Legislature(2021 - 2022)BUTROVICH 205

04/07/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Audio Topic
01:33:47 PM Start
01:34:34 PM Confirmation Hearing(s)
01:50:37 PM SB124
03:03:21 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Consideration of Governor's Appointees: Agnes TELECONFERENCED
Moran, Alaska Mental Health Trust Authority Board
of Trustees
-- Public Testimony --
+= SB 124 MENTAL HEALTH FACILITIES & MEDS TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
**Streamed live on AKL.tv**
ALASKA STATE LEGISLATURE                                                                                                      
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         April 7, 2022                                                                                          
                           1:33 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Shelley Hughes, Vice Chair                                                                                              
Senator Lora Reinbold                                                                                                           
Senator Tom Begich (via teleconference)                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Mia Costello                                                                                                            
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
CONFIRMATION HEARING(S):                                                                                                        
                                                                                                                                
Alaska Mental Health Trust Board                                                                                              
Agnes Moran  Ketchikan                                                                                                          
                                                                                                                                
     - CONFIRMATION ADVANCED                                                                                                    
                                                                                                                                
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                                                                                                             
                                                                                                                                
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                                                                           
05/04/21       (S)       Heard & Held                                                                                           
05/04/21       (S)       MINUTE(HSS)                                                                                            
05/05/21       (S)       JUD REFERRAL ADDED AFTER HSS                                                                           
05/06/21       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
05/06/21       (S)       <Bill Hearing Canceled>                                                                                
03/08/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/08/22       (S)       Heard & Held                                                                                           
03/08/22       (S)       MINUTE(HSS)                                                                                            
03/15/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/15/22       (S)       Heard & Held                                                                                           
03/15/22       (S)       MINUTE(HSS)                                                                                            
03/17/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/17/22       (S)       Heard & Held                                                                                           
03/17/22       (S)       MINUTE(HSS)                                                                                            
03/22/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/22/22       (S)       Heard & Held                                                                                           
03/22/22       (S)       MINUTE(HSS)                                                                                            
03/23/22       (S)       JUD AT 1:30 PM BUTROVICH 205                                                                           
03/23/22       (S)       <Bill Hearing Canceled>                                                                                
03/25/22       (S)       JUD AT 1:30 PM BUTROVICH 205                                                                           
03/25/22       (S)       -- MEETING CANCELED --                                                                                 
03/29/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
03/29/22       (S)       Heard & Held                                                                                           
03/29/22       (S)       MINUTE(HSS)                                                                                            
04/07/22       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
AGNES MORAN, Appointee                                                                                                          
Alaska Mental Health Trust Authority Board of Trustees                                                                          
Department of Revenue (DOR)                                                                                                     
Ketchikan, Alaska                                                                                                               
POSITION STATEMENT: Testified as the governor's appointee to the                                                              
Alaska Mental Health Trust Authority Board of Trustees.                                                                         
                                                                                                                                
DAVID WILLSON, Captain                                                                                                          
Central Office                                                                                                                  
Division of Alaska State Troopers                                                                                               
Department of Public Safety                                                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered question on SB 124.                                                                              
                                                                                                                                
                                                                                                                                
NANCY MEADE, General Counsel                                                                                                    
Office of the Administrative Director                                                                                           
Alaska Court System                                                                                                             
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Answered questions on SB 124.                                                                             
                                                                                                                                
HEATHER CARPENTER, Healthcare Policy Advisor                                                                                    
Department of Health and Social Services (DHSS)                                                                                 
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.                                                                             
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:33:47 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:33 p.m.  Present at the                                                               
call   to    order   were   Senators   Reinbold,    Begich   (via                                                               
teleconference), Hughes, and Chair Wilson.                                                                                      
                                                                                                                                
                                                                                                                                
^CONFIRMATION HEARING(S)                                                                                                      
                    CONFIRMATION HEARING(S)                                                                                 
     ALASKA MENTAL HEALTH TRUST AUTHORITY BOARD OF TRUSTEES                                                                 
                                                                                                                                
1:34:34 PM                                                                                                                    
CHAIR  WILSON  announced  the  consideration  of  the  governor's                                                               
appointment of  Agnes Moran,  to the  Alaska Mental  Health Trust                                                               
Authority Board of Trustees.                                                                                                    
                                                                                                                                
1:35:04 PM                                                                                                                    
AGNES  MORAN, Appointee,  Alaska  Mental  Health Trust  Authority                                                               
Board  of  Trustees,  Ketchikan,  Alaska, provided  some  of  her                                                               
history including that she had  a bachelor's degree in electrical                                                               
engineering,  had  worked   on  experimental  military  satellite                                                               
systems and  computer networking,  and had  run a  private grant-                                                               
making foundation. She has been on  the board of First Bank since                                                               
2003. She  returned to Alaska  in 1999  to raise her  family. She                                                               
started working in a voluntary  capacity with trust beneficiaries                                                               
who   experience  chronic   homelessness   and  substance   abuse                                                               
disorders,  first  by  volunteering   with  her  family  for  the                                                               
community meals program.  She wanted her children to  get to know                                                               
trust  beneficiaries as  individuals. She  moved on  to become  a                                                               
founder of  the overnight warming  center, and served as  a board                                                               
member of  First City  Homeless Services  until January  2021. In                                                               
2017 she  became the  executive director of  Women in  Safe Homes                                                               
(WISH), a  nonprofit organization that is  dedicated to providing                                                               
support to  victims of domestic  violence and sexual  assault and                                                               
their  families. At  the time,  WISH  was on  probation from  its                                                               
major  funder,  the  Council  on  Domestic  Violence  and  Sexual                                                               
Assault, the staff turnover rate  was 150 percent, the grant base                                                               
was  declining,  and  some  in the  community  were  calling  for                                                               
dissolution.                                                                                                                    
                                                                                                                                
MS.  MORAN related  that during  her  tenure, WISH  has come  off                                                               
probation, staff has stabilized, the  grant base has tripled, and                                                               
the  service  offerings  in the  community  have  been  expanded.                                                               
Importantly,  she said  the community  turned out  in force  when                                                               
WISH opened its new shelter  in October, 2021. During her tenure,                                                               
WISH has not  received much mental health  funding. She described                                                               
the broad spectrum of trust beneficiaries that WISH serves.                                                                     
                                                                                                                                
MS. MORAN  stated that she  has been working with  and supporting                                                               
trust  beneficiaries  for  over  ten  years  and  has  a  working                                                               
knowledge of leading a  service-providing organization. Her goals                                                               
in  serving on  the AMHTA  board  include being  an advocate  for                                                               
rural areas and to extend the  reach of the trust by establishing                                                               
collaborative relationships  with the  people in  communities who                                                               
work  directly   with  trust   beneficiaries.  She   thanked  the                                                               
committee for considering her appointment.                                                                                      
                                                                                                                                
1:39:02 PM                                                                                                                    
SENATOR  REINBOLD noted  that she  had an  impressive background.                                                               
She asked  how she  views her  role on  the Alaska  Mental Health                                                               
Trust Authority Board.                                                                                                          
                                                                                                                                
MS. MORAN  answered that  a strength she  brings is  that through                                                               
her work at the shelter she  is in contact with people throughout                                                               
the  state  who  are  doing on-the-ground  work  to  serve  trust                                                               
beneficiaries. She sees the challenges  in rural communities, and                                                               
believes her  role will  be to continue  to support  that on-the-                                                               
ground work.                                                                                                                    
                                                                                                                                
SENATOR  HUGHES commented  on her  impressive resume  and thanked                                                               
her for stepping  forward. She asked two questions,  the first of                                                               
which was  whether she had  any thoughts  about ways to  help the                                                               
trust  to fulfill  its responsibility  to  develop mental  health                                                               
trust  land. Second,  she asked  if the  foster care  program for                                                               
animals started with taking stray pets into her home.                                                                           
                                                                                                                                
1:42:14 PM                                                                                                                    
MS. MORAN  said yes and she  continues to bring animals  into her                                                               
home.  To the  question of  developing trust  land, she  said she                                                               
didn't have  a well-formed  opinion, but she  would do  some work                                                               
and follow up with a response.                                                                                                  
                                                                                                                                
SENATOR HUGHES  expressed confidence that  she would do  the work                                                               
to become knowledgeable in that area.                                                                                           
                                                                                                                                
CHAIR  WILSON  asked if  WISH  receives  indirect or  passthrough                                                               
funding from different types of  homeless assistance or emergency                                                               
shelter grants (ESG).                                                                                                           
                                                                                                                                
1:44:59 PM                                                                                                                    
MS.  MORAN  confirmed  that  WISH  does  receive  some  emergency                                                               
housing  vouchers  through  Alaska  Housing  Finance  Corporation                                                               
(AHFC). WISH also  receives ESG funding and  Treasury funds, both                                                               
of which are related to COVID-19.                                                                                               
                                                                                                                                
CHAIR WILSON recognized that the  CEO of the Alaska Mental Health                                                               
Trust was in the committee room to address an upcoming bill.                                                                    
                                                                                                                                
SENATOR HUGHES asked  Ms. Moran to also keep an  eye on the pilot                                                               
project called  Set Free Alaska  that seeks to  reduce recidivism                                                               
through  holistic and  comprehensive substance  abuse counseling.                                                               
Participants  are trained  in  how  to get  a  job, manage  their                                                               
finances and  other life skills  to help them be  successful when                                                               
they reenter the  community. She noted that  the organization had                                                               
been very good  in collecting data that hopefully  will show that                                                               
it is a successful model to improve public safety.                                                                              
                                                                                                                                
MS. MORAN agreed to keep an  eye on the project, adding that with                                                               
her engineering background she is "all about the data.                                                                          
                                                                                                                                
1:47:34 PM                                                                                                                    
CHAIR WILSON opened public testimony  on the appointment of Agnes                                                               
Moran  to  the Alaska  Mental  Health  Trust Authority  Board  of                                                               
Trustees; he found none and closed public testimony.                                                                            
                                                                                                                                
CHAIR  WILSON   found  no  further  questions   or  comments  and                                                               
solicited a motion.                                                                                                             
                                                                                                                                
1:47:59 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
1:48:13 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:48:16 PM                                                                                                                    
Senator Hughes stated  that in accordance with  AS 39.05.080, the                                                               
Senate  Health and  Social Services  Standing Committee  reviewed                                                               
the following and  recommends the appointments be  forwarded to a                                                               
joint session for consideration:                                                                                                
                                                                                                                                
Alaska Mental Health Trust Authority Board of Trustees                                                                        
Agnes Moran - Ketchikan, Alaska                                                                                                 
                                                                                                                                
Signing  the   report  regarding   appointments  to   boards  and                                                               
commissions in  no way reflects  individual members'  approval or                                                               
disapproval  of  the  appointees;   the  nominations  are  merely                                                               
forwarded to the full legislature for confirmation or rejection.                                                                
                                                                                                                                
1:48:46 PM                                                                                                                    
CHAIR  WILSON  found no  objection  and  Agnes Moran's  name  was                                                               
forwarded to a joint session for consideration.                                                                                 
                                                                                                                                
1:48:50 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
             SB 124-MENTAL HEALTH FACILITIES & MEDS                                                                         
                                                                                                                                
1:50:37 PM                                                                                                                    
CHAIR   WILSON  reconvened   the   meeting   and  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."                                                                                                         
                                                                                                                                
He  stated that  the  intent  today is  to  finish the  amendment                                                               
process, starting with Amendment 28.                                                                                            
                                                                                                                                
1:51:22 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment 28,  work order  32-                                                               
GS1730\B.19.                                                                                                                    
                                                                                                                                
                                                                                                                                
                                                32-GS1730\B.19                                                                  
                                                      Dunmire                                                                   
                                                      3/15/22                                                                   
                                                                                                                                
                          AMENDMENT 28                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 2, line 12:                                                                                                           
          Delete "mental health professional"                                                                                   
          Insert "physician [MENTAL HEALTH PROFESSIONAL]"                                                                   
                                                                                                                                
     Page 2, line 30:                                                                                                           
          Delete "mental health professional"                                                                                   
          Insert "physician [MENTAL HEALTH PROFESSIONAL]"                                                                   
                                                                                                                                
1:51:27 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR  REINBOLD explained  that  the amendment  is intended  to                                                               
ensure that  a physician informs  the arresting officer  that the                                                               
person they brought in is leaving the crisis center.                                                                            
                                                                                                                                
CHAIR WILSON asked if there was any discussion.                                                                                 
                                                                                                                                
SENATOR HUGHES said she didn't  support limiting the notification                                                               
to a physician  because the physician likely was not  the one who                                                               
was on the street.                                                                                                              
                                                                                                                                
CHAIR  WILSON  asked Senator  Reinbold  if  she had  any  closing                                                               
remarks on the amendment.                                                                                                       
                                                                                                                                
SENATOR REINBOLD  offered her  belief that  the bill  had massive                                                               
loopholes. The amendment is an  attempt to ensure that physicians                                                               
are involved  in something as  serious as a  crisis stabilization                                                               
center.                                                                                                                         
                                                                                                                                
1:53:34 PM                                                                                                                    
CHAIR WILSON asked for a roll call.                                                                                             
                                                                                                                                
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
Amendment  28  and  Senators Begich,  Hughes,  and  Wilson  voted                                                               
against. Therefore, Amendment 28 failed on a 1:3 vote.                                                                          
                                                                                                                                
CHAIR WILSON announced that Amendment 28 failed on a 1:3 vote.                                                                  
                                                                                                                                
1:54:16 PM                                                                                                                    
At ease.                                                                                                                        
                                                                                                                                
1:54:29 PM                                                                                                                    
CHAIR WILSON reconvened the meeting.                                                                                            
                                                                                                                                
1:54:31 PM                                                                                                                    
SENATOR REINBOLD withdrew Amendment 29.                                                                                         
                                                                                                                                
CHAIR WILSON found no objection and Amendment 29 was withdrawn.                                                                 
                                                                                                                                
1:54:48 PM                                                                                                                    
SENATOR REINBOLD moved to adopt Amendment 30, work order 32-                                                                    
GS1730\B.21.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.21                                                                  
                                                      Dunmire                                                                   
                                                      3/15/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 30                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 3, line 31:                                                                                                           
          Delete "probable cause"                                                                                               
          Insert "clear and convincing evidence [PROBABLE                                                                   
     CAUSE]"                                                                                                                    
                                                                                                                                
1:54:49 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR REINBOLD explained that the amendment raises the                                                                        
standard of proof to "clear and convincing evidence" to help                                                                    
ensure that the bill isn't exploited by people with ill intent.                                                                 
                                                                                                                                
SENATOR HUGHES requested Captain Willson speak to how clear and                                                                 
convincing evidence is used on the street.                                                                                      
                                                                                                                                
CHAIR WILSON clarified for the record that he and Captain                                                                       
Willson were not related.                                                                                                       
                                                                                                                                
1:56:06 PM                                                                                                                    
DAVID WILLSON, Captain, Central  Office, Division of Alaska State                                                               
Troopers, Department of Public  Safety, Anchorage, Alaska, stated                                                               
that clear and  convincing evidence is a civil  standard of proof                                                               
and  troopers  don't  receive  training  to  make  that  finding.                                                               
Troopers are trained  to identify the circumstances  to support a                                                               
probable cause finding. If this  amendment were to pass, it would                                                               
take some time and additional training to adopt that language.                                                                  
                                                                                                                                
SENATOR HUGHES  asked for  an explanation  of probable  cause and                                                               
how it is used.                                                                                                                 
                                                                                                                                
1:57:23 PM                                                                                                                    
CAPTAIN WILLSON said the general  definition is that a reasonable                                                               
person would believe the evidence  that the condition in question                                                               
exists.  For example,  that  the person  in  question is  gravely                                                               
disabled or suffering from mental  illness. The reasonable person                                                               
standard  is  part  of  the  probable  cause  determination  that                                                               
Troopers are familiar  with when applying for  search warrants or                                                               
making  arrest decisions.  It's an  evaluation that  Troopers use                                                               
daily.                                                                                                                          
                                                                                                                                
SENATOR  HUGHES  asked if  a  reasonable  person would  look  for                                                               
evidence.                                                                                                                       
                                                                                                                                
CAPTAIN  WILLSON answered  yes;  the Trooper  would  look at  the                                                               
totality of  the circumstances including  whether the  person is:                                                               
disinterested,  uninvolved when  there's an  emotional event,  or                                                               
impaired by alcohol or drugs. The  Trooper would also look at the                                                               
statements  the  person in  question  has  made  as well  as  the                                                               
witness statements before making a determination.                                                                               
                                                                                                                                
SENATOR  HUGHES  asked for  confirmation  that  a probable  cause                                                               
finding does involve  evidence and that the decision  is not made                                                               
on a whim.                                                                                                                      
                                                                                                                                
1:59:06 PM                                                                                                                    
CAPTAIN WILLSON confirmed  that there has to be  evidence to meet                                                               
the probable  cause standard.  The evidence  that is  gathered is                                                               
often  physical  or testimonial.  "Probable  cause"  is a  higher                                                               
standard than  "more likely than not,"  but it is not  as high as                                                               
"beyond a reasonable doubt.  It's  difficult to meet the probable                                                               
cause standard  without doing significant investigation  and fact                                                               
finding.  He noted  that beyond  a  reasonable doubt  is used  in                                                               
court.                                                                                                                          
                                                                                                                                
SENATOR HUGHES  asked whether officers  use standards  other than                                                               
probable cause, depending on the alleged non civil crime.                                                                       
                                                                                                                                
CAPTAIN  WILLSON  answered  no;  probable cause  is  the  primary                                                               
standard for an  officer to take action,  although the reasonable                                                               
suspicion standard  is used in  some cases  to stop and  search a                                                               
vehicle.  Troopers are  trained in  probable cause  and beyond  a                                                               
reasonable doubt, which covers the majority of police contact.                                                                  
                                                                                                                                
2:00:52 PM                                                                                                                    
SENATOR REINBOLD  asked if  he said that  probable cause  is only                                                               
used for criminal conduct, except in court.                                                                                     
                                                                                                                                
2:01:12 PM                                                                                                                    
CAPTAIN WILLSON  answered that  the two  standards that  are used                                                               
regularly are:  1) probable cause  that is  used in the  field to                                                               
gather  evidence  for  an  affidavit  for  an  arrest  or  search                                                               
warrant;  and  2) beyond  a  reasonable  doubt  that is  used  to                                                               
ascertain whether or not an  investigation is complete to move to                                                               
court. It's not always possible to  meet the standard of beyond a                                                               
reasonable doubt  before an arrest  is made, because of  the need                                                               
to weigh  public safety  and prevent  damage from  occurring. The                                                               
probable cause standard  is used when there is an  arrest but the                                                               
investigation doesn't  necessarily stop there. It  might continue                                                               
to a finding of beyond a reasonable doubt.                                                                                      
                                                                                                                                
SENATOR REINBOLD  opined that it is  a big deal to  take somebody                                                               
off the  street and  to a stabilization  center. She  pointed out                                                               
that  the person  potentially would  be  kept for  some time  and                                                               
injected with psychotropic medication.  She offered her view that                                                               
probable cause is probably and  another term would be better. She                                                               
also said  that she was surprised  to learn that a  criminal case                                                               
could be based  solely on probable cause. She  voiced support for                                                               
Amendment  30,  maintaining that  it  wouldn't  be difficult  for                                                               
Troopers to be  trained to use the clear  and convincing evidence                                                               
standard.                                                                                                                       
                                                                                                                                
2:03:41 PM                                                                                                                    
CAPTAIN WILLSON responded that probable  cause was currently used                                                               
and  accepted,  but if  the  law  were  to  change to  require  a                                                               
different standard, the change would be made.                                                                                   
                                                                                                                                
SENATOR  REINBOLD summarized  that he  didn't think  another word                                                               
could be used.  She also asked him to restate  the probable cause                                                               
standard.                                                                                                                       
                                                                                                                                
2:04:54 PM                                                                                                                    
CAPTAIN  WILLSON stated  that  he was  only  aware that  probable                                                               
cause and beyond  a reasonable doubt were the  standards that are                                                               
used  in  the  field  for everyday  business.  He  restated  that                                                               
probable  cause  is the  standard  of  evidence necessary  for  a                                                               
reasonable person  to use  based on  the facts  and circumstances                                                               
available under the  existing condition such as that  a person is                                                               
gravely ill or suffering from mental illness.                                                                                   
                                                                                                                                
SENATOR REINBOLD asked how he would define mental illness.                                                                      
                                                                                                                                
2:06:00 PM                                                                                                                    
CAPTAIN WILLSON responded  that if he were to  detain somebody to                                                               
take them  to a crisis  stabilization center, his  probable cause                                                               
finding  would  be  that  the  person  was  gravely  disabled  or                                                               
suffering from  mental illness and  likely to cause  serious harm                                                               
to self  or others and  that it was  of such an  immediate nature                                                               
that  considerations  of  safety  did  not  allow  initiation  of                                                               
involuntary  commitment procedures.  He cited  examples from  his                                                               
own experience.                                                                                                                 
                                                                                                                                
SENATOR  HUGHES  highlighted  that  in  a  previous  hearing  the                                                               
committee  clearly  heard  that  an  officer  would  be  in  full                                                               
violation  if the  officer  were to  arrest  somebody because  of                                                               
their  political  views. To  the  question  about using  probable                                                               
cause, she pointed out that Captain  Willson said that there is a                                                               
lower standard.  He also  stated that for  a finding  of probable                                                               
cause,  specific evidence  would  have to  be  identified at  the                                                               
scene so a decision could not be made on a whim.                                                                                
                                                                                                                                
SENATOR  HUGHES stated  that she  was comfortable  using probable                                                               
cause.                                                                                                                          
                                                                                                                                
SENATOR REINBOLD offered her  personal experience with harassment                                                               
and probably cause.  She also posited that a  higher standard was                                                               
necessary for something as serious  as removing somebody from the                                                               
street and taking them to a crisis center.                                                                                      
                                                                                                                                
2:10:20 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote on Amendment 30.                                                                        
                                                                                                                                
2:10:26 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion  to adopt  Amendment 30  and Senators  Begich, Hughes,                                                               
and Wilson voted against it.  Therefore, Amendment 30 failed on a                                                               
1:3 vote.                                                                                                                       
                                                                                                                                
2:10:41 PM                                                                                                                    
CHAIR WILSON announced that Amendment 30 failed on a 1:3 vote.                                                                  
                                                                                                                                
CHAIR  WILSON   listed  the   individuals  available   to  answer                                                               
questions.                                                                                                                      
                                                                                                                                
2:11:38 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment 31,  work order  32-                                                               
GS1730\B.22.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.22                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                          AMENDMENT 31                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 4, line 1, following "illness":                                                                                       
          Insert "with an examination by a licensed                                                                         
     physician"                                                                                                             
                                                                                                                                
2:11:40 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR  REINBOLD explained  Amendment  31 ensures  that a  peace                                                               
officer's determination  that a  person is suffering  from mental                                                               
illness is based on an examination by a licensed physician.                                                                     
                                                                                                                                
SENATOR HUGHES  said she  agrees that it  is important  to ensure                                                               
that people  are not  incorrectly taken to  a crisis  center, but                                                               
requiring an examination  by a licensed physician to  make such a                                                               
determination is not practical.                                                                                                 
                                                                                                                                
SENATOR BEGICH  stated opposition to  Amendment 31, and  shared a                                                               
friend's  experience of  walking  naked down  the Glenn  Highway.                                                               
There was  no way to  get a  physician there for  an examination,                                                               
but  the  Troopers   got  the  person  to   Providence  where  an                                                               
examination was done in an appropriate setting.                                                                                 
                                                                                                                                
2:13:34 PM                                                                                                                    
SENATOR REINBOLD said the amendment  calls for the examination by                                                               
a physician prior to admission. She urged a yes vote.                                                                           
                                                                                                                                
2:14:01 PM                                                                                                                    
SENATOR  HUGHES  clarified  that  the statute  is  talking  about                                                               
events  before the  person is  taken into  custody, not  prior to                                                               
admission.                                                                                                                      
                                                                                                                                
SENATOR  REINBOLD pointed  out that  Section 13  adds a  new Sec.                                                               
47.37.707 Admission to hold at a crisis stabilization center.                                                                   
                                                                                                                                
2:14:41 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote.                                                                                        
                                                                                                                                
2:14:45 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion  to adopt  Amendment 31  and Senators  Hughes, Begich,                                                               
Wilson voted against it. Therefore,  Amendment 31 failed on a 1:3                                                               
vote.                                                                                                                           
                                                                                                                                
2:15:01 PM                                                                                                                    
CHAIR WILSON announced that Amendment 31 failed on a 1:3 vote.                                                                  
                                                                                                                                
2:15:13 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment  32, work  order 32-                                                               
GS1730\B.23.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.23                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                              
                          AMENDMENT 32                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 4, lines 7 - 8:                                                                                                       
          Delete "[FOR EMERGENCY EVALUATION]"                                                                                   
          Insert "for emergency evaluation"                                                                                     
                                                                                                                                
2:15:15 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR REINBOLD  explained that her intention  with Amendment 32                                                               
is  to ensure  that  a  person taken  into  custody  is given  an                                                               
accurate evaluation. It's in keeping  with her view that the bill                                                               
needs to have more safeguards.                                                                                                  
                                                                                                                                
2:15:53 PM                                                                                                                    
CHAIR  WILSON   removed  his  objection;  he   found  no  further                                                               
objection and Amendment 32 was adopted.                                                                                         
                                                                                                                                
2:16:04 PM                                                                                                                    
SENATOR REINBOLD moved to adopt Amendment 33, work order 32-                                                                    
GS1730\B.24.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.24                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 33                                                                                      
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE             BY SENATOR REINBOLD                                                                      
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 4, line 22, through page 8, line 15:                                                                                  
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 13, lines 1 - 2:                                                                                                      
          Delete "secs. 1 - 27"                                                                                                 
          Insert "secs. 1 - 26"                                                                                                 
                                                                                                                                
     Page 13, lines 27 - 28:                                                                                                    
          Delete "sec. 23"                                                                                                      
          Insert "sec. 22"                                                                                                      
                                                                                                                                
     Page 13, line 29:                                                                                                          
          Delete "sec. 23"                                                                                                      
          Insert "sec. 22"                                                                                                      
                                                                                                                                
     Page 14, line 7:                                                                                                           
          Delete "Section 28"                                                                                                   
          Insert "Section 27"                                                                                                   
                                                                                                                                
2:16:08 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR REINBOLD stated that Amendment 33 deletes Section 13 of                                                                 
the bill.                                                                                                                       
                                                                                                                                
2:16:23 PM                                                                                                                    
SENATOR HUGHES said that the status  quo is that an officer takes                                                               
a person  to jail or  a hospital where  the family does  not have                                                               
access. By  comparison, these  crisis stabilization  clinics will                                                               
offer an  outpatient setting where  family and/or a  pastor could                                                               
visit.  Section 13  is an  improvement and  if the  bill were  to                                                               
pass, a lot of  the things that have been put  on the record will                                                               
carry forward, including such things  as not taking a person into                                                               
custody   for   political   differences.  Removing   Section   13                                                               
essentially  guts the  bill and  eliminates  the opportunity  for                                                               
crisis stabilization centers that offer an outpatient setting.                                                                  
                                                                                                                                
SENATOR HUGHES stated that she did not support Amendment 33.                                                                    
                                                                                                                                
CHAIR  WILSON offered  his  view that  Amendment  33 deletes  the                                                               
purpose of  the bill and continues  with the status quo  of using                                                               
the Department of  Correction to house people who  are in crisis.                                                               
It would not address the issue with the Disability Law Center.                                                                  
                                                                                                                                
SENATOR REINBOLD said  she recently spoke with a  chief of police                                                               
who didn't mind the status quo.  She said she didn't mind dealing                                                               
with the issue  with the Disability Law Center,  but she believes                                                               
that some  people would rather  be charged  than taken to  one of                                                               
these  crisis centers.  People in  jail have  certain rights  and                                                               
there  isn't  the  potential  that they  will  be  injected  with                                                               
psychotropic  drugs. She  reiterated her  belief that  Section 13                                                               
causes grave concerns.                                                                                                          
                                                                                                                                
2:19:38 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote.                                                                                        
                                                                                                                                
2:19:39 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion to adopt Amendment  33 and Senators Begich, Hughes and                                                               
Wilson voted against it. Therefore,  Amendment 33 failed on a 1:3                                                               
vote.                                                                                                                           
                                                                                                                                
2:19:55 PM                                                                                                                    
CHAIR WILSON announced that Amendment 33 failed on a 1:3 vote.                                                                  
                                                                                                                                
2:20:00 PM                                                                                                                    
SENATOR REINBOLD moved to adopt Amendment 34 32-GS1730\B.25.                                                                    
                                                                                                                                
                                                32-GS1730\B.25                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 34                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 8, line 28, following "has":                                                                                          
          Insert "strong"                                                                                                   
                                                                                                                                
2:20:04 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR  REINBOLD explained  that Amendment  34 is  a bookend  to                                                               
ensure  that  somebody  can't  haphazardly  decide  a  person  is                                                               
mentally  ill. There  has  to  be a  compelling  reason for  that                                                               
decision. She relayed  that the intent of all  her amendments are                                                               
to protect the patient.                                                                                                         
                                                                                                                                
CHAIR WILSON  asked Steven  Bookman for  the legal  definition of                                                               
 compelling" and whether it works in this amendment.                                                                            
                                                                                                                                
2:21:18 PM                                                                                                                    
STEVEN   BOOKMAN,  Senior   Assistant  Attorney   General,  Human                                                               
Services Section,  Civil Division  Department of  Law, Anchorage,                                                               
Alaska,  explained reasonable  suspicion,  probable cause,  clear                                                               
and  convincing  evidence,  beyond  a  reasonable  doubt,  and  a                                                               
preponderance of  the evidence  are all  standards for  burden of                                                               
proof. The  term compelling is none  of those and it's  not clear                                                               
how it would be interpreted.                                                                                                    
                                                                                                                                
SENATOR HUGHES  highlighted that  its  not  the officer,  but the                                                               
medical professional who  would need to have  a compelling reason                                                               
for  their decision.  She asked  if  anybody could  speak to  the                                                               
standard of reason that the medical professional would use.                                                                     
                                                                                                                                
2:22:31 PM                                                                                                                    
MR. BOOKMAN  explained that when  doctors talk about  the medical                                                               
judgements they  make, the court  looks at whether they  made the                                                               
decisions  with a  reasonable degree  of  medical certainty.  The                                                               
other evidence standards that he mentioned are for judges.                                                                      
                                                                                                                                
SENATOR HUGHES  asked if he  was saying  that a decision  that is                                                               
based on a reasonable degree of  medical certainty would not be a                                                               
willy-nilly  decision.  It  would  essentially  be  a  compelling                                                               
reason.                                                                                                                         
                                                                                                                                
MR. BOOKMAN answered yes.                                                                                                       
                                                                                                                                
SENATOR HUGHES  asked if it would  be a problem to  have the word                                                               
compelling in the determination for the medical professional.                                                                   
                                                                                                                                
2:23:44 PM                                                                                                                    
MR.  BOOKMAN opined  that it  would  introduce a  real degree  of                                                               
confusion among  medical professionals because there  is no clear                                                               
definition  for compelling.  It would  also make  it less  likely                                                               
that the bill would work as intended.                                                                                           
                                                                                                                                
SENATOR HUGHES asked  if he agreed that based on  the standard of                                                               
medical  certainty,   the  notion   of  compelling   was  already                                                               
embedded.                                                                                                                       
                                                                                                                                
MR. BOOKMAN answered yes.                                                                                                       
                                                                                                                                
SENATOR HUGHES said  she was comfortable with the  language as is                                                               
because she  wanted to avoid  confusion for providers.  Thus, she                                                               
would oppose Amendment 34.                                                                                                      
                                                                                                                                
2:25:12 PM                                                                                                                    
SENATOR REINBOLD asked Mr. Bookman what  he sees as the intent of                                                               
the bill.                                                                                                                       
                                                                                                                                
MR.  BOOKMAN  said  he  believes  the idea  is  to  provide  less                                                               
restrictive  and a  broader spectrum  of alternatives  for mental                                                               
health  care, so  people aren't  having  to wait  in places  like                                                               
emergency rooms and jails to get their special needs met.                                                                       
                                                                                                                                
SENATOR  REINBOLD   argued  that  people  could   say  that  it's                                                               
inappropriate  to  hold  people  in  these  crisis  stabilization                                                               
centers  that she  views as  mental  health mini  jails. If  it's                                                               
acceptable to  add the words  compelling or convincing,  she said                                                               
the amendment should pass.                                                                                                      
                                                                                                                                
2:26:59 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote.                                                                                        
                                                                                                                                
2:27:01 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion  to adopt  Amendment 34  and Senators  Begich, Hughes,                                                               
and Wilson voted against it.  Therefore, Amendment 34 failed on a                                                               
1:3 vote.                                                                                                                       
                                                                                                                                
2:27:20 PM                                                                                                                    
CHAIR WILSON announced that Amendment 34 failed on a 1:3 vote.                                                                  
                                                                                                                                
2:27:26 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment 35,  work order  32-                                                               
GS1730\B.26.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.26                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                          AMENDMENT 35                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
        TO:  CSSB 124(HSS), Draft Version "B"                                                                                   
                                                                                                                                
                                                                                                                                
     Page 9, line 7:                                                                                                            
          Delete "new subsections"                                                                                              
          Insert "a new subsection"                                                                                             
                                                                                                                                
     Page 9, lines 8 - 11:                                                                                                      
          Delete all material.                                                                                                  
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
2:27:29 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
2:27:31 PM                                                                                                                    
SENATOR REINBOLD explained Amendment  35 deletes [subsection (c)]                                                               
of  Section 15  relating to  ex parte  orders. The  intent is  to                                                               
ensure that a patient has representation.                                                                                       
                                                                                                                                
SENATOR  HUGHES said  her  reading is  that  the amendment  would                                                               
remove  the requirement  for ex  parte orders  and it  seems that                                                               
would remove protections that should remain in place.                                                                           
                                                                                                                                
2:28:43 PM                                                                                                                    
NANCY  MEADE,  General  Counsel,  Office  of  the  Administrative                                                               
Director,  Alaska Court  System, Anchorage,  Alaska, stated  that                                                               
subsection  (c) in  Section 15  addresses  circumstances where  a                                                               
mental health professional  sends a person in crisis  either to a                                                               
hospital  or  a  crisis  center in  an  emergency  situation  and                                                               
without an ex  parte court order. She agreed  with Senator Hughes                                                               
that removing  subsection (c) would remove  any court involvement                                                               
because there would be no provision  to bring the matter before a                                                               
judge.                                                                                                                          
                                                                                                                                
CHAIR WILSON asked  for confirmation that there  is a requirement                                                               
for a court to hear the matter  within 72 hours, so the person in                                                               
crisis  could be  held in  the hospital  or crisis  stabilization                                                               
center indefinitely.                                                                                                            
                                                                                                                                
MS. MEADE answered yes; it would  create a gap such that a person                                                               
could  be  detained  without  process.   Subsection  (c)  is  the                                                               
provision that requires  a person to go before the  court and get                                                               
the order  they did not  have time to  get previously due  to the                                                               
emergency situation.                                                                                                            
                                                                                                                                
2:30:18 PM                                                                                                                    
SENATOR  REINBOLD said  that  was not  intent  of the  amendment.                                                               
Rather, she wanted people in  a mental health crisis situation to                                                               
always have representation.                                                                                                     
                                                                                                                                
SENATOR REINBOLD withdrew Amendment 35.                                                                                         
                                                                                                                                
2:30:36 PM                                                                                                                    
CHAIR WILSON stated that Amendment 35 was withdrawn.                                                                            
                                                                                                                                
2:30:55 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment  36, work  order 32-                                                               
GS1730\B.27.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.27                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 36                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 9, line 28:                                                                                                           
          Delete "petitioner's [PROSECUTING]"                                                                               
          Insert "prosecuting"                                                                                                  
                                                                                                                                
2:30:59 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
2:31:00 PM                                                                                                                    
SENATOR REINBOLD  stated that she  brought the  amendment because                                                               
she wasn't  clear about  the difference and  thus the  reason for                                                               
changing  the  reference from  the  prosecuting  attorney to  the                                                               
petitioner's  attorney. She  asked if  somebody could  provide an                                                               
explanation.                                                                                                                    
                                                                                                                                
MR. BOOKMAN explained  that a prosecutor pursues  a criminal case                                                               
and  a  petitioner  is  somebody  who is  asking  the  court  for                                                               
something. Having the reference to a prosecuting attorney in                                                                    
that sentence indicates that the respondent has committed a                                                                     
crime.                                                                                                                          
                                                                                                                                
SENATOR REINBOLD stated that she was withdrawing Amendment 36                                                                   
because it didn't do what she intended which was to give                                                                        
patients more power.                                                                                                            
                                                                                                                                
CHAIR WILSON stated that Amendment 36 was withdrawn.                                                                            
                                                                                                                                
2:32:39 PM                                                                                                                    
SENATOR REINBOLD moved to adopt Amendment 37, work order 32-                                                                    
GS1730\B.28.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.28                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 37                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 10, line 27, through page 11, line 1:                                                                                 
          Delete all material.                                                                                                  
                                                                                                                                
     Renumber the following bill sections accordingly.                                                                          
                                                                                                                                
     Page 13, lines 1 - 2:                                                                                                      
          Delete "secs. 1 - 27"                                                                                                 
          Insert "secs. 1 - 26"                                                                                                 
                                                                                                                                
     Page 13, lines 27 - 28:                                                                                                    
          Delete "sec. 23"                                                                                                      
          Insert "sec. 22"                                                                                                      
                                                                                                                                
     Page 13, line 29:                                                                                                          
          Delete "sec. 23"                                                                                                      
          Insert "sec. 22"                                                                                                      
                                                                                                                                
     Page 14, line 7:                                                                                                           
          Delete "Section 28"                                                                                                   
          Insert "Section 27"                                                                                                   
                                                                                                                                
2:32:41 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
2:32:43 PM                                                                                                                    
SENATOR REINBOLD stated  that Amendment 37 removes  Section 18 of                                                               
the bill.  Her reasoning was that  it is one more  opportunity to                                                               
detain people in crisis too long  when they have not been charged                                                               
with a crime.                                                                                                                   
                                                                                                                                
SENATOR   HUGHES  observed   that   this   relates  to   previous                                                               
discussions  about  heart  attacks  and  other  situations  where                                                               
medical  professionals have  to  take action  quickly  to save  a                                                               
person's life, so there is not  time to talk to a spouse, parent,                                                               
or guardian beforehand. She said  it's good to remember that when                                                               
medications are  administered under these circumstances  they are                                                               
as  a last  resort.  Section 18  is  talking about  administering                                                               
medications as a  last resort to keep a person  from self-harm or                                                               
harming another person.  If providers are not  able to administer                                                               
these medications,  the alternative is physical  restraint, which                                                               
can also result  in harm to the person in  crisis. Providers have                                                               
to  document  all  the  steps  leading  up  to  the  decision  to                                                               
administer medication,  so a  spouse or parent  or the  court can                                                               
review the record. It is not a casual decision.                                                                                 
                                                                                                                                
SENATOR HUGHES stated that she  was comfortable with the existing                                                               
language in Section 18 and she would oppose Amendment 37.                                                                       
                                                                                                                                
2:35:08 PM                                                                                                                    
SENATOR  REINBOLD recalled  that the  committee previously  voted                                                               
down Amendment  17 that addressed  using psychotropic drugs  as a                                                               
last resort.                                                                                                                    
                                                                                                                                
2:35:57 PM                                                                                                                    
SENATOR HUGHES  asked for the  record to clearly  reflect whether                                                               
psychotropic drugs are administered as a last resort.                                                                           
                                                                                                                                
2:36:34 PM                                                                                                                    
HEATHER  CARPENTER,  Healthcare  Policy  Advisor,  Department  of                                                               
Health  and Social  Services  (DHSS),  Juneau, Alaska,  confirmed                                                               
that,  per statute,  crisis medication  is a  last resort  option                                                               
when  somebody  is  in  imminent danger  of  doing  self-harm  or                                                               
harming  the  provider  who  is giving  care.  All  the  previous                                                               
intervention efforts must be documented  so it's clear that there                                                               
is no  other safe alternative.  She deferred  further explanation                                                               
of the statute to Mr. Bookman.                                                                                                  
                                                                                                                                
SENATOR REINBOLD asked which statute she was citing.                                                                            
                                                                                                                                
2:37:40 PM                                                                                                                    
MR.  BOOKMAN  advised that  AS  47.30.838(a)(1)  states that  the                                                               
staff response to the behavioral  condition must be documented in                                                               
the patient's medical  record and it must  include an explanation                                                               
of  the  alternative  responses  to the  crisis  that  the  staff                                                               
considered or attempted, and why those were not sufficient.                                                                     
                                                                                                                                
SENATOR REINBOLD  offered her view  that the statute  doesn't say                                                               
these drugs will  be used as a last resort.  She also relayed the                                                               
concern from  some advocates that  some of the  existing statutes                                                               
won't apply to  the new statutes. She reiterated  that she wanted                                                               
the record  to be clear  that medical professionals in  these new                                                               
facilities  will only  administer  psychotropic drugs  as a  last                                                               
resort.                                                                                                                         
                                                                                                                                
SENATOR  HUGHES  asked if  the  statutory  language he  read  was                                                               
talking about  the alternatives  for treatment  before medication                                                               
could be administered. She posited  that the reason the committee                                                               
did not  pass [Amendment 17]  was perhaps because it  was already                                                               
in statute that it  is a last resort. She asked  if he could read                                                               
the  section of  statute  that says  that  the administration  of                                                               
medication is a last resort.                                                                                                    
                                                                                                                                
2:39:38 PM                                                                                                                    
MR.  BOOKMAN   advised  that  AS   47.30.838(a)  says   a  crisis                                                               
medication may be administered without  informed consent, only if                                                               
certain  conditions  are  met so  the  documentation  must  exist                                                               
before the crisis medication can be administered.                                                                               
                                                                                                                                
2:39:50 PM                                                                                                                    
SENATOR  REINBOLD  asked him  to  read  the statute  because  she                                                               
wanted assurance that the intent  of the bill is for psychotropic                                                               
medications to be used as the last resort.                                                                                      
                                                                                                                                
2:40:41 PM                                                                                                                    
MR. BOOKMAN read AS 47.30.838(a)(1):                                                                                            
                                                                                                                                
     Sec.  47.30.838.  Psychotropic   medication  in  crisis                                                                  
     situations.                                                                                                              
      (a)  Except  as  provided  in  (c)  and  (d)  of  this                                                                    
     section,   an   evaluation   facility   or   designated                                                                    
     treatment   facility    may   administer   psychotropic                                                                    
     medication to a patient  without the patient's informed                                                                    
     consent, regardless  of whether the patient  is capable                                                                    
     of     giving     informed     consent,     only     if                                                                    
          (1) there  is a crisis situation,  or an impending                                                                    
     crisis situation,  that requires  immediate use  of the                                                                    
     medication  to   preserve  the  life  of,   or  prevent                                                                    
     significant physical  harm to,  the patient  or another                                                                    
     person,  as   determined  by  a   physician,  physician                                                                    
     assistant, or  advanced practice registered  nurse; the                                                                    
     behavior or condition  of the patient giving  rise to a                                                                    
     crisis under  this paragraph  and the  staff's response                                                                    
     to the behavior or condition  must be documented in the                                                                    
     patient's  medical   record;  the   documentation  must                                                                    
     include an explanation of  alternative responses to the                                                                    
     crisis that  were considered or attempted  by the staff                                                                    
     and why those responses were not sufficient; and                                                                           
                                                                                                                                
2:41:55 PM                                                                                                                    
SENATOR REINBOLD asked if it was  accurate to say that the intent                                                               
is  that  psychotropic drugs  will  be  used  as a  last  resort,                                                               
including in these new crisis facilities described in the bill.                                                                 
                                                                                                                                
MR.  BOOKMAN   answered  yes;   verbal  de-escalation   or  other                                                               
techniques would always be used first.                                                                                          
                                                                                                                                
SENATOR REINBOLD  asked, "Is that  a yes; psychotropic  drugs are                                                               
the last intent                                                                                                                 
                                                                                                                                
MR. BOOKMAN answered yes.                                                                                                       
                                                                                                                                
2:42:51 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote on Amendment 37.                                                                        
                                                                                                                                
2:42:54 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion  to adopt  Amendment 37  and Senators  Hughes, Begich,                                                               
and Wilson voted against it.  Therefore, Amendment 37 failed on a                                                               
1:3 vote.                                                                                                                       
                                                                                                                                
2:43:09 PM                                                                                                                    
CHAIR WILSON announced that Amendment 37 failed on a 1:3 vote.                                                                  
                                                                                                                                
2:43:16 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment 38,  work order  32-                                                               
GS1730\B.41.                                                                                                                    
                                                                                                                                
                                                32-GS1730\B.41                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 38                                                                                      
                                                                                                                                
                                                                                                                                
     OFFERED IN THE SENATE                  BY SENATOR REINBOLD                                                                 
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 11, line 2:                                                                                                           
          Delete "a new section"                                                                                                
          Insert "new sections"                                                                                                 
                                                                                                                                
     Page 11, following line 4:                                                                                                 
          Insert a new section to read:                                                                                         
          "Sec. 47.30.914. Health outcome metrics. (a)                                                                        
     Crisis   residential   centers,  crisis   stabilization                                                                    
     centers,  and subacute  mental health  facilities shall                                                                    
     assess the  severity of an individual's  mental illness                                                                    
     each  day and  keep  a record  of  the assessment.  The                                                                    
     assessment shall use an objective  scale relating to an                                                                    
     individual's  ability to  function in  society and  the                                                                    
     impact that  the individual's mental health  has on the                                                                    
     individual's daily life.                                                                                                   
          (b)      Crisis    residential   centers,   crisis                                                                    
     stabilization  centers,  and   subacute  mental  health                                                                    
     facilities   shall  record   the  number   of  patients                                                                    
     involuntarily detained, the number  of patients to whom                                                                    
     psychotropic   medication   is   administered   without                                                                    
     informed  consent, the  number  of patients  physically                                                                    
     restrained, patient  complaints, patient  injuries, and                                                                    
     traumatic events experienced by a patient.                                                                                 
          (c)  A crisis residential center, crisis                                                                              
     stabilization  center,   and  subacute   mental  health                                                                    
     facility  shall  submit  a   quarterly  report  to  the                                                                    
     division of  the department responsible  for behavioral                                                                    
     health services  relating to aggregate  assessment data                                                                    
     gathered  under (a)  and (b)  of  this section  without                                                                    
     disclosing   information   that   would   identify   an                                                                    
     individual.                                                                                                                
          (d)  The division of the department responsible                                                                       
     for behavioral  health services  shall prepare  a semi-                                                                    
     annual   report  compiling   the  quarterly   aggregate                                                                    
     assessment  data reports  received  under  (c) of  this                                                                    
     section. The  division shall submit  the report  to the                                                                    
     senate secretary  and the chief  clerk of the  house of                                                                    
     representatives  and notify  the  legislature that  the                                                                    
     report is available."                                                                                                      
                                                                                                                                
2:43:18 PM                                                                                                                    
CHAIR WILSON objected for purposes of discussion.                                                                               
                                                                                                                                
SENATOR REINBOLD stated  that Amendment 38 adds a  new section in                                                               
bill  Section   19  related  to   health  outcome   metrics.  She                                                               
paraphrased  the language  in subsections  (a)-(d) and  explained                                                               
that the intent is to ensure  there is good reporting when people                                                               
are in crisis facilities. It's about patient advocacy.                                                                          
                                                                                                                                
SENATOR HUGHES referenced Section 26  that talks about the things                                                               
that will  be included in the  report to the legislature,  one of                                                               
which is the data that has  been collected. She asked if the idea                                                               
is that the department will develop a plan for data collection.                                                                 
                                                                                                                                
2:46:35 PM                                                                                                                    
MS. CARPENTER said yes. Advocates  and others have requested more                                                               
ready access  to information about  psychiatric care in  not just                                                               
these  new crisis  facilities but  also hospitals  and designated                                                               
evaluation and treatment (DET) facilities,  and Section 26 is the                                                               
action  plan  for that.  The  department  and the  Alaska  Mental                                                               
Health  Trust  Authority  have  one year  to  work  with  patient                                                               
advocates,  providers  of  these  services,  the  Disability  Law                                                               
Center, and  the Office of  the Ombudsman to work  on grievances,                                                               
how to put data collected  on a public-facing dashboard, and ways                                                               
to  improve  patient outcomes  as  Mr.  Gottstein suggested.  The                                                               
intent  is  to work  collaboratively  and  be as  transparent  as                                                               
possible to  the public and  the legislature,  but in a  way that                                                               
fits  with  providers' current  flow,  does  not duplicate  other                                                               
reports, and does not result in any unfunded mandate.                                                                           
                                                                                                                                
2:48:07 PM                                                                                                                    
SENATOR HUGHES  asked if  the recommendations  for the  data plan                                                               
would be  due by  the next legislature,  if legislation  would be                                                               
required,  or if  the  department could  move  forward once  that                                                               
stakeholder group comes to a decision.                                                                                          
                                                                                                                                
MS. CARPENTER replied  it will depend on what  the group decides,                                                               
but there will be a robust  public process and the report goes to                                                               
the legislature.                                                                                                                
                                                                                                                                
2:49:16 PM                                                                                                                    
SENATOR HUGHES asked whether the  report to the legislature would                                                               
be just the plan or if  it would include first-year data that was                                                               
gathered from the outpatient stabilizations.                                                                                    
                                                                                                                                
MS.  CARPENTER  offered  her belief  that  the  department  could                                                               
provide early data  from the 1115 Medicaid waiver as  well as any                                                               
Title  47 involuntary  commitments that  are tracked  through the                                                               
courts. Any information provided would be deidentified.                                                                         
                                                                                                                                
SENATOR  HUGHES  noted  that  the  first  part  of  Amendment  38                                                               
requires  providers to  keep a  record of  the assessment  of the                                                               
individual's  mental illness.  She  asked if  that would  already                                                               
happen as part of the routine.                                                                                                  
                                                                                                                                
MS.  CARPENTER  replied  that   the  behavioral  health  billings                                                               
indicate that  these individuals  are observed every  15 minutes,                                                               
so the daily record would be extensive.                                                                                         
                                                                                                                                
2:51:12 PM                                                                                                                    
SENATOR  BEGICH  pointed out  that  even  though the  information                                                               
would  be deidentified,  the data  collection called  for in  the                                                               
amendment could identify individuals in small rural areas.                                                                      
                                                                                                                                
MS. CARPENTER  said yes,  and the  department is  concerned about                                                               
Amendment 38 for that reason.                                                                                                   
                                                                                                                                
SENATOR REINBOLD  opined that the  things the report  is required                                                               
to include  or do  is purely  bureaucratic. She  summarized items                                                               
(1)-(3). By contrast, Amendment  38 is patient-centered and deals                                                               
with  health outcome  metrics. The  amendment  provides that  the                                                               
assessment  shall   use  an  objective  scale   to  determine  an                                                               
individual's  ability to  function.  She asked  if the  reporting                                                               
called for in bill Section 26 includes an objective assessment.                                                                 
                                                                                                                                
2:53:51 PM                                                                                                                    
MS. CARPENTER  answered that the  department will look  at scales                                                               
that are  industry standard. She  suggested that the  language in                                                               
the amendment was a little  confusing because it wasn't clear who                                                               
decides the scale  that's used is objective.  She reiterated that                                                               
the  department  would  look  at   best  practices  and  industry                                                               
standards so any recommendation is data-informed.                                                                               
                                                                                                                                
SENATOR  REINBOLD expressed  concern that  the department  didn't                                                               
want  to use  an objective  scale. She  read the  requirements in                                                               
subsection (b) of Amendment 38  and asked if the department would                                                               
be documenting those things.                                                                                                    
                                                                                                                                
MS. CARPENTER  responded that the  report will look at  the items                                                               
she  referenced  to  see  how the  information  can  be  provided                                                               
publicly.  The  department  will  look   at  a  host  of  things,                                                               
including  the things  listed  in the  amendment,  when it  talks                                                               
about  what to  consider.  One reason  the  department and  trust                                                               
suggested  doing this  report to  the  legislature is  to get  it                                                               
right the first time.                                                                                                           
                                                                                                                                
2:56:30 PM                                                                                                                    
SENATOR  REINBOLD said  it  sounds like  the  department will  be                                                               
doing the things required in  subsection (b) of Amendment 38. She                                                               
asked if  that information  would be available  if she  called to                                                               
ask for the report.                                                                                                             
                                                                                                                                
MS. CARPENTER  clarified that the  report will look at  the items                                                               
listed in (b) and talk about  how to move forward and provide the                                                               
information on a  broad scale. Certainly the number  of people on                                                               
an involuntary detention  or hold will be  documented and anytime                                                               
crisis  medication  is used  it  is  well documented.  Also,  the                                                               
report on page  13 of version B talks about  looking at instances                                                               
of restraint, complaints,  and grievances as well  as the changes                                                               
that  need  to be  made  to  processes,  how the  information  is                                                               
provided to the  public, those tracking this work, and  how it is                                                               
provided to the legislature.                                                                                                    
                                                                                                                                
CHAIR  WILSON offered  his understanding  that  the court  system                                                               
also has data on involuntary commitments.                                                                                       
                                                                                                                                
2:58:17 PM                                                                                                                    
SENATOR  HUGHES   agreed  with   Senator  Begich  that   even  if                                                               
information  is   deidentified,  it   would  be  easy   in  small                                                               
communities  to  figure  out   what  individuals  were  receiving                                                               
medications and  whether they were  restrained. It's the  kind of                                                               
private information that  should not be available  to the public.                                                               
She disagreed  with Senator  Reinbold that  Section 26  is purely                                                               
bureaucratic. Rather,  that section  looks at patient  rights and                                                               
grievances, and  it requires the  department to bring  together a                                                               
diverse  stakeholder  group,  including  patient  advocates.  The                                                               
group  collectively  would  be  very  concerned  about  upholding                                                               
patient  rights.  She opined  that  the  stakeholder group  would                                                               
bring  good data  forward  and address  concerns  that have  been                                                               
articulated.                                                                                                                    
                                                                                                                                
SENATOR HUGHES stated that she would oppose Amendment 38.                                                                       
                                                                                                                                
CHAIR WILSON asked  Nancy Meade to talk about the  data the court                                                               
keeps on involuntary commitments.                                                                                               
                                                                                                                                
3:00:02 PM                                                                                                                    
MS.  MEADE  stated that  everything  that  comes into  the  Court                                                               
System is  tracked, including the  number of ex parte  orders for                                                               
involuntary commitments  lasting 3  days, 30  days, 90  days, and                                                               
longer.                                                                                                                         
                                                                                                                                
SENATOR REINBOLD  paraphrased the provisions in  Amendment 38 and                                                               
emphasized  how  important it  is  to  protect patients  who  are                                                               
detained.                                                                                                                       
                                                                                                                                
3:02:04 PM                                                                                                                    
CHAIR WILSON asked for a roll call vote.                                                                                        
                                                                                                                                
3:02:06 PM                                                                                                                    
A roll  call vote was taken.  Senator Reinbold voted in  favor of                                                               
the motion to adopt Amendment  38 and Senators Hughes, Begich and                                                               
Wilson voted against it. Therefore,  Amendment 38 failed on a 1:3                                                               
vote.                                                                                                                           
                                                                                                                                
3:02:22 PM                                                                                                                    
CHAIR WILSON announced that Amendment 38 failed on a 1:3 vote.                                                                  
                                                                                                                                
3:02:28 PM                                                                                                                    
SENATOR  REINBOLD moved  to adopt  Amendment  39, work  order 32-                                                               
GS1730\B.42                                                                                                                     
                                                                                                                                
                                                32-GS1730\B.42                                                                  
                                                      Dunmire                                                                   
                                                      3/16/22                                                                   
                                                                                                                                
                                                                                                                                
                          AMENDMENT 39                                                                                      
                                                                                                                                
                                                                                                                                
    OFFERED IN THE SENATE               BY SENATOR REINBOLD                                                                     
         TO:  CSSB 124(HSS), Draft Version "B"                                                                                  
                                                                                                                                
                                                                                                                                
     Page 8, line 1:                                                                                                            
          Delete "47.30.815"                                                                                                    
          Insert "47.30.865"                                                                                                    
                                                                                                                                
3:02:31 PM                                                                                                                    
CHAIR WILSON found no objection and Amendment 39 was adopted.                                                                   
                                                                                                                                
3:02:38 PM                                                                                                                    
CHAIR WILSON [held SB 124 in committee].                                                                                        
                                                                                                                                
3:03:21 PM                                                                                                                    
There being  no further  business to  come before  the committee,                                                               
Chair  Wilson adjourned  the Senate  Health  and Social  Services                                                               
Standing Committee meeting at 3:03 p.m.                                                                                         

Document Name Date/Time Subjects
Agnes Resume AMHTA.pdf SHSS 4/7/2022 1:30:00 PM
SB 124 Letter Gottstein 3.29.22.pdf SHSS 4/7/2022 1:30:00 PM
SB 124
SB 124 Amend. 1-39 3.17.22.pdf SHSS 3/17/2022 1:30:00 PM
SHSS 3/22/2022 1:30:00 PM
SHSS 3/29/2022 1:30:00 PM
SHSS 4/7/2022 1:30:00 PM
SB 124
Agnes Moran Application_Redacted.pdf SHSS 4/7/2022 1:30:00 PM
Confirmations
SCF Crisis Now Legislation Letter of Support 4.6.22.pdf SHSS 4/7/2022 1:30:00 PM
SB 124
SB 124 Ammendments Considered 4.7.22.pdf SHSS 4/7/2022 1:30:00 PM
SB 124