02/11/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Bring the Kids Home | |
| SCR1 | |
| SB52 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | SCR 1 | TELECONFERENCED | |
| *+ | SB 52 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
February 11, 2009
1:33 p.m.
MEMBERS PRESENT
Senator Bettye Davis, Chair
Senator Joe Paskvan, Vice Chair
Senator Johnny Ellis
Senator Joe Thomas
MEMBERS ABSENT
Senator Fred Dyson
COMMITTEE CALENDAR
PRESENTATION: BRING the KIDS HOME (BTKH)
HEARD
SENATE CONCURRENT RESOLUTION NO. 1
Relating to establishing March 2009 as Brain Injury Awareness
Month.
MOVED SCR 1 OUT OF COMMITTEE
SENATE BILL NO. 52
"An Act relating to scheduling Salvia divinorum and Salvinorin A
as controlled substances."
HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SCR 1
SHORT TITLE: BRAIN INJURY AWARENESS MONTH: MARCH 2009
SPONSOR(s): SENATOR(s) MCGUIRE
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS
02/11/09 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 52
SHORT TITLE: SALVIA DIVINORUM AS CONTROLLED SUBSTANCE
SPONSOR(s): SENATOR(s) THERRIAULT
01/21/09 (S) PREFILE RELEASED 1/9/09
01/21/09 (S) READ THE FIRST TIME - REFERRALS
01/21/09 (S) HSS, JUD, FIN
02/11/09 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
JEFF JESSE, CEO
Alaska Mental Health Trust Authority
Anchorage, AK
POSITION STATEMENT: Presented an overview of the Bring the Kids
Home Initiative.
DEE FOSTER, Director
Child and Family Services
Anchorage Community Mental Health Services
Project Director, Alaska Child Trauma Center
Anchorage, AK
POSITION STATEMENT: Stressed the importance of early
identification of problems and the social and economic benefits
of treating children in their communities.
WALTER MAJORIS, Executive Director
Juneau Youth Services (JYS)
Juneau, AK
POSITION STATEMENT: Discussed the importance of addressing the
transition period from child to adult services and what JYS is
doing about it.
JULIAN STOWE, representing herself
Homer, AK
POSITION STATEMENT: Supported keeping kids at home and providing
community-based care.
LEN STOWE, representing himself
Homer, AK
POSITION STATEMENT: Supported caring for kids at home and in the
community.
SENATOR MCGUIRE
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Sponsor of SCR 1.
NANCY MICHAELSON, representing herself
Palmer, AK
POSITION STATEMENT: Supported SCR 1.
JILL HODGES, Director
Alaska Brain Injury Awareness Network (ABIN)
Anchorage, AK
POSITION STATEMENT: Discussed the risk of recurring injuries to
brain injury victims and what ABIN will be doing to promote
awareness during Brain Injury Awareness Month.
DAVE STANCLIFF, staff
to Senator Gene Therriault
Alaska State Legislature
Juneau, AK
POSITION STATEMENT: Read the sponsor statement FOR SB 52.
JACK DEGENSTEIN, representing a community of friends
Anchorage, AK
POSITION STATEMENT: Opposed SB 52.
BRETT PATTISON, representing himself
Anchorage, AK
POSITION STATEMENT: Opposed SB 52.
SCOTT KOHLHAAS, State Chairman
Alaska Libertarian Party
Anchorage, AK
POSITION STATEMENT: Opposed SB 52.
ACTION NARRATIVE
1:33:45 PM
CHAIR BETTYE DAVIS 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 Thomas, Ellis, Paskvan and Davis.
^Bring the Kids Home
BRING THE KIDS HOME
CHAIR DAVIS announced a presentation on Bring the Kids Home by
the Alaska Mental Health Trust Authority.
1:34:37 PM
JEFF JESSE, CEO, Alaska Mental Health Trust Authority,
Anchorage, AK, began the presentation.
MR. JESSE began on page 2, showing the exponential growth in the
use of out-of-state residential psychiatric treatment centers
(RPTC) between 1998 and 2004. This significant growth was
primarily because there was no mechanism to develop in-state
alternatives. The existing programs had seen no expansion for a
number of years; so for kids who couldn't stay at home, there
were really no services available until they got to Utah, Texas,
Colorado or one of the other out-of-state placements. By state
fiscal year 2004, 749 kids a year were going to out-of-state
RPTCs at a cost to the state of over $40 million. Commissioner
Gilbertson and the Murkowski administration decided it was
something they wanted to address, so they asked the Trust to
assist in forming a partnership to address the issue. They made
it a focus area at the Trust and drew in a broad-based group of
stakeholders including state agencies, tribal partners,
families, kids, advocates and providers, to look at it using a
rigorous, outcome-based approach. They went through a logic-
model process, developed strategies and very specific outcomes.
This is a very complex initiative because it not only involves
developing a continuum of services in the state, but workforce
development, rate reviews and other issues.
Page 3 shows the progress they have made; from the peak in 2004
with 571 non-custody out-of-state admissions, the number has
come down to well under 200 in 2008. In absolute numbers the
high water mark was about 439 kids out of state and it is now
164. They have done this by developing a continuum of resources
for these children, their families and the community.
1:40:14 PM
MR. JESSE continued to page 4, which shows that the issue is not
just bringing the kids back, it's keeping them in the community;
so one of the other metrics the Trust has looked at is the
recidivism rate for kids coming back into RPTC level care. It's
not enough to get them out; they have to keep them out. The
level has decreased significantly since 2004, from 20 percent
recidivism in a year to 8.4 percent. That is another indication
of the ability to provide services in the community. He stressed
that this is all part of looking at the initiative in a very
data-driven, outcome-focused manner, making sure that their
strategies are achieving their goals and, if they aren't, being
flexible enough to re-evaluate what they are doing.
1:41:22 PM
Although this initiative is titled "Bring the Kids Home" they
knew many these kids would not come back to in-state care. Many
of these kids age out of the system. One of the things they have
realized is that there is a lot more work to be done in
transition. Just treating these kids, whether it is in the
community or in a facility is not enough; when they age out of
children's system they need help to become fully integrated
members of their communities. That means having a job, being
able to live independently and manage their finances. The
initiative needs to look at how to support them as they make
that transition into adulthood.
MR. JESSE went on to page 5 showing the financial impact of
making the change from RPTC services out-of-state to in-state.
This graph shows that from the high of $40 million they have now
driven the number down to about $26 million per year and have
been able to increase the capacity of in-state RPTCs to handle
these kids.
1:42:55 PM
The fiscal strategy, as shown on slide 6, is similar to the
Harborview Developmental Center closure. Rather than throwing
more money and services at the problem and driving up overall
cost, they've used a reinvestment strategy. In the case of
Harborview, the Trust agreed to pay for running the institution
on the condition that the legislature would reinvest those
institutional dollars in the community. The legislature kept
their word and made that reinvestment and they were able to
close Harborview. In this case, they've reinvested the dollars
that were being spent out of state in in-state services.
The first four columns of the graph reflect the actual
expenditures over the past four years, showing that the out-of-
state RPTC has gone down from $38 million to $26 million while
they have made significant increases in in-state community-based
services. Going into fiscal years 2009 to 2013, as this
initiative continues, they will see a continual reinvestment of
these funds into community-based programs.
1:44:25 PM
MR. JESSE admitted that they really started this initiative from
the wrong end. To develop a comprehensive continuum of care for
these kids, they should have started with families and kids in
the home and only when all of those efforts failed would they
move to out-of-home placement in the community, regional hub
out-of-home placement, in-state institutional care and then out-
of-state care only for those few kids whose needs are so
intensive they can't be served in Alaska. The Trust knew that if
they had come to legislature and said "if you invest five or six
million dollars in these in-home services, trust us, in ten
years you will see a reduction in the use of out-of-state
psychiatric treatment facilities," funding would probably not
have been forthcoming; so they started the initiative by looking
at developing residential services in the state to start driving
down the numbers. Now they can use that success to, hopefully,
convince the legislature that they can do even better, that by
working closer with families and communities, they can reduce
not only out-of-state institutional care, but in-state
institutional care.
1:46:21 PM
MR. JESSE directed the committee to page 7, a breakdown of what
is ahead in FY 2010. This shows a variety of MHTAAR and GFMH
increments designed to flesh out the continuum of care. He
pointed out that one of their partners in this effort is the
tribal health community and they've been working very hard with
the tribal health providers to develop infrastructure, work
force and the capacity to serve tribal beneficiaries.
Page 8 continues with some additional increments for expanding
in-state capacity and assisting in the transition to adulthood.
He added that this is for developing their ability to help young
adults move into the community.
One of the most recent developments in the Bring the Kids Home
initiative is the creation of an education sub committee. The
reason for it is that many of the families will not access
services early on, when a child begins to display behaviors and
other issues that create problems for them. The Trust believes
the educational system is the best early-warning mechanism for
these kids. If they can get the schools to start helping them to
identify these kids early... The schools are increasingly being
called upon to provide an array of services that aren't really
in the educational system's core competencies. Social service
issues, mental health issues and family problems are things they
are faced with but are ill-equipped to handle and arguably
should not have to; so the Trust is hoping to create a
partnership with education. The level of commitment to this is
demonstrated by the fact that the co-chairs of the education
subcommittee are the commissioners of Health and Social Services
and Education and Early Childhood Development.
1:49:32 PM
MR. JESSE said, from it isn't so much that they're bringing a
lot of kids back, although that is happening; it is that many
fewer kids are now leaving. Now that they can provide the
community-based services to support them, they are going to
remain in the school districts and the districts need to find a
way to meet the needs of those kids.
Again, said Mr. Jesse, it involves a closer partnership with
Health and Social Services. One element of that is the
transition of children from residential care back to their
community schools; so they are working to build in a liaison
between those out-of-state placements and the local school
districts so the school districts are notified and engaged early
in the discharge process.
1:51:48 PM
DEE FOSTER, Director, Child and Family Services, Anchorage
Community Mental Health Services; Project Director, Alaska Child
Trauma Center, Anchorage, AK, said theirs is the largest
community mental health center in Alaska. In FY 08 they saw 700
seriously emotionally disturbed children. One of the changes the
Community Mental Health Center has made in the past four years
is that they have begun intervening with children earlier; so of
those 700 children, 70 percent were age 12 and under. They have
also been funded by Bring the Kids Home as one of the "Keep the
Kids Home" contingents. The Little Tikes day treatment program
is for children three to five years old, who are displaying
acting-out behaviors or are extremely withdrawn. The kids in
this program come from preschools and daycares where they were
not able to function because of their extreme behaviors. This
fiscal year they have served 19 children, 7 graduated. Of the 19
children in care, the root causes of their severe emotional
disturbances are listed on page 9. These are, from lowest to
highest: sexual abuse, physical abuse, family substance abuse
and 100 percent neglect, witness to domestic violence and
complex trauma. She explained that by "complex trauma" she means
children who have been exposed to multiple traumatic events
within the care giving system. Two of their children were
"failure to thrive" children because of severe neglect in the
first year of life.
MS. FOSTER corrected that, on page 10, the amount shown for the
grant from BTKH is not $41,797, but $123,000. They expect to
serve 30 children this year, so in terms of grant funds that
works out to about $4500 per child per year, but doesn't include
billing to Medicaid, which is an additional cost. Because they
are one of the 50 national sites in the National Traumatic
Stress Network, all of their practices are evidence-based; they
work with attachment issues, with affect or emotional
regulation; they work around a child's competencies with problem
solving, for example. They've run the program for about 4 years
and now, with the addition of the money from Bring the Kids
Home, are able to incorporate standardized testing, home visits,
and the evidence-based practices.
1:57:09 PM
MR. JESSE continued; the next two slides show a rather complex
timeline. They took an actual case and went back into the
child's historical records at what was and was not done to see
what the consequences were of not intervening earlier. Going
back to the child's birth in 1990, this shows that there were
indications in the child's early life of future problems [ADHD,
febrile seizure, kindergarten special education], but very few
resources were provided to help the child at that time. Page 12,
the second page of the timeline, shows that when the child
reached adolescence and the costs started to mount due to
repeated residential placements, juvenile justice involvement
and other costs to the kid and the community.
1:59:02 PM
The most important cost is the cost to the child and family of
struggling through these experiences without adequate support.
He asked Mr. Majoris to address what is being done in Juneau to
address some of these issues.
1:59:18 PM
WALTER MAJORIS, Executive Director, Juneau Youth Services (JYS),
Juneau, AK, referred to the critical time period from 16 to 21
years old, when children are moving toward adulthood and aging
out of children's services. It is not an easy transition period
and not an area, in terms of the continuum of care, where there
is much funding for services.
He talked about some positive things that are going on, such as
the new facility they build with several partners, a $1.7
million facility. About 46 percent of that funding came from the
Denali Commission, 42 percent from Alaska Housing Finance
Corporation and about 12 percent from Juneau Youth Services.
They built a 13 bed state-of-the-art facility serving kids from
18 to 21 years old; they have a resident case manager there,
which is a critical staff position. This is an example of an
excellent capital funding partnership that is critical for
building and sustaining this kind of facility.
2:00:52 PM
They also have a five-bed facility, so JYS has 18 beds for
children in that age group and one bed for kids who are 16 to 18
years old.
On the operating side of the equation it gets much more
difficult. Juneau Youth Service's budget for FY 08 was about
$279,000 and 75 percent of those funds came from the federal
government and from JYS savings; only 20 percent came from the
state of Alaska and 5 percent from Medicaid. Often, children are
not qualified for Medicaid, or they choose not to take advantage
of the services that can be provided through Medicaid.
MR. MAJORIS thanked Senators Ellis and Davis for their
leadership in co-sponsoring legislation to raise the eligibility
threshold for Denali Kid Care, which is another way SED [Serious
Emotional Disturbance] kids are able to access services.
He shared some of their data, saying that JYS served 57 youth in
the last year; 91 percent of those youth received employment and
other life-skills training and 83 percent received therapy. The
qualifier there is that only 9.17 hours of services were
provided per client per month, which averages about two hours
per week and is not enough. Despite that, they had positive
outcomes with 78 percent who completed the program successfully
and 96 percent who exited to safe living arrangements (not
correctional facilities).
MR. MAJORIS summarized that this is a critical and very poorly
funded area in the service continuum and one in which the state
should become a greater participant.
2:03:25 PM
MR. JESSE wrapped up by saying this is one of most successful
initiatives he's been involved in due to the broad base of
collaboration with partners such as the Division of Behavioral
Health, the Division of Juvenile Justice, the Office of
Children's Services and Medicaid. The Department [Department of
Health and Social Services] has been very open to working with
not only the Trust, but with their provider community, families,
advocates, and other partners.
He recognized that one topic of conversation this legislative
session is corrections issues and pointed out that, if the
legislature should decide it doesn't want to continue the type
of growth the state is seeing and projecting in the corrections
budget, there are strategies to invest those dollars
differently. An approach similar to what the Trust has used
here, in his opinion, could be very effective in keeping people
focused on outcomes in a fiscally responsible manner, rather
than just throwing money at the problem. He stressed that they
have to be committed to the outcome, because that would take
great effort and a long time; but he encouraged them to look at
it.
2:05:53 PM
JULIAN STOWE, representing herself, Homer, AK, said she was
diagnosed as bipolar and sent away to an out-of-state
residential treatment center. She was afraid; she had to leave
her family, her dog, all of her friends and was exposed to
horrible things that she should not have witnessed at 15 years
old. Things were going on in the treatment center that were
based around money and should not have been going on. If
patients' parents were paying out-of-pocket they got better
treatment; her parents were not paying out-of-pocket and she was
put in a different unit than the one she should have been. When
she came home, she quickly relapsed and was sent to an acute
care facility; they wanted to send her back to residential care
but she refused to go back. She went home and her parents got
her into therapy with a wonderful therapist who has been an
amazing help to her. "What I'm here today asking" she said "is
that you don't bring them home to lock them up. You bring them
home to stay at home." She stressed the need for recreational
options after school so kids won't turn to drugs, and for more
mental health skills trainers. These trainers go into schools
and spend time with kids to help them achieve their goals. She
suggests that people ask kids what they need help with, rather
than telling them what they need to get done.
MS. STOWE thanked the committee for the opportunity to testify.
LEN STOWE, representing himself, Homer, AK, is Julian's father.
He said that sending their daughter away at 15 was the hardest
thing their family has ever done. They agonized over it, but
didn't know of any other options at that time. This affected
their family very deeply; their other daughter did not get the
parenting she deserved because of their stress over Julian. He
and his wife did not always agree on the treatment, which caused
stress; also, when Julian was out-of-state she was allowed one
call a day and it wasn't always at the same time. They were her
life-line; so they had to find a way to be available for her. He
had to schedule a way to get out of work and his wife pretty
much stayed at home the whole time so they could be there to
talk with her and encourage her each day.
Julian was released early. In fact, the therapist who worked
with her in the out-of-state facility said she had to come home
or she would get worse. They brought her home and started
working with the psychiatrist, therapist and skills workers in
Homer and it really saved her and their family. She had gotten
way behind during her first ten years in school and nothing was
done to encourage her to progress until this happened; now with
the skills trainers in the charter school, she is starting to
improve. This school is specifically for kids who have trouble
in a regular school situation; they work closely with mental
health and have done a wonderful job with their daughter and
other children. They need more funding because there aren't
enough skills trainers to go around; he feels very fortunate for
the level of care and attention their daughter has gotten.
MR. STOWE added that the therapist at the center in Texas said
Julian doesn't need to be sent away again; it will not help her.
He and his wife agree whole heartedly. They never wanted to send
her away; they are glad she's back and is progressing now and
they thank the state for the funding they have provided to
mental health.
2:12:46 PM
JULIAN STOWE corrected her father's statement that there not
enough skills trainers to go around; there are plenty of skills
trainers, she said, but not everyone has access to mental
health, which means they can't have a skills trainer or get the
care they need.
2:13:44 PM
SENATOR ELLIS thanked Mr. And Ms. Stowe for sharing their
experiences. He asked who chose that facility for the out-of-
state placement and if any options were offered.
MR. STOWE said they looked into three different places; the one
in Texas that they finally chose was the only one that had beds
available at that time. The acute care facility where Julian was
being held actually chose it for them.
SENATOR ELLIS asked if the state of Alaska had a list of
certified programs outside from which to choose.
MR. STOWE said the acute care facility Julian went to initially
did have. They met with people there a couple of times about it
and they suggested that this was the best one for Julian. When
they arrived at the Texas facility they did not see everything,
of course; when Julian told them about some of the things that
were going on, it scared them but they didn't know what else to
do; she had to stay there until they released her.
JULIAN STOWE said the institution was very good at keeping
people "off the unit" so they wouldn't see the craziness, the
flying chairs, the people cutting themselves and that sort of
thing.
2:15:36 PM
MR. JESSE closed by saying that when they get further along in
this initiative, he believes Alaska will have the best continuum
of care for these kids in the country. However, they are very
worried about whether the state will sustain their efforts when
the focus comes off this issue. A number of providers have said
the state has a habit of adjusting costs based on cost and then
ignoring them as costs increase, until the quality of services
degenerates and they end up trying to rebuild systems of care.
Rates need to be revisited regularly for all types of care, not
just hospitals and nursing homes. As a matter of public policy,
it is not a good idea to regularly review and keep up with the
cost of care only for the most restrictive and expensive
services, while ignoring the more cost-effective and efficient
community-based services. He has heard from providers that they
are not able to open homes that have already been built, because
the daily rate isn't sufficient to operate them; he heard from a
provider today that projects in three years their costs will
cost the reimbursement rate and they will no longer be able to
provide services. He really hopes the bill to require regular
rate review for community services will pass. It would be a
shame to have built a system of care and see it fall apart over
time.
CHAIR DAVIS informed Mr. Jesse that the bill he referenced has
been heard once and they are working on a CS to bring back to
the committee at a later time.
She asked if there are any other providers or youth in the room
who wish to speak and thanked everyone for taking the time to
offer testimony to this committee and the Education committee.
2:18:25 PM
CHAIR DAVIS asked Mr. Majoris how long it took them to put
together the funding for the building they completed 18 months
ago.
MR. MAJORIS answered that it was a fairly accelerated process;
from concept to completion, it took 2 to 2 1/2 years.
CHAIR DAVIS said it would be helpful if he would share the
information about how they managed it. As he said himself, when
people and organizations come together they can accomplish a
great deal more than they can alone.
MR. MAJORIS commented that they have found it is often easier to
put the capital package together than it is to find the
sustainable operating funds they need. Their program could not
function if 75 percent of the funding were not coming from the
federal government and their agency directly.
2:20:25 PM
CHAIR DAVIS agreed and opined that they might be fortunate
enough to get some funds from the stimulus package to help with
the current initiative.
2:20:26 PM
She closed the presentation and called a brief at ease at 2:20
PM.
SCR 1-BRAIN INJURY AWARENESS MONTH: MARCH 2009
2:22:36 PM
CHAIR DAVIS announced consideration of SCR 1.
SENATOR MCGUIRE, presented the sponsor statement for SCR 1. She
said she brings this resolution every year, hoping to move one
heart or mind. This resolution draws awareness to traumatic
brain injury (TBI), to those who have suffered as well as their
families and care providers. Traumatic brain injury is a result
of damage to the brain as the result of a blunt trauma to the
head or violent shaking. Most victims go on to live with
permanent disabilities. The tragedy of TBI is exacerbated by the
fact that many of these injuries are preventable; so there is a
lot of guilt and frustration associated with this particular
type of injury. These injuries are life-altering and place
tremendous financial and emotional strain on families and their
victims. They often occur at an early age, before the victims
have secured a job, which means many years of tremendous medical
expenses and no way to cover them.
2:25:15 PM
Alaska again leads the United States for per capita traumatic
brain injury and TBI itself is one of the leading causes of
death to young people in this state. Over 800 traumatic brain
injuries are reported annually in Alaska and it is estimated
that over 12,000 Alaskans now living in the state have suffered
a traumatic brain injury. She reminded the committee that these
statistics are low; traumatic brain injury is a silent epidemic.
Many traumatic brain injuries are not reported because the
victims minimize or fail to understand the severity of their
injury; often they don't have access to health care to pay for
the MRI needed to understand the impact and potential long-term
damage. People with late stage manifestation of symptoms such as
learning problems, difficulty in judgment from frontal lobe
injury, difficulty in maintaining jobs and relationships, are
simply navigating through society without realizing their
problems are due to a brain injury.
SENATOR MCGUIRE continued; it is easy to see and understand an
injury like a broken limb and as a society we try to help, but
with a traumatic brain injury, there may be no visible signs. As
Alaskans, we need to be mindful that many of the people with
traumatic brain injury are living among us and it is incumbent
on us to do all we can.
The Brain Injury Association of America recognizes March each
year as Brain Injury Awareness Month; so this resolution would
comport with national recognition by making Alaska once again
recognize March 2009 as the state traumatic brain injury
awareness month.
She stated that there isn't enough done about TBI in this state;
they don't know how to reach families and individuals who are in
high risk categories and they are still dealing with insurance
issues, the overarching inability to respond quickly to treat
life-long consequences. TBI has economic consequences for the
state; it has social implications for the family and the state
and it is a preventable injury. Where the state can prevent it,
she said, she sees it as a place where the Senate HSS Committee
and the Senate as a whole should really direct attention. The
legislature already looks at helmet use and seat belts, which
are both very positive steps in the right direction. The Brain
Injury Network is a non-profit board that was formed five years
ago and is made up of TBI survivors, their family members and
those who make up the social organizations that respond, but
they are overwhelmed with the task. They don't have enough
money; they don't have enough support; they don't have enough
resources to get the word out. This resolution is also an
opportunity for survivors and their family members to get the
attention of the legislature.
2:31:08 PM
She spoke about her brother's accident. When he survived a
traumatic brain injury in an automobile accident at 17 years
old, there was no one for her family to turn to and a lack of
acute care. The landscape has changed, but there is still a long
way to go. She expressed her appreciation for Senator Davis's
support of brain injury awareness and for the committee's time.
2:32:04 PM
SENATOR THOMAS shared his support for this effort. He has a
nephew who was injured seven years ago. He is functioning now
but is having a lot of problems.
2:32:59 PM
SENATOR PASKVAN also supports this resolution. He understands
the difficulty from his 25 years of legal practice in the area
of personal injury. He agreed that to make this brain injury
awareness month is very appropriate.
2:34:16 PM
SENATOR MCGUIRE said she knows people in Senator Paskavan's
field who, in cases as recent as a month ago, have had
difficulty making jurors understand what traumatic brain injury
is and how profound and life-altering it can be.
She informed the committee that Alaska is one of 40 states
involved in a new pilot program called Impact that is being
carried out at Providence and Alaska Regional; they are working
with athletes in the schools, sports trainers, neurosurgeons and
neuropsychologists to understand cognitive brain damage and how
it can occur from seemingly minimal concussions. The hospitals
do brain scans immediately [after an incident] and test for
cognitive functions. The results will be part of the nationwide
results gathering effort that hopefully will lead to much better
understanding.
2:36:04 PM
CHAIR DAVIS thanked Senator McGuire and called for public
testimony on this resolution.
NANCY MICHAELSON, representing herself, Palmer, AK, is the
parent of a young man who suffered a traumatic brain injury six
years ago. Her son, Aaron was in a coma for two weeks of the
month he spent at Providence Hospital. At that time, they were
fortunate enough to get Aaron admitted to Craig Rehabilitation
Hospital in Denver, Colorado, where he spent the next six
months. She pointed out that she used the word "fortunate"
because her son had serious medical issues that needed
specialized care from a full team of doctors and he was able to
get that care in Denver while participating daily in a rehab
program specifically designed for brain injury patients. As a
result, although he has fairly low-level function, is mainly
immobile and speaks only a few words, he understands everything
that is said to him and is still improving even after six years.
2:37:58 PM
MS. MICHAELSON said that within the first 20 hours of their stay
at Craig Hospital, they were met with the attitude that Aaron
had widespread damage and they had a lot of work to do, so
they'd better get started right away. She stressed the
difference between that and the attitude of the doctors in
Alaska both before they left and after they returned. Yes, she
said, they were lucky to get Aaron into specialty brain injury
rehab center. The reason is hope, for Aaron's future and their
future as a family, for the life they can have regardless of his
cognitive difficulties or physical abilities. They came home
with the realization that they can fight for, move toward and
support quality of life for persons with brain injury regardless
of their stage of recovery or injury. They also learned to
appreciate the ability to look outside the box of traditional
physical rehab therapy and care programs to find approaches that
work for persons with brain injuries, always keeping in mind the
delicate balance between the physical abilities and the
cognitive realities.
2:39:22 PM
Insurance policies cover alternative approaches and there are
places these therapies can be found all over the United States;
but it has been very difficult to find them in Alaska. When the
Michaelsons returned to Alaska and visited with Aaron's rehab
doctor and staff for the first time, they expressed how
wonderful it was to have Aaron home with them; the medical
team's response was incredulity and even insulting comments. She
attributes their response to her family's outlook and their
acceptance that the only life they have is with their son,
regardless of what progress he makes or doesn't make and to a
general lack of awareness about brain injury.
MS. MICHAELSON commented that she finds the lack of awareness
about brain injury here in Alaska pretty amazing. Victims with
high needs and lower-level function, like her son, may look as
if they don't understand anything until they hear the right
joke, or get to do something they especially enjoy; then it is
clear that they understand more than is obvious. She thanked
Senator McGuire for mentioning the victims who show no outward
signs of damage. Some victims may walk, talk, drive, and teach
art, but be unable to balance a checkbook, keep a job, answer a
telephone or remember the routine they have to go through every
night to go to bed.
MS. MICHAELSON said her family has encountered a lot of problems
obtaining medical rehab or therapy since they got back to Alaska
due in part to the fact that Aaron started his therapy outside.
She fears for the growing number of returning veterans [who may
face similar difficulties in dealing with brain injuries].
Aaron's injury has affected his life and the life of her family,
He will require guardianship for the rest of his life; this kind
of psychological and emotional reality can and does break most
families. In her family, his care totally consumes their
schedules and finances since the injury; she lost her job when
he was injured because she had to take care of him. Brain injury
is known as "the silent epidemic," but it really isn't; there
are the sleepless nights and crying from pain Aaron doesn't
understand.
Above all else though, she is thankful that he is at home with
his family and that is where the legislature comes in. She
believes Alaskans deserve a local rehabilitation option that can
give them the chance to get on the road to whatever recovery is
possible and learn to live life to its fullest potential even
after surviving brain injury. But before that can happen,
Alaskans have to talk about awareness, awareness of the large
number of Alaskans who suffer brain injuries annually, awareness
of the wide scope of their rehabilitation needs, awareness of
the impact of brain injury on families and awareness that many
brain injuries can be prevented. The legislature can help all of
that become reality by passing this resolution.
2:44:02 PM
JILL HODGES, Director, Alaska Brain Injury Awareness Network
(ABIN), Anchorage, AK, thanked the Senators and all of those who
shared their personal stories. She feels very positive about the
future for people with brain injury here in Alaska and thinks
that they will soon move toward getting services they need here.
She wanted to highlight some successful TBI prevention
activities happening in the state and some upcoming challenges
the Brain Injury Network might face in preventing recurring
brain injuries among civilians and returning service members.
2:45:30 PM
With regard to successful TBI prevention activities, she cited
passage of the primary seatbelt law in 2003, saying that since
2001, brain injuries due to motor vehicle accidents have
decreased 38 percent. Motor vehicle accidents still cause brain
injuries, however 56 percent of those who suffer brain injury in
vehicle accidents were not wearing their seatbelts. Another
topic Senator McGuire touched on is the Impact Program, which is
a partnership between Providence Neurosurgery Clinic, the
Anchorage School District, the Mental Health Trust Authority and
the Brain Injury Network dealing with concussion management. A
CNN article recently covered brain injury among NFL players who
suffer concussions. In the past, people thought a concussion
might put athletes out of operation for a week or two before
they would be back on their feet; they are finding that multiple
concussions are causing lifelong damage to the brain that is not
showing up on CT scans or MRIs.
MS. HODGES continued; when people talk about prevention, they
are generally talking about preventing the primary injury; once
one has had a brain injury however, that person is more likely
to have recurrences with even more disabling effects. For
example, a woman came in to the Resource Navigation Program for
brain injury victims earlier this week; she had come in two
years before to talk about her pregnant daughter, who suffered
brain injury in a motor vehicle accident and needed a lot of
help after she was released from the hospital. She said that her
daughter recently had another accident, incurred a second brain
injury and is now in a nursing facility.
2:48:15 PM
She expressed concern about how this problem will affect our
returning service members; those with moderate to severe
injuries remain in the lower 48 for treatment, but many are
coming home with mild brain injuries. These veterans will be
going back to rural Alaska and statistics show that Alaska
Natives and residents of rural Alaska have the highest rates of
brain injuries from causes such as ATV and snow machine
accidents; 69 percent of those victims are not wearing helmets
at the time of their injuries. ABIN worries that the returning
service members are going to be very active when they return,
perhaps living subsistence lifestyles and those communities need
to be aware that they need to prevent further injury to this
population.
2:49:06 PM
During the month of March, the Brain Injury Network will be
working closely with the Alaska Native Tribal Health Consortium,
the Department of Health and Social Services, the Mental Health
Trust Authority and the veterans' clinic at Elmendorf AFB, doing
press conferences, publishing newspaper ads, television
commercials, and YouTube and Facebook video for the youth. The
VA has offered to sponsor a public health forum in the month of
March as well. They did that last year and had about 50 people
in Anchorage show up for their presentation.
MS. HODGES thanked the Senators for their leadership in
promoting healthy lives and said she looks forward to working
with them on future legislation to improve the service system
for people with brain injuries.
2:50:23 PM
CHAIR DAVIS the will of the committee.
SENATOR PASKVAN moved to report SCR 1 from committee with
individual recommendations and attached zero fiscal note. There
being no objection, it was so ordered.
SB 52-SALVIA DIVINORUM AS CONTROLLED SUBSTANCE
2:51:19 PM
CHAIR DAVIS announced consideration of SB 52.
DAVE STANCLIFF, Staff to Senator Therriault, read the sponsor
statement FOR SB 52, an Act relating to scheduling Salvia
Divinorum and Salvinorin A as controlled substances. This bill
would place the natural plant and the substance within the plant
on the same schedule in our statutes that contains mescaline,
LSD, peyote and other similar hallucinogenic substances. He
recommended that, if any of the members wish to learn more "up
close and personal," there are over 1000 sites on YouTube where
they can actually watch persons under the influence of this
particular hallucinogenic substance, which is available to
children through the internet or down the street at the local
smoke shop. It is legal in Alaska, which is telling Alaska's
kids it's OK. States and countries around the globe are finding
that they need to control this substance because it is a danger.
2:53:04 PM
CHAIR DAVIS called for brief public testimony.
2:53:17 PM
JACK DEGENSTEIN, Anchorage, AK, asked if the committee intends
to move this bill today.
CHAIR DAVIS answered that she does not intend to move the bill;
the committee is simply taking testimony at this time.
MR. DEGENSTEIN said he represents a group of people who are part
of a community that is involved with this plant. He stated that
in the three years since this bill first came up, they have seen
no problems related to its use, which he feels proves that it is
not creating a health or social crisis. Passing this bill would
serve only to impose upon citizens' individual liberties; so
while he does support regulation of the drug, he opposes this
bill.
BRETT PATTISON, representing himself, also opposes this bill. He
said he has never taken any illicit substances, not even tobacco
or alcohol. He had a psychotic episode in 1998 at the age of 17
and was moved out-of-state to a medical facility where he was
diagnosed as bi-polar. While there, he was prescribed
medications like Paxil and Depakote, which caused him terrible
headaches, and during one episode was injected with Haldol,
which caused serious side-effects. He has used salvia numerous
times during the past five years without any lasting affects
either mentally or physically and it has not impacted his daily
life at all. He sees potential for the drug in medical
applications and is in favor of regulation while conducting
further research into its use.
SCOTT KOHLHAAS, State Chairman, Alaska Libertarian Party, said
he is representing his party's 6600 registered voters today on
in opposition to SB 52. Libertarians believe in a strict respect
for civil liberties and he thinks this bill would violate those
civil liberties, not only religious liberties, but people's
right to live in whatever manner they choose and engage in
whatever practices they wish as long as they are peaceful. The
libertarians also take a principled stand on the free-market
economy; if this is driven underground, certainly the pushers
will make money and if it is prohibited, the pharmaceutical
companies will make a ton of dough as well. The libertarians are
opposed to prohibition; they think the committee should be
taking items off the scheduled substance list and not adding to
it. He asked the committee to let this bill die.
CHAIR DAVIS held SB 52 in committee.
2:57:30 PM
There being no further business to come before the committee,
Chair Davis adjourned the meeting at 2:57 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| REVISED2 BB BTKH Leg Presentation Wed.ppt |
SHSS 2/11/2009 1:30:00 PM |