriefing for fear of blame and punishment, which
prevents adequate recordkeeping for the benefit of the patient
involved as well as the staff who must deal with the patient on
the next shift. Code Grey, he explained, is called when more
staff are needed for a behavioral emergency, oftentimes the code
is for a show of support and moving more PNA staff onto the
floor, which has the calming effect of safety in numbers. The
theory behind the 101 and the 201 is that it prevents harm to
the patient as well as the staff and often this is enough to
prevent what otherwise might be a restraint. The staff receives
only a couple of days of training per year by the PNA-4;
however, many PNA-4s are themselves investigated for performing
restraints incorrectly. He said, API was found to have four
times the number of assaults as other residential mental health
facilities.
4:25:28 PM
REPRESENTATIVE ZULKOSKY requested the definition of PNA, and the
ratio of staff to patient. She said she thought that Mr.
Raduege had said there was an additional 12, and he had stated
another number.
MR. RADUEGE answered that a psychiatric nursing assistant is a
PNA. Previously, staffing was based on acuity wherein a high
acuity patient would be a four, a low acuity patients would be a
one, and the unit would be staffed for the day or the next shift
by that acuity. Currently, he explained, it is a core of three
staff members no matter the height of the acuity, and there is
extra staff if a patient is on a one-to-one which means they are
observed by one person 24 hours per day sometimes.
4:26:40 PM
REPRESENTATIVE ZULKOSKY asked Mr. Raduege to repeat his
testimony wherein he had mentioned additional recommendations
for additional positions.
MR. RADUEGE reiterated that the way staffing was previously
followed was by an acuity on the severity of the milieu, and now
it is a flat three number, if that is the number, of staff that
come in every day.
REPRESENTATIVE ZULKOSKY commented that she thought Mr. Raduege
had mentioned an additional 12 staff per shift.
MR. RADUEGE clarified that he meant 12 staff for the whole 24-
hour period.
4:27:30 PM
REPRESENTATIVE JOHNSTON said she thought Mr. Raduege had
mentioned an additional 8 staff for the weekend.
MR. RADUEGE answered that on the weekends, staff works 12-hour
shifts. There are three shifts on the weekdays and then 12-hour
shifts which would decrease the number needed on the weekend
because they work 12-hour shifts on the weekends.
REPRESENTATIVE JOHNSTON requested the current number of vacant
PNA positions.
MR. RADUEGE responded that he does not know the number of vacant
positions.
REPRESENTATIVE JOHNSTON surmised that Mr. Raduege suggested that
even with API's current positions, staff is basically put on the
floor according to a flat number versus the level of acuity and
there is room for a management change here.
MR. RADUEGE answered that Representative Johnston was correct.
REPRESENTATIVE JOHNSTON surmised that the plan for acuity has
changed as far as management's approach.
MR. RADUEGE answered that Representative Johnston was correct.
4:28:32 PM
CHAIR SPOHNHOLZ commented that Mr. Raduege has been performing
this work for 30 years, which is a longtime for a public servant
in any line of work but particularly in this line of work.
4:29:04 PM
SHEILA LITTLE, Registered Nurse (RN), Alaska Psychiatric
Institute (API), Shop Steward for the Alaska State Employees
Association Local 52, advised that she is a level 2 registered
nurse (RN) at API and she usually works a 12-hour shift on a 10
bed unit and supervises anywhere from two to five PNAs during
her shift. First of all, she pointed out, some of API's members
had a peaceful demonstration in front of API, which was posted
on social media. After reading some of the comments on the
post, it occurred to her that there is a rather negative image
of the people who work at API, and state workers in general, but
especially people who work with the mentally ill. She advised
that she has been in the workforce for 42 years and without
reservation she could say that the staff at API are some of the
finest people she has ever worked with, these people bring
integrity, experience, and knowledge to this job. The staff is
from all over the world and they are the most diverse workforce
she has ever seen. She described the mental health field as the
least desirable of all healthcare fields to work in due to its
very nature, it is a complex series of illnesses and disorders,
it is hard to interpret, hard to understand, and hard to treat.
There is not a great deal of job satisfaction and feeling like
"you are really accomplishing something" because the patients
suffer with these illnesses for the rest of their lives.
Sometimes, she offered, the best that the staff can do is patch
them up and send them back out again, and that becomes very
disheartening. In addition, when patients are admitted to an
acute care facility, they are ill to begin with, they have often
been off of their medications, and are frustrated and fed up
with their illness and the changes it brings to their lives.
Consider that these patients usually do not have a good support
system or housing, they are not working, they do not have
insurance, and on top of that they are now committed to this
facility by family members or someone in the community, she
remarked. By the time these patients are admitted to API they
are quite upset and spoiling for a fight, unfortunately, the
PNAs are the closest staff upon which to vent their
frustrations, she advised.
4:32:03 PM
MS. LITTLE stressed that the first 24-hours, the first three
days, the patients admitted to API are incredibly dangerous for
the PNAs. The PNAs have suffered injuries, such as: injury to
their backs; legs; knees when patients kick their legs out from
under them; bones have been broken including their fingers and
faces; staff have endured the patients spitting blood on them;
and throwing urine into their eyes and mouths to cause as much
damage as they possibly can because the patients are extremely
angry people. Ms. Little stressed that these wounds are carried
by the staff for the rest of their lives. She advised that her
rotator cuff had to be repaired because she happened to be
walking down the hallway when a patient grabbed her arm, threw
it behind her, ripped it, and in just a matter of seconds, she
could not lift her arm.
4:33:02 PM
MS. LITTLE explained that as difficult as these physical
injuries are, the worst parts are the constant verbal assaults
with vile and vicious attacks regarding the staff's race,
gender, the shape of staff's bodies, and so forth. These
attacks are meant to disarm the staff and make them lose
confidence in themselves, and even though the staff expects this
type of treatment, it is not always easy to put things, such as
those verbal attacks, away. She advised that the staff shared
with her that the greatest current issue facing them is this
culture of fear that began approximately seven years ago. Seven
years ago, the safety department was staffed with nursing staff
who understood the interactions on the floor, when the cameras
were installed, the safety department was then staffed with
social workers who had no experience with the interactions on
the floor or with patients. Currently, everything the staff
does is judged and judged quite harshly, and there is no nursing
staff input when it comes to reviewing the tapes when an
incident takes place, she expressed. A Code Grey is not called
as it should be called, when a Code Grey is called everyone
knows it is serious and everyone needs to respond. Currently,
the staff is hearing things like the staff needs a show of
support because the difference there is that there is no
paperwork for a show of support, the paperwork generates the
reviews, and once the reviews take place, people start getting
suspended, she advised. She reiterated that this is a culture
of fear wherein people no longer want to respond. She described
a "bystander effect" wherein when the staff does show up for
codes, the staff stand around waiting for someone else to take
the first move. The common attitude is, she remarked, if staff
does not touch anyone and does not say anything, the staff
cannot get in trouble.
4:35:25 PM
MS. LITTLE explained that together with the culture of fear, the
staff shortage definitely contributes to a cycle of ill will
between the patients and staff, and it interferes with the
staff's ability to give the patients the help they need. Due to
the shortage of staff, they are not available to talk to the
patients, calm their fears, and give them what they need.
Therefore, she explained, the patients become even more
disgruntled with the staff, become more aggressive and more
demeaning toward the staff, thereby causing the staff to "kind
of drift into the nurses' station and stay away from them, it is
a cycle."
MS. LITTLE pointed out that this entire situation from poor
staffing to poor management and a hostile safety environment
makes it almost impossible to work at API, and during the two
years she has returned to API, it lost a good majority of its
experienced staff. She advised that PNAs are not formally
trained, they learn everything they know about mental illness on
the job. The on-call staff currently working at API know
absolutely nothing about mental health so they cannot bring
their concerns to the nurses because they do not necessarily
know how to read a situation, they do not know what it looks
like when a patient is escalating, or when a patient is
decompensating and looking for a quiet place to slip away and do
danger to themselves. Documentation from the on call staff is
proof of this situation because time and time over again what
they have written in the documentation is very generic with no
useful information whatsoever, and from what she has been told,
on any given day, 35 percent of the staff are the on-call people
coming in. She stressed that API is no longer a safe
environment.
4:37:24 PM
REPRESENTATIVE SULLIVAN-LEONARD requested information regarding
her interactions with the nursing supervisors and the
administration in order to seek problem solving solutions for
the issues she discussed.
MS. LITTLE shared that previously, she worked on the forensic
unit but was recently moved to another unit because an incident
took place on the floor of the forensic unit. She stated, "I'm
going to be very careful here because I don't want to be
retaliated against." Ms. Little explained that the ball was
dropped for a particular patient by the psychiatric staff, the
psychologist, wherein the PNA staff was put in the position
where someone was injured and then someone was fired. She
stressed that none of this would have taken place if the
psychology staff had handled this issue in the manner it would
normally have been handled for this particular patient.
Wherein, she and all of the PNAs involved complained and advised
that "this is where everything went wrong, if this would have
been fixed, none of this would have happened." As a result,
within three weeks of the incident, each person who complained
received a letter to be interviewed and they all received some
sort of instruction. There was an interview with one of the
PNAs because he was looking at a newspaper between performing
his locator rounds. She explained that every 15 minutes the PNA
has a slip of paper with everyone's name on it, and they walk
around and make eye contact with each patient and write down the
time, and this takes place four times in one hour. On the very
back of the slip of paper, it actually read, "While you are
doing the locator, you are not to do anything else, you cannot
be distracted." The PNA had performed his rounds as required,
then stood at the desk flipping through a newspaper while still
looking out and keeping an eye on what was happening on the
unit, with eight patients in bed asleep at the time. The PNA
was called upstairs for reading that newspaper in between
performing his rounds, and she was called upstairs for failing
to supervise him and allowing him to read that newspaper between
rounds. Now, she said, they both have a letter of instruction
and she believes this was simply retaliation because the
administration was so insistent in not holding the psychology
staff responsible for what had taken place with this very
volatile patient.
4:40:03 PM
REPRESENTATIVE SULLIVAN-LEONARD asked whether she could explain
whether there were pro-active meetings and not reactive
meetings. She further asked whether the nursing staff
supervisors hold weekly meetings to discuss what had taken place
with the patients on the floor, whether they discuss continuing
education unit (CEU) for educational purposes for the staff, and
whether there are meetings with the administration where it is
looking at pro-active solutions.
MS. LITTLE responded that each of the five units are supposed to
have a nurse manager, and for almost a year, three of the units
have not had a nurse manager with the Taku Unit being one of the
units. The Taku Unit did not have a supervisor or a liaison,
and occasionally the Director of Nursing would hold a meeting in
the Taku Unit once a week, usually at 6:00 a.m. She advised
that the meeting was on her day off and she rarely made the
meeting because she lives 45 miles away. The nursing shift
supervisors usually have their meeting amongst themselves
upstairs and the floor staff has its meetings daily at shift
change. She related that when concerns are shared with the
shift supervisors, it is on a very casual basis as they make
their rounds.
4:41:25 PM
REPRESENTATIVE JOHNSTON referred to Ms. Little statement that
outsourced nurses come in, and in looking back at the earlier
presentation, there are four traveling nurses. She asked
whether these are two different approaches, one group are
traveling nurses and the other group are outsourced nurses.
MS. LITTLE answered that the traveling nurses are different from
the on-call staff, the on-call staff are PNAs and they are all
the unschooled PNA staff, psychiatric nursing assistants. The
traveling nurses are a recent new approach in filling those 11
nursing vacancies, and she has not yet encountered any of the
traveling nurses.
4:42:35 PM
REPRESENTATIVE JOHNSTON referred to the 11 nursing [leave]
vacancies due to various reasons, and asked whether any of those
leave vacancies were due to suspensions, fear, knowledge, or are
they all related to illnesses, birth of babies, and so forth.
MS. LITTLE replied that she was unsure, although, a couple of
months ago there was an exodus of approximately three nurses who
had been employed at API for some time. She opined that the
exodus had something to do with discontent over the nurse-3
positions, the nurse manager positions. These are nurses who
wanted these positions and yet the positions were not being made
available, at least one nurse moved on because she was unable to
apply for a position that she was well qualified for even though
the need was there.
4:43:46 PM
REPRESENTATIVE JOHNSTON asked whether it was seven years ago
that API installed the cameras, or seven years ago it changed
from nurses reviewing the cameras to social workers.
MS. LITTLE responded that both of those actions occurred
approximately seven years ago and at the same time. She
explained that she first went to work at API in 2009, and when
the new prison in valley, that was close to her home, opened she
moved to the prison and worked for two years. She then returned
to API in 2016 and has been there for two years wherein she has
noticed a big change. She related that the cameras were
installed and the safety department switched over to social
services type individuals rather than the nursing staff around
the time she left API.
REPRESENTATIVE JOHNSTON asked whether the social services
individuals have Master of Social Work Degrees (MSW) or are just
people with a social services backgrounds and risk assessment
backgrounds.
MS. LITTLE opined that that is the case, but there is not a lot
of personal interaction from the people downstairs with the
people upstairs. She related that about the only time they see
the people upstairs is when staff has been called upstairs.
4:45:54 PM
MUSA KANTEH, Psychiatric Nursing Assistant (PNA), Alaska
Psychiatric Institute (API), advised that he has been employed
at API since 2011, he is graduate of (indisc.). He explained
that he had been on-call staff for four years, and the last five
years he has been full-time staff. He described that API has
been sliding downhill since 2011 with staffing being the number
one issue, and he has observed that the training is currently
quite different from 2011, such that, "When we got cited last
time by OSHA, we used to (indisc.). With man some of the
patients are violent toward themselves or the patient peers or
staff so you can hold them down, we decide what we need to do,
call the doctor, and the doctor will write the order."
Previously, the training department staff had been there for 25-
30 years and they all left. Currently, the staff must find a
place to hide when the patients are violent toward the staff,
and there are people training the staff that he has never seen
on the floor, and if he sees them, after 5-10 minutes they have
left the floor. He commented that a person cannot train when
they have no idea of the job duties, and requested that the
staff receive professional training, which would help the staff
train themselves. For example, two years ago, a supervisor
trained the staff, which resulted in four out of seven staff
members cited for mishandling the patients, and he questioned
how someone could teach him who was cited based on doing the job
right. He stated that has received verbal assault and has been
beat up while performing his job duties, and now, most of the
experienced staff are all leaving by retiring or moving on.
Most of the staff have five years invested, and he said, "you
take a hike, you don't want to go into be on medical care for
the rest of your life." For example, a couple of his co-workers
were beat up in front of him and now they can no longer walk.
He related that he is scared going to work and prays to God that
he completes the day in one piece and continues to enjoy his
life with his family. Another example, a supervisor was beat up
a couple of times, suffered broken ribs, and due to the violence
stepped down and is now going to school and leaving. There is
no communication between the upstairs and the downstairs, and
working as a team is not happening because everyone is scared.
The staff is afraid that if they do something, they might lose
their job making it very stressful to work at API. He stressed
that he loves his work, but he is scared as to whether he will
lose his job or be injured.
4:51:21 PM
REPRESENTATIVE SULLIVAN-LEONARD referred to the situations the
staff has been experiencing and said that she knows the staff is
working closely with their union. She asked whether the staff
is unable to all band together and have the types of
interactions with the administrators at API as he is having with
the committee. Obviously, she said, the administrators must
know and hear about these situations.
MR. KANTEH explained that he has a good relationship with most
of the supervisors he works with, but there is no contact with
the administrators because "they pass by, they're gone." The
staff is supposed to have a monthly meeting with the management
but that is not taking place, he noted that the staff has a
safety committee but if the staff's comments are unlikeable,
they will be dropped from the safety committee.
REPRESENTATIVE JOHNSTON related that part of her challenge is
that he has no authority with the operations of API itself, but
the staff collectively at least has its union. She suggested
that the staff "very strongly" have those meetings with the
administrators and have a "come to Jesus meeting." It is
clearly unacceptable for people to be hurt consecutively and
continually at the API, and it is a real challenge to see the
dollars, the low numbers of staff, and so forth. She offered
her appreciation for Mr. Kanteh to travel to Juneau to offer his
testimony.
MR. KANTEH added that a couple of on-calls have been hired, but
the on-calls have no job guarantee or benefits, so when you want
to train those people they are not interested and they make
clear that their jobs are not guaranteed and they will not get
into anything. He noted that when patients bang their head
against the wall, the staff now walk away and cry because the
patients cannot be touched until someone gives the order to hold
the patient down. Previously, when a patient started banging
their head, the staff would put a pillow under their head, but
now the staff cannot do that. For example, he advised, a
patient said a bad word to him and he said, "yeah, I like it,"
and he was pulled off the floor for six weeks, plus there was an
incident where six staff members were pulled off the floor for
six weeks.
4:55:16 PM
CHAIR SPOHNHOLZ offered appreciation for his testimony and noted
that one of the reasons he was asked to testify was to share
some his concerns.
4:55:40 PM
JASON LESSARD, National Alliance on Mental Illness Anchorage
(NAMI), pointed out that API is the only organization of its
kind in the state and it is a critical component to the safety
and recovery of many Alaskan. He said that when the National
Alliance on Mental Illness (NAMI) hears reports of concerned
safety issues and workplace violence, it worries about the
safety of Alaskans in the acute phase of serious mental illness
who may have symptoms causing them to be violent or have severe
cognitive impairments and/or a danger to themselves or others.
The NAMI also greatly worries about the safety of those who have
chosen to work in this field in any capacity that supports
those suffering from serious mental illness and their path to
recovery. He pointed out that if the API environment is unsafe,
there are really no other options for those patients in API who
are in a state that puts them among the most vulnerable. All
too often, [DOC] becomes the de facto provider of mental health
services, which is not only inadequate with regard to the
services and support of patient needs but it is also not the job
of the (indisc.). The staff are not trained as mental health
professionals and it is unfair to all involved when it becomes
the only other option. The fact that such a vital component in
the continuum of care does not have an alternative and that the
environment is unsafe is extremely disconcerting, he stressed.
For these reasons, those at NAMI believe it is imperative that
the safety concerns and staff shortages be addressed, not just
quickly, but thoughtfully, collaboratively, and with a holistic
approach in relation to the larger mental health community in
the state. He related that NAMI is confident that in working
together a solution will be found.
4:58:10 PM
ALISON KULAS, Executive Director, Alaska Mental Health Board,
advised that she is the Executive Director of the Advisory Board
of Alcoholism and Drug Abuse, and the board is statutorily
charged with advising the governor, the related departments, and
the legislature in planning and coordinating mental health
services funded by State of Alaska. This board advocates for
programs and services that serve people with behavioral health
disorders, their families, care providers, and communities, it
has long partnered with Department of Health and Social Services
(DHSS) and EPI. This board has a standing seat on the API board
to better understand the service needs and identify resources
for Alaskans experiencing a mental health disorder episode. The
Alaska Mental Health Board believes it has long been
demonstrated that there is a need for additional acute
behavioral health care services in Alaska and she noted the lack
of residential facilities for adults with acute mental health
needs. The inpatient psychiatric emergency services and
inpatient psychiatric hospitals, emergency departments, and
inpatient general hospitals, are the primary location for these
services. This board is working with partners across the
spectrum to truly understand the current needs of API patients
and staff, and she advised that it is gathering information as
to other state's promising best practices, such as the Georgia
legislation, and some promising work out of the Unity Program in
Portland, Oregon. She stated that this board is committed to
continuing this conversation with providers, patient advocates,
and the department to identify short-term and long-term
solutions. This board will then pull all of this information
together with some proposed solutions wherein the legislature
and all stakeholders involved can share back their comments.
Additionally, this board is advocating for allowing other
hospitals and community health programs across the state to
increase capacity through the enhanced DSH funding that Director
Burns mentioned. This additional funding, together with the
federal funds, will alleviate the immediate needs in order to
provide the appropriate level of care to Alaskans experiencing a
mental health crisis. Long-term solutions are underway, she
advised, to increase behavioral health treatment with the
additional Certificates of Need that addresses Title 11.15,
Division of Behavioral Health Demonstration Waiver. This board
wants to look at the big picture of the structure of all of the
above services in Alaska and identify where those situations are
occurring and how to meet the needs of Alaskans, she explained.
5:01:43 PM
REPRESENTATIVE SULLIVAN-LEONARD asked whether Ms. Kulas said she
is on the API board.
MS. KULAS responded that the Alaska Mental Health Board does
have a seat on API's board (indisc.) current board member
working with API.
5:02:07 PM
REPRESENTATIVE SULLIVAN-LEONARD referred to the testimony of the
psychiatric nursing assistant and the nurse working at API, and
requested her comments as to these great concerns.
MS. KULAS answered that she had been taking a lot of notes
during this entire hearing, and this is something the Alaska
Mental Health Board has heard about and has discussed. This
board will have this quarter's full board meeting next week and
this discussion will be continued. She said that one of the
questions the board has asked, particularly when it pertains to
the violence piece, is where the violence is occurring, on which
unit, and whether it is patient to patient, patient to staff,
staff to patient, in order to understand the issues and
incorporate that information into its proposed solution. The
board members are definitely asking those questions in order to
support the staff and patients at API.
5:03:01 PM
REPRESENTATIVE JOHNSTON referred to slide 22, "Patient Injury
Rate - Number of Client Injury Events for all Causes that
Occurred for Every 1000 Inpatient Days" from 2014 to the second
half of 2017; and slide 23, "Staff Injury Rate - Number of Staff
Injury Events of any Severity that Occurred for Every 1000
Inpatient Days" from 2014 to the second quarter of 2017.
Representative Johnston commented that both slides are
interesting graphs because the incidents are from zero to 3.5,
and they look fairly dramatic. She asked whether Ms. Kulas had
reviewed these slides and studied why there are peaks and
sometimes drops in injuries. She further asked whether this has
been part of the board's discussions, whether the board is aware
of these graphs because it appears things have changed on the
floor since 2013, and she would like to see the stats beginning
in 2011.
MS. KULAS answered that she is not entirely sure about those
graphs in particular, but she knows this board does have some of
that information and she would follow up with Director Burns to
be sure she has a copy. This board is also interested in the
peaks of injury, and what changes were taking place to really
understand what that data means. One of the testifiers
mentioned that during the last seven years the staff has noticed
the change, and it is important for the board to ask additional
questions, she commented.
5:06:15 PM
CHAIR SPOHNHOLZ noted that Ms. Kulas mentioned other assets in
the community, and a couple of Certificate of Needs were
recently approved for Alaska Regional Hospital and Matanuska-
Susitna Regional Hospital to add a significant number of
additional behavioral health beds. She asked whether Ms. Kulas
believes that is an important remedy, whether it is just a piece
of the puzzle, and whether that remedy will be a significant
contributor from her perspective.
MS. KULAS replied that definitely it is critical that the
members of the communities follow this issue so it does not all
fall directly onto API, and asked what other support can be
given to the communities. The additional Certificates of Need
is one piece and it is a little bit more of an intermediate
solution, and just to make sure that those facilities are
getting up and running and able to serve the needs. That is
where this board also sees the Disproportionate Share Hospital
(DSH) funding that is currently in the House of Representative's
budget in giving (indisc.) in addition to getting that other
(indisc.) match to increase the services across the state. She
related that originally, when they put this proposal together as
Director Burns mentioned, they were anticipating a lot more of
that community support piece but that really has not happened.
She opined that with the Certificates of Need and potential DSH
funding, there can be more community based support to relieve
some of that pressure.
5:08:04 PM
CHAIR SPOHNHOLZ requested information regarding the forensic bed
capacity challenges, and pointed out that the committee is aware
that the Department of Corrections (DOC) has turned into the de
facto provider of mental health care when there is not enough
capacity at API. She asked whether the Alaska Mental Health
Board has been looking into that issue.
MS. KULAS responded that this board is especially interested in
the forensic bed study as this is something that some of the
board members have taken a particular interest in as to what
other states are doing, how does Alaska differ, what can be
pulled from other state's models, and definitely supporting the
Alaska Mental Health Trust Authority in the forensic bed study.
5:09:19 PM
STEVE WILLIAMS, Chief Operating Officer, Alaska Mental Health
Trust Authority, offered that due to time constraints and the
wealth of information offered today, he will defer to any
outstanding questions or verifications the committee may have
wherein the trust could provide additional information.
5:09:48 PM
REPRESENTATIVE TARR referred to the testimony that PNA positions
are not formally trained, and noted her surprise in terms of
making sure people have the background and resources to be
successful in their positions, even absent staffing challenges
and behavioral challenges. It appears, she said, that the
Alaska Mental Health Trust Authority, because it funds the
initial phrase of work, or start up projects, could be a place
to fill that gap and provide some additional support. She asked
whether that is something the Trust has considered or how could
the legislature look to the Trust to help address that issue.
MR. WILLIAMS asked whether Representative Tarr was talking
specifically about the Trust providing some additional support
as it relates to workforce training, and in particular API.
REPRESENTATIVE TARR answered in the affirmative, and
specifically for these individuals who are doing the best they
can but given the staffing and safety challenges, are put in
harm's way just to go to work every day. She explained that she
was talking about training in de-escalation or other behavioral
modification training.
MR. WILLIAMS answered that for several years, the Trust has been
heavily focused on workforce training and development, and it is
largely focused in community behavioral health and other systems
of care that serve Trust beneficiaries. In order to make sure
there is a well trained field workforce that can provide that
quality of care, and in listening to the discussion today,
certainly this is an area in which the Trust could work with the
department and Director Burns in looking at the opportunities
here where the Trust might be able to partner to help provide
additional training to staff on an ongoing basis.
5:12:29 PM
REPRESENTATIVE TARR asked whether the Trust has the authority
to, within its own budget, have funding available because the
legislature is not quite finished with the budget for the Alaska
Mental Health Trust Authority, and if there is something that
needs to be included, now would be time. The state is in a
crisis situation, she described, and she is thinking of
something more immediate and "very near term kind of activity."
Even if it was just more in a therapeutic sense, it almost
sounds like the trauma associated with the positions must be
taking its toll. She asked whether that is something the Trust
could independently do given the authority and the dollars it
has, or is it something the legislature must specifically
outline as a priority.
MR. WILLIAMS answered that it would be something the Trust would
want to discuss with API as to its staffing and training needs.
The Trust certainly has the ability to help in a short-term and
quick manner if there is a need, and it has the ability to pull
in the additional training these folks need. He stressed that
it would require sitting down to really understand the training
needs and what is missing in getting the staff that training.
5:13:55 PM
REPRESENTATIVE TARR commented that that suggestion sounds like a
good idea, and she truly hopes that that is an issue that
receive attention in the very near future for everyone's safety,
the safety of vulnerable Alaskans who need tremendous support,
and also the safety of the staff. She expressed that she is
thankful there are people who are willing to take those
positions, especially given the challenges, and she hopes the
Trust and API can talk soon so the legislature will learn the
results of that discussion soon.
MR. WILLIAMS replied that the Trust will be happy to share the
results of those conversations with the legislature.
5:14:36 PM
REPRESENTATIVE JOHNSTON referred to slide 28, "What is DBH Doing
to Work these Problems? Staff Injuries (continued)" and noted
that it appears API is working with the Western Interstate
Commission for Higher Education (WICHE) to access the value of
the API training programs. It appears that with Mr. Williams
having a discussion with [API], and hopefully outside resources
are being pulled in which can be of great benefit, that this is
something the Trust could be doing no matter what the
legislature ends up doing.
MR. WILLIAMS answered that that is exactly what the Trust does
with these and other types of situations, and the WICHE report
is one, there have been several others in talking with API that
pointed out areas for improvement or for services and the Trust
can sit down with the department and look at how to get to those
ends and "get this recommendation."
5:15:51 PM
REPRESENTATIVE ZULKOSKY commented that in trying to wrap her
mind about this discussion, it is clear that not enough
resources have been put forward for API in understanding what
the facility staffing needs are, married with the actual
facility needs, infrastructure needs, as well as the needs of
ongoing continuing education. Having had this conversation, it
is important to know the numbers of staffing needs versus what
has actively been budgeted, so the legislature can understand
from a high level of perspective what the funding needs are
overall and how the legislature can help API get positioned to a
place where the staff are safe and the patients are actually
receiving the resources and care they need at such an important
facility she said.
MR. WILLIAMS asked whether hers was an overarching statement and
that when the information is provided back to the committee
members, having some of this detailed information better
illustrated would be helpful.
REPRESENTATIVE ZULKOSKY answered in the affirmative and that it
was an overall request that was not so much focused solely on
the Alaska Mental Health Trust Authority.
5:17:47 PM
CHAIR SPOHNHOLZ referred to the capacity level, and asked
whether there is the capacity to meet the needs for acute
psychiatric care in the state. She related that she continues
to be concerned when speaking with patient advocates, about the
state's tendency "for lack of a better word, sort of get people
stabilized or tuned up and then send them back out into the
community" without a lot care, and the fact that the state has
many folks with severe mental illness in prisons. She asked Mr.
Williams to describe the discussions around looking at the
forensic bed capacity within API.
MR. WILLIAMS answered that Director Burns talked about it in his
presentation when walking through the beds and services API
provides to Alaskans with mental health issues. Director Burns
mentioned that API carved out 10 beds dedicated to the forensic
unit and those beds are generally used for individuals with a
pending criminal charge wherein their legal competency has been
raised. He explained that the person's criminal case is stayed
until a staff psychologist has performed a forensic competency
evaluation for the court. He further explained that the results
of a competency evaluation are as follows: in the event the
evaluation determines the person competent to stand trial, the
trial will commence; if the person is not competent but there is
a potential for competency and restoration, the criminal case is
stayed until the person is restored to legal competency and they
are aware of the court's surroundings, the charges against them,
and are able to assist their attorney in their own defense,
wherein the criminal case proceeds; and there are situations
where a person is found not competent and not capable of
restoration, in which case the determination is reported back to
the court and the charges are generally dismissed.
5:20:52 PM
MR. WILLIAMS advised that the impact of the competency
evaluations are significant because currently there are 10 beds
for this service and the courts have a steady referral rate for
these types of evaluations. The evaluations are timely, and
when a person cannot access the restoration piece and also the
initial evaluation, the person ends up staying in DOC until the
evaluation or restoration can take place. He pointed out that
that poses problems for the DOC and it certainly poses issues
for the due process of the person in terms of the pending
charges. The Trust is looking at where that type of service is
delivered and how it is delivered in an effort to potentially
free up some space at API and the people not involved in the
criminal justice system can access additional beds or treatment
in a more expedited manner. Also, he said, to expedite the
process itself so people are not languishing in the DOC waiting
for this process to take place and their criminal case to come
to resolution in some fashion.
5:22:39 PM
CHAIR SPOHNHOLZ referred to slide 13, "API and its Forensic
Population" and noted that Director Burns described that the
Alaska Court System's demand for forensic services exceeds API's
capacity to manage the caseload, and he used the word "crisis."
Director Burns is seeking support for a feasibility study to
explore the value of establishing a forensic hospital in Alaska.
MR. WILLIAMS responded that part of that study is to: try to
find another location; what is that location; is it feasible;
and then start looking at: accreditation; staffing needs; the
operations; transportation needs because individuals are often
transported back and forth to the court for their hearing;
wherein all of these issues will be taken into consideration
together with looking at how other states manage their forensic
population and competency issues.
5:23:57 PM
CHAIR SPOHNHOLZ asked whether he has a sense of the numbers in
terms of people sitting in the Department of Corrections (DOC)
awaiting entry into API for psychiatric stabilization.
MR. WILLIAMS answered that he does not have the exact number,
but roughly 160 Alaskans received competency evaluation orders
in FY 2017. As to the delay and someone is sitting in DOC
awaiting those types of evaluations, there are variables in play
as to how long someone sits in DOC. For example, he offered,
there is a difference when someone has a pending serious felony
level charge and the defendant's competency is in question, and
there is someone else with a lower level charge where their
legal exposure in terms of the amount of time they may be
sentenced to a crime if convicted is much less. He explained
that API does what it can to try to triage and prioritize, but
the judicial system is set up with different court locations
statewide ordering these evaluations which includes
transportation. For example, because all of these evaluations
take place through API, and defendants are flown in statewide,
clearly "things can get stacked up pretty quickly." Also, due
to staffing and the amount of time required for these types of
evaluations, defendants can end up sitting DOC for periods of
time that one would hope would be shortened, he offered.
5:26:06 PM
CHAIR SPOHNHOLZ noted that stakeholders and the legislature are
looking for ways to strategize and free up space for folks who
really need serious mental health services, and that the
forensic patients tend to be at API for twice as long as other
patients. She referred to Slide 4, which lists the length of
stay, and noted that it depicted an average of 44 days for a
forensic patient in API versus a much lower number ranging
between 10 and 24 days for the non-forensic patients. It
appears, she pointed out, that addressing that forensic patient
needs would be a useful strategy.
MR. WILLIAMS explained that part of that differential can be the
amount of time required for someone to be re-stabilized on
medications in order to understand the upcoming legal process
with their pending criminal charge, and assist in the defense of
their own processing of the case. In fact, he pointed out,
there are longer periods of time because the requirement is that
a person is at the legal competency threshold. He described
that it is not "apples to apples."
5:27:49 PM
CHAIR SPOHNHOLZ noted that she had heard the Alaska Mental
Health Trust Authority may be exploring preparing a feasibility
study for the needs gap or the capacity gap currently existing
at API, and she requested an update.
MR. WILLIAMS responded that that is something the Alaska Mental
Health Trust Authority and the department are preparing separate
from this forensic look. He explained that the feasibility
study is working with the department all the way back to when
the current API facility was designed and built, and he has been
discussing the design and building with Director Burns and
reviewing documents from history, noting that it was built with
the potential to possibly expand or add an additional wing in
the future. Therefore, he said, the Trust, in partnership with
the department and API, will go back and look at how API was
originally designed and built to determine whether the current
facility has the capacity to literally add a wing to the
existing facility. In the event that is the case, then taking a
step further and looking at the planning and zoning issues that
might be attached within the municipality. In the event all of
those issues play out and it is possible not only from a campus
and facility perspective and but a planning and zoning
perspective, they will start looking at what the additional wing
would look like, its capacity, how many beds, conceptual
designs, ultimate construction costs, contingencies, and so
forth. He advised that the Trust would not be looking at the
operating costs associated with that expansion, it would
literally look at the capital costs for an additional wing.
5:30:30 PM
REPRESENTATIVE SULLIVAN-LEONARD referred to slide 13, third
bullet and noted that Dr. Patrick Fox provided a November 2016
report regarding the forensic needs for API. Considering the
that report of November 2016 is available, she asked whether Mr.
Williams believes there is a need for a new forensic study.
MR. WILLIAMS answered that that study looked at API and its
forensic service process and the way API managed its cases, it
was not necessarily looking at the possibility of having that
service in a different location and serving that population in a
separate manner. Certainly, he said, the Trust has access to
that report and it will be reviewing that report, there is no
interest in re-inventing the wheel, especially given that the
report is only two years old.
5:32:14 PM
REPRESENTATIVE SULLIVAN-LEONARD offered that her interest was
peaked when Mr. Williams talked about expanding a wing at API,
which is why she believes this study may correlate with those
efforts.
5:32:38 PM
MR. WILLIAMS thanked the committee for taking the time to look
into this issue, obviously it is a complex situation with many
people interested in providing quality care. Many Alaskans are
looking for that quality of care from the Alaska Psychiatric
Institute (API), and the Trust is certainly interested in making
sure that goal is reached. He also thanked those who testified
previously, including the department, patient advocates, and the
staff members. These are very complex needs for Alaskans and
the community behavioral health system cannot meet their
psychiatric needs, thereby for whatever reasons, these needs
have moved into a psychiatric crisis. This is a safety net, he
described, and there must be a safety net to meet those needs
and get people back into the community in positive manner as
quickly as possible.
CHAIR SPOHNHOLZ remarked that the people who count on the state
to care for them at API are the most vulnerable and are at API
because they have no other place to go, and it is incumbent upon
the legislature to make sure it is thoughtful about their care.
She noted that many topics had been discussed today, but the
committee did not cover in great detail the access issues of the
lack of community health supports for people who inevitably
leave API and go back out into the community for whom there are
not many supports. She opined that Ms. Merrit referenced that
issue when she described the challenges her daughter suffers in
finding appropriate community supports for her serious mental
health issues. There are serious acute psychiatric services
needs with gaps in terms of community supports, in which "we'll
see more of being offered in the private sector" at MatSu
Regional Hospital and Alaska Regional Hospital soon. There was
a small discussion regarding the forensic needs for the State of
Alaska, and she commented that its criminal justice system only
works when the people tried for crimes actually understand the
crimes for which they've been accused, and are competent to
stand trial. She stressed that that is definitely a "big need
gap." Also, a topic not discussed today, she advised, is the
shortage for adolescent acute care behavioral needs. She
described long stays for children in emergency departments,
sometimes as long as 14 days in Anchorage, Fairbanks, and MatSu,
and the community providers of these services are not able to
keep up with those needs, thereby leaving children sitting in
emergency departments. She noted that the commissioner has been
in attendance since the beginning of this meeting for those who
are listening in and watching, as have her deputy commissioner
and assistant commissioners.
5:37:20 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:37 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| DHSS presentation before HHSS 4.10.2018.pdf |
HHSS 4/10/2018 3:00:00 PM |
API |
| Violence and Aggression in an Inpatient Psychiatric Hospital G. Martone.pdf |
HHSS 4/10/2018 3:00:00 PM |
API |
| Dvoskin Final Report on API March 17 2015.pdf |
HHSS 4/10/2018 3:00:00 PM |
API |
| Vitae for Joel Dvoskin.pdf |
HHSS 4/10/2018 3:00:00 PM |
API |