Legislature(2021 - 2022)BUTROVICH 205

05/04/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Audio Topic
01:49:28 PM Start
01:49:58 PM SB124
03:08:43 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SB 124 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
-- Public Testimony --
+= SB 38 NATUROPATHS: LICENSING; PRACTICE TELECONFERENCED
<Bill Hearing Canceled>
<Bill Hearing Rescheduled to 05/06/2021>
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                          May 4, 2021                                                                                           
                           1:49 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Tom Begich                                                                                                              
Senator Mia Costello                                                                                                            
Senator Lora Reinbold                                                                                                           
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 124                                                                                                             
"An  Act relating  to admission  to and  detention at  a subacute                                                               
mental health  facility; establishing a definition  for 'subacute                                                               
mental health  facility'; establishing  a definition  for 'crisis                                                               
residential  center'; relating  to  the  definitions for  'crisis                                                               
stabilization   center';  relating   to  the   administration  of                                                               
psychotropic  medication  in  a  crisis  situation;  relating  to                                                               
licensed facilities; and providing for an effective date."                                                                      
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
SENATE BILL NO. 38                                                                                                              
"An  Act relating  to the  practice of  naturopathy; establishing                                                               
the  Naturopathy Advisory  Board;  relating to  the licensure  of                                                               
naturopaths; relating to  disciplinary sanctions for naturopaths;                                                               
relating to  the Department of Commerce,  Community, and Economic                                                               
Development; and providing for an effective date."                                                                              
                                                                                                                                
     - BILL HEARING CANCELED AND RESCHULED TO 5/6/21                                                                            
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 124                                                                                                                  
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS                                                                                    
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR                                                                                    
                                                                                                                                
04/12/21       (S)       READ THE FIRST TIME - REFERRALS                                                                        
04/12/21       (S)       HSS, FIN                                                                                               
04/27/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/27/21       (S)       Heard & Held                                                                                           
04/27/21       (S)       MINUTE(HSS)                                                                                            
04/29/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
04/29/21       (S)       -- MEETING CANCELED --                                                                                 
05/04/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
MARK REGAN, Attorney                                                                                                            
Disability Law Center of Alaska                                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
FRANCESCA ALLEGREZZA, representing self                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 124.                                                                        
                                                                                                                                
MAJOR DAVID HANSON, Deputy Director                                                                                             
Central Office                                                                                                                  
Division of Alaska State Troopers                                                                                               
Department of Public Safety                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
KATHLEEN WEDEMEYER, Citizens Commission on Human Rights                                                                         
Northwest Chapter                                                                                                               
Seattle, Washington                                                                                                             
POSITION STATEMENT: Testified about concerns with SB 124.                                                                     
                                                                                                                                
ANN RINGSTAD, Executive Director                                                                                                
National Alliance on Mental Illness Alaska                                                                                      
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
SARAH KOOGLE, Director of Adult Services                                                                                        
Alaska Behavioral Health                                                                                                        
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
ROGER BRANSON, representing self                                                                                                
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
BEVERLY SCHOONOVER, Executive Director                                                                                          
Advisory Board on Alcoholism and Drug Abuse and                                                                                 
Alaska Mental Health Board                                                                                                      
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Testified in support of SB 124.                                                                           
                                                                                                                                
CHRISTINE ROBBINS, representing self                                                                                            
Fairbanks, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 124.                                                                        
                                                                                                                                
ANDREA MCLEOD, representing self                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Testified in opposition to SB 124.                                                                        
                                                                                                                                
LISA GENTEMANN, representing self                                                                                               
Eagle River, Alaska                                                                                                             
POSITION STATEMENT: Testified in opposition to SB 124.                                                                        
                                                                                                                                
KRISTIANA FITZWATER, representing self                                                                                          
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Testified in opposition to SB 124.                                                                        
                                                                                                                                
HEATHER CARPENTER, Health Care Policy Advisor                                                                                   
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 124.                                                                             
                                                                                                                                
ALBERT WALL, Deputy Commissioner                                                                                                
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 124.                                                                             
                                                                                                                                
STEVEN BOOKMAN, Senior Assistant Attorney General                                                                               
Human Services Section                                                                                                          
Civil Division                                                                                                                  
Department of Law                                                                                                               
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions on SB 124.                                                                             
                                                                                                                                
NANCY MEADE, General Counsel                                                                                                    
Administrative Staff                                                                                                            
Office of the Administrative Director                                                                                           
Alaska Court System                                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 124.                                                                           
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:49:28 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:49 p.m.  Present at the                                                               
call  to  order were  Senators  Hughes,  Costello, Reinbold,  and                                                               
Chair Wilson.  Senator Begich  arrived during  the course  of the                                                               
meeting.                                                                                                                        
                                                                                                                                
             SB 124-MENTAL HEALTH FACILITIES & MEDS                                                                         
                                                                                                                                
1:49:58 PM                                                                                                                    
CHAIR WILSON announced the consideration of SENATE BILL NO. 124                                                                 
"An  Act relating  to admission  to and  detention at  a subacute                                                               
mental health  facility; establishing a definition  for 'subacute                                                               
mental health  facility'; establishing  a definition  for 'crisis                                                               
residential  center'; relating  to  the  definitions for  'crisis                                                               
stabilization   center';  relating   to  the   administration  of                                                               
psychotropic  medication  in  a  crisis  situation;  relating  to                                                               
licensed facilities; and providing for an effective date."                                                                      
                                                                                                                                
CHAIR WILSON  stated his intent  to take public testimony  for SB
124, sponsored  by the Senate  Rules Committee by the  request of                                                               
the governor. He  noted that the committee had  heard an overview                                                               
of the bill on April 27.                                                                                                        
                                                                                                                                
1:51:01 PM                                                                                                                    
CHAIR WILSON opened public testimony on SB 124.                                                                                 
                                                                                                                                
1:51:12 PM                                                                                                                    
MARK   REGAN,  Attorney,   Disability  Law   Center  of   Alaska,                                                               
Anchorage, Alaska, stated that SB  124 makes it easier for people                                                               
in  crisis  to  get  short-term   mental  health  treatment.  The                                                               
Disability  Law  Center of  Alaska  endorses  SB 124  with  minor                                                               
language  adjustments  regarding  the appointment  of  attorneys,                                                               
evaluations  performed by  residential centers,  readmission, and                                                               
staffing capacity. SB  124 replaces an outdated  system. He urged                                                               
the legislature to moderately revise and pass SB 124.                                                                           
                                                                                                                                
SENATOR REINBOLD  asked if SB  124 is  based on a  Disability Law                                                               
Center lawsuit against Alaska.                                                                                                  
                                                                                                                                
MR.  REGAN replied  that SB  124 is  an idea  independent of  the                                                               
Disability Law  Center of  Alaska's lawsuit.  It will  help solve                                                               
the problems  raised by  the settled case  and is  an improvement                                                               
that would be before members regardless  of the suit. It makes it                                                               
possible for people to get  through the process cleaner, simpler,                                                               
and faster.                                                                                                                     
                                                                                                                                
1:55:01 PM                                                                                                                    
FRANCESCA  ALLEGREZZA,  representing   self,  Anchorage,  Alaska,                                                               
stated  she  does  not  support   unconstitutional  SB  124.  She                                                               
questioned  how a  person is  determined to  be mentally  ill and                                                               
feared   that  having   an  opposing   view  could   lead  to   a                                                               
determination  of  being  mentally  ill.  She  considers  SB  124                                                               
government  overreach  and  a  precursor to  red  flag  laws  and                                                               
reeducation camps.                                                                                                              
                                                                                                                                
MAJOR DAVID HANSON, Deputy Director,  Central Office, Division of                                                               
Alaska State  Troopers, Department  of Public  Safety, Anchorage,                                                               
Alaska,  stated the  Department of  Public Safety  (DPS) supports                                                               
subacute mental health facilities  for people experiencing mental                                                               
health  crises. DPS  views law  enforcement's response  to mental                                                               
health calls  as a  serious priority.  Troopers often  respond to                                                               
incidents  where  people  are  experiencing  suicidal  ideations,                                                               
manic episodes,  delusions, depression,  or states  of distortion                                                               
due to the ingestion of  drugs or alcohol. Trooper investigations                                                               
sometimes  reveal  no  crime, but  the  subject  needs  immediate                                                               
assistance;  such an  occurrence is  when a  crisis stabilization                                                               
center  can offer  an alternative  to inappropriate  placement in                                                               
jails, full-scale medical services, or being left to suffer.                                                                    
                                                                                                                                
1:59:21 PM                                                                                                                    
SENATOR  REINBOLD asked  that a  scene  be described  in which  a                                                               
state trooper, without mental health  training, needs to detain a                                                               
person  experiencing  a mental  health  crisis.  She opined  that                                                               
mental  health   certification  for  peace  officers   should  be                                                               
included in SB 124.                                                                                                             
                                                                                                                                
1:59:58 PM                                                                                                                    
MAJOR HANSON  replied that troopers receive  mental health crisis                                                               
training at  the academy,  which covers  a variety  of illnesses.                                                               
They cannot diagnose an individual  on scene, and they respond to                                                               
identify  problems  and  investigate   crimes.  He  stated  peace                                                               
officers would  be able  to take individuals  to a  subacute care                                                               
facility for aide.                                                                                                              
                                                                                                                                
SENATOR REINBOLD  reiterated that she wanted  a clear description                                                               
of a person  experiencing a mental health crisis. She  asked if a                                                               
person would be reported as mentally  ill if they did not want to                                                               
be vaccinated or  expressed a political opinion.  She wondered if                                                               
clear  and convincing  evidence would  be approved  over probable                                                               
cause, as probable cause is an opinion.                                                                                         
                                                                                                                                
MAJOR  HANSON replied  that law  enforcement would  not act  on a                                                               
person solely expressing an opinion.                                                                                            
                                                                                                                                
Through  training   and  collaboration  with   stakeholders,  the                                                               
centers described  in SB 124  would be the  best place to  take a                                                               
mentally ill person  who is perceived to be a  harm to themselves                                                               
or others.                                                                                                                      
                                                                                                                                
2:03:16 PM                                                                                                                    
SENATOR REINBOLD  replied that  she wanted  a description  of the                                                               
situation.  She  also asked  if  reporting  individuals would  be                                                               
based on clear and convincing evidence and not probable cause.                                                                  
                                                                                                                                
MAJOR   HANSON  stated   his  belief   that  all   troopers  have                                                               
encountered  individuals  experiencing  mental  health  episodes,                                                               
such  as a  delusional  person screaming  in  their driveway  and                                                               
frightening others.  Troopers do  not diagnose people.  Their job                                                               
is to  stabilize a  situation, get needed  help, and  keep people                                                               
safe.  They  are  to  assist  and  resolve  problems.  He  stated                                                               
troopers are never  in a position where they can,  at the moment,                                                               
say something  is one hundred  percent true. Troopers  respond to                                                               
rapidly evolving  situations and must use  the tools, facilities,                                                               
and services available at the  time. To suggest that troopers use                                                               
a clear and  convincing standard goes beyond  being reasonable in                                                               
many situations.                                                                                                                
                                                                                                                                
2:06:31 PM                                                                                                                    
KATHLEEN   WEDEMEYER,  Citizens   Commission   on  Human   Rights                                                               
Northwest  Chapter,  Seattle,  Washington,  stated  the  Citizens                                                               
Commission on Human Rights is  a mental health watchdog group. SB
124 rethinks  the psychiatric system  for Alaska.  The commission                                                               
is against any increased detention  for evaluation and any forced                                                               
treatment   provisions  of   SB   124  that   would  affect   the                                                               
constitutional rights of  Alaska citizens. No one  should be held                                                               
for more than  72 hours without judicial  review. Additionally, a                                                               
psychiatrist  must  be  the gatekeeper  of  detention  beyond  24                                                               
hours. One  of the many  issues with  SB 124 is  that individuals                                                               
may  be  subject  to  unjustifiable  confinement  and  subsequent                                                               
consequences of being labeled mentally ill.                                                                                     
                                                                                                                                
MS.  WEDEMEYER  said a  key  element  of  SB  124 should  be  the                                                               
enactment  of  health  outcome  measurements.  When  establishing                                                               
systems  that promote  treatment, governments  and courts  should                                                               
consider  the lack  of accountability  that has  been built  into                                                               
treatment  systems   that  utilize  involuntary   commitment  and                                                               
community  treatment   laws.  They   should  also   consider  the                                                               
importance of  information when seeking  to create health  in the                                                               
people forced into treatment. The  public is told about treatment                                                               
failures  but  not  about recommended  treatment  that  fails  to                                                               
produce the outcome psychiatry and advocates promoted.                                                                          
                                                                                                                                
In  public mental  health, tracking  system outcomes  are favored                                                               
over mental  health outcomes. Service utilization,  engagement in                                                               
services,  demographics,   and  ethnic  information   are  system                                                               
outcomes. There is almost a  complete lack of tracking for actual                                                               
health outcomes.                                                                                                                
                                                                                                                                
2:08:45 PM                                                                                                                    
MS.  WEDEMEYER   opined  that  the  envisioned   system  must  be                                                               
accountable to  the citizens  via the  government that  funds it.                                                               
Tracking patient health  outcomes should be an  essential part of                                                               
SB  124  and  not  be  ignored  because  of  imaginative  closure                                                               
violations. On  the web pages  of advocates  for SB 124,  such as                                                               
Crisis  Now, NAMI,  and hospitals,  there is  minimal information                                                               
about the toxic nature of psychiatric  drugs and the long list of                                                               
dangerous side effects.                                                                                                         
                                                                                                                                
There  must  be  a  system to  address  individuals  experiencing                                                               
emotional crises and represent harm  to themselves or others. The                                                               
legislature must  work out this  system to safeguard  the public.                                                               
She opined that SB 124 has the following issues:                                                                                
   • Lack of accountability and oversight                                                                                       
   • Lack of health outcomes                                                                                                    
   • Wide-open-door to system expansion                                                                                         
   • Lack of emphasis on overall health                                                                                         
   • Opens the door to increased involuntary commitment of                                                                      
     adults and youth                                                                                                           
   • Raises concerns regarding parental oversight of minors                                                                     
                                                                                                                                
MS. WEDEMEYER said  focusing on a system that  creates health and                                                               
identifies   physical   ailments   and   disorders   that   mimic                                                               
psychiatric disorders will benefit Alaska citizens.                                                                             
                                                                                                                                
She said she  is willing to impart information to  anyone who has                                                               
questions about psychiatric illness.                                                                                            
                                                                                                                                
2:10:58 PM                                                                                                                    
SENATOR   HUGHES  asked   Ms.  Wedemeyer   to  provide   language                                                               
suggestions to SB  124 that might bring about  the principles she                                                               
listed in her testimony.                                                                                                        
                                                                                                                                
MS. WEDEMEYER  replied that she would  provide modified language.                                                               
She stated  she has  gone through  SB 124  and is  very concerned                                                               
with the jump from 72 to 120 hours of confinement.                                                                              
                                                                                                                                
SENATOR REINBOLD said  she would like to work  with Ms. Wedemeyer                                                               
on her concerns about SB 124.                                                                                                   
                                                                                                                                
2:14:31 PM                                                                                                                    
ANN  RINGSTAD, Executive  Director, National  Alliance on  Mental                                                               
Illness  Alaska, Anchorage,  Alaska,  stated  that NAMI  provides                                                               
education,  advocacy, and  public awareness  so that  individuals                                                               
affected by mental illness can  build better lives. She said that                                                               
NAMI Alaska  supports SB  124 because it  addresses the  need for                                                               
appropriate lower-level care response for behavioral health.                                                                    
                                                                                                                                
SB 124 is  essential to Alaska   implementation  of proven crisis                                                               
response  improvements,   including  the   nationally  recognized                                                               
Crisis Now model. Instead of  an emergency room, first responders                                                               
could take  individuals in  crisis to  a low,  no barrier,  or No                                                               
Wrong  Door  crisis  stabilization   center.  This  new  approach                                                               
follows  the national  guidelines  for  behavioral health  crisis                                                               
care using  best practices  endorsed by  the Substance  Abuse and                                                               
Mental  Health Services  Administration of  the US  Department of                                                               
Health and  Social Services.  Their guidelines  are science-based                                                               
and  real-world tested  best practices  in the  behavioral health                                                               
field.                                                                                                                          
                                                                                                                                
NAMI  Alaska applauds  the Alaska  Mental Health  Trust Authority                                                               
for analysis and  consideration of a framework  suited for Alaska                                                               
through  the Crisis  Now  model and  looks  forward to  continued                                                               
discussions about the Crisis Now initiative.                                                                                    
                                                                                                                                
2:16:59 PM                                                                                                                    
SENATOR REINBOLD  asked if NAMI  was involved in drafting  SB 124                                                               
and whether it would benefit  financially from the legislation if                                                               
passed.                                                                                                                         
                                                                                                                                
CHAIR  WILSON  replied  that  no  one is  given  funds  from  the                                                               
Department  of  Health  and  Social   Services  (DHSS)  to  draft                                                               
legislation.                                                                                                                    
                                                                                                                                
MS. RINGSTAD replied that statement was correct.                                                                                
                                                                                                                                
SENATOR REINBOLD said  her question was did NAMI  Alaska stand to                                                               
financially benefit if the legislation passes.                                                                                  
                                                                                                                                
CHAIR WILSON responded  that the entire state  would benefit, and                                                               
the answer would  be opinion-based. He asked if  NAMI helped DHSS                                                               
write any part of SB 124.                                                                                                       
                                                                                                                                
[Online contact with Ms. Ringstad was lost.]                                                                                    
                                                                                                                                
2:18:16 PM                                                                                                                    
SARAH  KOOGLE,  Director  of Adult  Services,  Alaska  Behavioral                                                               
Health,  Fairbanks,  Alaska, testified  that  SB  124 would  help                                                               
individuals  receive  correct levels  of  care.  With the  proper                                                               
resources in  place, high hospitalization  rates can  be avoided.                                                               
First responders are  working outside of their  scope of practice                                                               
trying  to  help Alaska's  behavioral  health  crisis. Using  the                                                               
Crisis Now model, adequately trained  individuals will step in to                                                               
assist and avoid a trip  to the emergency room. Alaska Behavioral                                                               
Health supports SB 124.                                                                                                         
                                                                                                                                
2:19:27 PM                                                                                                                    
ROGER BRANSON, representing self,  Eagle River, Alaska, stated he                                                               
advocates for mental  health consumers. In 1987 he  was granted a                                                               
temporary   restraining  order   to   prevent   the  state   from                                                               
involuntarily medicating  him with Thorazine. Hundreds  of people                                                               
living  on the  streets of  Anchorage stand  to benefit  from the                                                               
Crisis Now model following the  pandemic. SB 124 will enable that                                                               
model to be operational in time  to serve those people. There has                                                               
been  a massive  grassroots movement  to make  this care  happen.                                                               
Passing  SB 124  will enable  people to  help each  other. Mental                                                               
health problems are hard to  define but easily recognizable. From                                                               
his personal  experience, 72-hours to a  scheduled hearing always                                                               
took 120  hours because of weekends  and holidays.  He  finds the                                                               
increase to 120 hours concerning. However,  he urged SB 124 to be                                                               
moved  forward  so  that  people currently  on  the  streets  can                                                               
benefit from Crisis Now.                                                                                                        
                                                                                                                                
2:22:30 PM                                                                                                                    
BEVERLY  SCHOONOVER,   Executive  Director,  Advisory   Board  on                                                               
Alcoholism  and  Drug  Abuse  and  Alaska  Mental  Health  Board,                                                               
Division of  Behavioral Health, Department  of Health  and Social                                                               
Services,  Juneau,  Alaska  said Alaska's  citizen-led  statewide                                                               
advisory  boards are  tasked with  evaluating  federal and  state                                                               
laws  concerning  mental  health, alcoholism,  substance  misuse,                                                               
prevention, and treatment services.                                                                                             
                                                                                                                                
The  legislature has  supported many  policy efforts  to build  a                                                               
continuum of  care for Alaska's  most vulnerable  populations. SB
124  is a  crucial policy  needed for  ongoing behavioral  health                                                               
reform efforts.                                                                                                                 
                                                                                                                                
SB 124 would expand existing  Title 47 authorities to allow peace                                                               
officers and mental healthcare  professionals to temporarily hold                                                               
Alaskans  at  subacute  mental  health  facilities  if  they  are                                                               
experiencing  a  mental  health  crisis.  This  expansion  is  an                                                               
emergency medical intervention for  Alaskans whose mental illness                                                               
causes them  to be  a danger  to themselves.  It is  for Alaskans                                                               
experiencing severe mental, emotional, and physical distress.                                                                   
                                                                                                                                
MS. SCHOONOVER said there are  few places for Alaskans to receive                                                               
the support they  need, and they often end up  in emergency rooms                                                               
or local jails. Crisis emergency  medical centers will be staffed                                                               
by   medical  professionals   and   trained   peers  with   lived                                                               
experience. She  urged the members to  pass SB 124 and  asked for                                                               
support with ongoing behavioral health reform efforts.                                                                          
                                                                                                                                
2:24:26 PM                                                                                                                    
CHRISTINE  ROBBINS, representing  self, Fairbanks,  Alaska, urged                                                               
members to  vote against SB  124 because  no one should  have the                                                               
right  to  impose  medical   intervention  without  consent.  She                                                               
offered her belief  that it is unconstitutional, and  she said no                                                               
insurance would  indemnify the administrator against  harm caused                                                               
to  the  recipient.  Another  danger  of  SB  124  would  be  the                                                               
administration of drugs  based solely on training  and not actual                                                               
medical  qualifications  and   certifications.  She  offered  her                                                               
belief  that   legislators  should  make  public   inebriation  a                                                               
punishable offense to deter it from happening.                                                                                  
                                                                                                                                
2:26:16 PM                                                                                                                    
MS.  ROBBINS  testified  that  as  a person  who  works  in  jail                                                               
ministry, putting  mentally ill individuals in  jail with inmates                                                               
creates  a  dangerous  environment  because  they  are  not  kept                                                               
separate.                                                                                                                       
                                                                                                                                
2:26:58 PM                                                                                                                    
ANDREA MCLEOD, representing self,  Anchorage, Alaska, stated that                                                               
the Mental  Health Trust has a  lot of programs and  grants. NAMI                                                               
could be  a beneficiary of one  of its grants. The  mental health                                                               
system  in  Alaska  is industry-driven,  and  the  Alaska  Mental                                                               
Health Trust Authority (AMHTA) is in it for money.                                                                              
                                                                                                                                
She maintained that:                                                                                                            
   • SB 124 does not provide proper mental health treatment.                                                                    
 • The mental health system in Alaska is broken and sporadic.                                                                   
   • Programs that were once available are gone.                                                                                
   • Emergency acute psychiatric care standards continue to be                                                                  
     lowered.                                                                                                                   
   • Certification standards are being lowered. A person no                                                                     
     longer needs to be a psychiatrist to administer                                                                            
     psychotropic drugs.                                                                                                        
                                                                                                                                
There is a diminishment of  real psychiatric help. The mission of                                                               
AMHTA is  to get people better  with its millions of  dollars. SB
124  does  not get  Alaska  where  it  needs to  be.  Involuntary                                                               
injections are  not how people get  better. It is horrific  to be                                                               
involuntarily  injected, and  it  does not  produce any  positive                                                               
outcome. SB  124 is  a catch  and release  bill to  alleviate the                                                               
demands for services at hospitals.                                                                                              
                                                                                                                                
MS. MCLEOD said  hospitals have a strong lobby and  get what they                                                               
want. Hospitals  continue to have  fewer psychiatric  patients as                                                               
they are being left  on the street with no care.  Crisis Now is a                                                               
catch and release program. The  mentally ill will be caught, kept                                                               
involuntarily for a short period,  injected, and then be released                                                               
back to the street with no  genuine care or treatment in the long                                                               
term. Fully funding the Alaska  Psychiatric Institute (API) would                                                               
answer a lot of mental health problems.                                                                                         
                                                                                                                                
2:31:40 PM                                                                                                                    
LISA GENTEMANN,  representing self,  Eagle River,  Alaska, stated                                                               
she  is  firmly  against  SB  124.  She  has  been  a  healthcare                                                               
provider, dental  hygienist, and  mom. She  has learned  that the                                                               
most  critical component  for good  relationships and  success is                                                               
patient  consent. Forcing  students  to do  work  or patients  to                                                               
floss  doesn't work.  She  took  someone she  loved  to a  mental                                                               
health facility  and had a  terrible experience  involving force,                                                               
which  hurt  her  relationship with  this  person.  The  person                                                                 
condition  worsened.   Success  came   when  this   person  began                                                               
exercising  and   found  spiritual  guidance.  Desire   from  the                                                               
individual is critical to success.                                                                                              
                                                                                                                                
2:33:50 PM                                                                                                                    
CHAIR WILSON acknowledged Senator Begichs arrival.                                                                              
                                                                                                                                
2:33:59 PM                                                                                                                    
KRISTIANA  FITZWATER, representing  self, Palmer,  Alaska, stated                                                               
she has  concerns after reading SB  124 and wonders if  there are                                                               
regulations on what constitutes a  mentally ill person. She takes                                                               
issue with  the state having the  ability to drug a  person three                                                               
times without consent;  she believes it is a  power easily abused                                                               
and violates individual rights.                                                                                                 
                                                                                                                                
2:35:49 PM                                                                                                                    
CHAIR WILSON closed public testimony on  SB 124. He called on Ms.                                                               
Carpenter.                                                                                                                      
                                                                                                                                
2:37:16 PM                                                                                                                    
HEATHER  CARPENTER, Health  Care  Policy Advisor,  Office of  the                                                               
Commissioner, Department  of Health and Social  Services, Juneau,                                                               
Alaska,  reminded  members  that  SB   124  is  about  the  civil                                                               
involuntary  commitment process.  The  bulk  of Alaskans  needing                                                               
mental  or   behavioral  health  treatment  are   served  through                                                               
voluntary treatment.  Alaskans need a robust  and improved crisis                                                               
psychiatric  response  system   for  individuals  experiencing  a                                                               
crisis and are unable to seek the care they need voluntarily.                                                                   
                                                                                                                                
The  only options  for evaluation  and  treatment are  designated                                                               
hospitals  or API.  These facilities  are currently  only in  the                                                               
communities of Anchorage, Fairbanks, Mat-Su, and Juneau.                                                                        
                                                                                                                                
She said there is a  constitutional process for involuntary civil                                                               
commitment.  A person  with mental  illness  who is  a threat  to                                                               
themselves or others  or considered gravely disabled  is held for                                                               
evaluation upon application to the  court. Mentally ill, a threat                                                               
to self or  others, and gravely disabled are  defined in statute.                                                               
Individuals  meeting  these  definitions  are  offered  voluntary                                                               
treatment. When  a hospital files a  petition, it is signed  by a                                                               
mental  health professional,  and a  full evidentiary  hearing is                                                               
conducted where legal counsel represents the patient.                                                                           
                                                                                                                                
2:39:01 PM                                                                                                                    
MS.  CARPENTER said  SB 124  is a  monumental shift  because care                                                               
will be provided in less  restrictive environments. Mental health                                                               
care at  the lower levels  of the new  system can be  compared to                                                               
receiving physical help at an urgent care facility.                                                                             
                                                                                                                                
The  1115  Behavioral  Health  Medicaid   Waiver  is  also  being                                                               
leveraged.  The  1115  waiver   allows  for  referral-based  care                                                               
determined by  need, which  means there  is immediate  support to                                                               
stabilize  individuals  through   crisis  stabilization  centers.                                                               
Crisis stabilization  centers are a less  restrictive alternative                                                               
to  traditional involuntary  commitment  holds.  The 1115  waiver                                                               
will  provide   referral  pathways   for  individuals   who  need                                                               
additional behavioral  health services, either  through admission                                                               
to  a  residential crisis  center  or  community care.  The  1115                                                               
waiver  has already  enabled  DHSS to  set  up an  administrative                                                               
services  organization  that  tracks  individuals'  outcomes  and                                                               
referrals to ongoing community care.                                                                                            
                                                                                                                                
The 1115 waiver drives down  healthcare costs by enabling payment                                                               
for  service providers  of  critical  behavioral health  support,                                                               
including  crisis stabilization  and residential  crisis centers.                                                               
Payment  is possible  because suitable  individuals are  diverted                                                               
from  costly  hospital and  emergency  room  care to  a  Medicaid                                                               
reimbursable  crisis  response  system, which  has  already  been                                                               
approved for  Medicaid and Medicare services.  These services are                                                               
delivered  by qualified  board and  state-licensed mental  health                                                               
professionals.                                                                                                                  
                                                                                                                                
MS. CARPENTER  said these professionals connect  individuals in a                                                               
behavioral  health  crisis  to the  appropriate  level  of  care,                                                               
preventing the crisis from escalating. A  goal of DHSS is to have                                                               
more  treatment  options,   including  crisis  stabilization  and                                                               
residential  centers  in the  nine-state  regions  served by  the                                                               
waiver.                                                                                                                         
                                                                                                                                
2:41:10 PM                                                                                                                    
MS.  CARPENTER  said these  centers  would  allow individuals  to                                                               
receive psychiatric care  closer to home. Rural  areas often have                                                               
long  wait  times  for  transport  to  a  designated  involuntary                                                               
commitment facility.                                                                                                            
                                                                                                                                
In 2016, the passage of Senate  Bill 74 74 included language that                                                               
directed  DHSS  to specifically  apply  for  the 1115  Behavioral                                                               
Health  Waiver  that  would improve  behavioral  health  outcomes                                                               
while containing health care costs.  This waiver has allowed DHSS                                                               
to target resources towards  individuals who are super-utilizers.                                                               
These users  are Medicaid recipients who  repeatedly receive care                                                               
at the  most costly and acute  end of the behavioral  health care                                                               
continuum.                                                                                                                      
                                                                                                                                
DHSS has  established a range  of effective  needs-based services                                                               
and supports  through the  1115 waiver.  The new  options created                                                               
under SB 124 supplement Alaska's  current psychiatric crisis care                                                               
system with less restrictive involuntary  commitment care. SB 124                                                               
is  a win  for patients  because it  provides a  less restrictive                                                               
system  of  care.  It  is  a  win  for  hospitals  and  ERs  that                                                               
specifically asked  for resources to  free up  beds. It is  a win                                                               
for  law  enforcement because  it  provides  broader options  for                                                               
handling individuals experiencing a mental health crisis.                                                                       
                                                                                                                                
2:43:33 PM                                                                                                                    
MS.  CARPENTER clarified  that  minors have  the  same rights  as                                                               
adults in  civil commitment statutes,  and they have  more rights                                                               
for court-appointed  guardian ad  litem and parental  rights. Any                                                               
parent of a minor in  an involuntary commitment hold receives all                                                               
notices  that a  minor child  receives. A  minor and  parent each                                                               
gets  an   appointed  attorney,   which  ensures  a   parent  has                                                               
representation  if   there  is  disagreement  with   the  minor's                                                               
attorney.                                                                                                                       
                                                                                                                                
Emergency involuntary  commitment holds can be  started by police                                                               
officers,  physician assistants,  physicians, and  psychologists,                                                               
ensuring that access  to care happens quickly  when an individual                                                               
needs it the most.                                                                                                              
                                                                                                                                
The  definition of  peace officer  was expanded  to enable  peace                                                               
officers  to hold  an  in-crisis individual  for  the purpose  of                                                               
transport to a  treatment center. This change does  not mean that                                                               
a peace  officer may recommend or  administer crisis medications,                                                               
other care or  determine if an individual  meets the requirements                                                               
of a  future hold.  The qualified  mental health  professional on                                                               
staff at  the center  will determine  if the  individual requires                                                               
crisis  medication, other  care or  meets the  requirement for  a                                                               
future  hold. Allowing  a  peace officer  hold  was requested  by                                                               
Anchorage providers and  the community to assist  in their effort                                                               
to erect mobile crisis teams.                                                                                                   
                                                                                                                                
MS.  CARPENTER asserted  it  is  inaccurate to  say  that SB  124                                                               
allows police  officers to medicate individuals  involuntarily or                                                               
provide crisis  medication. The  language in  SB 124  only allows                                                               
crisis medication  to be prescribed  by a physician,  an advanced                                                               
nurse practitioner,  or a physician  assistant. At no time  can a                                                               
police officer administer medicines to  a person in their care or                                                               
custody.                                                                                                                        
                                                                                                                                
2:46:12 PM                                                                                                                    
SENATOR HUGHES  opined that  involuntary commitment  holds should                                                               
have  defined  parameters  so   individuals  are  protected.  She                                                               
suggested SB  124 be  referred to  the Judiciary  Committee since                                                               
matters   such   as    constitutional   rights,   court-appointed                                                               
attorneys,  and evidentiary  hearings are  better suited  to that                                                               
committee's scope.                                                                                                              
                                                                                                                                
2:47:39 PM                                                                                                                    
SENATOR REINBOLD  agreed that  SB 124 should  be referred  to the                                                               
Judiciary Committee. She offered her  belief that the standard of                                                               
probable  cause  in Section  2  should  be  raised to  clear  and                                                               
convincing  or beyond  a reasonable  doubt.  On page  2, line  7,                                                               
mental illness should  be defined and not left  to opinion. Also,                                                               
on the top  of page 2, she does not  think licensed psychiatrists                                                               
and physicians should be removed from the language.                                                                             
                                                                                                                                
SENATOR   HUGHES  clarified   that  licensed   psychiatrists  and                                                               
physicians  are not  being deleted  from  SB 38.  They are  being                                                               
encapsulated into a definition.                                                                                                 
                                                                                                                                
2:51:00 PM                                                                                                                    
ALBERT  WALL, Deputy  Commissioner, Office  of the  Commissioner,                                                               
Department  of  Health  and   Social  Services,  Juneau,  Alaska,                                                               
clarified that the people being  added to the definition of peace                                                               
officer  are   not  people  who  are   allowed  to  involuntarily                                                               
commitment and  individual. They are  the people who can  take an                                                               
individual  to a  crisis center.  Due process  does have  a legal                                                               
definition, as  does mental  health. He  deferred to  Mr. Bookman                                                               
for the explanations.                                                                                                           
                                                                                                                                
2:52:38 PM                                                                                                                    
STEVEN   BOOKMAN,  Senior   Assistant  Attorney   General,  Human                                                               
Services Section,  Civil Division, Department of  Law, Anchorage,                                                               
Alaska,  stated  that  mental   illness  is  already  statutorily                                                               
defined,  and  SB  124  would not  change  that  definition.  The                                                               
definition in AS 47.30.915(14) reads:                                                                                           
                                                                                                                                
      mental   illness   means   an   organic,  mental,   or                                                                    
     emotional  impairment  that   has  substantial  adverse                                                                    
     effects   on  an   individual's  ability   to  exercise                                                                    
     conscious  control  of   the  individual's  actions  or                                                                    
     ability   to  perceive   reality   or   to  reason   or                                                                    
     understand;   intellectual  disability,   developmental                                                                    
     disability,  or  both,  epilepsy, drug  addiction,  and                                                                    
     alcoholism  do not  per se  constitute mental  illness,                                                                    
     although  persons suffering  from these  conditions may                                                                    
     also be suffering from mental illness.                                                                                     
                                                                                                                                
MR.  BOOKMAN stated  that procedural  due process  is a  flexible                                                               
idea that depends  on the circumstance. It  is essentially notice                                                               
and  the  opportunity   to  be  heard.  In   the  current  30-day                                                               
commitment  laws, due  process involves  an evaluation  period, a                                                               
petition, and a hearing in front  of a judge. Before the hearing,                                                               
the respondent will have had the  right to read the plea ahead of                                                               
time and have  the attorney go over their medical  charts. At the                                                               
hearing, certain  things are proved,  and the respondent  has the                                                               
right to  cross-examine, present  witnesses, and testify  if they                                                               
want to.                                                                                                                        
                                                                                                                                
2:55:00 PM                                                                                                                    
SENATOR  COSTELLO  asked  if  parental  rights  are  relinquished                                                               
through the  involuntary commitment  of a  minor. She  also asked                                                               
how  a disagreement  between  a parent  and  child's attorney  is                                                               
resolved.                                                                                                                       
                                                                                                                                
2:55:59 PM                                                                                                                    
NANCY  MEADE, General  Counsel, Administrative  Staff, Office  of                                                               
the  Administrative   Director,  Alaska  Court   System,  Juneau,                                                               
Alaska, deferred to Mr. Bookman.                                                                                                
                                                                                                                                
MR.   BOOKMAN  replied   that  parental   rights  would   not  be                                                               
relinquished  or suspended  during this  process. The  child will                                                               
have an attorney,  and each parent will have  their attorney. The                                                               
judicial  officer  would  resolve   disputes.  For  example,  the                                                               
child's attorney could  argue that the child  should be released,                                                               
one parent  could say that the  child should stay, and  the other                                                               
parent  may  say  the  child should  be  released.  The  judicial                                                               
officer would then make the determination.                                                                                      
                                                                                                                                
2:57:20 PM                                                                                                                    
SENATOR COSTELLO asked members if  they would like the input from                                                               
the  Disability Law  Center to  be  put into  draft language  for                                                               
consideration.  One  clarifying  suggestion had  been  whether  a                                                               
person held involuntarily has a court-appointed attorney.                                                                       
                                                                                                                                
MS.  MEADE  replied   that  a  person  held   on  an  involuntary                                                               
commitment  is appointed  an  attorney, and  the  court does  the                                                               
appointing.                                                                                                                     
                                                                                                                                
2:58:28 PM                                                                                                                    
SENATOR  COSTELLO asked  what happens  when  someone is  released                                                               
from a stabilization center but is immediately readmitted.                                                                      
                                                                                                                                
MR. WALL  stated there  is a  provision for  preauthorization for                                                               
readmittance in  SB 124. He  said he will  find and submit  it in                                                               
writing to the members.                                                                                                         
                                                                                                                                
2:59:41 PM                                                                                                                    
SENATOR  BEGICH asked  what happens  to the  settlement with  the                                                               
Alaska Disability Law Center, if SB 124 does not pass.                                                                          
                                                                                                                                
3:00:17 PM                                                                                                                    
MR. WALL replied to the  previous question that readmission for a                                                               
patient is subject to a court  order and is part of the admission                                                               
process.                                                                                                                        
                                                                                                                                
CHAIR WILSON repeated the question that  if SB 124 does not pass,                                                               
will  the  state  violate  the   settlement  between  the  Alaska                                                               
Disability Law Center and DHSS.                                                                                                 
                                                                                                                                
MR. WALL  answered no;  as Mark  Regan testified,  SB 124  is not                                                               
tied to that settlement. However, SB  124 would be part of easing                                                               
the burden on the system and  addressing the needs of patients in                                                               
Alaska. SB  124 creates  a base  level of  service and  care that                                                               
will support  the model  discussed in  the Alaska  Disability Law                                                               
Center settlement, but it is not tied to it.                                                                                    
                                                                                                                                
3:01:52 PM                                                                                                                    
SENATOR  REINBOLD  stated   that  if  SB  124   were  only  about                                                               
establishing subacute  care facilities,  she would have  no issue                                                               
with  it. She  would  like  the Disability  Law  Center to  draft                                                               
suggested language for SB 124. She  asked if SB 124 would provide                                                               
representation for every person committed involuntarily.                                                                        
                                                                                                                                
MS. MEADE  answered that SB  124 provides public counsel  and the                                                               
right to  a hearing  for respondents,  including minors,  who are                                                               
involuntarily  admitted  to  a crisis  stabilization  center.  An                                                               
individual is  not provided an  attorney during the  23-hour hold                                                               
period.                                                                                                                         
                                                                                                                                
3:04:32 PM                                                                                                                    
SENATOR REINBOLD  asked for comment  on the advanced  health care                                                               
directive portion of SB 124.                                                                                                    
                                                                                                                                
MS.  MEADE   replied  that  Section  9   addresses  the  advanced                                                               
healthcare directive portion  of SB 124. The  first several lines                                                               
of  the   statute  remain  unchanged.   Section  9   states  that                                                               
medication can be administered only  with court approval. A long-                                                               
standing  statute  regarding  the involuntary  administration  of                                                               
psychotropic  medication  is  referenced  on  page  6,  line  22.                                                               
Healthcare providers  must petition  the court.  There will  be a                                                               
hearing  and an  attorney  appointed. A  court appointed  visitor                                                               
will arrange  for evaluations to  be performed on  the respondent                                                               
and  make  recommendations  to  the  court  on  the  individual's                                                               
capacity to give  informed consent. New language on  page 21 says                                                               
if the patient  can provide informed consent, and  gives it, then                                                               
medication can be given.                                                                                                        
                                                                                                                                
3:06:43 PM                                                                                                                    
CHAIR WILSON stated Mr. Wall  would provide written commentary on                                                               
the advanced  healthcare directive and answer  whether the Alaska                                                               
Psychiatric  Institute  goes  through  the  certificate  of  need                                                               
process.                                                                                                                        
                                                                                                                                
SENATOR  HUGHES  stated  that   the  sixth  principle  of  mental                                                               
healthcare  listed  in AS  47.30.655  is  concerning. It  states,                                                               
"that persons  who are mentally  ill but not dangerous  to others                                                               
be  committed  only  if  there is  a  reasonable  expectation  of                                                               
improving their mental condition." She  asked if consent would be                                                               
required in this instance since  it is not for protecting anyone.                                                               
Her  concern  is  that  the   sixth  principle  would  allow  for                                                               
involuntary commitment for non-safety purposes.                                                                                 
                                                                                                                                
[SB 38 was held in committee.]                                                                                                  
                                                                                                                                
3:08:43 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson  adjourned  the Department  of  Health  and  Social                                                               
Services Standing Committee meeting at 3:08 p.m.                                                                                

Document Name Date/Time Subjects
SB 124 Anchorage Fire Department Letter of Support.pdf SHSS 5/4/2021 1:30:00 PM
SB 124
SB 124 Disability Law Center second letter 5.3.21.pdf SHSS 5/4/2021 1:30:00 PM
SB 124
SB 124 Public Input 5.4.21.pdf SHSS 5/4/2021 1:30:00 PM
SB 124
SB 124 Nancy Meade Ak Court System.pdf SHSS 5/4/2021 1:30:00 PM
SB 124