Legislature(2001 - 2002)

03/04/2002 01:35 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                    
      SENATE HEALTH, EDUCATION & SOCIAL SERVICES COMMITTEE                                                                    
                          March 4, 2002                                                                                         
                            1:35 p.m.                                                                                           
MEMBERS PRESENT                                                                                                               
Senator Lyda Green, Chair                                                                                                       
Senator Gary Wilken                                                                                                             
Senator Bettye Davis                                                                                                            
MEMBERS ABSENT                                                                                                                
Senator Loren Leman, Vice Chair                                                                                                 
Senator Jerry Ward                                                                                                              
COMMITTEE CALENDAR                                                                                                            
SENATE BILL NO. 302                                                                                                             
"An Act  defining the  term 'mental  health professional'  for the                                                              
purpose of  statutes relating to  the evaluation of  prisoners who                                                              
may need psychological  or psychiatric treatment,  for the purpose                                                              
of statutes relating to the evaluation  of children in need of aid                                                              
and delinquent  minors who  may need  to be  confined in  a secure                                                              
residential  psychiatric   treatment  center  or  who   should  be                                                              
released  from  such  a  center,   for  the  purpose  of  statutes                                                              
requiring certain  professionals to report the possibility  that a                                                              
vulnerable  adult  has  been  abused or  neglected,  and  for  the                                                              
purpose of statutes relating to mental  health civil commitments."                                                              
     MOVED SB 302 OUT OF COMMITTEE                                                                                              
SENATE BILL NO. 295                                                                                                             
"An  Act  relating  to the  disclosure  of  information  regarding                                                              
delinquent  minors to  certain licensing  agencies; and  providing                                                              
for an effective date."                                                                                                         
     MOVED SB 295 OUT OF COMMITTEE                                                                                              
SENATE BILL NO. 342                                                                                                             
"An Act relating to the long term care ombudsman."                                                                              
     HEARD AND HELD                                                                                                             
SENATE BILL NO. 230                                                                                                             
"An Act  relating to recommending  or refusing psychotropic  drugs                                                              
as a treatment  for children and  to the evaluation  and treatment                                                              
of children with behavioral or psychological problems."                                                                         
     HEARD AND HELD                                                                                                             
PREVIOUS SENATE COMMITTEE ACTION                                                                                              
SB 302 - No previous action to record.                                                                                          
SB 295 - No previous action to record.                                                                                          
SB 342 - No previous action to record.                                                                                          
SB 230 - No previous action to record.                                                                                          
WITNESS REGISTER                                                                                                              
Mr. Jerry Burnett                                                                                                               
Staff to Senator Green                                                                                                          
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT: Presented SB 256 for the sponsor                                                                          
Dr. David McGuire                                                                                                               
3418 Lakeside Dr.                                                                                                               
Anchorage, AK                                                                                                                   
POSITION STATEMENT:  Supports SB 256                                                                                          
Dr. Leonard Abel                                                                                                                
Division of Mental Health & Developmental Disabilities                                                                          
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Supports SB 302                                                                                          
Ms. Suzanne Price                                                                                                               
Fairbanks Community Mental Health Center                                                                                        
Fairbanks, AK                                                                                                                   
POSITION STATEMENT: Supports SB 302                                                                                           
Ms. Sharon Bullock                                                                                                              
Clinical Director                                                                                                               
Fairbanks Community Mental Health Center                                                                                        
Fairbanks, AK                                                                                                                   
POSITION STATEMENT:  Supports SB 302                                                                                          
Mr. Wayne McCollum                                                                                                              
Fairbanks Community Mental Health Center                                                                                        
Fairbanks, AK                                                                                                                   
POSITION STATEMENT:  Supports SB 302                                                                                          
Ms. Diane Weber                                                                                                                 
Director, Yukon-Koyukuk Mental Health                                                                                           
Galena, AK                                                                                                                      
POSITION STATEMENT:  Supports SB 302                                                                                          
Ms. Anne Henry                                                                                                                  
Division of Mental Health & Disabilities                                                                                        
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Answered questions regarding SB 302                                                                      
Ms. Wendy Hall                                                                                                                  
Staff to Senator Pete Kelly                                                                                                     
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Testified for the sponsor of SB 295                                                                      
Mr. Robert Buttcane                                                                                                             
Division of Juvenile Justice                                                                                                    
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Supports SB 295                                                                                          
Mr. Jeff Jessee, Executive Director                                                                                             
Alaska Mental Health Trust Authority                                                                                            
Department of Revenue                                                                                                           
550 W 7th Ave., Ste. 1820                                                                                                       
Anchorage AK 99501                                                                                                              
POSITION STATEMENT: Supports SB 342                                                                                           
Ms. Laraine Derr                                                                                                                
Alaska State Hospital & Nursing Home Assn.                                                                                      
426 Main St.                                                                                                                    
Juneau, AK  99801                                                                                                               
POSITION STATEMENT:  Expressed concerns about SB 342                                                                          
Mr. Richard Benavides                                                                                                           
Staff to Senator Davis                                                                                                          
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Testified for the sponsor of SB 230                                                                      
Mr. Greg Maloney                                                                                                                
Special Education                                                                                                               
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Expressed concerns about SB 230                                                                          
Mr. Richard Warner, President                                                                                                   
Citizens Commission on Human Rights                                                                                             
Seattle, WA                                                                                                                     
POSITION STATEMENT: Supports SB 230                                                                                           
Mr. John Breeding, Director                                                                                                     
Texans for Safe Education                                                                                                       
No address provided                                                                                                             
POSITION STATEMENT:  Supports SB 230                                                                                          
Ms. Debbie Ossiander                                                                                                            
Anchorage School Board                                                                                                          
Municipality of Anchorage                                                                                                       
PO Box 196650                                                                                                                   
Anchorage, AK  99519                                                                                                            
POSITION STATEMENT:  Supports SB 230 but expressed a concern.                                                                 
Mr. Richard Rainery                                                                                                             
Alaska Mental Health Board                                                                                                      
Department of Health &                                                                                                          
  Social Services                                                                                                               
PO Box 110601                                                                                                                   
Juneau, AK  99801-0601                                                                                                          
POSITION STATEMENT:  Supports SB 230 but expressed a concern                                                                  
Mr. Frank Turney                                                                                                                
PO Box 70392                                                                                                                    
Fairbanks, AK  99707                                                                                                            
POSITION STATEMENT:  Supports SB 230                                                                                          
Ms. Betty Rollins                                                                                                               
PO Box 55163                                                                                                                    
North Pole, AK  99705                                                                                                           
POSITION STATEMENT:  Supports SB 230                                                                                          
Mr. Charles Rollins                                                                                                             
PO Box 55163                                                                                                                    
North Pole, AK  99705                                                                                                           
POSITION STATEMENT:  Supports SB 230                                                                                          
Mr. Brock Eidsness                                                                                                              
No address provided                                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Supports SB 230                                                                                           
ACTION NARRATIVE                                                                                                              
TAPE 02-15, SIDE A                                                                                                            
Number 001                                                                                                                      
CHAIRWOMAN  LYDA  GREEN  called the  Senate  Health,  Education  &                                                            
Social Services Committee  meeting to order at 1:35  p.m.  Present                                                              
were Senators Wilken,  Davis and Green.  The committee  took up SB
               SB 256-CERTIFICATE OF NEED PROGRAM                                                                           
MR. JERRY  BURNETT,  staff to Senator  Lyda Green,  sponsor  of SB
256, informed  members that a  proposed committee  substitute (CS)                                                              
is before the  committee (Version O). The CS  contains significant                                                              
changes  to the  original bill.    He explained  those changes  to                                                              
members as follows.                                                                                                             
   · Section  1 provides  that all  nursing  home and  psychiatric                                                              
     beds  are subject  to  a certificate  of  need regardless  of                                                              
     their location in Alaska;                                                                                                  
   · It increases  the threshold for  a certificate of need  to $2                                                              
     million for  facilities and $1  million for equipment  but it                                                              
     exempts  communities with  a population  of more than  55,000                                                              
     from  certificate   of  need  requirements  for   acute  care                                                              
   · Section 2 removes  a section in current law  that only allows                                                              
     for   replacement  of   ambulatory-surgical  facilities   and                                                              
     applies to smaller communities;                                                                                            
   · Section 3 allows  an exact replica of a facility  to be built                                                              
     on the  same site without a  certificate of need  and defines                                                              
     what  is included  in the $1  and $2  million thresholds.  It                                                              
     says a  donation or  transfer of  equipment is also  included                                                              
     under the threshold for a certificate of need;                                                                             
   · Section   4  establishes   a   specific   timeline  for   the                                                              
     certificate of need process;                                                                                               
   · Section 5 sets up a time limit for decisions;                                                                              
   · Section 6 puts  all acute care, psychiatric  and nursing home                                                              
     beds under  the same standards  for review, which  allows the                                                              
     budgetary resources of the state to be considered;                                                                         
   · Sections  7, 8, 9,  10, 11 and  12 address technical  changes                                                              
     required by changes made in earlier sections of the bill;                                                                  
   · Section 13 contains moratorium language for certain                                                                        
     psychiatric  beds (only  those beds  designated for  children                                                              
     and adolescents);                                                                                                          
   · Section 14 creates a working group to look at psychiatric                                                                  
     care services and the certificate  of need program. The group                                                              
     consists  of  7  members:  two  providers  of  mental  health                                                              
     services,  two  mental  health  service  consumers  or  their                                                              
     parents or  guardians; a physician whose primary  practice is                                                              
     not   the   provision   of   mental   health   services;   an                                                              
     administrator of  a hospital who is not a  provider of mental                                                              
     health  services; and  the commissioner  of  DHSS or  his/her                                                              
     designee.  This  working group is tasked with  looking at the                                                              
     principles  used  to  develop the  state's  psychiatric  care                                                              
     system and  certificate of need process for  psychiatric care                                                              
     beds  and to recommend  changes to  statutes and  regulations                                                              
     governing  the certificate  of  need program  to clarify  the                                                              
     standards applied during the application process.                                                                          
SENATOR WARD moved to adopt Version O as the working document of                                                                
the committee.  There being no objection, the motion carried.                                                                   
CHAIRWOMAN GREEN called Dr. David McGuire to testify.                                                                           
DR. DAVID MCGUIRE, an orthopedic surgeon practicing in Anchorage,                                                               
gave the following testimony.                                                                                                   
     I appreciate  the opportunity to testify on  this bill -                                                                   
     or the committee substitute  and to discuss very briefly                                                                   
     with you the issue of certificate of need in general.                                                                      
     As most  of you probably  know, the certificate  of need                                                                   
     was originally  enacted by the United  States government                                                                   
     during the Lyndon Johnson years  in an effort to control                                                                   
     the cost  of health care. The  theory was that  if there                                                                   
     were too many  providers, all of the providers  would be                                                                   
     duplicating services  and they would all have  to charge                                                                   
     more  money for  the duplication.   Unfortunately,  that                                                                   
     theory  doesn't  work  in anything  else  that  we  know                                                                   
     about, and neither did it work in medicine.                                                                                
     By 1987 the federal government  recognized that this was                                                                   
     not working and  they repealed the law in  its entirety.                                                                   
     Unfortunately, as is seemingly  the habit of the federal                                                                   
     government,  they had by then  mandated that  all states                                                                   
     adopt  this legislation  in  order to  be in  compliance                                                                   
     with  the Medicare-Medicaid  regulations.  But when  the                                                                   
     federal government  got rid of the certificate  of need,                                                                   
     they left  it entirely to  the states. Many  states have                                                                   
     gotten  rid of  the CON,  others have  modified it,  and                                                                   
     some, like Alaska, have it pretty  much intact from what                                                                   
     it was when it was first adopted.                                                                                          
     It doesn't take  much of a student of the  scene to know                                                                   
     that medicine  has changed dramatically in  the last few                                                                   
     decades. The way we do medicine,  the things that we can                                                                   
     do  and  the  way  that  it's   delivered  is  radically                                                                   
     different  than what it  was 20, 30  years ago.  And so,                                                                   
     the problem is, that there are  many kinds of procedures                                                                   
     that can be  done better, quicker, cheaper  in a setting                                                                   
     other than a traditional hospital setting.                                                                                 
     Well, as of  not too long ago, the  hospital association                                                                   
     seemed to  think the  same way and  they argued  for the                                                                   
     repeal of the  certificate of need.  Since  then they've                                                                   
     changed  their  opinion  and   they  argue  that  having                                                                   
     surgery centers  will cherry pick the patients.  I don't                                                                   
     know  how many patients  really think  of themselves  as                                                                   
     being cherries  to be picked, most of the  time we think                                                                   
     that patients  would want to  have a choice and  be able                                                                   
     to go  where they want to  go. They argue that  having a                                                                   
     surgery  center will  undercut the  revenue base of  the                                                                   
     hospital and that it will in  turn cause the hospital to                                                                   
     go broke or  to rely upon public subsidies  or something                                                                   
     of that nature.   And even a superficial  examination of                                                                   
     the  situation  in  Anchorage, Fairbanks  and,  to  some                                                                   
     extent, the Mat-Su, would lead  you to rapidly different                                                                   
     conclusions.   The hospitals,  in fact, are  doing quite                                                                   
     well.   They  have sufficient  resources  that they  are                                                                   
     able to spend on any project  they want.  They build any                                                                   
     time they  want and  so I think  the idea that  they are                                                                   
     endangered is probably not a good one.                                                                                     
     The certificate of need process,  even if it were a good                                                                   
     idea to begin with, has now  become subject to political                                                                   
     machinations to  obfuscation to uncertainties  as to who                                                                   
     needs and  who doesn't need.  The department  determined                                                                   
     that  a certificate  of need was  required in  Fairbanks                                                                   
     for   two   ambulatory   centers.   Unfortunately,   the                                                                   
     individual to whom this had  been issued was not able to                                                                   
     complete in a  timely fashion the building  of those two                                                                   
     ambulatory  operating  rooms.  The assumption  would  be                                                                   
     that since Fairbanks has grown,  and since the needs are                                                                   
     greater, not  less, that that  same certificate  of need                                                                   
     issued  some  six or  seven  years  ago would  still  be                                                                   
     operant.  But,  we  found  upon   application  that  the                                                                   
     commissioner  was able  to, in short  order, request  an                                                                   
     RFP for a study and the study  was issued within 30 days                                                                   
     of the RFP  and the study was required to  report within                                                                   
     60 days  its conclusions.   Well,  it came to  Fairbanks                                                                   
     and  studied  the  situation  and  came  back  with  the                                                                   
     following recommendation  - that  there was only  a need                                                                   
     for one ambulatory surgery room  and that that being the                                                                   
     case,  one was  not  economically viable  and  therefore                                                                   
     none were needed.                                                                                                          
     But, it's  interesting to see  how they did  that study.                                                                   
     How they  did it  is they said  that the operating  room                                                                   
     that FMH was granted in the  original CON that was given                                                                   
     to Dr.  Odom (ph),  FMH got one  at the same time,  that                                                                   
     was  to be designated  as an  ambulatory operating  room                                                                   
     where  you  can  only count  minutes  in  an  ambulatory                                                                   
     operating room  from 7 in the  morning until 5  at night                                                                   
     because  you  don't do  elective  surgery  at 3  in  the                                                                   
     morning.  So  that gives you 5 days a week  times from 7                                                                   
     to 5  and that's the number  of minutes.  But  when they                                                                   
     came back  to do the  study, they  lumped that in  as an                                                                   
     acute care room and therefore  you get to count 24-7 365                                                                   
     which is some 50 - 60 percent  increase in the number of                                                                   
     operating  room   minutes  and  that's  how   the  study                                                                   
     determined that no certificate of need is needed.                                                                          
     So my  point, I  guess, is it  was a  bad idea to  begin                                                                   
     with and  it never worked  and hasn't worked  and hasn't                                                                   
     worked anywhere  else and it  has become a  process that                                                                   
     is   highly,    highly   political   and    subject   to                                                                   
     manipulation,  is not fair, is  not reasonable.   To the                                                                   
     extent  that  the  very  small  communities  feel  their                                                                   
     hospital  care is  threatened,  this  bill would  exempt                                                                   
     them  from  any such  threat.  Communities  like  Homer,                                                                   
     Kenai,  Juneau, etcetera  would continue  to live  under                                                                   
     the same  certificate of need  that's been in  existence                                                                   
     since  it was first  put on  the books.   But in  larger                                                                   
     communities  where there is  a demonstrable need,  in my                                                                   
     opinion,  for  competitive  activities,  the  experiment                                                                   
     could  be done without  a disaster  occurring to any  of                                                                   
     the hospitals.   For  those reasons,  I would urge  your                                                                   
     consideration and support of this.                                                                                         
CHAIRWOMAN GREEN said at this time she will set aside SB 256 to                                                                 
give members time to study it.  She then took up SB 302.                                                                        
               SB 302-MENTAL HEALTH PROFESSIONALS                                                                           
SENATOR  WILKEN, sponsor  of SB  302, explained  that the  measure                                                              
deals with an  expansion of mental health providers.  He then read                                                              
the following sponsor statement.                                                                                                
     SB 302  recognizes the growth  in the clinical,  medical                                                                   
     health  profession   and  broadens  the   mental  health                                                                   
     professional  definition  to   include:  1)  a  licensed                                                                   
     clinical  social  worker;  2)  a  licensed  marital  and                                                                   
     family  therapist;   and  3)  a  licensed   professional                                                                   
     counselor.  The current Title  47 definition was written                                                                   
     in  1986, prior  to the  passage  of Alaska's  licensing                                                                   
     requirements governing these  master level mental health                                                                   
     The   more   inclusive   mental    health   professional                                                                   
     definition  increases the  capacity  of Alaska's  mental                                                                   
     health  system to protect  our youth  and adult who  are                                                                   
     experiencing    acute   psychiatric   crises    in   our                                                                   
     communities.    Today   not    enough   mental    health                                                                   
     professionals   are   authorized   under   the   current                                                                   
     definition  to respond  to some  critical public  safety                                                                   
     situations,  particularly  in  rural  Alaska.   And  yet                                                                   
     there  are hundreds  of licensed  professionals who  are                                                                   
     qualified to aid these Alaskans but cannot.                                                                                
     SB 302 recognizes this problem  and updates the Title 47                                                                   
     definition.  The  expanded  mental  health  professional                                                                   
     definition,  as stated in SB  302, increases  the number                                                                   
     of  trained professionals  who  will be:  1) allowed  to                                                                   
     provide  mental  health  treatment   for  prisoners;  2)                                                                   
     authorized  to evaluate children  and minors in  custody                                                                   
     to   determine   placement  in   residential   treatment                                                                   
     centers;  3) required  to report  incidents  of harm  to                                                                   
     vulnerable  adults;  and  4) allowed  to  conduct  civil                                                                   
     commitment evaluation.                                                                                                     
SENATOR WILKEN  referred members  to the  bill's zero fiscal  note                                                              
and  a  chart  in members'  packets  that  compares  the  training                                                              
requirements for mental health providers  in Alaska. He noted that                                                              
members' packets  also contain  about 12 letters  of support.   He                                                              
offered to answer questions.                                                                                                    
CHAIRWOMAN  GREEN announced  that  Senators  Davis, Ward,  Wilken,                                                              
Leman were present.                                                                                                             
DR. LEONARD ABEL, manager of the  Community Mental Health Services                                                              
Program at  the Department of  Health and Social  Services (DHSS),                                                              
informed members one  of the top priority programs  in his unit is                                                              
psychiatric emergency services. That  is what SB 302 is about, and                                                              
its  passage  is very  important.  Currently,  on any  given  day,                                                              
psychiatric  emergency  services  happen  in  32  catchment  areas                                                              
around   the  state,  delivered   by  about   140  mental   health                                                              
professionals.  Any time - day or  night - a psychiatric emergency                                                              
occurs,  those  professionals go  out,  assess the  individual  to                                                              
determine  the  presence  or  absence  of a  mental  illness,  and                                                              
whether that  illness will  endanger self or  others.   Right now,                                                              
there  are  not  enough  people who  meet  the  current  statutory                                                              
definition  to deliver  that  service; only  physicians,  licensed                                                              
psychologists and psychological associates  or MSWs with two years                                                              
of experience are able to. When that  definition was put in place,                                                              
there  was no  social  work licensing  law.  It  appears that  the                                                              
intent  at the  time was  to cover  everyone  who was  practicing.                                                              
Now,   social  workers,   marriage  and   family  therapists   and                                                              
professional counselors  are licensed. A client must  be sent to a                                                              
hospital, if the  mental health provider does not  fall within the                                                              
definition, he  or she cannot file  an ex parte order,  the normal                                                              
procedure.  As  a result,  providers  must  be very  creative  and                                                              
usually rely on 7 AAC 47.705, the  order for emergency evaluation,                                                              
commonly known as the peace officer's  application.  They must ask                                                              
a VPSO  or trooper to  assess the client,  even though  the mental                                                              
health provider has a master's degree  in their field. The problem                                                              
is that  to use the  emergency evaluation,  the situation  must be                                                              
imminently  dangerous.   If the  VPSO does  not see  a gun in  the                                                              
person's hand or a bottle of pills,  they will not be shipped out.                                                              
The standard is much higher.                                                                                                    
DR. ABEL  referred to  the chart  provided by  Senator Wilken  and                                                              
noted    that   under    practice   definitions,    psychologists,                                                              
psychological  associates, clinical  social workers, marriage  and                                                              
family  therapists   and  licensed  professional   counselors  can                                                              
diagnose  and  treat.  Diagnosis   is  the  essential  feature  of                                                              
emergency  services.  The  definition  in  AS  47.30.915  pertains                                                              
specifically  to the commitment  process but  it is referenced  in                                                              
other  areas of  statute,  one being  under  the requirements  for                                                              
reporting  on vulnerable  adults. Therefore,  marriage and  family                                                              
therapists  and  professional  counselors   are  not  required  to                                                              
report. Changing this definition  would automatically require them                                                              
to report.  Also, AS 47.30.915  is referenced in  statutes related                                                              
to placement  of children in  juvenile detention  facilities. This                                                              
bill would  allow more  professionals to  make those  assessments.                                                              
Finally,  the   statutes  referring  to  adults   in  correctional                                                              
facilities references  the same statute  so the definition  change                                                              
would also affect that group of people.   He urged members to pass                                                              
the bill.                                                                                                                       
CHAIRWOMAN GREEN  asked Dr.  Abel if there  is anything  about the                                                              
legislation  that  makes him  uneasy  about authorizing  a  mental                                                              
health  provider  to do  something  for which  he  or  she is  not                                                              
DR. ABEL said  there is not because  they are all qualified  to do                                                              
essential emergency assessment.                                                                                                 
CHAIRWOMAN  GREEN   asked  if   there  are  continuing   education                                                              
requirements for mental health providers.                                                                                       
DR.  ABEL  said there  are;  to  the  best  of his  knowledge  all                                                              
professions   must  pass   a  qualifying   examination  and   have                                                              
professional references.                                                                                                        
CHAIRWOMAN  GREEN asked  if providers  who refer  a person  on for                                                              
emergency  treatment are  trained  adequately  and regularly  with                                                              
continuing education courses.                                                                                                   
DR. ABEL  said the  answer lies somewhere  in between.  Assessment                                                              
for emergency treatment  is a standard part of training  but it is                                                              
not a major part  unless it is the provider's  specialty area. For                                                              
example, all physicians have standard  training in surgery but are                                                              
not necessarily surgeons.                                                                                                       
CHAIRWOMAN  GREEN asked  if the  passage  of SB  302 would  prompt                                                              
additional coursework.                                                                                                          
2:01 p.m.                                                                                                                       
DR. ABEL  said the division is  looking at ensuring  that everyone                                                              
will  get  training  and  be made  familiar  with  the  commitment                                                              
process.   The division does that  on an ongoing basis  anyway but                                                              
if the bill passes, it would make another effort.                                                                               
SENATOR LEMAN  said that  according to  the chart no  professional                                                              
references are  required for family and marital  therapists, while                                                              
they  are for  all  other providers.    He asked  if  that was  an                                                              
DR. ABEL said  it was an oversight  that was taken care  of in the                                                              
licensing regulations.                                                                                                          
SENATOR LEMAN  said he is  aware of another  situation in  which a                                                              
requirement was put in regulation  that required something without                                                              
statutory authority.  He asked if  someone could refuse to provide                                                              
references because they are not required by statute.                                                                            
DR. ABEL said he was not sure he could answer that question.                                                                    
SENATOR LEMAN  said if  it is true,  that could  be fixed  in this                                                              
piece of legislation, especially if it is not controversial.                                                                    
CHAIRWOMAN GREEN took public testimony.                                                                                         
MS. SUZANNE PRICE, Fairbanks Community  Mental Health Center, said                                                              
she has  been involved in  the mental  health field for  almost 30                                                              
years,  and in Alaska  since 1986.  In 1986,  almost every  mental                                                              
health  center had  a licensed  psychologist,  and sometimes  two.                                                              
She  cannot  think of  one  mental  health  center today  that  is                                                              
operated  by or  with a  licensed psychologist.  Most workers  are                                                              
Masters   level  MSWs,   marital   and  family   therapists,   and                                                              
professional  counselors.  She  is  one  of  a  few  psychological                                                              
associates.  The changing patterns  of who is working in the field                                                              
have been enormous over the last  15 years. Fifteen years ago, all                                                              
case managers had  Masters level degrees; now  they have bachelors                                                              
degrees  while  supervisors have  masters  level  degrees. As  the                                                              
profession  evolves and  changes  and the  licensing  requirements                                                              
change,  the  statues  and  regulations  need to  change.  She  is                                                              
finding  it very  difficult to  provide enough  services with  the                                                              
available manpower.                                                                                                             
MS. SHARON BULLOCK,  clinical director of the  Fairbanks Community                                                              
Mental  Health Center,  agreed that  the mental  health field  has                                                              
changed over the  last 15 years. SB 302 would allow  a wider range                                                              
of  people  to do  emergency  assessments.  However,  a  community                                                              
mental health  center often  employs people  fresh out  of college                                                              
with a masters  degree therefore 24-months  is a bit long  to wait                                                              
before  that person  can perform  that  duty.   All employees  are                                                              
under the supervision of a licensed  clinical employee anyway. She                                                              
supports SB 302 but hopes the 24-month  requirement can be changed                                                              
to 12 months. Her center has a difficult  time retaining employees                                                              
because by the time they get the two years in, they move on.                                                                    
MR. WAYNE  MCCOLLUM, community  support  program director  for the                                                              
Fairbanks Community Mental Health  Center, expressed concern about                                                              
the  licensed  staff shortage  problem  in  Alaska. He  said  that                                                              
trying  to  recruit clinicians  for  the  Bush is  very  difficult                                                              
because the  wages are not  very competitive  so they end  up with                                                              
people without  the kinds of degrees  needed to meet  the existing                                                              
MS. DIANE  WEBER, director of  the Yukon-Koyukuk Mental  Health in                                                              
Galena, which represents  six villages off of the  road system and                                                              
in very  rural areas,  voiced  support for  SB 302.   The bill  is                                                              
important to  her region  because under  the current statute,  her                                                              
clinic is required  to have a clinician  with a Ph.D. or  a MSW to                                                              
do an emergency commitment and there  are none in her region. That                                                              
means that  civil commitment  is nearly  impossible. In  addition,                                                              
the  health  center  is  unable  to  use  police  officers  to  do                                                              
commitments.   There are no police  officers in her only  area and                                                              
only two troopers cover a region  the size of Israel. The troopers                                                              
are too  busy with  other duties.  An additional  problem is  that                                                              
people  need a  psychological  evaluation  before  her center  can                                                              
access  the  Division  of  Mental   Health's  transfer  system  to                                                              
transport them to  a hospital. She agreed it is  very difficult to                                                              
get a mental health professional  with a master's degree to take a                                                              
job in  the Bush,  let alone  one who  is licensed.  She said  the                                                              
process  of supervision  for licensing  is  thorough and  requires                                                              
authorization  by a  licensing  board. Her  final  point was  that                                                              
assessment  for lethality for  suicide is  not a terribly  complex                                                              
procedure and  anyone with  a master's degree  in a mental  health                                                              
field is capable  of doing that. Passing SB 302 will  help to save                                                              
2:13 p.m.                                                                                                                       
MS.  ANNE  HENRY,  Division of  Mental  Health  and  Developmental                                                              
Disabilities, explained  that in answer  to a question  by Senator                                                              
Leman,  the  requirement  for  references  for  psychologists  and                                                              
psychological  associates  is  also   in  regulation  rather  than                                                              
statute.  She said the error on the  chart was on oversight on her                                                              
part but noted that placing that  requirement in regulation is not                                                              
SENATOR LEMAN said  in that case, the committee  probably does not                                                              
need to make any changes.                                                                                                       
CHAIRWOMAN GREEN suggested waiting  for the sunset legislation for                                                              
those professions to put the requirement in statute.                                                                            
MS. HENRY then  said, regarding the request to reduce  the time of                                                              
experience from  24 to 12 months,  the 24 month requirement  is in                                                              
current statute  as it defines  what significant experience  is in                                                              
the field of mental illness for social  workers who are allowed to                                                              
do this work.                                                                                                                   
CHAIRWOMAN GREEN  asked, "So, I mean,  we're sort of bound  by the                                                              
current statute to leave it - consistent with here?"                                                                            
MS. HENRY  said if  the committee  chooses to  reduce the  time of                                                              
experience to  12 months, the  division would be  comfortable with                                                              
that change as it  would open up access to a few  more folks to do                                                              
this work.                                                                                                                      
SENATOR WILKEN  said he would look  into whether or not  to reduce                                                              
the time of  experience to 12 months  and bring it up  to the next                                                              
SENATOR  LEMAN  moved  SB  302  from   committee  with  individual                                                              
recommendations  and its  accompanying  zero fiscal  note.   There                                                              
being no objection, the motion carried.                                                                                         
CHAIRWOMAN GREEN announced the committee would take up SB 295.                                                                  
          SB 295-LICENSING:DISCLOSURE OF MINORS RECORDS                                                                     
MS. WENDY  HALL, staff to Senator  Pete Kelly, sponsor of  SB 295,                                                              
explained  that  this  measure  addresses  a  concern  within  the                                                              
Department of Health  and Social Services. State  and federal laws                                                              
require  all child  and adult  day care  licensing authorities  to                                                              
review criminal  history reports of  every individual aged  16 and                                                              
older who  is seeking either a  care license, employment  with the                                                              
care provider, or residing in the  home of a care provider seeking                                                              
licensure.  Current  law does not explicitly authorize  release of                                                              
delinquency information  when a juvenile is 16 or  17 years of age                                                              
and is residing  in the home where care services  will be provided                                                              
and the juvenile  will not be  an employee of the  license holder.                                                              
Therefore,  the state is  requiring the  licensing authorities  to                                                              
review the criminal  background of anyone living in  the home, yet                                                              
the department is  unable to release that information  unless that                                                              
individual  will be  an employee.  SB 295 will  authorize DHSS  to                                                              
release  that information  so that  a scenario  does not arise  in                                                              
which an  applicant is given a  license even though  an adolescent                                                              
who is a convicted child molester is living in the home.                                                                        
CHAIRWOMAN GREEN  asked if  SB 295 only  pertains to  minors since                                                              
similar legislation was enacted that applies to adults.                                                                         
MS. HALL said that is correct.                                                                                                  
MR. ROBERT  BUTTCANE, Juvenile Probation  Officer at  DHSS, stated                                                              
that over the past few years, various  state and federal laws have                                                              
been   enacted  that   require   licensing   agencies  to   access                                                              
delinquency records  information as  part of their  license review                                                              
process.  As the  Department of  Education  and Early  Development                                                              
(DOEED)  was  working  on  procedures  to  license  child  daycare                                                              
centers in  Alaska, DHSS was unclear  about its authority  to give                                                              
DOEED information  about juveniles who  reside in the home  of the                                                              
day  care  license  applicant  but  are  not  employees.  In  some                                                              
situations, those juveniles have  delinquency records that brought                                                              
into question the safety of providing  services in that home. DHSS                                                              
worked with  the Department of Law  and Senator Kelly and  came up                                                              
with SB 295,  which adds a section to DHSS's  confidentiality laws                                                              
that gives explicit authority to  release that information to care                                                              
providers, whether  for senior care,  foster care, or  child care.                                                              
He stated support for SB 295.                                                                                                   
2:22 p.m.                                                                                                                       
SENATOR WARD asked if this came about  because of an applicant who                                                              
had a dangerous youth living at the home.                                                                                       
MR. BUTTCANE said it did not actually  happen but the scenario was                                                              
raised. DHSS was  able to construct a strong  enough justification                                                              
to release  the information to  DOEED, according to  the assistant                                                              
attorney general.                                                                                                               
TAPE 02-16, SIDE B                                                                                                              
CHAIRWOMAN GREEN  asked if criminal background information  can be                                                              
accessed on other adults living in the home.                                                                                    
MR. BUTTCANE said  the information contained in  APSIN (the Alaska                                                              
Public Safety Information Network)  for all adult criminal history                                                              
records is available to licensing  agencies now by statute. SB 295                                                              
is specific to delinquents because that authority is missing.                                                                   
SENATOR WARD  asked if  an applicant  must disclose anything  that                                                              
might be dangerous to clients on the application.                                                                               
MR.  BUTTCANE  said  he  is  not  familiar  with  every  licensing                                                              
application  process,   but  on   some  that  is   a  requirement.                                                              
Applicants sign  authorizations for the licensing  agency to check                                                              
APSIN  so  that  if  the  information  is  not  disclosed  on  the                                                              
application, it would be available in APSIN.                                                                                    
CHAIRWOMAN  GREEN  acknowledged that  in  the case  of  juveniles,                                                              
agencies  cannot access  that information.  She noted  she has  no                                                              
problem moving this  bill to the Judiciary Committee  where it can                                                              
address infringement issues.                                                                                                    
SENATOR  LEMAN  moved  SB  295  from   committee  with  individual                                                              
recommendations  and  its  accompanying zero  fiscal  note.  There                                                              
being no objection, the motion carried.                                                                                         
The committee took up SB 342.                                                                                                   
                 SB 342-LONG TERM CARE OMBUDSMAN                                                                            
MR. JERRY  BURNETT,  staff to Senator  Green,  sponsor of SB  342,                                                              
explained that SB  342 clarifies the duties of the  long term care                                                              
ombudsman  and increases  some statutory  authority.  He gave  the                                                              
following testimony.                                                                                                            
     Each  state  is  required  to  have  a  long  term  care                                                                   
     ombudsman under the Older Americans  Act (OAA). Alaska's                                                                   
     long  term care  ombudsman is  located  in the  [Alaska]                                                                   
     Mental  Health Trust  Authority  and  recently the  long                                                                   
     term  care  ombudsman resigned,  citing  as  one of  the                                                                   
     reasons for  his resignation, frustration  with Alaska's                                                                   
     statutes.   Discussion  with the  executive director  of                                                                   
     the Alaska Mental  Health Trust led to the  filing of SB
     342,  which  brings Alaska  statutes  in line  with  the                                                                   
     federal law.                                                                                                               
     Specifically,  SB   342  directs  the  long   term  care                                                                   
     ombudsman  to  visit  long   term  care  facilities  and                                                                   
     identify  problems,   rather  than  assuming   the  more                                                                   
     passive  role  of  only  responding  to  complaints.  It                                                                   
     provides  that  no  long term  care  facility  may  deny                                                                   
     immediate access  to an employee  or volunteer  from the                                                                   
     long term  care ombudsman's office who is  responding to                                                                   
     a complaint  and it gives  the long term care  ombudsman                                                                   
     an  active role  in developing  and providing  technical                                                                   
     support to volunteer organizations  which are interested                                                                   
     in  the health,  safety,  welfare  and rights  of  older                                                                   
CHAIRWOMAN GREEN asked Mr. Burnett  to address the question of why                                                              
this issue is being revisited.                                                                                                  
MR. BURNETT  said, according to  the executive director  of AMHTA,                                                              
state statutes  have not been  brought up to  date and are  not in                                                              
compliance with federal law so there  are tasks the long term care                                                              
ombudsman should be directed to do which he or she is not.                                                                      
SENATOR LEMAN asked  if the subsections in Section  3 will respond                                                              
to changes in federal law.                                                                                                      
MR. BURNETT  said he is not  sure whether they respond  to changes                                                              
in federal  law  or to the  existing federal  law.   He noted  the                                                              
development of  the volunteer  organizations and family  councils,                                                              
etcetera, is specified.                                                                                                         
CHAIRWOMAN  GREEN  said  that  sounds  like an  iteration  of  the                                                              
federal statute.                                                                                                                
MR. BURNETT  added that  the long  term care  ombudsman is  funded                                                              
with a combination  of state and federal money.   This bill should                                                              
not affect those funds.                                                                                                         
SENATOR  LEMAN   referred  to  subsection   (f)  and   asked  what                                                              
"technical support" means in this context.                                                                                      
MR. JEFF JESSEE,  Executive Director of the AMHTA,  explained that                                                              
a  little  over  a year  ago,  the  AMHTA  took over  the  job  of                                                              
overseeing the  office of  the long term  care ombudsman.   During                                                              
that  process he  reviewed the  framework under  which the  office                                                              
operated  and identified  discrepancies  between  the federal  and                                                              
state laws.   Section 3 of SB  295 contains a number  of functions                                                              
the long  term care ombudsman should  be undertaking that  are not                                                              
required  in  state law.  The  formation  of resident  and  family                                                              
councils  will assist  folks who  either  live in  or have  family                                                              
members in  long term  care facilities  to organize themselves  so                                                              
they aren't  dependent on  the long term  care ombudsman  or other                                                              
individuals.   Those councils  will carry out  a number  of roles,                                                              
all  of them  of  an  oversight nature,  but  they  are also  very                                                              
valuable  in providing  activities  or other  support services  to                                                              
residents and family members to enable  them to work toward common                                                              
goals.   Recently,  the long  term  care ombudsman  who was  hired                                                              
after the  office came under  the purview  of the AMHTA,  left the                                                              
position.    One reason  he  cited  for  his resignation  was  the                                                              
difficulty  he  encountered  when  looking  at  reinstituting  the                                                              
volunteer  program.   When  the original  OAA  was  passed over  a                                                              
decade ago, the volunteer ombudsman  component was part and parcel                                                              
of what Congress  had in mind.   Congress wanted to  avoid another                                                              
huge bureaucracy that  relied only upon paid employees  to provide                                                              
the critical functions of providing  assistance to people who live                                                              
in  long term  care  facilities.   A  volunteer  program has  been                                                              
instituted  in every  state  and  the OAA  sets  out clearly  that                                                              
volunteers are a critical part of the program.                                                                                  
MR. JESSEE said that volunteers undergo  training and testing, and                                                              
are  certified  and  supervised.   He  informed  members  that  he                                                              
provided copies of  manuals used to train volunteers  to committee                                                              
members. That manual  is quite comprehensive and is  being used as                                                              
a model around  the nation. It includes education  and training in                                                              
ethics, the  role of the long  term care ombudsman,  the statutory                                                              
framework,   the   aging   process,  long   term   care   facility                                                              
regulations,  etcetera.  The  AMHTA  believes  volunteers  are  an                                                              
important part  of the program,  particularly in Alaska.  If state                                                              
employees  were hired to  do this  work, the  office would  have a                                                              
huge  staff. He  acknowledged there  is an  ongoing dispute  among                                                              
some  assisted living  home providers  as to  whether the  current                                                              
statutes allow volunteers to have  access to their homes. One home                                                              
provider actually got a legal opinion  that said the home owner is                                                              
not required to allow volunteers  to enter her facility. The AMHTA                                                              
hopes  this  legislation  will clarify  that  matter  and  prevent                                                              
litigation. He offered to answer questions.                                                                                     
SENATOR LEMAN  asked Mr. Jessee if  "technical support" is  a term                                                              
of art  that means other  than financial  support and asked  if it                                                              
comes from the federal bill.                                                                                                    
MR. JESSEE  affirmed  that term refers  to information  on  how to                                                              
organize those  groups, their  structure, regulations  and patient                                                              
CHAIRWOMAN GREEN  said she has  heard several concerns  expressed,                                                              
the first  being about confidentiality  that is referenced  on the                                                              
bottom of page 1 of the bill. She  asked him to provide an example                                                              
of how that will work.                                                                                                          
MR. JESSEE said  he will describe what it does not  mean.  It does                                                              
not mean  that the  ombudsman or  employees or  volunteers  in the                                                              
office  are   able  to  share  confidential   information  without                                                              
complying with the confidentiality  requirements that apply to the                                                              
office. It does mean there is a responsibility  on the part of the                                                              
office   to  provide   information   to  public   agencies   about                                                              
individuals  who  reside in  long  term care  facilities.  Without                                                              
giving individual  information, the  ombudsman is responsible  for                                                              
bringing systemic issues to entities  such as the legislature, the                                                              
Older Alaskans Commission  and other public agencies  that need to                                                              
be aware of the  problems of older Alaskans who live  in long term                                                              
care facilities.                                                                                                                
CHAIRWOMAN GREEN  asked if this  information will be  dispensed to                                                              
every agency in the state.                                                                                                      
MR. JESSEE  said  it does not  and, in  fact, the  long term  care                                                              
ombudsman's office  is prohibited from  doing so by  AS 47.62.030.                                                              
AS  47.62.025(b)  specifically  requires   consent  of  the  older                                                              
Alaskans or  their legal guardians  or, if unable to  consent with                                                              
no  legal guardian,  a  court order  is  required  to get  medical                                                              
CHAIRWOMAN GREEN said the other area  she has heard concerns about                                                              
is  at the  end  of the  bill  that says  a  person  may not  deny                                                              
immediate  access to  a long  term care  facility or  to an  older                                                              
Alaskan  by  the  ombudsman,  an  employee,  volunteer,  or  other                                                              
representative  of  the  office.   She  noted  it  is  the  "other                                                              
representative  of the  office"  that is  cause  for concern.  She                                                              
asked who would fall under that category.                                                                                       
MR. JESSEE said he cannot provide  a specific example at this time                                                              
but he said that state and federal  laws already require access to                                                              
any  ombudsman, employee,  volunteer  or other  representative  to                                                              
investigate a  complaint. They must  have completed  the training;                                                              
they must be certified; and they  must be supervised. He suggested                                                              
that it might be an intern who has completed the training.                                                                      
CHAIRWOMAN GREEN indicated  that she thought it might  be a higher                                                              
level investigator or inspector.                                                                                                
MR. JESSEE said it could conceivably be a contractor.                                                                           
CHAIRWOMAN GREEN said  the bigger issue is that  these people must                                                              
be trained, certified, and supervised.                                                                                          
MR. JESSEE  said that is correct.   He commented that he  is aware                                                              
of concerns about how the volunteer  program operated in the past.                                                              
He  assured  her  that  the AMHTA  will  work  with  the  provider                                                              
community  to ensure  that the  volunteer program  operates as  it                                                              
should. If  providers feel  at any  time that  the program  is not                                                              
operating  in a proper  manner, he  encourages  them to hold  that                                                              
office and the AMHTA accountable for those shortcomings.                                                                        
CHAIRWOMAN GREEN asked Mr. Jessee  if the AMHTA will be doing some                                                              
training or  transitioning with the  providers when  the volunteer                                                              
program is reinstituted.                                                                                                        
MR. JESSEE  said he has already  opened dialog with  the providers                                                              
and will continue to so that they  are brought into the process of                                                              
developing the volunteer program.                                                                                               
CHAIRWOMAN  GREEN announced  that she  would hold  the bill  until                                                              
MS.  LARRAINE  DERR,  Alaska  State   Hospital  and  Nursing  Home                                                              
Association, informed  members that SB  342 causes long  term care                                                              
facilities great  concern.   Alaska has had  three long  term care                                                              
ombudsmen in the last three years.   The changeover was due to the                                                              
fact that the ombudsmen were unable  to handle the job duties they                                                              
had: SB 342  adds more responsibilities  to the job. She  said the                                                              
Association  is  comfortable  with   the  ombudsman's  ability  to                                                              
investigate and resolve problems,  but is concerned about what the                                                              
word "identify"  means.   Providers are  also concerned  about the                                                              
word "immediate"  in  relation to  access and  would like to  know                                                              
that that  means. She  questioned whether  anyone associated  with                                                              
the ombudsman's office  can come to the door and  demand immediate                                                              
access. She  said the  bill has a  "big brother"  feel to  it. She                                                              
asked for more time to poll her membership and review the bill.                                                                 
CHAIRWOMAN  GREEN said more  time will  be provided and  announced                                                              
that the committee would take up SB 230.                                                                                        
             SB 230-PSYCHOTROPIC DRUGS FOR CHILDREN                                                                         
MR. RICHARD  BENAVIDES,  staff to Senator  Bettye Davis,  sponsor,                                                              
gave the following explanation of the measure.                                                                                  
     The  use of psychiatric  drugs in  our nation's  schools                                                                   
     has  more than  doubled in the  first half  of the  last                                                                   
     decade   and  continues   to  escalate.   While  it   is                                                                   
     recognized  that properly used,  these medications  have                                                                   
     been  shown  to  improve  behavioral  patterns  of  some                                                                   
     children,   as  well   as  improve   their  ability   to                                                                   
     concentrate  in   a  classroom,  there   are  documented                                                                   
     incidents  of  negative  consequences  from the  use  of                                                                   
     these drugs.   There is also parental  concern regarding                                                                   
     the issue  of diagnosis and  medication and  using these                                                                   
     drugs for  what are  essentially problems of  discipline                                                                   
     that may  be related  to a variety  of causes and  their                                                                   
     impact on student achievement.                                                                                             
     Currently, ten states have laws  on the books related to                                                                   
     the  use of  psychiatric  drugs  on children  and  while                                                                   
     there is  no hard data on  the total number  of children                                                                   
     in Alaska  on these medications, [indisc.]  hope to make                                                                   
     clear the  responsibilities of both parents  and schools                                                                   
     and the  growing debate  on the use  of these drugs  are                                                                   
     requiring   school    districts   to   adopt    policies                                                                   
     restricting  school personnel  from recommending that  a                                                                   
     student  be  given  psychiatric  drugs.  It  would  also                                                                   
     prohibit a child from being  considered to be a child in                                                                   
     need of aid  simply based on the refusal  of the child's                                                                   
     custodian to give psychiatric drugs to the child.                                                                          
He informed members that several  people were available to testify                                                              
on different aspects of the bill.                                                                                               
SENATOR LEMAN  asked Mr.  Benavides if  the words psychiatric  and                                                              
psychotropic are used interchangeably in relation to drugs.                                                                     
MR.  BENAVIDES said,  "Some people  identify  them as  psychiatric                                                              
drugs, others call  them psychotropic drugs.  It  depends on - the                                                              
different  drugs - what  they -  their full  term affects  on kids                                                              
because a variety of drugs are used."                                                                                           
CHAIRWOMAN GREEN  called Mr. Maloney  to testify and asked  him to                                                              
touch on  what is actually happening  in school districts  now and                                                              
what  this bill  will  require school  districts  to do  regarding                                                              
setting policy.                                                                                                                 
MR.  GREG   MALONEY,  Director  of   Special  Education   for  the                                                              
Department of  Education and Early  Development (DOEED),  made the                                                              
following statement.                                                                                                            
     The use of psychotropic groups  with children is an area                                                                   
     of critical  importance. Ongoing research on  the impact                                                                   
     of such drugs  on developing brains and  neural networks                                                                   
     mandate that decisions regarding  their use must be made                                                                   
     carefully   by  parents  and   professionals  with   the                                                                   
     capacity to make these decisions.  SB 230 would put into                                                                   
     law   what   is   already   an   ethical,   professional                                                                   
     requirement, namely  that school professionals  act only                                                                   
     in their areas  of expertise. In other words,  there are                                                                   
     individuals  in the  school setting  who are trained  to                                                                   
     provide  information  providing  certain  diagnoses  and                                                                   
     possible  interventions,  including   at  times  medical                                                                   
     interventions.   Such  a  person   would  be  a   school                                                                   
     psychologist.   I'm   a  nationally   certified   school                                                                   
     psychologist  myself. Part of  the training is  to learn                                                                   
     more and then provide the parents  information about the                                                                   
     pros and cons, benefits, consequences of medication.                                                                       
     Alaska's  teachers, I  must say,  do work  hard for  the                                                                   
     interest  of children  and  this measure  would  provide                                                                   
     additional guidance to them.  The tendency to think that                                                                   
     teachers are providing this  maliciously because this is                                                                   
     a way  - if the kids are  not performing, this is  a way                                                                   
     that we can  do something about that. However  at times,                                                                   
     teachers also may make suggestions  regarding medication                                                                   
     out of an attempt to be helpful  because they are trying                                                                   
     to  help  parents  come  up with  options  that  may  be                                                                   
     useful. Again, this points out  the need for training in                                                                   
     that area  because while the suggestion maybe  from good                                                                   
     intentions, it may not have the intended consequences.                                                                     
     SB  230  also  requires  school   staff  to  communicate                                                                   
     behavioral or  emotional concerns to parents.   The bill                                                                   
     may be  too prescriptive  when it  requires a letter  be                                                                   
     sent  to   the  parent   or  guardian  recommending   an                                                                   
     evaluation be  conducted by a licensed physician.   This                                                                   
     presupposes that  a student may need medication  and for                                                                   
     purposes other  than medication, a physician  may not be                                                                   
     the best  person suited to  conduct that assessment.  In                                                                   
     other words,  if a student  has behavioral or  emotional                                                                   
     concerns,  part of it  may eventually  get to the  point                                                                   
     where a  medical evaluation  may need to be  considered.                                                                   
     Prior  to  that,   there  are  a  number   of  kinds  of                                                                   
     interventions  that  are  non-medical   in  nature.  One                                                                   
     example  that  you  may  be   familiar  with  is  called                                                                   
     positive   behavior   support   in  which   the   school                                                                   
     environment  within which  the student  is operating  is                                                                   
     changed  and positive  and negative  reinforcements  are                                                                   
     provided  in  order  to help  the  student  make  better                                                                   
     choices. Interventions other  than medication, including                                                                   
     positive behavioral supports,  have been shown to have a                                                                   
     positive durable impact.                                                                                                   
     Another issue that  some of you may be familiar  with is                                                                   
     that under  the Individuals with Disabilities  Education                                                                   
     Act  as  amended  in  1997,  referred  to  as  IDEA  97,                                                                   
     districts  are expected to  pay for medical  evaluations                                                                   
     that are  suggested as  part of  a student referral  for                                                                   
     special education services.  In other words, if, as part                                                                   
     of  the evaluation,  it's  been  noted that  the  school                                                                   
     district  has  some  concerns  related  to  a  student's                                                                   
     medical  needs  or the  need  for an  evaluation,  quite                                                                   
     likely the school district would  be required to pay for                                                                   
     that evaluation  so that may have some fiscal  impact on                                                                   
     the school district.                                                                                                       
     I  suggest  that  the language  be  changed  to  require                                                                   
     school  districts  to  notify parents  or  guardians  of                                                                   
     emotional or behavioral concerns.  This may occur in the                                                                   
     form  of  a  letter,  a telephone  call,  or  during  an                                                                   
     intervention  team  meeting.  One  of  the  really  nice                                                                   
     things that  has been developing  in the last  few years                                                                   
     is a  focus on pre-referral  - in other words,  prior to                                                                   
     the  referral   of  a  student  for   special  education                                                                   
     services,  a team meeting  made up of  interdisciplinary                                                                   
     professionals.   So,  in  other words,  you  may have  a                                                                   
     teacher,  an  administrator,  a  speech  pathologist,  a                                                                   
     special education teacher coming  together - not to talk                                                                   
     about  whether  the  student  is  eligible  for  special                                                                   
     education, but  what kinds of  things can be  done prior                                                                   
     to the referral for special  education that would enable                                                                   
     the student to continue to make  progress in the regular                                                                   
     classroom and  not require either medication  or special                                                                   
     education services.                                                                                                        
     On a final note, I also do not  read this legislation to                                                                   
     be  limiting  the  legitimate  role  of  trained  school                                                                   
     personnel,  such  as  a school  psychologist  or  school                                                                   
     nurse,  to  provide  important  information  to  parents                                                                   
     concerning  potential   benefits  and  consequences   of                                                                   
     medical  interventions.   And  so  one   other  possible                                                                   
     suggestion  would be to consider,  instead of  using the                                                                   
     term school  personnel, regarding who this  is referring                                                                   
     to -  it may  be teachers.   Some  state laws that  have                                                                   
     other  states  that  have enacted  laws  have  specified                                                                   
     teachers rather than school  personnel precisely because                                                                   
     of  the issue  that  it  may limit  unintentionally  the                                                                   
     services provided  by a school psychologist  or a school                                                                   
     nurse.  The  difference we see is that it is  one of the                                                                   
     advocacy  - a school  psychologist  or school nurse  may                                                                   
     provide  information, however  that  is not  necessarily                                                                   
     advocating  for  the  use  of medication  -  but  it  is                                                                   
     important that parents have  quality information as they                                                                   
     go about making this decision.                                                                                             
MR. MALONEY offered to answer questions.                                                                                        
SENATOR  DAVIS  commented  that   regarding  a  special  education                                                              
student,  a school  district is  already  required to  pay for  an                                                              
evaluation and SB 230 would not change  that. She pointed out that                                                              
SB 230 will affect students who are  not in special education. She                                                              
said she  does not  have a problem  with limiting  what is  in the                                                              
letter, but  she doesn't  understand why this  will cause  a great                                                              
expense  to school districts.  She  also noted  she does not  want                                                              
this bill  to apply  to teachers  only because  too many  children                                                              
have  been  placed in  special  education  and put  on  medication                                                              
because they have behavioral problems.  She added that nurses have                                                              
estimated that 800  students in the Anchorage  School District are                                                              
given psychotropic drugs.                                                                                                       
MR. MALONEY said, in regard to his  statement that a referral to a                                                              
physician  could  require  an additional  expense,  if  a  teacher                                                              
believes a  student should have  a medical evaluation  independent                                                              
of this larger, more informed process,  it could mean the district                                                              
would have  to pay for it  even though the special  education team                                                              
may not have recommended one.                                                                                                   
SENATOR DAVIS noted  that IEPs are done for all  special education                                                              
students but  other students are put  on medication yet  do not go                                                              
through that  process.  She  wants to make  sure they do  not slip                                                              
between the cracks.  She pointed out that some  children have been                                                              
denied the  right to come  to school.   SB 230 prohibits  a school                                                              
district from  keeping a  child out of  school because  the parent                                                              
does not want the child to take psychotropic drugs.                                                                             
CHAIRWOMAN GREEN took public testimony.                                                                                         
MR. RICHARD WARNER, President of  the Citizens Commission on Human                                                              
Rights of Seattle, said SB 230 represents  an important first step                                                              
toward  establishing  some clear  limitations  on  the ability  of                                                              
state  agencies   to  force  parents   to  give   normal  children                                                              
psychotropic drugs.  By way of background, one  reason some states                                                              
are  addressing  this   issue  right  now  is  that   the  use  of                                                              
psychiatric drugs  by children is skyrocketing.  These drugs, with                                                              
the exception of  Paxil and Ritalin, have never  been approved for                                                              
use on children  by the FDA.   Paxil and Ritalin are  not approved                                                              
for use  by children  under the  age of  six.   The findings  of a                                                              
February  2000  study  in  the Journal  of  the  American  Medical                                                              
Association  warned that  the use  of  stimulants on  preschoolers                                                              
tripled  during the  1990s. Another  survey by  INS Health,  which                                                              
tracks  pharmaceutical  usage  for  the  pharmaceutical  industry,                                                              
found the use  of newer anti-depressants, like  Prozac and Zoloft,                                                              
on children older than six increased  580 percent between 1995 and                                                              
MR. WARNER indicated  DOEED includes these children  in a category                                                              
entitled, "Other  Health Impaired."   He was  able to  determine a                                                              
200 percent  increase in the number  of children in  that category                                                              
between December of  1995 and December of 2000.   During that same                                                              
time  period, total  school  enrollment  increased  by 7  percent.                                                              
Legislation  recently  passed the  Utah House  of  Representatives                                                              
that   prohibits   teachers   from   recommending   or   requiring                                                              
psychotropic  drugs  for  a  child   or  recommending  psychiatric                                                              
treatment or  evaluation.  It also  provides that the  Division of                                                              
Family and  Youth Services  may not remove  a child from  the home                                                              
because the parents  refuse to drug their child.   Mr. Warner said                                                              
the state  should not  intervene in  parental decisions  regarding                                                              
medical  treatment  for their  children  when  there is  no  clear                                                              
consensus  regarding the  effectiveness  of the  treatment or  the                                                              
risk of the proposed treatment.   In the case of ADD and ADHD, the                                                              
drugs  have been  proven  to have  serious  side  effects and  the                                                              
diagnosis itself is in question,  so it is more important to state                                                              
the limits  of state intervention.   Adverse reactions to  some of                                                              
these drugs  include anorexia, nausea,  rapid heart  beat, cardiac                                                              
arrhythmia,    weight    loss,   psychological    problems,    and                                                              
physiological problems, such as liver  disorders, blood disorders,                                                              
convulsions,  gran mal  seizures,  agitation, hostility,  abnormal                                                              
thinking,  and 20  to 30  percent decrease  in blood  flow to  all                                                              
parts of the brain.                                                                                                             
MR. WARNER  stated support  for SB  230 and  agreed that  a letter                                                              
home  should only  state  what a  teacher  has  expertise in,  for                                                              
example,  the  observation  of  specific  behaviors  or  emotional                                                              
problems in  a child.  Sending a letter  home requiring  a medical                                                              
evaluation  is tantamount to  suggesting the  child has  a medical                                                              
disorder.   He pointed  out that  a national consensus  conference                                                              
was held on this  issue in 1998. Participants  concluded there was                                                              
no  independent valid  test  for ADHD,  and  there is  no data  to                                                              
indicate  these children  have any  brain malfunction  whatsoever.                                                              
There  are  literally  hundreds of  conditions  that  can  produce                                                              
similar symptoms so it is dangerous  to use a blanket diagnosis of                                                              
ADHD for children  who could have one of hundreds  of things going                                                              
MR. JOHN  BREEDING, Director  of Texans for  Safe Education  and a                                                              
psychologist, asked  committee members to consider  the statistics                                                              
provided  by previous  speakers.   He sees  this issue  as one  of                                                              
informed consent  regarding accurate information and  free choice.                                                              
SB 230 is, to  some extent, an anti-coercion bill.  He recommended                                                              
expanding Section  9 to say  that school personnel  not recommend,                                                              
suggest, or pressure.  He agreed  with Mr. Warner that language be                                                              
included in  the bill to restrict  schools from requiring  the use                                                              
of psychiatric drugs  as a condition of school  attendance because                                                              
parents are being  threatened with expulsion of  their children in                                                              
many  places.   Regarding  Section  3,  he   recommends  including                                                              
language to prevent  children from being removed  from their homes                                                              
if  parents  refuse  to  medicate  them,  because  that  has  been                                                              
occurring in other states.                                                                                                      
TAPE 02-16, SIDE A                                                                                                              
MR.  BREEDING commented  that not  only  is it  proper for  school                                                              
personnel to provide  a comprehensive evaluation  for children who                                                              
are selected out, he believes it  is illegal not to do so. He said                                                              
it is proper for the school to do a full behavioral evaluation.                                                                 
MS. DEBBIE  OSSIANDER, legislative  chair of the  Anchorage School                                                              
Board,  stated support  for  the  intent of  the  bill. The  board                                                              
believes school  personnel should not be recommending  medications                                                              
as that is  not their area  of expertise or their  work. Anchorage                                                              
already employs  severe prohibitions  against doing so.  The board                                                              
is  concerned   about  the  letter   recommending  a   medical  or                                                              
behavioral   health  evaluation   because   of  implications   for                                                              
requiring  districts  to pay  for  that evaluation.  However,  the                                                              
board is generally supportive of providing information.                                                                         
MR.  RICHARD RAINERY,  Executive  Director  of the  Alaska  Mental                                                              
Health  Board,  stated  support  for  the intent  of  SB  230  but                                                              
expressed concern that recommending  evaluations by physicians may                                                              
impact smaller  communities as they  may not have  the appropriate                                                              
personnel.   He referred  to SB 302  and suggested broadening  the                                                              
pool of people who can do evaluations.                                                                                          
MR. FRANK  TURNEY, testifying  via teleconference from  Fairbanks,                                                              
informed  committee members  that  the North  Star Borough  School                                                              
District has  brought in  psychiatrists from  other states  on two                                                              
different  occasions  to  give  teachers  a pep  talk  on  how  to                                                              
identify children with ADHD in the  classroom. During the seminar,                                                              
the psychiatrist supported the use  of Ritalin and another drug as                                                              
part of  the treatment plan.  Also the  school district has  had a                                                              
long time relationship  with Dr. Ferguson (ph) who  is a leader in                                                              
prescribing  Ritalin in Fairbanks.  He asked  the school  board to                                                              
have Dr. Ferguson  to come in and give an opinion  on evaluating a                                                              
child  for  ADHD and  psychotropic  drugs  but they  declined.  In                                                              
addition, he  has requested  data from  the school district  three                                                              
times to  determine  how much Ritalin  is being  dispensed  by the                                                              
school nurse but  the district has not provided  that information.                                                              
He informed members  that the Colorado School Board  was the first                                                              
in the nation  to pass a resolution warning parents  about the use                                                              
of Ritalin  in schools. He stated  support for SB 230 and  said he                                                              
will send proposed amendments to the committee.                                                                                 
MS.  BETTY ROLLINS  stated  support  for SB  230  and  said it  is                                                              
important to not send a mixed message  to students about drug use.                                                              
MR.  CHARLES  ROLLINS stated  support  for  SB 230  and  suggested                                                              
checking children  in state  custody to  see what medication  they                                                              
are taking.                                                                                                                     
MR. BROCK EIDSNESS, and 8 grader from Dzantik'i Heeni Middle                                                                    
School in Juneau, read the following testimony.                                                                                 
     Imagine   a   society   where  children   are   all   on                                                                   
     psychotropic drugs.   Imagine it is the  teachers' fault                                                                   
     because they referred all of  the kids - a society where                                                                   
     the  drugs are  doing  more bad  than  good. That  could                                                                   
     happen  if  someone doesn't  take  the power  away  from                                                                   
     teachers to  put kids on psychotropic drugs.  This could                                                                   
     be a  serious problem  in the near  future. I think  you                                                                   
     should pass SB 230 and save our society's children.                                                                        
     SB  230  is  trying  to  limit  teachers'  influence  on                                                                   
     putting kids on psychotropic  drugs.  Psychotropic drugs                                                                   
     are drugs  to calm  children down,  like Ritalin,  or to                                                                   
     treat  mental  disabilities  like  depression.  Teachers                                                                   
     sometimes   recommend   these   drugs  to   parents   of                                                                   
     disobedient kids for behavioral  problems.  According to                                                                   
     the Journal  of the  American Medical Association,  from                                                                   
     1991  to  1995  the  number  of  preschoolers  on  anti-                                                                   
     depressants  increased  200 percent  and  the number  of                                                                   
     children  ages  2  to  4  taking  stimulants  more  than                                                                   
     doubled.  Chemically treating our  children at  the rate                                                                   
     we  are now may  lead to  problems in  our society  that                                                                   
     [indisc.]  emotional  and financial  costs  to  correct.                                                                   
     These medications  are being  prescribed to children  at                                                                   
     increasingly younger ages and  I believe this is because                                                                   
     of the school influence.                                                                                                   
     Ritalin is a commonly used psychotropic  drug. There are                                                                   
     some  children  for  whom  Ritalin  may  be  their  best                                                                   
     option.  However  there are  countless  others that  are                                                                   
     being  drugged unnecessarily.  There are some  downsides                                                                   
     to  Ritalin,  like  Ritalin  is derived  from  the  same                                                                   
     family  as  cocaine;  Ritalin  lasts  only  four  hours,                                                                   
     Ritalin  treats  only  some  of  the  symptoms  of  ADD;                                                                   
     Ritalin  provides  superficial  healing  - it  does  not                                                                   
     treat the  root of the  problem; Ritalin can  cause side                                                                   
     effects  such  as  appetite   loss,  anxiety,  insomnia,                                                                   
     ticks,  headaches  and  stomach aches;  Ritalin  use  is                                                                   
     responsible  for causing  children to  begin a habit  of                                                                   
     taking  drugs; Ritalin  may  need to  be  taken over  an                                                                   
     entire life span.                                                                                                          
     Stimulant   drugs   were  found   to   have   short-term                                                                   
     effectiveness  of  60  to 80  percent  in  reducing  the                                                                   
     hyperactivity,  distractibility,  and  impulsiveness  of                                                                   
     school  age children.  Studies began  in the 1960s  show                                                                   
     that  children  who took  stimulants  for  hyperactivity                                                                   
     over several years  did just as poorly in  later life as                                                                   
     a group of hyperactive children  who took no medication.                                                                   
     Doctors sharply criticized the  lack of a uniform system                                                                   
     for  diagnosing and  treating  ADHD,  saying the  health                                                                   
     department  had  largely  ignored  national  health  and                                                                   
     medical research recommendations  published in 1997. Dr.                                                                   
     Florence  Levy from the  Sydney Children's Hospital  has                                                                   
     expressed   concern  at  the   frequency  of   incorrect                                                                   
     diagnoses before.                                                                                                          
     The  facts   are  straight:   the  number  of   kids  on                                                                   
     psychotropic  drugs  is  rising.   School  influence  is                                                                   
     forcing parents to put their  kids on psychotropic drugs                                                                   
     by threatening to take them  to social services and even                                                                   
     reporting them.  Most teachers  probably have never been                                                                   
     to  medical  school  and can't  diagnose  that  kind  of                                                                   
     disorder.  If there is,  I'd like to  meet them  but for                                                                   
     now   we   need   to  limit   what   schools   can   do.                                                                   
SENATOR DAVIS  stated her  intent in bringing  SB 230  forward was                                                              
not  to address  what many  people  have referred  to as  teachers                                                              
making these  recommendations. She  said if  a teacher  was making                                                              
such recommendations,  the teacher  would not  be the one  writing                                                              
the  letter. Teachers  might  say  something informally  during  a                                                              
parent-teacher  conference, but anything  official would  not come                                                              
from a teacher. She said her concern  is about how these drugs are                                                              
being  introduced to  children in  general, regardless  of who  is                                                              
doing it.                                                                                                                       
CHAIRWOMAN  GREEN   asked  those  participants  who   have  raised                                                              
questions  to  work with  Senator  Davis  and  her staff  to  find                                                              
SENATOR WARD asked  if there is any way to find  out the number of                                                              
children on Ritalin.                                                                                                            
MR.  BENAVIDES  said  there  would   be  no  record  if  a  parent                                                              
administers  the  drug before  school  or  if  a child  takes  the                                                              
medication on  his or her own,  however the number  of medications                                                              
administered by school personnel should be recorded.                                                                            
SENATOR DAVIS corrected a previous  statement she made and said in                                                              
the Anchorage School District 480  students were identified by the                                                              
school nurse, not 800.                                                                                                          
MR. BENAVIDES  said it  should be  possible to  get the  number of                                                              
students receiving medications from school personnel.                                                                           
There being no further business to come before the committee,                                                                   
CHAIRWOMAN GREEN adjourned the meeting at 3:27 p.m.                                                                             

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