03/08/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HCR10 | |
| SB156 | |
| SB124 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HCR 10 | TELECONFERENCED | |
| += | SB 124 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 156 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 8, 2022
1:32 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Lora Reinbold
Senator Tom Begich
MEMBERS ABSENT
Senator Mia Costello
COMMITTEE CALENDAR
HOUSE CONCURRENT RESOLUTION NO. 10
Proclaiming February 2022 as American Heart Month.
- HEARD & HELD
SENATE BILL NO. 156
"An Act relating to COVID-19 immunization rights; and relating
to objection to the administration of a COVID-19 vaccine."
- MOVED CSSB 156(HSS) OUT OF COMMITTEE
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: HCR 10
SHORT TITLE: AMERICAN HEART MONTH
SPONSOR(s): REPRESENTATIVE(s) GILLHAM
02/09/22 (H) READ THE FIRST TIME - REFERRALS
02/09/22 (H) RLS
02/16/22 (H) TRANSMITTED TO (S)
02/16/22 (H) VERSION: HCR 10
02/22/22 (S) READ THE FIRST TIME - REFERRALS
02/22/22 (S) HSS
03/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
BILL: SB 156
SHORT TITLE: PROHIBIT COVID-19 VACCINE DISCRIMINATION
SPONSOR(s): SENATOR(s) REINBOLD
01/18/22 (S) PREFILE RELEASED 1/7/22
01/18/22 (S) READ THE FIRST TIME - REFERRALS
01/18/22 (S) STA, HSS
02/03/22 (S) STA AT 3:30 PM BUTROVICH 205
02/03/22 (S) Heard & Held
02/03/22 (S) MINUTE(STA)
02/08/22 (S) STA AT 3:30 PM BUTROVICH 205
02/08/22 (S) Heard & Held
02/08/22 (S) MINUTE(STA)
02/10/22 (S) STA AT 3:30 PM BUTROVICH 205
02/10/22 (S) Moved SB 156 Out of Committee
02/10/22 (S) MINUTE(STA)
02/11/22 (S) STA RPT 2DP 1AM
02/11/22 (S) DP: SHOWER, REINBOLD
02/11/22 (S) AM: HOLLAND
03/01/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/01/22 (S) Heard & Held
03/01/22 (S) MINUTE(HSS)
03/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
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
WITNESS REGISTER
REPRESENTATIVE RON GILLHAM
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Sponsor of HCR 10.
EDRA MORLEDGE, Staff
Representative Ronald Gillham
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Answered questions on HCR 10.
JAMIE MORGAN, Government Relations Director
Western States Region
American Heart Association
Sacramento, California
POSITION STATEMENT: Testified by invitation on HCR 10.
ED MARTIN, representing self
Kenai, Alaska
POSITION STATEMENT: Testified during the hearing on HCR 10 and
spoke off-topic.
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
156.
STEPHEN WILLIAMS, Chief Executive Officer
Alaska Mental Health Trust Authority
Anchorage, Alaska
POSITION STATEMENT: Provided an overview of SB 124 and answered
questions.
HEATHER CARPENTER, Health Care Policy Advisor
Office of the Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Provided background information on SB 124.
JAMES COCKRELL, Commissioner
Department of Public Safety
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on SB 124.
MARK REGAN, Legal Director
Disability Law Center of Alaska
Anchorage, Alaska
POSITION STATEMENT: Provided invited testimony on SB 124.
ALBERT WALL, Deputy Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on SB
124.
ACTION NARRATIVE
1:32:23 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:32 p.m. Present at the
call to order were Senators Reinbold, Begich, Hughes, and Chair
Wilson.
HCR 10-AMERICAN HEART MONTH
1:33:15 PM
CHAIR WILSON announced the consideration of HOUSE CONCURRENT
RESOLUTION NO. 10 Proclaiming February 2022 as American Heart
Month.
1:33:30 PM
REPRESENTATIVE RON GILLHAM, Alaska State Legislature, Juneau,
Alaska, sponsor of HCR 10, stated that he became interested in
promoting American Heart Month because he had a heart attack on
January 26, 2022. He recalled his medical providers lamenting
that the public lacked information about cardiovascular disease
and preventative measures despite 690,000 deaths per year being
attributed to heart-related issues. He said most heart issues
are due to lifestyle choices, but 33 percent are due to
genetics. He explained that calcium scoring is a diagnostic test
that can prevent a heart attack.
1:36:40 PM
SENATOR BEGICH said he was glad Mr. Gillham survived.
1:36:56 PM
SENATOR HUGHES pointed out that the calcium scoring test doesn't
prevent a heart attack because it is a diagnostic test. She
asked whether doctors could prescribe medication if they
identified a problem.
1:37:35 PM
REPRESENTATIVE GILHAM stated that calcium scoring is similar to
an ultrasound. He explained that a routine exam could have shown
that he had a blocked artery, but it may not have indicated he
was prone to a heart attack. However, it would have been a
better indicator if he had undergone calcium scoring. He related
that the higher the score, the more likely the person was to
have a heart attack. He said the calcium scoring diagnosis could
help prevent a heart attack. He stated his goal was to help
prevent others from having heart attacks.
1:38:38 PM
SENATOR HUGHES asked if this was the first year this resolution
was introduced.
1:38:57 PM
EDRA MORLEDGE, Staff, Representative Ronald Gillham, Alaska
State Legislature, Juneau, Alaska, related that the legislature
passed a similar resolution in 2012.
1:39:16 PM
CHAIR WILSON turned to invited testimony.
1:40:45 PM
JAMIE MORGAN, Government Relations Director, Western States
Region, American Heart Association (AHA), Sacramento,
California, began invited testimony on HCR 10. She stated that
cardiovascular disease is the world's leading cause of
preventable death. She said cardiovascular disease affects men,
women, and children of every age and race in the United States.
MS. MORGAN reported that deaths from heart disease increased by
4.8 percent from 2019-2020, which was the largest increase in
heart disease deaths since 2012. She related that stroke deaths
increased by 50 percent during that same timeframe.
Cardiovascular disease continues to be the leading cause of
death in the US, exacting a financial toll. Direct and indirect
costs of cardiovascular disease was $378 billion from 2017-2018.
1:40:53 PM
MS. MORGAN related that the US had made great progress in
reducing the death rate, but it has been more modest concerning
cardiovascular disease in women and minorities. Furthermore,
cardiovascular diseases are the number one killer of women in
the US, killing more than all forms of cancer combined, and the
leading cause of maternal death in the US. She said heart
disease is the number one killer of new moms.
MS. MORGAN stated that AHA believes that the research is clear
that community-based and preventative-based strategies can
increase survival rates from cardiovascular disease. AHA feels
that thousands of lives could be saved by raising awareness,
speaking out about heart disease, and empowering others to
reduce their risk for cardiovascular disease. She urged members
to support HCR 10.
1:42:02 PM
At ease
1:43:00 PM
CHAIR WILSON reconvened the meeting and opened public testimony.
1:43:27 PM
ED MARTIN, representing self, Kenai, Alaska, stated he has
resided in Alaska for 56 years and had his first heart attack in
his late 40s and a second one years later. He said he has six
stents in his heart, and he currently has a blocked carotid
artery. The remainder of his testimony was off-topic.
CHAIR WILSON noted that written testimony could be submitted to
the committee at [email protected].
1:45:52 PM
CHAIR WILSON, after first determining no one else wished to
testify, closed public testimony on HCR 10.
1:46:02 PM
REPRESENTATIVE GILHAM said he had considered introducing a bill
but decided to introduce a resolution each year to raise
awareness.
1:46:40 PM
CHAIR WILSON held HCR 10 in committee.
1:46:54 PM
At ease
SB 156-PROHIBIT COVID-19 VACCINE DISCRIMINATION
1:49:00 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 156 "An Act relating to COVID-
19 immunization rights; and relating to objection to the
administration of a COVID-19 vaccine."
CHAIR WILSON solicited amendments.
1:49:20 PM
SENATOR REINBOLD moved to adopt Amendment 1, work order 32-
LS1352\I.7.
32-LS1352\I.7
Dunmire/Foote
3/4/22
AMENDMENT 1
OFFERED IN THE SENATE BY SENATOR REINBOLD
Page 1, line 1:
Delete "and"
Page 1, line 2, following "vaccine":
Insert "; and providing for an effective date"
Page 2, following line 30:
Insert a new bill section to read:
"* Sec. 2. This Act takes effect immediately under
AS 01.10.070(c)."
1:49:23 PM
CHAIR WILSON objected for discussion purposes.
1:49:25 PM
SENATOR REINBOLD explained that Amendment 1 would insert an
immediate effective date. She related that, in her experience,
sometimes bills were delayed because they lacked sufficient
votes on the Senate floor to adopt the effective date clause.
1:49:43 PM
SENATOR BEGICH stated that adding an effective date to this bill
could delay it if the Senate did not have a two-thirds vote to
adopt the effective date clause.
1:50:05 PM
At ease
1:50:39 PM
CHAIR WILSON reconvened the meeting.
1:50:46 PM
SENATOR BEGICH stated his question was whether Amendment 1 was
to add an effective date to the bill that would require 14 votes
for the effective date clause to pass the Senate. He advised
that if the bill does not have an effective date, it will
default to becoming effective 90 days after passage.
1:51:033 PM
SENATOR REINBOLD stated she intended to add an immediate
effective date in SB 156 because the unvaccinated were being
discriminated against.
1:51:26 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 1 was adopted.
1:51:38 PM
SENATOR REINBOLD moved to adopt Amendment 2, work order 32-
LS1352\I.8.
32-LS1352\I.8
Dunmire/Foote
3/4/22
AMENDMENT 2
OFFERED IN THE SENATE BY SENATOR REINBOLD
Page 1, line 1:
Delete "and"
Page 1, line 2, following "vaccine":
Insert "; and relating to COVID-19 vaccination
status and eligibility for health care insurance"
Page 2, following line 30:
Insert a new bill section to read:
"* Sec. 2. AS 21.54.100(a) is amended to read:
(a) A health care insurer that offers, issues
for delivery, delivers, or renews a health care
insurance plan in the group market may not establish
rules for eligibility, including continued eligibility
and waiting periods under the plan, for an individual
or dependent of an individual based on
(1) health status;
(2) medical condition, including physical
and mental illnesses;
(3) claims experience;
(4) receipt of health care;
(5) medical history;
(6) genetic information;
(7) evidence of insurability, including
conditions arising from acts of domestic violence;
[OR]
(8) disability; or
(9) the individual's COVID-19 vaccination
status; in this paragraph, "COVID-19" has the meaning
given in AS 18.09.290."
1:51:40 PM
CHAIR WILSON objected for discussion purposes.
1:50:41 PM
SENATOR REINBOLD stated that members received 500 emails on SB
156, noting that several constituents requested adding
eligibility for health care insurance. She explained that
Amendment 2 would say that insurance could not deny a claim
based on vaccine status.
1:52:27 PM
SENATOR BEGICH pointed out that her concern was already covered
under current law. He referred to page 1, lines 15-19 of
Amendment 1, to AS 21.54.100(a)(1)(5). He stated that health
status, medical condition, including physical and mental
illnesses, claims experience, receipt of health care, and
medical history cannot be used as reasons. Further, the
Affordable Care Act (ACA) also prohibits pre-existing
conditions. He said he would not oppose Amendment 2 but wanted
to point out that in his discussions with the Division of
Insurance and in reading the statutes, adding paragraph (9)
would add redundancy.
1:54:06 PM
SENATOR HUGHES asked if Title 21 relates to insurance, so adding
this language to the statute would clarify that COVID-19
vaccination status cannot be discriminated against.
1:54:26 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), Anchorage,
Alaska, responded that Title 21 relates to the insurance code.
She agreed with Senator Begich that a health care insurer could
not ask any questions related to pre-existing conditions. Thus,
a health care insurer cannot ask if someone has received polio,
shingles, or pneumonia vaccines.
SENATOR BEGICH said it might not be necessary to add the
language.
1:55:02 PM
SENATOR REINBOLD asked if Amendment 2 would complement current
statute.
MS. WING-HEIER replied that Amendment 2 would likely create
confusion because people may wonder about the intent. The
current statute does not need to be complemented because it is
already addressed in the five paragraphs.
SENATOR REINBOLD offered her belief that discrimination
regarding COVID-19 vaccination status was occurring nationwide.
She offered her view that insurance claims were being denied for
vaccinations and for those who were unvaccinated.
1:56:13 PM
SENATOR HUGHES asked whether federal and state laws prohibit
insurers from asking about vaccination status or pre-existing
conditions.
1:56:34 PM
MS. WING-HEIER replied that it was based on federal law, but
state law mimics federal law as much as possible.
1:56:47 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 2 was adopted.
1:56:58 PM
SENATOR BEGICH moved to adopt Amendment 3, work order 32-
LS1352\I.6.
32-LS1352\I.6
Foote
3/3/22
AMENDMENT 3
OFFERED IN THE SENATE BY SENATOR BEGICH
Page 1, following line 3:
Insert a new bill section to read:
"* Section 1. The uncodified law of the State of
Alaska is amended by adding a new section to read:
LEGISLATIVE INTENT. It is the intent of the
legislature that every person should have the right to
choose their own medical interventions because art. I,
sec. 22, of the Constitution of the State of Alaska
protects a person's right to privacy."
Page 1, line 4:
Delete "Section 1"
Insert "Sec. 2"
1:57:00 PM
CHAIR WILSON objected for discussion purposes.
1:57:02 PM
SENATOR BEGICH stated that numerous arguments had been made in
committee and on the floor about tying legislation to a person's
autonomy and right to make medical decisions. He explained that
Amendment 3 would add legislative intent that every person has
the right to choose their medical intervention and a right to
privacy.
1:57:57 PM
SENATOR REINBOLD asked for assurance that Amendment 3 did not
eliminate Section 1.
SENATOR BEGICH answered that Amendment 3 does not delete any
language in the bill, but the sections are renumbered.
1:58:52 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 3 was adopted.
SENATOR REINBOLD stated that SB 156 would provide for individual
choice without discrimination based on COVID-19 vaccination
status. She said it would prohibit immunity passports. She
expressed concern that a hostess at a restaurant would ask for a
vaccination card.
2:01:28 PM
CHAIR WILSON solicited the will of the committee.
2:01:34 PM
SENATOR HUGHES moved to report SB 156, work order 32-LS1342\I,
as amended, from committee with individual recommendations and
attached Statement of zero fiscal impact.
CHAIR WILSON found no objection and CSSB 156(HSS) was reported
from the Senate Health and Social Services Standing Committee.
2:01:57 PM
At ease
SB 124-MENTAL HEALTH FACILITIES & MEDS
2:05:05 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."
2:05:52 PM
CHAIR WILSON solicited a motion.
2:05:55 PM
SENATOR HUGHES moved to adopt the committee substitute (CS) for
SB 124, work order 32-GS1730\B, as the working document.
2:06:07 PM
CHAIR WILSON objected for purposes of discussion.
2:06:25 PM
STEPHEN WILLIAMS, Chief Executive Officer, Alaska Mental Health
Trust Authority, Anchorage, Alaska, offered to provide a brief
overview of SB 124. He said he would cover the components of the
Crisis Now model. The state would like to implement this model
in many communities throughout the state to address Alaskans
experiencing a behavioral health crisis more appropriately. This
bill would relieve the first responders, such as law enforcement
and emergency medical technicians (EMT), from the current
default response. He envisioned that the Crisis Now model would
allow for early intervention by mental health professionals to
assist Alaskans experiencing a mental health crisis. Currently,
if an Alaskan facing a behavioral health crisis calls 911, law
enforcement or EMTs would respond. While that response is good,
those professionals are not trained for or have the necessary
tools to address someone in a behavioral health crisis.
MR. WILLIAM explained that the goal is to provide the person in
crisis with the appropriate care by the appropriate
professionals to address the situation, keeping the person and
others safe. He elaborated that taking someone into care is
currently limited to the designated evaluation treatment
facilities in Anchorage, Mat-Su, Fairbanks, and Juneau. However,
when beds in those facilities are full, the only other option is
to transport the person to a hospital emergency room or a
correctional facility. Neither of those settings is appropriate
for someone experiencing a behavioral health crisis, and neither
is designed to address the individual and their mental health
needs.
2:08:41 PM
MR. WILLIAMS stated that SB 124 would use the framework of the
Crisis Now model that has demonstrated success in other states.
That model would consist of a crisis call center, a mobile
crisis team that includes a mental health professional, and a
trained peer, such as someone in recovery or someone who had
experienced a behavioral health crisis. It would establish a 23-
hour 59-minute crisis stabilization center that law enforcement,
EMTs, and a mobile crisis team will accept as the appropriate
facility to transport a person facing a behavioral health
crisis. The 23-hour 59-minute crisis stabilization center would
accept the individuals and place them under their care,
relieving the entity from dropping them off to resume their
traditional duties. He related that it would create a short-term
crisis residential center that would allow someone to receive a
longer period of care if needed, up to 7 days, and receive the
services and support needed to return to their community. He
summarized that SB 124 would effectuate the various pieces of
the model, so the behavioral health crisis system of care
provides a full continuum of services to provide early
intervention in the least restrictive manner.
2:10:36 PM
HEATHER CARPENTER, Health Care Policy Advisor, Office of the
Commissioner, Department of Health and Social Services (DHSS),
Juneau, Alaska, reminded members about the work done last year
on SB 124. She explained that SB 124 builds on the 1115
behavioral health waiver that sets up a Medicaid payment
structure for these services, by instituting a mobile crisis
team, a crisis stabilization center, and a crisis residential
center. She highlighted that the bulk of care when someone needs
mental health services is voluntary, just as the current care
provides.
2:11:06 PM
MS. CARPENTER said unfortunately, when a situation arises, such
as when a person with "grave disability" as defined in statute,
poses imminent harm to themselves or others, law enforcement and
other providers must be able to act appropriately to ensure that
person can receive care. She indicated that was the reason for a
narrow change to the state's involuntary commitment statutes,
which are used very heavily today. She indicated that this bill
comes from the Department of Health and Social Services
settlement with the Disability Law Center. She explained that
the department and state were sued in late 2018 due to some
individuals being held in correctional facilities while
experiencing mental health crises because the Alaska Psychiatric
Institute or other locations lacked room. The judge in that case
ordered the department to do more than increase its beds at API.
2:12:11 PM
MS. CARPENTER reviewed some key takeaways on SB 124. She said
the bill would create a no-wrong door approach to providing
medical care to a person in a psychiatric crisis. This means
that if a police officer were to drop someone off at a crisis
stabilization center or crisis residential center, those
facilities would act as emergency facilities because they would
not turn someone away. SB 124 would provide law enforcement with
additional tools to protect public safety. It would also expand
the number of facilities allowed to conduct a 72-hour
evaluation, which is required by statute if someone is held on
an ex parte hold. It would add less restrictive levels of care
outside of inpatient hospital settings. These facilities could
act faster and provide a more appropriate response to a crisis,
expanding the number of first responders that can transport a
person in crisis to an appropriate facility.
2:13:10 PM
MS. CARPENTER stated that the bill would not change an officer's
authority or ability to make an arrest. It does not change who
has the current statutory authority to administer crisis
medication, who can order an involuntary commitment, or reduce
the individual rights of an adult or juvenile in crisis or
parental rights, or the existing due process rights of an
individual in crisis.
MS. CARPENTER highlighted some key improvements that were made
in the committee substitute (CS) for SB 124. She stated that new
language would define a "health officer in Section 22 because
the definition of peace officer was changed to reflect the
definition as given elsewhere in statute. She related that it
would also change the length of stay at a crisis residential
center from "up to 5 days" to "up to 7 days."
2:14:18 PM
At ease
2:14:28 PM
CHAIR WILSON reconvened the meeting.
2:14:29 PM
MS. CARPENTER explained that it increases the stay in a crisis
residential center in recognition of adding provisions for
protecting patient rights. One of the key things the department
worked on during the interim was to obtain feedback from patient
advocates and from the Disability Law Center and the court. The
72-hour clock must start when a person enters a crisis
stabilization center, the 23-hour, 59-minute center, or a crisis
residential center, whichever is entered first. That change
mirrors precisely how the system works today when someone goes
on an ex parte hold to API, a hospital, or Designated
Evaluation and Treatment (DET) facilities. The bill will also
ensure that an attorney is appointed immediately. Based on
feedback from the legislature, she noted that one key change was
to add a requirement that guardians are notified of any
hearings. The Alaska Court System (ACS) will notify them. She
related that there are more private guardians than public
guardians in the state. One provision added in Section 26 would
direct the department and the Alaska Mental Health Trust
Authority (AMHTA) to work together and submit a report and
recommendations called an action plan for patient rights. It
would include patient grievance and appeal policies, data
collection on patient grievances, appeals and resolution, and
patient reports of harm, restraint, and resolution.
MS. CARPENTER offered to provide a detailed sectional analysis.
2:16:22 PM
CHAIR WILSON stated that in the interest of time, the committee
would forgo a detailed sectional analysis of SB 124 and move to
invited testimony.
2:17:12 PM
CHAIR WILSON opened invited testimony on SB 124.
2:17:26 PM
JAMES COCKRELL, Commissioner, Department of Public Safety,
Anchorage, Alaska, began invited testimony on SB 124. He
emphasized his view that the state needs to provide more mental
health services. He clarified that this was his personal view,
not the department's opinion, based on his law enforcement
experience and a relative that suffered a mental health
breakdown. He said his relative spent 81 days in a state
correctional facility when they should have been in a mental
health facility. While he said he did not fault the officer for
making the arrest, the state needs to keep mental health
patients out of jail and in professional mental health
facilities.
COMMISSIONER COCKRELL paraphrased prepared remarks. He spoke in
support of SB 124. He stated that the Department of Public
Safety supports sub-acute mental health facilities for people
experiencing mental health crises. The department views law
enforcement responses to mental health calls as a serious
priority. Troopers often respond to incidents where people are
experiencing suicidal thoughts, manic or delusional episodes,
depression, or due to drugs or alcohol. The person is not safe
and poses a risk to themselves or others.
COMMISSIONER COCKRELL related that law enforcement officers
often must choose between taking the person to the hospital or
to jail, when neither seems appropriate, creating tension
between their duty to serve and their duty to protect. Troopers
may investigate a crime and discover that the subject needs
immediate assistance. This provides the type of situation in
which a crisis stabilization center can offer an alternative to
placing the person having a behavioral health crisis in jail,
providing full scale medical services, or simply leaving them
alone to suffer. Currently, if troopers have a Title 47 hold in
Mat-Su, they will transport the person to the Mat-Su Regional
Hospital emergency room.
COMMISSIONER COCKRELL indicated that first responders spend
excessive time waiting to transfer those experiencing mental
health crises from emergency holding facilities. Although this
experience is difficult and frustrating, it is a common
experience for many Alaska State Troopers throughout the state.
Often, an officer must seek care for an individual in crisis.
Even though that person has not committed a crime, officers must
keep them in custody, usually handcuffed in the back of a law
enforcement vehicle. In his personal experience, the trooper
would transport the person from the Mat-Su to Anchorage only to
discover that the Alaska Psychiatric Institute (API) is full,
which means they must drive them back to the Mat-Su.
COMMISSIONER COCKRELL recalled that it was not uncommon for
troopers to spend their entire shift trying to find a suitable
place to leave a person in crisis. He offered his view that it
is not fair to the person in crisis and prevents troopers from
performing other important public safety duties.
2:21:16 PM
COMMISSIONER COCKRELL said the bill would create an additional
option for individuals in crisis by promptly connecting them to
the appropriate care needed. Under the bill, law enforcement
could take individuals experiencing a mental health crisis to a
23-hour, 59-minute crisis stabilization center, or a crisis
residential center rather than transport them to local emergency
rooms or jails. SB 124 would ensure that people have access to
swift, appropriate care, minimizing the impact on first
responders. The centers described in SB 124 were developed in
collaboration with stakeholders to provide a person in a mental
health crisis who is perceived likely to harm themselves or
others better access to care. He highlighted that the existing
options in the community are limited by current law. He urged
members to take prompt and favorable action on SB 124 to provide
additional tools for police officers in Alaska.
2:22:31 PM
SENATOR HUGHES asked whether SB 124 would be less or more
restrictive.
COMMISSIONER COCKRELL answered that the options in SB 124 will
give officers the discretion to take a person experiencing a
mental health crisis to a place where they can receive immediate
help.
2:23:16 PM
SENATOR HUGHES related her understanding that taking a person
experiencing a mental health crisis to a crisis stabilization
center or a crisis residential center would be less restrictive
than taking them to jail or a hospital emergency room.
COMMISSIONER COCKRELL agreed that it would be less restrictive
for an individual to go to a crisis residential center than an
emergency room or prison.
2:23:51 PM
SENATOR HUGHES expressed concern that provisions in SB 124 could
be wrongfully used against someone. Suppose someone voices a
position on something controversial, and the person is taken to
a medical facility and drugged. She said she did not believe
that was what SB 124 does. Still, she needed to know the types
of behavior officers use to identify that the person is
suffering from mental illness rather than the person being
disagreeable or holding an opposing view. She surmised that
officers would need to observe incoherent speech or other
behaviors that indicate the person needed to go to a crisis
residential center and be given psychotropic drugs.
2:25:16 PM
COMMISSIONER COCKRELL stated that the department currently has
the authority in Title 47 to take the person into protective
custody. SB 124 would not change law enforcement's authority to
take someone into protective custody under Title 47 or to a
treatment center. He emphasized that police must currently
protect first amendment rights, including freedom of speech. The
US Constitution is clear that police cannot arrest someone for
speech, so law enforcement must ensure that the individual is at
risk of harming themselves or others. For instance, a person at
the Walmart store protesting something has the right to do so.
Currently, law enforcement could charge the person with
disorderly conduct or trespassing. However, he was unsure that
any law enforcement agency in the state had been accused of
being overzealous regarding Title 47. He said he did not
envision that law enforcement would make any changes regarding
arrests.
2:26:39 PM
SENATOR HUGHES asked what officers look for to determine if
someone is having a behavioral health crisis and ensure they are
not interfering with someone's individual liberties and
constitutional rights.
COMMISSIONER COCKRELL answered that the individual officer's
experience would determine their actions. He highlighted that
incoherent speech alone would not suffice and that the officer
must determine that the person was at risk of harming themselves
or another person. Someone running back and forth through
traffic trying to get hit would be at risk of harming themselves
and would likely be identified as someone suffering from a
mental health crisis. Officers encounter people who are under
the influence of drugs or alcohol daily, but they don't arrest
them. He said police officers are trained to make assessments
and use discretion when assessing behavior, such as someone is
brandishing a weapon, threatening people, or taking some action
to harm themselves or others. However, an officer would not take
someone into custody for talking.
SENATOR HUGHES thanked him for his examples.
2:28:54 PM
SENATOR REINBOLD said he addressed several of her concerns.
2:29:10 PM
CHAIR WILSON removed his objection to adopt the committee
substitute (CS) for SB 124, work order 32-GS1730\B; he found no
further objection, and Version B was adopted as the working
document.
2:29:17 PM
SENATOR REINBOLD expressed concern that Tamara Lich was arrested
for organizing a convoy protest in Canada, which she viewed as
disturbing. She noted that many countries arrest their political
enemies. She stated that she wants to avoid those types of
issues and ensure that the bill doesn't have loopholes. She
referred to a letter dated March 7, 2022, from Jim Gottstein.
She asked whether he would support the definition of gravely
disabled. She asked whether she should read the letter for the
record.
CHAIR WILSON answered no. He offered his belief that the
department would address the letter.
2:31:22 PM
SENATOR REINBOLD noted that Mr. Gottstein had highlighted four
pages of concerns. She further noted that the Commission on
Human Rights and others had listed concerns.
2:21:16 PM
At ease
2:32:38 PM
CHAIR WILSON reconvened the meeting.
2:32:44 PM
SENATOR BEGICH asked whether it was fair to say each case that
officers deal with is individualized and different. He related
his understanding that SB 124 would offer law enforcement less
intrusive means to get people who may be experiencing mental
health crisis to professionals who are more able to make that
determination.
COMMISSIONER COCKRELL answered that he viewed SB 124 as
providing a much more humane approach to those experiencing a
behavioral health crisis.
2:33:24 PM
CHAIR WILSON related that some people might be experiencing an
episode of active psychosis, noting that law enforcement handles
numerous calls from people who are suicidal. He asked how many
of these cases troopers handle and if SB 124 would help them.
COMMISSIONER COCKRELL offered to provide those figures to the
committee. He noted that rural Alaska experiences a high volume
of suicides.
2:34:07 PM
SENATOR HUGHES asked if a minor was struggling with suicide if
law enforcement or someone else would pick them up.
COMMISSIONER COCKRELL responded that it would depend on the
community. He stated that the parents, Office of Childrens
Services (OCS), or law enforcement agencies could get involved.
2:34:53 PM
CHAIR WILSON stated that one emergency physician in the Mat-Su
Valley indicated that they had kids in their emergency room for
up to 30 days. He said he couldn't imagine they could not place
an individual. He further recalled that the Department of
Corrections indicated they still use facilities in the state for
that purpose. He highlighted the need to fix this situation.
2:35:38 PM
SENATOR BEGICH, in response to Senator Hughes' question, stated
that the ability to place someone in protective custody extends
to juveniles.
2:35:49 PM
SENATOR REINBOLD expressed concern about parental rights and
informed consent. She expressed concern about using psychotropic
drugs for children and the process for appointing a guardian ad
litem.
2:37:39 PM
MARK REGAN, Legal Director, Disability Law Center of Alaska,
Anchorage, Alaska, provided invited testimony, noting he had
submitted written testimony. He offered his view that
improvements from last year were that everyone is appointed a
lawyer at the beginning of the process. Everyone is entitled to
a hearing within 72 hours to decide whether someone should stay
in the system, which is an important improvement.
MR. REGAN stated that he would like to testify in response to
Senator Hughes' initial questions to the commissioner. She had
asked whether SB 124, the Crisis Now bill, would impose a less
restrictive or more restrictive system. He provided examples to
show this was a less restrictive system. For example, suppose a
person was picked up in Anchorage and taken to a hospital on
hold because API was at capacity and not taking patients. In
that case, the person might be taken to Alaska Regional
Hospital. He stated that he had been in the holding areas used
to hold those with mental health issues. He characterized it as
a very sterile, nontherapeutic place that is not peaceful or
calming. He related that if a person was picked up in Haines,
the person could be held in the Haines jail cell awaiting
transportation to Juneau. He offered his view that a cell is not
where a person suffering a mental health crisis belongs. He said
he knew someone in Bethel who had been in a cycle of short-term
mental health treatment for suicidal or other threats. While
suffering a mental health crisis, he was taken to and held at
the Yukon Kuskokwim Hospital, flown to Anchorage for evaluation
and short-term treatment at API, and flown back to Bethel. He
recalled hearing him describe his experience as frightening.
2:40:52 PM
MR. REGAN stated that under SB 124, people experiencing these
mental health crises could be transported to a center where they
receive short-term treatment instead of short-term holds. They
would receive attention from medical professionals who are there
to help them recover their mental health. He highlighted that
often mental health treatment is short-term treatment. He
indicated that SB 124 allows the legislature to improve the
situation for hundreds of Alaskans by making it possible for
them to receive short-term treatment closer to where they live.
For example, he envisioned that Bethel could have a crisis
residential center so the person experiencing a mental health
crisis would not need to be transported to Anchorage for
evaluation. Haines could have a crisis stabilization center
where the person could calm down and not be held in jail.
Anchorage could provide centers that are much less sterile and
less threatening than an Alaska Regional Hospital holding area.
He offered the Disability Law Center of Alaska's approval for
the changes incorporated in SB 124.
2:42:24 PM
SENATOR REINBOLD stated she still has concerns but thanked him
for assisting [a constituent] to obtain a hearing and legal
counsel.
MR. REGAN noted that most of the work was done by the
department, the Alaska Mental Health Trust Authority, and other
advocates.
2:43:36 PM
SENATOR BEGICH noted that Mr. Jim Gottstein was one of the
people who has written about involuntary commitment and the
potential damage to individuals. He stated that stakeholder
groups have requested that SB 124 include several recognized
ways to enshrine patient rights, some of which have been
accomplished in the bill. He asked whether he was open to
working on a Patient's Bill of Rights.
2:44:35 PM
MS. CARPENTER answered that the department had discussed this
with patient advocates, including Mr. Gottstein. She offered her
view that Section 26 would be a great spot to address a
comprehensive Patient's Bill of Rights.
CHAIR WILSON asked whether she suggested referencing it but not
including it in statute.
MS. CARPENTER agreed.
2:45:23 PM
SENATOR BEGICH said he hoped to work with the department and
advocate for it. He stated that he spoke to the department about
the report to the legislature, providing assessment
recommendations from the stakeholders. He asked whether the
committee supports the department in creating an annual
dashboard and reporting data. He acknowledged that it might
require some department expenditure, but it would provide
citizens access to the information. He indicated he was not
requesting information on individuals that would violate the
Health Insurance Portability and Accountability Act of 1996
(HIPAA) but to post aggregate data.
2:46:10 PM
MS. CARPENTER agreed that the department could consider a
dashboard. Still, she hoped that the department would have
flexibility on the design. She offered to work with patient
advocates and providers to understand how to make that data
public.
2:46:42 PM
SENATOR BEGICH said he received a letter from Mr. Gottstein,
dated March 7, 2022, regarding SB 124 with four excellent
recommendations. He expressed an interest in the department's
viewpoint.
2:48:08 PM
MS. CARPENTER responded that she found the letter addressing the
committee substitute (CS) for SB 124, Version B, helpful. She
said DHSS, the Department of Law, and AMHTA reviewed and agreed
with his recommendations. She related that the first two
recommendations came from old court hearings. The first one
would update the definition in AS 47.39.015 (7), for "gravely
disabled," which would match a lawsuit outcome. The second one
would update the court-ordered administration of medication
statutes. She indicated the department supports this concept but
would like to carefully review the language to ensure that it is
correct. She directed attention to the changes Mr. Gottstein
suggests at the bottom of page 3 of the letter. She highlighted
a similar recommendation to AS 47.30.707, the crisis
stabilization, and AS 47.30.708, which had a typo. She offered
her view that it would add clarity. Still, it might be a bit
repetitive, so a court might interpret that a respondent is
suffering from an acute behavioral health crisis and is likely
to cause harm to self or others. However, the department has no
problem offering the language to ensure that it is clear to
professionals. Finally, Mr. Gottstein added a small
recommendation to add to the report section to consider things
that could improve patient outcomes, which the department
supports.
2:50:16 PM
SENATOR BEGICH responded that made him feel more comfortable
with the legislation. He recalled hearing some criticism about
the House version of the bill, and he was unsure whether it was
a valid criticism. However, he had observed such effort by the
department and the trust. He would like to see the bill meet the
needs of advocates for patient rights and have mental health
professionals evaluate those with behavioral health crises, not
the police. He related that in the early 2000s, the legislature
provided the department with screening and assessment tools for
youth experiencing substance use or mental health issues. He
offered his view that placing mental health practitioners in the
department ensured that youth received the appropriate
treatment, which is key. He emphasized lowering the level of
escalation into the system. He characterized SB 124 as a good
faith effort. He offered to help draft amendments.
2:52:30 PM
CHAIR WILSON asked whether the court-ordered administration of
medication would be a separate bill since SB 124 doesn't address
it as a separate in-depth item.
MS. CARPENTER answered that the department did not rewrite the
involuntary commitment statutes in order to narrowly focus on
crisis stabilization and crisis residential centers. The bill
would allow the court-ordered and involuntary psychotropic
medication to be administered by the same medical providers but
allow these drugs to be given in crisis stabilization and crisis
residential centers when someone is in imminent danger to
themselves or others.
2:53:29 PM
SENATOR HUGHES recalled the opening statement indicated that
there were more private than public guardians. She asked how
many have guardians, the difference between private and public
guardians, and whether the guardians must consent to administer
psychotropic drugs.
2:54:48 PM
CHAIR WILSON deferred to Mr. Wall. He recalled that psychotropic
drugs could be given in times of crisis without obtaining
permission.
2:55:38 PM
ALBERT WALL, Deputy Commissioner, Department of Health and
Social Services (DHSS), Juneau, Alaska, responded that a public
guardian is assigned by the court. In contrast, a person
establishes a private guardian through their attorney. He
elaborated that the court assigned public guardians to those
individuals who cannot make decisions for themselves, primarily
due to their mental condition. Suppose a person were to show up
in court but obviously suffered from some mental health
condition and did not have a guardian. In that case, the court
will assign a public guardian, typically via the Office of
Public Advocacy. Some individuals with a disability, such as
dementia, but have the means can hire someone to care for them,
often a family member. Suppose his mother had dementia, but
while she was still lucid, she asked him to become her guardian.
In that instance, an attorney would draft her wishes, and he
would become her private guardian.
2:57:23 PM
SENATOR HUGHES asked how many have guardians.
2:57:38 PM
MR. WALL indicated that the number changes over time. He offered
to report figures to the committee. He stated that crisis
medications are given in an inpatient setting when their
clinical and mental condition is such that they pose a danger to
themselves or others. Suppose a person is in a heightened state
of anxiety and may be exhibiting suicidal ideation and is
uncontrolled, such that the medical staff cannot reason with
them. A psychiatrist would make a clinical determination and
prescribe medication. He stated that the court would be
involved. He explained that crisis stabilization is separate. It
is not addressing bringing people to crisis stabilization
centers and administering medication against their will.
Instead, a crisis stabilization center is a place where a person
goes to become stable over time. If they need inpatient care, an
ex parte or inpatient care can be prescribed. Still, a crisis
stabilization center is not considered inpatient care, nor where
crisis medications would routinely be administered. Those
medications would not be administered without court oversight.
He deferred to one of the attorneys to further elaborate on the
process.
3:00:15 PM
SENATOR HUGHES offered her view that if someone has a guardian,
the guardian should be involved if any medication will be
administered. She said she would like to see that happen at the
crisis stabilization centers. She acknowledged that if someone
was suicidal, there might not be time to involve the guardian.
3:00:56 PM
MR. WALL assured the committee that a guardian is always
involved. The issue relates to the moment of crisis. For
instance, if an individual goes to an emergency room with a
heart attack and is unconscious, the doctors will administer
medication to keep them alive. He highlighted that medical
professionals are trained to do so. The psychiatric matter is
similar to that because crisis medications are only given to
patients hurting themselves or others, so there is no time to
call someone to ask. He characterized it as a life-or-death
matter. He indicated that the court is involved in the crisis
med order, and guardians and patients are always informed.
3:02:53 PM
MR. WILLIAMS added that crisis medications are the last resort
for intervention. Other approaches are built into this least
restrictive system, which is designed to protect the individual.
He indicated that if the lower levels of intervention fail,
crisis medications provide a medically-trained professional with
a means to keep the person safe from further harm.
3:03:48 PM
CHAIR WILSON held SB 124 in committee.
3:04:32 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:04 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HCR 10 Sponsor Statement.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| HCR 10 - CDC Heart Disease Facts.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| HCR 10 2021 AMA 2021 Update.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/10/2022 1:30:00 PM |
HCR 10 |
| SB 156 Amdmt I.6 Begich.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 156 Amdt I.7 Reinbold.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 124 Version GS 1730 A.PDF |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 Transmittal Letter.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 Sectional Analysis Version GS1730 A.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 - Sectional Anaylsis Ver. Work Draft CS.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 Definitions in AS 47.30.915.pdf |
SHSS 3/8/2022 1:30:00 PM SJUD 4/27/2022 1:30:00 PM |
SB 124 |
| SB 124 - Fiscal Note - SB124-DOH-MS-2-4-2022.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 - Fiscal Note - SB124-JUD-ACS-4.28.21.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 - Fiscal Note - SB124-DPS-DET-03-07-22.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 - Fiscal Note -SB 124-DFCS-IMH-3-4-2022.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB 124 - Infographics - Proposed Statutory Changes to Title 47 3.6.22.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 124 |
| SB124-HB172Ltr Psych Rights 2.22.22.pdf |
SHSS 3/8/2022 1:30:00 PM |
HB 172 SB 124 |
| SB 124 CS Work Draft V. B.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/17/2022 1:30:00 PM SHSS 3/22/2022 1:30:00 PM |
SB 124 |
| SB 124 - Memo to DHSS-HB 172 (SB 124) response to Gottstein comments 3.3.2022.pdf |
SHSS 3/8/2022 1:30:00 PM |
HB 172 SB 124 |
| SB 156 Letters 3.3.22.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 156 Testimony (Sponsor) 3.7.22.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 156 Testimony 3.7.22.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 156 Amdmt I.8 Reinbold.pdf |
SHSS 3/8/2022 1:30:00 PM |
SB 156 |
| SB 124 - Letter Psych Rights 3.7.22.pdf |
SHSS 3/8/2022 1:30:00 PM SHSS 3/17/2022 1:30:00 PM |
SB 124 |