Legislature(2021 - 2022)DAVIS 106
04/01/2021 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s):|| Mental Health Trust Authority|| State Medical Board | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 1, 2021
3:06 p.m.
MEMBERS PRESENT
Representative Liz Snyder, Co-Chair
Representative Tiffany Zulkosky, Co-Chair
Representative Ivy Spohnholz (via teleconference)
Representative Zack Fields
Representative Mike Prax
Representative Christopher Kurka
MEMBERS ABSENT
Representative Ken McCarty
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Mental Health Trust Authority
Annette Gwalthney-Jones Anchorage
Anita Marie Halterman Eagle River
Rhonda Boyles Anchorage
Brent Fisher Anchorage
- HEARD
State Medical Board
David Boswell - Fairbanks
Richard Wein - Sitka
- HEARD
Larry Daugherty - Anchorage
- SCHEDULED BUT NOT HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
ANNETTE GWALTHNEY-JONES, Appointee
Board of Trustees
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
ANITA MARIA HALTERMAN, Appointee
Board of Trustees
Alaska Mental Health Trust Authority
Eagle River, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
RHONDA BOYLES, Appointee
Board of Trustees
Alaska Mental Health Trust
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Board of Trustees.
BRENT FISHER, Appointee
Board of Trustees
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Testified as appointee to the Alaska Mental
Health Trust Authority Board of Trustees.
DAVID BOSWELL, Appointee
State Medical Board
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community, and Economic Development
Fairbanks, Alaska
POSITION STATEMENT: Testified as public appointee to the State
Medical Board.
RICHARD WEIN, MD, Appointee
State Medical Board
Division of Corporations, Business and Professional Licensing
Department of Commerce, Community, and Economic Development
Sitka, Alaska
POSITION STATEMENT: Testified as physician appointee to the
State Medical Board.
ACTION NARRATIVE
3:06:06 PM
CO-CHAIR LIZ SNYDER called the House Health and Social Services
Standing Committee meeting to order at 3:06 p.m.
Representatives Prax, Fields, Spohnholz (via teleconference),
Zulkosky, and Snyder were present at the call to order.
Representative Kurka arrived as the meeting was in progress.
^CONFIRMATION HEARING(S):
^Mental Health Trust Authority
^State Medical Board
CONFIRMATION HEARING(S):
Mental Health Trust Authority
State Medical Board
3:06:57 PM
CO-CHAIR SNYDER announced that the only order of business would
be confirmation hearings for appointees to the Mental Health
Trust Authority and the State Medical Board.
3:07:20 PM
CO-CHAIR SNYDER explained that the Alaska Mental Health Trust
Authority ("the Trust") is a state corporation that administers
a perpetual trust to improve the lives of beneficiaries. The
Trust operates much like a private foundation, using its
resources to ensure that Alaska has a comprehensive integrated
mental health program. The Trust Land Office protects and
enhances the values of the Trust's lands while maximizing
revenues from those lands over time. Duties of the Trust's
board include protecting the Trust, providing leadership and
advocacy planning, implementing and funding of a comprehensive
integrated mental health program, proposing a budget for the
comprehensive integrated mental health program, coordinating
with state agencies on programs and services that affect
beneficiaries, and reporting to the legislature, the governor,
and the public about Trust activities.
3:08:42 PM
The committee took an at-ease from 3:08 p.m. to 3:13 p.m.
3:13:26 PM
CHAIR SNYDER further explained that the seven members of the
board are appointed by the governor and confirmed by the
legislature. Members are appointed based on their ability in
financial management and investment, in land management, or in
services for the beneficiaries of the Trust. She requested the
appointees provide testimony explaining why they are qualified
and interested in serving on the board.
3:14:14 PM
ANNETTE GWALTHNEY-JONES, Appointee, Board of Trustees, Alaska
Mental Health Trust Authority, stated that serving her community
is one of her core values and that she has over 25 years of
managerial experience and leadership in human resources and
social services. Her career background includes program work
and development within many Trust beneficiaries serving
organizations in the Anchorage area, including the Arc of
Anchorage, the Salvation Army Booth Memorial Home and Covenant
House. She has a Master's in Business Organizational Management
with dual emphasis in human resources and information
technology, an undergraduate degree in psychology and an
undergraduate degree in human services. She became a court
appointed special advocate volunteer as well as a single parent
in the Alaska Foster Care Program. After marrying her U.S. Air
Force husband, she worked in human resource management and staff
development capacities while located at her husband's various
duty stations in the Lower 48. Following her husband's
retirement and their return to Alaska she has continued her
career as a human resources professional at Lowe's and now at
Furniture Enterprises.
MS. GWALTHNEY-JONES stated that her background in human
resources and internal development and training will bring a
relevant perspective to the work of the Board of Trustees.
Since September 2020 she has actively demonstrated her
dedication to the role of trustee, which is a five-year
appointment and commitment. She will meet the time commitment
and offer her skills working with her fellow trustees to help
advance the Trust's important efforts to improve the lives and
circumstances of its beneficiaries. A key strength she brings
to this board is in her duty of care ethos, and she will apply
her skills, expertise, and passion to help steer the board
toward an even greater success.
3:20:34 PM
CO-CHAIR ZULKOSKY acknowledged the large amount of business
experience that Ms. Gwalthney-Jones brings to her appointment.
She requested the appointee to speak to her experience and
familiarity with mental health services in Alaska.
MS. GWALTHNEY-JONES replied that the Booth Memorial Home was a
residential treatment facility for young ladies who were
pregnant and needed a therapeutic place to grow and evolve, and
at the Covenant House she was a counselor. So, she is very
familiar with working in mental health fields and believes that
her experience and knowledge are very beneficial to the Trust.
She allowed she has been gone from Alaska and the field for a
relatively long time but said that in the field of mental health
the needs don't change, they just get bigger.
3:22:20 PM
REPRESENTATIVE PRAX offered his understanding that Ms.
Gwalthney-Jones was appointed in September 2020.
MS. GWALTHNEY-JONES confirmed that is correct.
REPRESENTATIVE PRAX noted the Board of Trustees is responsible
for the Trust, which is a large fund. He asked Ms. Gwalthney-
Jones whether she has received experience and familiarity with
the "trust trustee part of the job" since her appointment.
MS. GWALTHNEY-JONES answered that she received an excellent
orientation from the Mental Health Trust, which provided an
overall introduction to the Trust Authority.
3:23:55 PM
CO-CHAIR SNYDER noted that for this specific board the governor
is to consider a list of persons that is prepared by a panel of
six people. That panel is to consist of an individual from the
Alaska Mental Health Trust Board, an individual selected by the
Governor's Council on Disabilities and Special Education, an
individual selected by the Advisory Board on Alcoholism and Drug
Abuse, an individual selected by the Alaska Commission on Aging,
an individual selected by the Alaska Native Health Board, and
one person selected by the Authority. She asked Ms. Gwalthney-
Jones whether she is aware if she was put forward on that list.
MS. GWALTHNEY-JONES replied she is not aware.
3:25:02 PM
CO-CHAIR ZULKOSKY asked about which of the Trust focus areas Ms.
Gwalthney-Jones believes is well positioned to make great
progress and what is of great interest to the appointee.
MS. GWALTHNEY-JONES responded that she believes the Trust is in
a good position currently, but hard work will be needed because
[the COVID-19 pandemic] is going to seriously impact the mental
health needs in the next five to ten years. It is going to be
even more important that the Trust is protected through [the
Board's] fiduciary responsibility and the responsibility to
enhance the Trust's assets in the coming years because of that
coming need.
MS. GWALTHNEY-JONES further responded that given her military
background, suicide prevention is very important to her because
22-plus military members or veterans commit suicide every day.
As well, she is very invested in substance abuse and special
needs. It's all very important, but some aspects of the field
are more important than others.
3:27:17 PM
REPRESENTATIVE FIELDS inquired whether the appointee's positions
at Furniture Enterprises, Lowe's, or West Corporation have
involved mental health in any way.
MS. GWALTHNEY-JONES answered yes, in some respects. She said
that as the human resources person she deals with employees
having mental health issues. If it is believed that substance
abuse is involved the individual would be sent to an employee
program for counseling. Every day her psychology degree goes
into play when she meets with the people who come into her
office with a variety of mental health and personal needs.
3:28:43 PM
REPRESENTATIVE SPOHNHOLZ recalled the appointee's statement that
"the needs don't change" and said that since the late 1990s when
Ms. Gwalthney-Jones last worked in the field, the Alaska
Psychiatric Institute (API) has experienced a series of real
challenges. She related that Alaska's mental health system is
undergoing massive reform because of a huge gap in services in
the community, which resulted in increased criminalization and
homelessness for people who experience serious mental health
issues. She argued that the needs have changed significantly
and stated that the Alaska Mental Health Trust Authority is one
of the most important organizations in Alaska in trying to solve
these problems. The Authority's job is to work to accelerate
change to ensure that its beneficiaries are getting their needs
met. She said she doesn't doubt the professionalism of Ms.
Gwalthney-Jones but doesn't know that human resource work is a
good analogue for this kind of work. She asked what the
appointee is doing to learn about the Mental Health Trust's big
and complex work.
MS. GWALTHNEY-JONES clarified that when she said, "the needs
don't change," she should have been more specific and said, "the
needs of the human psyche don't change." She stated that the
needs of a community might increase and the number of people
with those needs might change. With COVID-19 the need of people
is going to increase as well, and [Alaska's] mental health is
going to get slammed hard. Currently she is reading and
participating in the different meetings so she can learn about
the current needs that are impacting Alaskans and she went
through a second orientation because this is such a huge
monster, there is a lot to learn, and it takes time to learn.
She is committed to taking the time to go to meetings, to read,
and learn what she needs to know so she can best represent the
beneficiaries and improve their lives.
3:32:33 PM
REPRESENTATIVE SPOHNHOLZ related that the Alaska Mental Health
Trust Authority Board of Trustees is clearly prescribed in
statute and defines a clear list of qualifications for a board
member. She asked whether Ms. Gwalthney-Jones meets those
qualifications and whether the panel of six people [selected her
for the governor's consideration].
MS. GWALTHNEY-JONES replied that she doesn't know any of the
behind-the-scenes workings, but she received a phone call and
was made an offer. She said she presumes that that is what
occurred [if being selected by the panel] is required.
CO-CHAIR SNYDER stated she thinks that the panel's selection of
a list of appointees for the governor to consider is an
important thing. She said the committee appreciates that the
individuals may or may not be notified of the process.
3:34:03 PM
REPRESENTATIVE KURKA concurred with the appointee's concern
about the significant increase in mental health needs in Alaska
because of COVID-19 and the isolation and lockdowns. He asked
whether Ms. Gwalthney-Jones has seen any research or studies
that would indicate the likelihood or increased need associated
with isolation in terms of suicides or other consequences.
MS. GWALTHNEY-JONES responded she has read a few studies, and
some said there is an increase. She has looked at some of the
numbers the State of Alaska has put online, and it is on the
rise. From what she has read, her opinion is that it is going
to increase, and she has seen this specifically in veterans
because the lockdowns have impacted them even more so.
3:35:58 PM
CO-CHAIR ZULKOSKY requested the appointee's perspective on
whether the State of Alaska offers a sufficient level of
resources for mental health services that can leverage and
complement the Trust's annual investments.
MS. GWALTHNEY-JONES answered she thinks "they're getting there"
and that "there is a lot of work to do." She continued: "I
think we need to move forward very quickly, otherwise we're
going to continue to stay behind and try to play catchup and
that's what it appears we've been doing for quite a few years."
CO-CHAIR ZULKOSKY requested the appointee to be more definitive
in what she meant by the words "getting there". She related
that the House Health and Social Services Standing Committee has
worked on the budget subcommittee of the state's annual
investments in mental health and there have been significant
reductions in behavioral health funding as well as flatline
funding for intellectual and developmental disabilities (IDD)
services.
MS. GWALTHNEY-JONES replied she is still learning and cannot
give any exact things off the top of her head. She said she
will follow up with a written response to the committee.
3:38:33 PM
ANITA MARIA HALTERMAN, Appointee, Board of Trustees, Alaska
Mental Health Trust Authority, said she began on the board in
August 2019 and quickly assumed several leadership roles,
including vice chair and chair of the board's Audit and Risk
Committee, and chair of the Finance Committee. Serving on the
board has expanded her knowledge of the mental health needs and
the many programs offered throughout Alaska. In giving back to
her community by serving on the board she has learned about new
strategies and funding opportunities that can help shape
meaningful reform for Alaska's mental health programs and she
would like to continue that journey.
MS. HALTERMAN related that she worked as a chief of staff during
the 29th Alaska State Legislature, has been active in her
community, especially in telemedicine, and earned her Master's
in Business Administration from Wayland Baptist University in
Anchorage. She has worked with the [Iowa Department of Health
and Human Services and the Alaska Department of Health and
Social Services (DHSS)], including work experience in Medicaid
programs, Division of Senior and Disability Services, mediating
administrative appeals, serving as a program manager and a
supervisor, and child support. She has also worked in the
[Iowa] Department of Corrections, [Alaska] Department of Public
Safety, and [Iowa and Alaska] division of public assistance
programs. After leaving the legislature [in 2016] she started
her own consulting business as an insurance producer, in 2019
she began working with an information technology company as an
account executive, and in 2020 she joined a media production
company working in sales and administration. Her work has given
her new perspectives about the health care needs for the
privately insured individuals and has helped expand her
understanding of the more global workforce issues that Alaskans
face as they move forward.
MS. HALTERMAN concluded by saying she hopes to continue to use
her experience to help reform the programs for the future so
they can be sustained for populations that need them most as
[the Trust] works in partnership with DHSS and other
stakeholders to build an integrated comprehensive mental health
program that better meets the Trust's beneficiaries' needs. She
added that she looks forward to working with legislators to help
solve Alaska's mental health problems.
3:43:25 PM
CO-CHAIR ZULKOSKY requested Ms. Halterman to provide detail on
what she envisions as meaningful reforms.
MS. HALTERMAN responded that the Trust has been working on the
Crisis Now Intervention program, a relatively new program area
for her. The Trust has expanded the technology for many
providers and nonprofit providers that serve beneficiaries, so
those two areas of program are very different than they were
previously and hopefully will help adapt to meet rural community
needs. As a whole Alaska is rural and there are some serious
gaps and deficiencies in rural communities. Alaska has a
shortage of many kinds of providers to meet the needs throughout
the state. She would like to continue her involvement in
innovative, technology-driven solutions that explore alternative
options which don't drain the existing system that is not
currently meeting the needs of beneficiaries.
CO-CHAIR ZULKOSKY requested Ms. Halterman to speak to how she
thinks the Crisis Now model will serve Alaskans well.
MS. HALTERMAN replied her hope is that those programs will
address the crisis in a more meaningful way that is preventive
and not as punitive as in the past. Rather than involving law
enforcement, addressing mental health issues with families will
help repair families and address some of the mental health needs
that go unaddressed in that correctional system. Law
enforcement can be kept in the background for when it is
necessary.
CO-CHAIR ZULKOSKY asked Ms. Halterman to speak to her position
on the governor's proposed use of Mental Health Trust funds or
reserve funds to replace undesignated general funds in certain
parts of the state's budget.
MS. HALTERMAN answered that this complicated question deserves a
full legal response. She referred the committee to the Trust's
1/26/[21] letter written to the Senate outlining the Trust's
position on the use of the reserve's funds.
CO-CHAIR ZULKOSKY inquired whether Ms. Halterman supports the
position taken within that letter.
MS. HALTERMAN replied yes.
3:47:10 PM
CO-CHAIR SNYDER asked whether Ms. Halterman knows if she was one
of the persons on the list put forth by the panel for the
governor to consider.
MS. HALTERMAN responded she was not selected from that list.
She said she is aware of the process because she "sat on that
board for ... Brent Fisher."
3:48:47 PM
RHONDA BOYLES, Appointee, Board of Trustees, Alaska Mental
Health Trust, related that after 44 years of living in the
Interior she took her husband to Phoenix for three years of
medical help for Diffuse Lewy Body Disease. After his death a
year ago, she bought a home in Anchorage. During her
professional career in the Fairbanks area, she worked several
years as the school lunch director, then built three Wendy's
restaurants and purchased Clinkerdagger's Restaurant. While
owning the restaurants she served on many boards and
commissions, including positions of leadership. After selling
her restaurants she served as mayor of the Fairbanks North Star
Borough from 2000-2003, during which time she had the
opportunity to make a large difference in the budget, the mill
rates, land management issues, and planning and zoning. After
serving as mayor, she worked in the Pioneer Home, including in
the dementia wing. She then worked five years for Congressman
Don Young before retiring to care for her husband.
MS. BOYLES shared that when she was called about serving on the
Board of Trustees, it was a part of her life that she had not
spent much time on, outside of personal family experiences with
alcoholism, drug addiction, brain injuries from accidents, her
father's Parkinson's Disease, her mother-in-law's Alzheimer's
Disease, and caring for her husband. She came into the Mental
Health Trust with the na?ve belief that she was going to change
the world in dementia in Alaska only to find it is a steep
learning curve because the Trust serves so many of the state's
dependents and beneficiaries. She pointed out that trustees do
not receive pay and it's a part-time job. Ms. Boyles said her
strength on the Board of Trustees is financial and land
management, not as an expert in dementia even though she's had
several years attached to it. She stated that when a board is
managing millions of dollars, the role of a trustee must be
understood, which is fiduciary in every way. When the Board of
Trustees gives out $20 million in grants, the questions asked of
the hopeful grant recipients are very thorough. The Trustees
take the staff's report, do their reading, and ask questions.
3:55:25 PM
REPRESENTATIVE PRAX asked when Ms. Boyles was appointed to the
Board of Trustees.
MS. BOYLES replied she has served since being confirmed in
January 2020. Prior to that she worked through the lengthy
process to be invited to join the Trust. Her telephonic
interview by [the previously mentioned panel] occurred at 6:00
p.m. while she was standing in the lobby of the House of
Representatives in Washington, DC. She knew she was being
looked at, being interviewed, but she cannot say whether she was
approved by that [panel]; she just assumed she'd been approved
by that [panel] when it went to the next step for confirmation.
REPRESENTATIVE PRAX inquired about what is involved in the role
and responsibility of a trustee. He further inquired about the
expertise that Ms. Boyles brings to that position.
MS. BOYLES responded that she sees [the role of a] trustee as 70
percent or more fiduciary. She said that when serving as a
trustee of a formal or informal trust the trustee has a direct
responsibility to the beneficiaries. The Trust is designed with
rules and regulations that a trustee must honor, because if the
trustee doesn't, the beneficiaries can sue the trustee or ask
the trustee to leave. The trust itself is like a corporation,
it's a body, and it could ask a trustee to leave. It's a very
important, serious position when it comes to the assets or the
non-cash assets of the Alaska Mental Health Trust. That is in
the directive of the litigation that was settled after 10 years
in 1994 when the state was found remiss in handling its
fiduciary responsibilities. The Mental Health Trust was formed
and a board of seven trustees was hired. The trustees have
diverse backgrounds, but every trustee has been told and each
trustee does take very seriously, the financial responsibilities
of administering the fund, to making decisions, and protecting
for the future beneficiaries.
3:59:13 PM
CO-CHAIR ZULKOSKY noted that the legislature did not convene in
joint session for confirmation of the governor's appointees in
2020. She requested Ms. Boyles to clarify her statement about
being confirmed as a trustee.
MS. BOYLES answered that [appointees] were confirmed on the
House floor at the very end of the legislative session when a
vote was taken on the governor's COVID-19 emergency declaration.
[Appointees] were confirmed to serve until 12/15/2020 when that
emergency declaration could not be renewed. Appointees served
like they were supposed to. She understood she could vote and
that the decisions made during that time were valid, which was
asserted by the Department of Law. In December when the
emergency declaration was not renewed, 90-some confirmed
commissioners went away and had to be reconfirmed. That is why
she and Ms. Halterman went through four confirmation hearings a
year ago and are now back at it because of the emergency
declaration approach.
4:01:13 PM
REPRESENTATIVE SPOHNHOLZ stated she clearly remembers the
emergency disaster declaration bill and the provision that
allowed appointees who had not been confirmed to continue to
serve in those positions through December. That was not an
official confirmation; what was said was that [appointees] were
neither confirmed nor denied as long as confirmations took place
before the end of 2020. A confirmation session never actually
took place. There is some legal disagreement about whether the
governor could reappoint essentially candidates who have been
serving for the last year and, so far, [the legislature's]
attorneys have believed that the governor can do that.
Representative Spohnholz concurred that Ms. Boyles is correct
that she was legally able to continue to serve as a nominee
through that point in time by a statute that was passed at that
point in time. However, the [nominees] last year were not
confirmed, which is a very important legal distinction.
4:02:38 PM
CO-CHAIR SNYDER noted that the three abilities highlighted as
necessary experience for serving on the Board of Trustees are
ability in financial management and investment, in land
management, or in services for the beneficiaries of the Trust.
She requested Ms. Boyles to provide some background on her land
management experience given Ms. Boyles' statement that land
management was one of her strengths.
MS. BOYLES replied that "land management is spaces and steps",
and you have to clear one before you can go into another,"
whether it be permitting, or establishing the protocols of the
development, or the prognosis of the development, and more than
anything it is when investing in that land management, in that
land development. Land that is not being developed and is
sitting there is costing money, so she takes an assertive
approach. When the land management division presents a proposal
there are questions to be asked, such as "Are we going to get
our money back?" Or, if it is a lease, the legal terms must be
looked at. Many things must be judged when developing land,
just like when buying a piece to build a house on. She had to
learn that 20 years ago and learned it the hard way when she
purchased her own property commercially to build restaurants as
opposed to owning the land versus long-term leasing.
CO-CHAIR SNYDER asked whether she is correct in summarizing that
Ms. Boyles' personal experience in land management is related to
her experience in owning and managing restaurants.
MS. BOYLES responded no. She explained that much of what is
done in the Fairbanks North Star Borough is comprised of dealing
with land - planning and zoning, appropriate uses, title
conveyance. During her three years as the mayor, she would have
been inept at her job had she not understood that when putting
forth resolutions with her signature. She learned more in land
management from a commercial aspect and the borough's large body
of land. Of the one million-plus acres within the borough, 92
percent is owned by the federal government, so the borough has a
lot of things to look at on the 8 percent that is left.
4:06:14 PM
REPRESENTATIVE FIELDS requested Ms. Boyles to elaborate about
her nursing education at Yale University.
MS. BOYLES answered that she was given a three-year scholarship
to Eli Whitney School of Nursing which is in Yale University.
She spent 18 months there and found she did not like it and
wasn't cut out to be a nurse. She moved to Alaska and went to
the University of Alaska where she received an Associate's in
Business and waited tables until she determined she wanted to
build her own restaurant and built Wendy's.
REPRESENTATIVE FIELDS related that according to admissions staff
at Yale University there is no attendance record of someone
named Rhonda Boyles or Kerwin.
MS. BOYLES replied it was Eli Whitney School of Nursing
affiliated with Yale University during the years 1971-1973.
REPRESENTATIVE SPOHNHOLZ inquired whether Ms. Boyles attended or
graduated [Eli Whitney at Yale] before coming to Alaska to
pursue something different.
MS. BOYLES responded she attended for 18 months. In further
response, she confirmed she did not graduate from Yale.
4:08:51 PM
BRENT FISHER, Appointee, Board of Trustees, Alaska Mental Health
Trust Authority, stated he is a veteran of the U.S. Army Medical
Service Corps and started his career in the military after
college. His degrees include a BA from Brigham Young University
with a double major in International Relations and Portuguese,
and an MBA from the University of Texas at Austin with
specialties in International Strategic and Healthcare
Management. He is board certified in both hospital and medical
group management and has been elected a fellow in the American
College of Healthcare Executives and the American College of
Medical Practice Executives. His career has been primarily
associated with healthcare but also includes a wide variety of
organizations. His writings have been published in numerous
journals, trade magazines, and newspapers. He believes in
giving back to his community and has served on the boards of
directors of professional associations, and civic, business, and
religious organizations. He expressed his gratitude for the
opportunity to serve on the Alaska Mental Health Authority Board
of Trustees.
4:10:45 PM
REPRESENTATIVE PRAX requested Mr. Fisher to elaborate on what he
would bring to his role as a trustee.
MR. FISHER replied that the Trust operates primarily as a
foundation, as mentioned in its mission. He said he has had
responsibilities as a fiduciary trustee in other organizations
and in academic endowments, and therefore has experience in the
management of trust funds or foundation funds. He also started
a foundation that looked at improving educational opportunities
in the areas of sleep medicine and sleep disorders.
4:12:25 PM
REPRESENTATIVE SPOHNHOLZ noted that Mr. Fisher was recommended
by the panel that is defined in statute and his name was
forwarded to the governor as a highly qualified candidate based
on his previous experience.
4:12:49 PM
CO-CHAIR ZULKOSKY requested Mr. Fisher to speak to how, as a
trustee, he would utilize his experience in telemedicine and
telehealth to deliver mental health services to all Alaskans.
MR. FISHER responded that he believes in and is a big supporter
of telemedicine. He said that having been a Medical Service
Corps officer in the military, any methodology of communication
and providing services to those who need physical or mental
health care has always been on the forefront with him. For
eight years he worked in the arena of emergency medicine, and
emergency departments tend to be a place where many folks with
mental or behavioral health issues end up. If there is any
place in the U.S. where telemedicine ought to be freely
available to people and reimbursed with parody it is the state
of Alaska. There are so many exceptions that Alaska should be
getting from primarily federal statutes because of Alaska's
geographic challenges with providing any kind of health care,
especially mental health care. He was involved in discussions
when the first legislation came up about providing telemedicine
services and prescription services within Alaska for those with
mental health or psychiatric disorders. He sits on the board of
the Alaska Collaborative For Telemedicine & Telehealth and has
been involved with that for a number of years. He and his wife
are the majority owners of the Alaska Sleep Clinic, which has
diagnostic testing facilities in Anchorage, Soldotna, Wasilla,
and Fairbanks, and which has done telemedicine and telemedicine
consults for at least 12 years. Many mental and behavioral
health issues are associated with sleep disorders. Telemedicine
and telehealth provide access to professionals and to
appropriately given prescriptions for folks who need care
regarding sleep as well as straight psychiatric care.
4:16:24 PM
REPRESENTATIVE FIELDS recalled that in 2015 Mr. Fisher wrote an
article in which he stated that before expanding Medicaid Alaska
should ask some hard questions. He inquired about Mr. Fisher's
current view on Medicaid expansion, its successes, and health
care challenges in Alaska it has not yet solved.
MR. FISHER answered he doesn't recall exactly what he wrote in
2015 about Medicaid expansion, but his intent in writing that
article was to at least raise some questions about what the
value would bring to increasing Medicaid. Medicaid does not pay
for itself, it pays variable costs, it does not pay for any of
the infrastructure that is needed to actually provide health
care, no matter what kind it is. So, caution is needed when
expanding Medicaid to make sure a thorough look is taken at what
is being done to the infrastructure that is actually paid for
primarily by commercial insurance.
4:18:08 PM
REPRESENTATIVE FIELDS inquired about Mr. Fisher's view on the
role of Medicaid expansion in helping to serve Mental Health
Trust fund beneficiaries.
MR. FISHER replied it depends on what it is, mental health is a
broad area. Certainly, he explained, some things are going to
be covered by Medicaid, but a lot of services aren't covered by
a health care insurance or a health care and payer program. He
qualified that he is a new trustee having started 1/18/[21] but
said one part of the agenda is to have representatives and
beneficiaries from organizations that have received Trust funds,
to come talk about how they benefitted through the program and
through the Trust funds provided to them and their organization.
One important thing to him when talking about the expanding
needs of support and assistance in the mental health world is
that what is wanted is to try to prevent as well as to help
people out of the problems and challenges that they've gotten
into because of a mental health disorder. In one presentation
beneficiaries talked about how a grant allowed them to start
their own home businesses, which brought self-esteem and value
into their lives because they were providing goods and services
to others by their work. It also allowed them to do things
within their capabilities and to provide for themselves at least
partially in that way. That is not something that is going to
be provided by a Medicaid expansion, yet to get people out of
complete dependence that kind of program adds real value to the
beneficiaries. So, a look must be taken at what Medicaid
expansion does and what is going to help the beneficiaries the
most. Is it Medicaid expansion that provides certain kinds of
services? Or is it going into some of these nonprofit programs
that provide things outside of traditional health care that gets
individuals with mental health challenges to become productive
members of society?
4:21:03 PM
REPRESENTATIVE FIELDS explained he is asking these questions
because he values the Trust's advocacy for beneficiaries,
including looking at different resources like federal Medicaid
resources. He related three of the questions asked by Mr.
Fisher in the article, which he thought good: 1) Will all
payers pay less for health care under expansion? 2) Will
uninsured have better health care access with expansion? 3) Why
is Alaska Medicaid reimbursement higher than Medicare?
Regarding the first question, Representative Fields shared that
in the last couple years Alaska has seen an end of growth in the
cost of health care and State of Alaska employees have seen a
small reduction in the cost of their state plan premiums. He
said a research report he requested found that with Medicaid
expansion insuring an additional 65,000 people, uncompensated
care was reduced which in turn produced savings for the private
insured market. Even though growth has been arrested, he said
progress still needs to be made given that major reductions
haven't been seen. Regarding the second question,
Representative Fields shared that 65,000 more people are insured
under expansion, but there have been mixed experiences with
additional private insurers coming into the market with motive
being here and then not being here. Regarding the third
question, Representative Fields shared that he has heard from
providers that Medicare doesn't cover the cost of providing
care. He said a look needs to be taken at raising Medicare
reimbursement in Alaska and that Mr. Fisher is correct in
referencing that a look must be taken at the actual costs of
providing care. Representative Fields maintained the federal
government is not meeting its obligations for Medicare in
Alaska, creating market distortions because it is effectively
subsidizing through private insurance which is hard on
employers. Medicaid expansion, he continued, is huge in terms
of providing care through [Alaska's] community especially for
Trust beneficiaries.
4:23:56 PM
REPRESENTATIVE SPOHNHOLZ noted the Trust has been involved in
the Section 1115 Medicaid waiver ("1115 waiver") process. She
recalled Mr. Fisher stating that many nonprofit organizations
provide services that help Mental Health Trust beneficiaries get
back on their feet. She asked whether Mr. Fields is aware that
most of those nonprofit organizations bill Medicaid for those
services.
MR. FISHER responded that there are different kinds of
nonprofits. He said he is sure some get Medicaid reimbursement,
but he knows that some don't and that lots of programs are only
provided by donations, government grants on the state level, or
by trusts and foundations.
REPRESENTATIVE SPOHNHOLZ inquired whether Mr. Fisher can provide
examples of those organizations.
MR. FISHER answered he doesn't have any examples off the top of
his head.
REPRESENTATIVE SPOHNHOLZ stated that the Salvation Army raises
lots of money from the community, but most Salvation Army
programs, such as the Clitheroe Center and McKinnell House, are
funded by Medicaid and grants from the State of Alaska. She
further stated that many of the programs, including faith-based
programs, that are often thought of as being entirely supported
by charitable contributions are supported by Medicaid. She
asked whether Mr. Fisher has had a chance to learn more about
the Section 1115 Medicaid waiver since becoming involved with
the Mental Health Trust Authority.
MR. FISHER responded he has not.
REPRESENTATIVE SPOHNHOLZ encouraged Mr. Fisher to learn more
about the 1115 waiver program, which was designed to make it
easier for people who experience a mental health or substance
abuse issue to get community supports to prevent them from
having to go into expensive in-patient psychiatric or hospital
emergency rooms where there is a lot of that uncompensated care.
4:27:08 PM
REPRESENTATIVE SPOHNHOLZ inquired whether Ms. Boyles is familiar
with the Legislative Budget & Audit performance audit of the
Mental Health Trust Authority that was done in February 2018.
MS. BOYLES replied that it has been referenced in presentations,
but she has not read the audit.
REPRESENTATIVE SPOHNHOLZ encouraged Ms. Boyles to read the
audit, which identified land management, investment practices,
and meeting practices of the Trust that were not complying with
statute. Regarding land management expertise, she said there
were some issues with the policies and procedures of the Mental
Health Trust Authority that were very well documented. An
effort was made to reform the Trust policies, procedures, and
bylaws to make sure the law was being complied with, or that the
Trust come to the legislature with a proposal to change the law.
She asked whether the Board of Trustees has discussed either of
those things.
MS. BOYLES answered she doesn't know and deferred the question
to administration.
4:29:09 PM
CO-CHAIR SNYDER opened public testimony on the appointees to the
Alaska Mental Health Trust Authority Board of Trustees. She
closed public testimony after ascertaining no one wished to
testify.
4:29:37 PM
CO-CHAIR SNYDER moved to the confirmation hearing for appointees
to the State Medical Board. She explained that the governor
appoints a Board of Examiners to be known as the State Medical
Board and consisting of five physicians licensed in the state
and residing in as many separate geographical areas of the state
as possible; one physician assistant licensed; and two persons
with no direct financial interest in the healthcare industry.
Among other things, the duties include the examination and
issuance of licenses to applicants, development of written
guidelines to ensure that licensing requirements are not
unreasonably burdensome, that after a hearing they impose
disciplinary sanctions on persons who violate the chapter of the
regulations or orders of the board, and they adopt regulations
ensuring that renewal of licenses is contingent on proof of
continued competency on the part of the licensee.
4:31:19 PM
DAVID BOSWELL, Appointee, State Medical Board, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community, and Economic Development (DCCED), stated he
has been the senior minister for the Northern Lights Church of
Christ in downtown Fairbanks for the past 16.5 years. Over
those years he has served as a volunteer with the Fairbanks Food
Bank, the Denali Center and Pioneer Home, and the hospice
program in Fairbanks. He was a foster parent for five years
during which time he had nine children and adopted four of those
children. While serving as a member of the Governor's Council
for Disabilities and Special Education he was introduced to the
opportunity to volunteer and serve on the State Medical Board as
a public member. As a foster parent he had many opportunities
to utilize various medical facilities throughout the state in
ways he had never imagined before. He was appointed to the
board at a time that was unique to the state of Alaska, the
nation, and the world. Since last March he has been the
secretary of the State Medical Board and at the last meeting he
was asked to continue in that role. Over the past months the
State Medical Board has met weekly to prepare members for the
impending necessity of formulating emergency regulations to meet
the needs of the pandemic. During this past year he has
received trainings provided by Medical Board legal
representatives and administrative staff; attended conferences
of the Federation of State Medical Boards via Zoom; been
introduced to the national issues facing other state medical
boards; and gained access to resources he will be able to
utilize in the future should similar issues need to be addressed
in Alaska. He looks forward to continuing to serve on this
important board as it is a worthy donation of time, attention,
and energy.
4:33:54 PM
CO-CHAIR ZULKOSKY asked Mr. Boswell to speak to the challenges
faced by the board during a global pandemic and some of the
decisions that had to be made. She further asked Mr. Boswell to
speak more definitively about his service over the past year and
what has served him well with regard to continued service.
MR. BOSWELL concurred the board came in at a unique, challenging
time. He said the amount of information that board members had
to absorb was like drinking a waterfall through a funnel. It
was well managed by the State Medical Board's administrative
staff and legal representatives who did an excellent job of
informing board members. Members addressed and overcame some of
the obstacles from the audit of the State Medical Board, steps
were taken to prepare for this coming year, and the board is in
a good position to continue.
4:35:56 PM
REPRESENTATIVE SPOHNHOLZ observed that Mr. Boswell does not have
much medical experience. She noted that this board is about
regulating the practice of medicine in Alaska and asked what
motivated Mr. Boswell to serve on this board.
MR. BOSWELL replied that one of the things that qualifies a
prospective public member is not being financially tied to the
medical commission. He said he did three years of pre-medicine
in his time at the University of Alberta, Canada, prior to
finishing his degree in seminary. He has always been following
medical things and when this opportunity arose, he was willing
to put forward his name.
REPRESENTATIVE SPOHNHOLZ noted the State Medical Board regulates
abortion procedures. She requested Mr. Boswell to speak to the
current litigation against the board about some new regulations
that have been established regarding the practice of abortion.
MR. BOSWELL responded that the first introduction to the State
Medical Board that he and other individuals received was
informing them that their names had been added in their capacity
on the State Medical Board to a lawsuit that was being imposed
upon the board. Since it is a current legal matter, he said he
is unsure how much he is legally allowed to speak about it other
than to say he is aware of it, and it is ongoing at present.
REPRESENTATIVE SPOHNHOLZ related that a search she did revealed
the lawsuit is because regulations were implemented that
restricted those who can perform abortions. She asked whether
any changes have been made to the standards to practice abortion
in Alaska since Mr. Boswell has been on the board.
MR. BOSWELL answered that the lawsuit was already taking place
based on something that happened previously. He said he isn't
sure about the motivation for the timing of the lawsuit but that
it was prior to his time serving on the board. He said he is
aware the lawsuit is taking place.
REPRESENTATIVE SPOHNHOLZ inquired whether any changes have taken
place in regulations to practice abortion in the state of Alaska
since Mr. Boswell has been on the board.
MR. BOSWELL replied, "Not to my knowledge," and added that the
board has been working primarily with pandemic related issues.
4:39:25 PM
RICHARD WEIN, MD, Appointee, State Medical Board, Division of
Corporations, Business and Professional Licensing, Department of
Commerce, Community, and Economic Development (DCCED), pointed
out that over a year ago all members of the State Medical Board
were completely new and within two weeks of their being seated
the world was turned upside down. Despite having full-time
practices and lives, the board met more than any other board in
the state to meet the needs of Alaska's medical community and
patients. With all new members, none of the board's work could
have been accomplished without the incredible resources offered
to board members, along with help and guidance from the
executive administrator and her staff, the Department of Law,
the Investigative Unit, and the leadership of division director
Sara Chambers. He received his Doctor of Medicine from Tufts
University School of Medicine in Boston. He has more than 40
years of experience as a physician, surgeon, and patient
advocate, 20 of those years in New Jersey and 20 years in
Alaska. Upon moving to Alaska, he was on staff and a surgeon at
the Southeast Alaska Regional Health Consortium (SEARHC)
Hospital in Sitka for ten years. He has provided "7/24
coverage" across multiple specialties. He also served on staff
at Sitka Community Hospital for seven years. Additionally, he
has served on the Sitka City & Borough Assembly. His commitment
to the State Medical Board should be apparent from his service
over the last year as chairman and attending numerous other
meetings, such as the chair's meeting, the prescription drug
monitoring program (PDMP) user group, and the many peripheral
meetings and duties that are needed to have the Alaska State
Medical Board represented. He expressed his willingness to
continue serving on the board.
4:43:55 PM
REPRESENTATIVE KURKA asked whether Dr. Wein is familiar with the
Barrington Declaration, an alternative approach to dealing with
COVID-19.
DR. WEIN replied he is aware of the Barrington Declaration.
REPRESENTATIVE KURKA requested Dr. Wein's thoughts on the
Barrington Declaration.
DR. WEIN responded that a very complex situation exists in the
pandemic. There was much confusion when the pandemic first
arrived. At the beginning there was a greater deal of unity,
but as more and more information came out a number of people
through many walks of the scientific community and elsewhere
developed other diverse opinions related to the current
research. The Barrington Declaration was a group of people who
developed opinions based on information that they felt was
appropriate. He has read it and what he says to [the authors of
the declaration] and others is that he is happy they are
attempting to make sense of a very complicated situation.
REPRESENTATIVE KURKA inquired about Dr. Wein's assessment of the
declaration and whether he thinks it off base or has some
legitimate points as far as a treatment approach to COVID-19 on
a larger scale.
DR. WEIN answered that not everybody agrees, especially in
medicine, and it is good to have second opinions. He said that
for him there are always kernels of truth in diverse opinion and
he tries to glean those important things and weave them into how
he proceeds. As chairman of the State Medical Board, he tries
not to develop opinions or take too many stands because he
doesn't want that to get in the way of his ability to function
in how he proceeds.
4:48:15 PM
REPRESENTATIVE SPOHNHOLZ referred to comments made by Dr. Wein
in a public forum when the [Sitka] Assembly met on 2/10/21 that
the CDC had published vaccination problems and 501 deaths were
so far associated with the vaccine. She asked Dr. Wein to
describe the context of that statement.
DR. WEIN replied that he tells stories to make a point. In that
situation he was interrupted and so no one ever knew what he was
going to say or what was his meaning. The journalism was
incomplete because he was not asked the context before the
article was published.
4:50:24 PM
REPRESENTATIVE SPOHNHOLZ said the reason she is asking is to
give Dr. Wein the opportunity to give context.
DR. WEIN explained there was an article in the newspaper which
came from the vaccine database that is supported by the Federal
Drug Administration (FDA) and the Centers for Disease Control
and Prevention (CDC). He said one aspect with this database is
that anyone from the public can input any potential adverse
effect that they may have had from any vaccine, including COVID-
19. Another aspect is that anyone can search the database and
query any problem. Somebody queried the database and came up
with certain information, one piece of information being that
501 people had died from the COVID-19 vaccine. Dr. Wein stated
that his point in context was that [the public] has been given
so much confusing data - wear no mask, then wear one mask, then
wear two masks, not sure whether this medication works or
whether that medication works, and so forth. His point, he
continued, was that people are wondering about vaccine hesitancy
to which his answer is that he wishes the CDC and others would
have a more consistent message and therefore [people] may have
more consistent understanding of the various needs for
vaccination. Most people would agree there is a lot of
confusion out there. Anybody can call up the nonverified data
on the database and draw their own conclusions, which just
increases confusion in a time when people need to legitimately
buy into the reasons that their leaders are giving them. Dr.
Wein further stated that he was asking why that article was out
there. He explained that the CDC must review those deaths
within 24 hours, so if that is the CDC's mandate, then why not
hold back the ability to call up that information before it is
released to the public? His purpose was to say that vaccine
hesitancy is in part a responsibility of the leaders who are
giving out this information. He said he wanted to make the
statement, "Let's clean up some of the data and ... things would
be much better in the delivery of health care and vaccine
rollout."
REPRESENTATIVE SPOHNHOLZ offered her appreciation for Dr. Wein's
response.
4:54:45 PM
CO-CHAIR SNYDER opened public testimony on the appointees to the
State Medical Board. She closed public testimony after
ascertaining no one wished to testify.
CO-CHAIR SNYDER said the committee will continue hearing from
additional appointees in the coming days. [The confirmation
hearings for the following governor's appointees were held over:
Annette Gwalthney-Jones, Anita Halterman, Rhonda Boyles, and
Brent Fisher for the Alaska Mental Health Trust Authority and
David Boswell and Richard Wein for the State Medical Health
Board.]
4:55:39 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 4:56 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Anita Halterman Board Application_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
GOVERNOR'S APPOINTEES |
| Annette R. Gwalthney-Jones Resume_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Anita Halterman Resume_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Brent Fisher Board Application_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Brent Fisher Resume_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Rhonda Boyles Board Application_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Rhonda Boyles Resume_MHTA_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Dave Boswell Board Application_SMB_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Larry Daugherty Board Application_SMB_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |
|
| Richard Wein Resume_SMB_4.1.pdf |
HHSS 4/1/2021 3:00:00 PM |