Legislature(2011 - 2012)ANCH LIO Rm 220
08/21/2012 09:00 AM Senate HEALTH & SOCIAL SERVICES
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| Mental Health Grievance Procedures | |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
August 21, 2012
9:02 a.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Dennis Egan
Senator Fred Dyson
MEMBERS ABSENT
Senator Johnny Ellis
Senator Kevin Meyer
COMMITTEE CALENDAR
MENTAL HEALTH GRIEVANCE PROCEDURES AT ALASKA PSYCHIATRIC
INSTITUTE (API) AND OTHER INSTITUTIONS
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
RON ADLER, CEO and Director
Alaska Psychiatric Institute (API)
Anchorage, AK
POSITION STATEMENT: Provided patient statistics and information
about the grievance procedures at API.
PAUL CORNILS, Chair
API Advisory Board
Anchorage, AK
POSITION STATEMENT: Described the work of the API consumer
advisory board.
KATE BURKHART, Executive Director
Alaska Mental Health Board, Advisory Board on Alcoholism and
Drug Abuse, and Statewide Suicide Prevention Council
Juneau, AK
POSITION STATEMENT: Testified that Alaska has committed to the
idea that mental health clients are active participants in their
treatment who have taken a role in driving their grievance
procedures, and she would hate to see state government take that
away.
JIM GOTTSTEIN, President
Law Project for Psychiatric Rights
Anchorage, AK
POSITION STATEMENT: Testified during the hearing on grievance
procedures at mental health treatment facilities and highlighted
the problems with over-drugging.
FAITH MYERS, representing herself
Anchorage, AK
POSITION STATEMENT: Testified during the hearing on grievance
procedures at mental health treatment facilities and listed the
complaints that API patients filed in one year.
DORRANCE COLLINS, representing himself
Anchorage, AK
POSITION STATEMENT: Testified that psychiatric patients are
complaining about their treatment and the grievance procedure.
CHARLENE MILES, representing herself
Anchorage, AK
POSITION STATEMENT: Testified during the hearing on grievance
procedures at mental health treatment facilities and described a
personal experience.
JAMILIA SAEIDS, representing herself
Anchorage, AK
POSITION STATEMENT: Testified that there is a clear need to
establish an easy procedure for individuals to object to their
mental health treatment.
DARYL NELSON, representing himself
Anchorage, AK
POSITION STATEMENT: Advocated for the state to adopt mental
health grievance procedures similar to those used by Medicare
and Medicaid.
BONNIE NELSON, representing herself
Anchorage, AK
POSITION STATEMENT: Testified that working on the grievance
procedure at mental health treatment facilities is a good start.
KAREN PURDUE, President and CEO
Alaska State Hospital and Nursing Home Association (ASHNA) and
former commissioner, Department of Health and Social Services
Anchorage, KA
POSITION STATEMENT: Testified that community hospitals have done
a good job helping people in the community so they are less
likely to have to go to API.
SHIRLEY HOLLOWAY, representing herself
Anchorage, AK
POSITION STATEMENT: Testified in support of the efforts to come
up with a functional procedure for individuals who need to file
grievances.
MARK REGAN, Legal Director
Disability Law Center (DLC)
Anchorage, AK
POSITION STATEMENT: Testified in support of amending the
existing grievance statute.
ACTION NARRATIVE
9:02:40 AM
CHAIR BETTYE DAVIS called the Senate Health and Social Services
Standing Committee meeting to order at 9:02 a.m. Present at the
call to order were Senators Dyson, Egan and Chair Davis.
^Mental Health Grievance Procedures
MENTAL HEALTH GRIEVANCE PROCEDURES
9:03:09 AM
CHAIR DAVIS announced the business before the committee was to
listen to suggestions for changing the mental health grievance
procedures at the Alaska Psychiatric Institute (API) and other
institutions.
9:04:14 AM
THOMAS OBERMEYER, staff to Senator Davis, summarized Senator
Davis's efforts to change the grievance procedures. Last session
she introduced SB 55 to amend Title 47 and change [Rule 82,
Alaska Rules of Civil Procedure, and Rule 508, Alaska Rules of
Appellate Procedure]. The concern is that increasing numbers of
mental health patients are appearing in both private and public
institutions, yet one grievance procedure does not cover all
institutions. Some of the suggestions were to hire an outside
advocate and institute central data collection. He noted that
the State of Maine has one of the best procedures for a central
advocacy reporting system and the State of Georgia has a state
ombudsman.
Although AS 47.30.847(a) says that an impartial body within the
treatment facility will hear patient grievances, it is difficult
to have an impartial review when the entire process is internal,
Mr. Obermeyer stated.
9:10:46 AM
SENATOR DYSON asked what the argument is against having private
institutions under the purview of this law.
MR. OBERMEYER answered that the institutions believe they can
adequately handle any issues that arise. The problem is that
complaints typically do not go beyond a chief executive officer
and the state has no knowledge of what happened. He said a
letter from North Star Behavioral Health indicated that
juveniles should be handled differently because they might
target individual employees and cause terminations, but there is
no way of knowing whether that is a problem or not.
SENATOR DYSON said he assumes that private institutions did not
object in CSSB 55, version O, to the addition of [paragraphs 12-
19] to AS 47.30.840(a).
MR. OBERMEYER described those as generic additions that most
states have adopted.
SENATOR DYSON asked if the committee would hear about the kinds
of abuses that have made it necessary to ensure that there is an
appeal and review process.
CHAIR DAVIS said yes.
9:15:09 AM
RON ADLER, CEO and Director, Alaska Psychiatric Institute (API),
informed the committee that API's policies and procedures on
grievances evolve every year and undergo review on an ongoing
basis. API welcomes the dialog and transparency, he stated.
MR. ADLER said that 2,955 individuals were admitted to API over
the last two years; 98.24 percent were involuntary admissions
and 1.76 percent were voluntary. Staff inform patients of the
grievance process in both group and individual meetings which
take place daily on each unit. Grievance forms and locked
submittal boxes are located in an open area in each unit. Posted
next to these boxes is the notice of patient rights and
responsibilities and telephone numbers for the Disability Law
Center, Adult Protective Services, Ombudsman's Office, and API's
Consumer and Family Specialist.
The grievance forms give patients four options; patients can
comment, compliment the hospital or staff, complain about
services or treatment, or formally lodge a grievance. API staff
pick up the forms every day, and the consumer and family
specialist meets with the patient within 48 hours to resolve the
issue at the level the patient chooses. Level I complaints are
resolved informally at the unit and level II complaints are
resolved formally at the administrative level.
Level I complaints resolve within seven days. Patients exercise
self-advocacy and problem solving skills, and API staff honors
the API philosophy that patients actively participate in their
own recovery.
Level II grievances receive a written, administrative-level
response within 7 days and an outcome letter within 30 days. The
director's contact information is included in case the patient
disagrees with the findings.
MR. ADLER reiterated that a patient can submit a level II
grievance on any issue of concern. Also important is that all
allegations of abuse are immediately submitted as a level II
grievance. These forms are not part of a patient's permanent
medical record.
Policies and procedures for grievances were implemented in
October 2007 following lengthy discussions between consumers and
the advisory board. Two consumers presented a list of about 20
complaints based on their experiences while at the hospital. The
process was further clarified on April 2, 2012 in direct
response to a Disability Law Center investigation finding.
National hospital accreditation agencies for Medicare and
Medicaid recently gave API policy and documentation positive
reviews. Site reviewers observed that patients are obviously
comfortable filing complaints, and they gave kudos for the
efforts to resolve complaints at the unit level.
CHAIR DAVIS asked where the complaint goes if the patient is
unsatisfied with an administrative-level decision.
MR. ADLER answered that patients always have the ability to
lodge a complaint with the Disability Law Center, Adult
Protective Services, and the Office of the Ombudsman. He
confirmed that those complaints are confidential, and not shared
with API.
9:24:04 AM
CHAIR DAVIS asked if API was overcrowded and if that was causing
problems.
MR. ADLER answered no. The average daily census for the last two
years suggests that the hospital is about 70 percent full.
Almost everyone is admitted within 24 hours.
CHAIR DAVIS asked how many adolescents were currently in the
hospital.
MR. ADLER responded that eight adolescents were in the hospital
yesterday and the unit has ten beds.
SENATOR DYSON asked if API receives referrals for psychiatric
evaluation from hospital emergency rooms.
MR. ADLER said sometimes.
SENATOR DYSON asked how long it takes to do a psychiatric
evaluation.
MR. ADLER answered that 72 hours is generally granted to do the
evaluation and make a report to the court. This includes
treatment recommendations and a recommendation about whether the
individual would benefit from a 30-day commitment.
SENATOR DYSON asked who pay the bills for most patients.
9:26:56 AM
MR. ADLER explained that the API operating budget is between $28
million and $30 million depending on the amount of premium pay.
A portion of that comes from federal Disproportionate Share
Funds (DSH) that are allocated through the Social Security
Administration Act for state psychiatric hospitals that are
deemed institutions for mental disease (IMD). API's annual
disproportionate share is about $6.5 million, and state general
funds match that amount. The rest of the funding comes from
third-party reimbursement and additional general fund dollars.
SENATOR DYSON commented that virtually no one pays his or her
own bills.
MR. ADLER clarified that private sector clients pay their own
bills; API collects about $6 million a year in third-party
reimbursements.
SENATOR DYSON commented that private sector payments generally
mean a third-party payer.
MR. ADLER responded that there are times when people write a
check because of the co-pay associated with their insurance. One
stipulation for federal DSH payments is that the institution has
to make a good faith effort to collect hospital bills. When an
API patient has a third-party insurer, the patient is invoiced
for any co-pay and the hospital receives money for the services
provided.
CHAIR DAVIS asked for a breakdown on the third-party payers.
MR. ADLER explained that API bills Medicaid for the population
up to age 21 and over age 65. It also does business with TRICARE
for veterans and active military, and all the other major
insurance companies that operate within Alaska.
SENATOR DYSON asked if API does business with any Native health
organizations.
MR. ADLER answered no.
9:29:49 AM
MR. ADLER reviewed the data that was collected on the grievance
policy and procedure for the past fiscal year. Of 1,630
admissions, 168 complaints were filed and 22 grievances had to
be resolved. Fifty-eight percent of the comments concerned how
staff treated individuals. He said that a member of the advisory
board reviews those grievances on a monthly basis.
CHAIR DAVIS asked who appoints the members of the advisory board
and how long they serve.
MR. ADLER said the DHSS commissioner appoints the members after
Paul Cornils, the current board chair, has reviewed the names.
He said he didn't know how long the members serve.
CHAIR DAVIS noted that the Legislature did not confirm the
members, and asked for a list of the current members.
MR. ADLER agreed to follow up with the information.
9:33:27 AM
MR. ADLER explained that the advisory board member who reviews
the grievances submits that information to the full board. He
described the constant feedback as a quality-assurance process.
He opined that API is the only hospital in the nation with this
level of transparency with a consumer-driven advisory board.
CHAIR DAVIS asked how many members were on the advisory board
and an unidentified speaker in the audience said there were 11
members.
MR. ADLER said the number of actual grievances dropped between
2011 and 2012 and the number of comments increased. Over a five-
year period, there were 8,004 admissions, 1,074 complaints, and
133 grievances filed.
9:37:56 AM
CHAIR DAVIS asked if any advisory board members wanted to
testify.
9:38:54 AM
PAUL CORNILS, Chair, API Advisory Board, said he calls the board
a consumer advisory board. There are quarterly meetings and
subcommittee work takes place as necessary.
CHAIR DAVIS asked if he had any concerns to express about the
grievance process.
MR. CORNILS said the current process developed over the course
of a year and models the Maine Riverside Hospital process.
CHAIR DAVIS said she would appreciate it if each of the advisory
board members would review SB 55 and comment on it as a board.
MR. CORNILS said he did not object to the bill as written. He
offered his understanding that some people believe that some
grievance issues rise to level III and that these should be
addressed outside the hospital. He said he had no evidence that
the current process wasn't working.
SENATOR DYSON asked if any grievances resulted in criminal
charges for assault or rape.
MR. ADLER replied those issues are handled through the incident
reporting process and seldom get as far as a grievance. The
response is generally within 24 hours. He confirmed that there
were some of these grievances, but he wasn't sure if any
resulted in criminal charges.
CHAIR DAVIS asked who would have that information.
MR. ADLER replied he would have to look back in the records.
SENATOR DYSON expressed surprise at the answer and expressed
interest in getting the information.
CHAIR DAVIS asked Mr. Adler to follow up.
MR. ADLER committed to provide the information within 24 hours.
9:46:08 AM
KATE BURKHART, Executive Director, Alaska Mental Health Board,
Advisory Board on Alcoholism and Drug Abuse, and Statewide
Suicide Prevention Council, said her comments were on behalf of
the boards for which she works. She informed the committee that
the AMHB has a seat on the API consumer advisory board; until
recently it was filled by Andrea Schmook, a mental health
consumer who in the past spent time at API. She has represented
AMHB very well over the years and has been a major participant
in the quality assurance committee. She provided ongoing updates
and conversations about how API has gone through the quality
improvement and procedure review over the years.
She said that in 2007 AMHB received stakeholder input with a
list of concerns about patient grievances at API. The Alaska
Mental Health Board decided to assemble an ad hoc committee, and
Ms. Schmook served on both committees to ensure information
sharing and work coordination. API and the advisory board
focused on grievance procedures at the state psychiatric
hospital and the ad hoc committee focused on grievance
procedures that were in place in community mental health
centers.
MS. BURKHART said API addressed those stakeholder concerns by
developing a consumer driven grievance procedure, and AMHB would
recommend that any legislative action reinforce and respect that
consumer-driven process. Alaska has committed to the idea that
mental health clients are active participants in their treatment
who have taken a role in driving their grievance procedures. She
said she would hate to see state government take that away.
9:49:25 AM
CHAIR DAVIS emphasized that she liked the process and wanted to
make it better.
MS. BURKHART explained that the majority of mental health
services in Alaska are voluntary and provided through non-profit
community mental health centers. API and non-profit hospitals in
Fairbanks, Juneau, and Anchorage provide all the involuntary
commitment services in the state. She relayed that the
distinction that the boards have made consistently through this
process is that a grievance procedure for someone undergoing
forced mental health treatment should focus strictly on
protecting the patient. Community mental health centers also
have grievance procedures as required by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) and the
Centers for Medicare and Medicaid Services and (CMS).
She directed attention to the packets and explained that in 2009
the boards compared the grievance procedures required by CMS and
JCAHO to the procedures that API had developed over the last
couple of years. The document shows the requirements under which
Alaska's community health centers and hospitals already operate.
She cautioned that any ensuing legislation should not conflict
with these federal requirements or be overly bureaucratic such
that the people receiving services find the process unnavigable.
It should promote the idea of patient-centered care that the
community mental health centers have embraced.
9:52:48 AM
MS. BURKHART suggested that having a separate grievance
procedure for mental health consumers furthers their stigma. If
the goal is to protect patients and ensure respectful and
dignified treatment, the focus should be on a comprehensive,
universal patient protection and grievance procedure. It should
not distinguish mental health consumers.
SENATOR DYSON asked if individuals identified as vulnerable to
suicidal are often committed by court order.
MS. BURKHART answered yes. She relayed that the boards regularly
receive comments from individuals concerning their experience
with community and institutional mental health services. The
boards respond in force to those complaints so that is another
avenue for consumers.
9:57:05 AM
JIM GOTTSTEIN, President, Law Project for Psychiatric Rights,
reviewed the things he wanted the committee to consider
including the book, "Anatomy of an Epidemic" and a law review
article he wrote about involuntary commitment and forced
drugging cases. He questioned the grievance statistics that Mr.
Adler presented and emphasized that it did not have to be the
case that more than 98 percent of the commitments are forced. He
said the preamble to the current Alaska commitment statute says
that people should have the opportunity for voluntary
participation before initiating any legal proceedings, but that
isn't honored because it's so easy to haul these people in, lock
them up, and drug them against their will.
He pointed out that in Myers v. Alaska Psychiatric Institute,
the Alaska Supreme Court ruled that Alaska's forced drugging
statute was unconstitutional to the extent that it did not
require proof that drugging was in the person's best interest
and there was no less intrusive alternative. Dr. Loren Mosher
testified that in his entire career he had never had to call the
police to keep someone from committing personal grievous harm,
because he and the patient agreed beforehand how to move forward
with treatment.
MR. GOTTSTEIN stated that the ubiquitous use of psychiatric
drugs is causing massive problems. They knock down symptoms in
the short term, but in the long term they dramatically increase
not only health problems but also the number of people who do
not recover. This is borne out by the statistic that shows that
on average, people in the public mental health system die 25
years earlier than the general population. It demonstrates how
little value these people have. In the U.S. 5-20 percent of
mental health recipients recover; Finland uses the "Open Dialog"
approach to treatment and 80 percent of mental health recipients
recover.
He emphasized the importance of both due process and a realistic
appeal process, and stated support for the provision in SB 55 to
amend Rule 82 so it would not apply to patients who appeal an
adverse decision. This is very important because the Office of
the Attorney General has a policy of seeking attorney's fees
whenever it wins a case. That was an issue in the Myers case.
10:05:23 AM
SENATOR DYSON surmised that the reason the attorney general
might want to recover attorney fees is to dampen frivolous
suits. He asked if that was a real concern in his constituency.
MR. GOTTSTEIN opined that the policy intended to discourage
lawsuits in general.
SENATOR DYSON asked if suits claiming over-drugging have been
successful nationally.
MR. GOTTSTEIN said no, but that is a goal of the Law Practice
for Psychiatric Rights.
SENATOR DYSON expressed surprise at the lack of criminal
negligence and/or civil suits if inappropriate drugging is such
a problem and causing so many people to die.
MR. GOTTSTEIN responded that the tort system is probably not a
good system for resolving these issues. The assumption is that
people diagnosed with serious mental illness do not have income
potential so lawyers aren't very interested. Nevertheless, it is
important to have an effective and speedy grievance procedure.
Mr. Adler testified that API usually handles the grievance
within 24 hours, but there needs to be a formal procedure to
ensure that happens.
He emphasized the importance of having an effective grievance
procedure for people who are forcibly committed and drugged
against their will. The facts don't show that they do. Private
facilities should be subject to the same rules when they are
operating under the state's involuntary commitment procedures.
10:11:47 AM
FAITH MYERS, representing herself, listed the complaints that
API patients filed in one year: 54 related to respect and
dignity; 7 related to privacy; 3 related to communications; 1
related to religion; 4 were HIPAA issues; 14 related to
discharge issues; 1 related to the right to refuse treatment; 3
were sexual allegations; 44 were complaints about treatment; 18
related to safety; 11 related to dietary issues; 17 related to
medication; 4 were complaints regarding medical treatment; 11
were complaints against doctors or therapists; and 28 related to
basic rights, 6 of which were about smoking.
She relayed that when she filed a complaint as a patient in a
psychiatric institution she did not receive a written response
and was not able to file an appeal. She also filed a complaint
at Providence Hospital psychiatric unit concerning physical
abuse. It took 40 days to receive a written resolution denying
the claims and there was no information about any appeal
process. She noted that a psychiatric hospital can grant itself
a 30-60 day extension to solve a patient's complaint without
informing the patient.
MS. MYERS said the local newspapers support the claim that the
current psychiatric patient grievance procedures are not
working. She cited examples and highlighted that a common thread
is that the psychiatric patients received unreasonable responses
to their complaints. She urged the state to shorten the response
time to patient complaints and to provide greater oversight and
protection. The average stay for a patient is 14 days so 30 days
is too long for a patient in a psychotic state to wait to
receive an answer to a complaint. She urged the Legislature to
amend AS 47.30.847 to include due process for complaints, an
appeal process, and an urgent grievance requirement. The
committee substitute for SB 55 is a good start.
10:16:09 AM
DORRANCE COLLINS, representing himself, stated that psychiatric
patients are complaining about their treatment and the grievance
procedure. He said a person with a mental illness doesn't have
to break a law to be handcuffed and transported to a locked
psychiatric unit. They often arrive with legitimate complaints.
He noted that the grievance and appeal processes vary depending
on the facility. Some psychiatric facilities have an appeal
process for patient complaints and some do not. Some resolve
patient complaints in 7 days and some take 30 days. Some
psychiatric facilities have an informal complaint process but no
timeframe for completion. Some facilities give grievance and
appeal information to patients and some do not. Almost every
psychiatric facility can grant itself a 30-day extension to
resolve a patient complaint, but is not obliged to inform the
patient or state. Patient advocacy organizations may help a
patient file a complaint, but it may take 30 days or more to get
a response.
MR. COLLINS said that psychiatric patients will find alternative
solutions if they do not receive a response to a complaint or
appeal within a reasonable period. Those solutions are often
tragic. He emphasized that psychiatric patients need to be
given, by law, the right to file a complaint when they choose
and with detailed due process. They need the right to file an
appeal, including an appeal that goes beyond the walls of the
institution. Patients need access to a grievance procedure that
is shorter than 7 days, and help filing the grievance if needed.
Finally, the state should be required to keep statistics on the
number and type of complaints filed by psychiatric patients and
the resolutions. Access to this information should be public. He
said AS 47.30.847 needs amendment and HB 55 is a good starting
point.
10:19:40 AM
CHARLENE MILES, representing herself, described an incident when
she was an inpatient at the Fairbanks hospital. The police came
into the ward and arrested another patient after throwing him to
the ground and handcuffing him. The process was very chaotic and
frightening to the other patients, but the staff did nothing to
deescalate their anxiety. When she tried to talk about the
incident, the staff told her it was not her concern. Because of
that incident, she is afraid of seeking additional psychiatric
help at that hospital. She emphasized the importance of knowing
that a psychiatric ward is a safe place and more than just a
time-out chair. In conclusion, she offered her belief that
returning veterans very quickly will overwhelm the capabilities
of the Fairbanks hospital psychiatric ward.
10:24:29 AM
JAMILIA SAEIDS, representing herself, described herself as a
psychiatric survivor, the parent of children with psychiatric
difficulties, a professional mental health clinician, and mental
health care specialist and advocate. She said there is a clear
need to establish an easy procedure for individuals to object to
their mental health treatment. The procedure must be readily
accessible, the complaint review impartial, and the
institutional response timely.
The current law covering grievance procedures, AS 47.30.850, is
vague, does not provide due process or appeal procedures, and
has no provision for immediate, urgent grievances. The evidence
indicates that grievances are not resolved quickly; oftentimes
it is well after discharge. She emphasized that it is in the
community's best interest to do everything possible to
facilitate the recovery of an individual experiencing mental
health issues. The absence of a workable grievance procedure
undermines recovery and can have dire consequences for a
community. She urged legislators to pass some version of SB 55;
it is a substantial improvement over current law.
10:28:47 AM
DARYL NELSON, representing himself, said he has advocated for
all disabilities his entire life. He suggested adopting mental
health grievance procedures similar to those used by Medicare
and Medicaid. He described over-drugging and the harm it does;
sometimes it's like being in a straitjacket. There has to be a
better solution.
10:33:16 AM
BONNIE NELSON, Daryl's mother, said her son made her strong. She
said working on the grievance procedure is a good start. She
expressed hope that next session there would be time to look at
not only the grievance procedure but also what the grievances
are about. She said she has been helping Daryl design an open
dialog program together with Senator Dyson so that people can
gather to talk about their out-of-control feelings without being
afraid that they will be locked up in a psychiatric unit and
lose their self-determination.
MS. NELSON described the range of mental health treatments that
she and other family members have undergone. No one was forced
into treatment or an institution, but some of the experiences
were frightening and traumatic.
She concluded that learning how to deal with emotions should not
be a within a medical model; it should be an educational
process.
10:41:17 AM
KAREN PURDUE, President and CEO, Alaska State Hospital and
Nursing Home Association (ASHNA), and former commissioner of the
Department of Health and Social Services (DHSS), said the
community hospitals have done a good job helping people in the
community so they are less likely to have to go to API. ASHNA
wants to incent community hospitals to care for patients in the
community, but providing this care can be overwhelming.
ASHNA has formed a behavioral health committee to explore ways
that community hospitals can be more involved in finding
solutions. She said she would like to work to avoid grievances
by giving patients what they need when they need it. She also
questioned the need for community hospitals to have a separate
grievance system for mental health patients because hospitals
already have rigorous complaint procedures in place.
10:44:52 AM
MS. PURDUE suggested the committee also take a serious look at
the capacity at API and if it is sufficient to meet the needs
over the next decade or two. The hospital has a capacity of 80
beds, but just 50 beds cycle.
SENATOR DYSON asked if grievance procedures should apply
universally to both private and public institutions. He also
asked if institutions should be required to report grievances
regularly.
MS. PURDUE said she supports transparency and a trend analysis
of complaints would be good.
SENATOR DYSON repeated the first question.
MS. PURDUE said she was concerned in particular about community
hospitals whose business is much more than mental health
treatment. She suggested looking at the complaint procedures
already in place in community hospitals and cautioned against
applying anything extraordinary.
SENATOR DYSON asked if community hospitals include for-profit
hospitals.
MR. PURDUE named just two for-profit hospitals. Alaska Regional
Hospital operates as a community hospital and North Star
Behavioral Health treats children.
CHAIR DAVIS said the reason for bringing this to the public is
that mental health patients often can't speak for themselves.
She expressed optimism that subsequent legislation would improve
on SB 55, but it is a good start.
10:51:24 AM
SHIRLEY HOLLOWAY, representing herself, said she is speaking as
a mother and she applauds the efforts to come up with a
functional procedure for individuals who need to file
grievances. She said the state and nation needs a comprehensive
mental health plan because accessing help can be a nightmare.
When her daughter was admitted to API, she was hopeful that she
would receive a comprehensive diagnosis and treatment, but she
was released very soon and committed suicide. Ms. Holloway said
she is advocating for continued work.
10:53:06 AM
MARK REGAN, Legal Director, Disability Law Center (DLC), said
the DLC believes the grievance statute needs modification. It
needs to include specifics about procedures for raising a
complaint, getting timely processing with a result, and appeal
outside the institution to the commissioner level or court. The
idea behind SB 55 is good.
MR. REGAN noted that the committee had two different things
before it. The first is the statement of rights that people
ought to have in an institution. The second is a description of
the procedures that institutions are supposed to use. He said
the right to an individualized plan and review of that plan is
good, but it also needs to include discharge planning. He noted
that the rights listed in SB 55 come out of the commitment and
treatment statutes and should be cross-referenced.
10:57:35 AM
He addressed how the procedure should work. Currently API is
under requirements from CMS and the JCAHO system to have a
grievance procedure. CMS requires all hospitals to have
timelines in their grievance procedures. The most important ones
for patients are timelines for a decision and a response.
Subsequent legislation should include similar timelines. An
outside tracking system is also valuable.
11:00:13 AM
SENATOR DYSON asked him to comment on the lack of criminal and
civil actions that been filed, given the national statistics.
MR. REGAN said his response is similar to Mr. Gottstein's;
individual personal injury actions against people working at
institutions are difficult and take a long time. Regarding
criminal actions, he said it is not the way to run an
institution to assume that somebody who does something wrong
will be punished in a criminal process. One reason the grievance
process is so important is that it can call attention to an
issue relatively quickly. That is probably why the current
statute requires a grievance procedure. All regulatory agencies
at the federal level require all hospitals to have one, and it
would be a good idea for the committee to push forward to
develop a more detailed process.
11:06:09 AM
SENATOR DYSON asked about the potential for criminal action if a
patient called 911 to report an assault or a guardian reported
an assault or inappropriate restraint. He said the longevity
statistics for people with mental health issues are alarming.
MR. REGAN said SB 55 lists the right of informed consent and
other rights on freedom from restraint. Psychiatric institutions
have authority that the federal government recognizes to impose
seclusion and restraint under some circumstances. The Disability
Law Center has a special responsibility to investigate and
respond to complaints and bring them to the attention of the
institution. That has been done at API and there have been
differences of opinion. A provision in SB 55 provides a way to
resolve issues and change procedures at an institution even when
the individual who filed the grievance is no longer a patient.
That is accomplished by API's current procedures, but it would
be cemented by reintroduction of SB 55.
SENATOR DYSON asked if the process is working for patients or
their guardians who call the police with a criminal complaint.
MR. REGAN said he didn't know if criminal cases have been
prosecuted, but a police officer who is investigating what
happened at an institution would have many layers to navigate.
SENATOR DYSON asked him to think about ways the Legislature
could improve the process.
MR. REGAN said there are a number of ways to help things work
better and the criminal system is one, but not the first.
11:09:21 AM
CHAIR DAVIS invited written comments to improve SB 55; that
information will be submitted to the new HSS committee in
January. She expressed particular interest in receiving comments
on the grievance processes used by Georgia and Maine. She asked
if there were closing comments.
DORRANCE COLLINS said both Maine and Georgia had the JCAHO
system but patients in those states were systematically abused
and some died. It was the law that helped.
11:11:53 AM
JIM GOTTSTEIN said he probably gets one call every two weeks
from someone who was dissatisfied with their treatment at API.
It illustrates the magnitude of the problem.
11:13:59 AM
CHAIR DAVIS thanked the participants and committee members and
adjourned the Senate Health and Social Services Standing
Committee meeting at 11:13 a.m.
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