Legislature(2021 - 2022)BUTROVICH 205
04/07/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| Confirmation Hearing(s) | |
| SB124 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | SB 124 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
April 7, 2022
1:33 p.m.
MEMBERS PRESENT
Senator David Wilson, Chair
Senator Shelley Hughes, Vice Chair
Senator Lora Reinbold
Senator Tom Begich (via teleconference)
MEMBERS ABSENT
Senator Mia Costello
COMMITTEE CALENDAR
CONFIRMATION HEARING(S):
Alaska Mental Health Trust Board
Agnes Moran Ketchikan
- CONFIRMATION ADVANCED
SENATE BILL NO. 124
"An Act relating to admission to and detention at a subacute
mental health facility; establishing a definition for 'subacute
mental health facility'; establishing a definition for 'crisis
residential center'; relating to the definitions for 'crisis
stabilization center'; relating to the administration of
psychotropic medication in a crisis situation; relating to
licensed facilities; and providing for an effective date."
- HEARD & HELD
PREVIOUS COMMITTEE ACTION
BILL: SB 124
SHORT TITLE: MENTAL HEALTH FACILITIES & MEDS
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
04/12/21 (S) READ THE FIRST TIME - REFERRALS
04/12/21 (S) HSS, FIN
04/27/21 (S) HSS AT 1:30 PM BUTROVICH 205
04/27/21 (S) Heard & Held
04/27/21 (S) MINUTE(HSS)
04/29/21 (S) HSS AT 1:30 PM BUTROVICH 205
04/29/21 (S) -- MEETING CANCELED --
05/04/21 (S) HSS AT 1:30 PM BUTROVICH 205
05/04/21 (S) Heard & Held
05/04/21 (S) MINUTE(HSS)
05/05/21 (S) JUD REFERRAL ADDED AFTER HSS
05/06/21 (S) HSS AT 1:30 PM BUTROVICH 205
05/06/21 (S) <Bill Hearing Canceled>
03/08/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/08/22 (S) Heard & Held
03/08/22 (S) MINUTE(HSS)
03/15/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/15/22 (S) Heard & Held
03/15/22 (S) MINUTE(HSS)
03/17/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/17/22 (S) Heard & Held
03/17/22 (S) MINUTE(HSS)
03/22/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/22/22 (S) Heard & Held
03/22/22 (S) MINUTE(HSS)
03/23/22 (S) JUD AT 1:30 PM BUTROVICH 205
03/23/22 (S) <Bill Hearing Canceled>
03/25/22 (S) JUD AT 1:30 PM BUTROVICH 205
03/25/22 (S) -- MEETING CANCELED --
03/29/22 (S) HSS AT 1:30 PM BUTROVICH 205
03/29/22 (S) Heard & Held
03/29/22 (S) MINUTE(HSS)
04/07/22 (S) HSS AT 1:30 PM BUTROVICH 205
WITNESS REGISTER
AGNES MORAN, Appointee
Alaska Mental Health Trust Authority Board of Trustees
Department of Revenue (DOR)
Ketchikan, Alaska
POSITION STATEMENT: Testified as the governor's appointee to the
Alaska Mental Health Trust Authority Board of Trustees.
DAVID WILLSON, Captain
Central Office
Division of Alaska State Troopers
Department of Public Safety
Anchorage, Alaska
POSITION STATEMENT: Answered question on SB 124.
NANCY MEADE, General Counsel
Office of the Administrative Director
Alaska Court System
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124.
HEATHER CARPENTER, Healthcare Policy Advisor
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Answered questions on SB 124.
STEVEN BOOKMAN, Senior Assistant Attorney General
Human Services Section
Civil Division
Department of Law
Anchorage, Alaska
POSITION STATEMENT: Answered questions on SB 124.
ACTION NARRATIVE
1:33:47 PM
CHAIR DAVID WILSON called the Senate Health and Social Services
Standing Committee meeting to order at 1:33 p.m. Present at the
call to order were Senators Reinbold, Begich (via
teleconference), Hughes, and Chair Wilson.
^CONFIRMATION HEARING(S)
CONFIRMATION HEARING(S)
Alaska Mental Health Trust Authority Board of Trustees
1:34:34 PM
CHAIR WILSON announced the consideration of the governor's
appointment of Agnes Moran, to the Alaska Mental Health Trust
Authority Board of Trustees.
1:35:04 PM
AGNES MORAN, Appointee, Alaska Mental Health Trust Authority
Board of Trustees, Ketchikan, Alaska, provided some of her
history including that she had a bachelor's degree in electrical
engineering, had worked on experimental military satellite
systems and computer networking, and had run a private grant-
making foundation. She has been on the board of First Bank since
2003. She returned to Alaska in 1999 to raise her family. She
started working in a voluntary capacity with trust beneficiaries
who experience chronic homelessness and substance abuse
disorders, first by volunteering with her family for the
community meals program. She wanted her children to get to know
trust beneficiaries as individuals. She moved on to become a
founder of the overnight warming center, and served as a board
member of First City Homeless Services until January 2021. In
2017 she became the executive director of Women in Safe Homes
(WISH), a nonprofit organization that is dedicated to providing
support to victims of domestic violence and sexual assault and
their families. At the time, WISH was on probation from its
major funder, the Council on Domestic Violence and Sexual
Assault, the staff turnover rate was 150 percent, the grant base
was declining, and some in the community were calling for
dissolution.
MS. MORAN related that during her tenure, WISH has come off
probation, staff has stabilized, the grant base has tripled, and
the service offerings in the community have been expanded.
Importantly, she said the community turned out in force when
WISH opened its new shelter in October, 2021. During her tenure,
WISH has not received much mental health funding. She described
the broad spectrum of trust beneficiaries that WISH serves.
MS. MORAN stated that she has been working with and supporting
trust beneficiaries for over ten years and has a working
knowledge of leading a service-providing organization. Her goals
in serving on the AMHTA board include being an advocate for
rural areas and to extend the reach of the trust by establishing
collaborative relationships with the people in communities who
work directly with trust beneficiaries. She thanked the
committee for considering her appointment.
1:39:02 PM
SENATOR REINBOLD noted that she had an impressive background.
She asked how she views her role on the Alaska Mental Health
Trust Authority Board.
MS. MORAN answered that a strength she brings is that through
her work at the shelter she is in contact with people throughout
the state who are doing on-the-ground work to serve trust
beneficiaries. She sees the challenges in rural communities, and
believes her role will be to continue to support that on-the-
ground work.
SENATOR HUGHES commented on her impressive resume and thanked
her for stepping forward. She asked two questions, the first of
which was whether she had any thoughts about ways to help the
trust to fulfill its responsibility to develop mental health
trust land. Second, she asked if the foster care program for
animals started with taking stray pets into her home.
1:42:14 PM
MS. MORAN said yes and she continues to bring animals into her
home. To the question of developing trust land, she said she
didn't have a well-formed opinion, but she would do some work
and follow up with a response.
SENATOR HUGHES expressed confidence that she would do the work
to become knowledgeable in that area.
CHAIR WILSON asked if WISH receives indirect or passthrough
funding from different types of homeless assistance or emergency
shelter grants (ESG).
1:44:59 PM
MS. MORAN confirmed that WISH does receive some emergency
housing vouchers through Alaska Housing Finance Corporation
(AHFC). WISH also receives ESG funding and Treasury funds, both
of which are related to COVID-19.
CHAIR WILSON recognized that the CEO of the Alaska Mental Health
Trust was in the committee room to address an upcoming bill.
SENATOR HUGHES asked Ms. Moran to also keep an eye on the pilot
project called Set Free Alaska that seeks to reduce recidivism
through holistic and comprehensive substance abuse counseling.
Participants are trained in how to get a job, manage their
finances and other life skills to help them be successful when
they reenter the community. She noted that the organization had
been very good in collecting data that hopefully will show that
it is a successful model to improve public safety.
MS. MORAN agreed to keep an eye on the project, adding that with
her engineering background she is "all about the data.
1:47:34 PM
CHAIR WILSON opened public testimony on the appointment of Agnes
Moran to the Alaska Mental Health Trust Authority Board of
Trustees; he found none and closed public testimony.
CHAIR WILSON found no further questions or comments and
solicited a motion.
1:47:59 PM
At ease.
1:48:13 PM
CHAIR WILSON reconvened the meeting.
1:48:16 PM
Senator Hughes stated that in accordance with AS 39.05.080, the
Senate Health and Social Services Standing Committee reviewed
the following and recommends the appointments be forwarded to a
joint session for consideration:
Alaska Mental Health Trust Authority Board of Trustees
Agnes Moran - Ketchikan, Alaska
Signing the report regarding appointments to boards and
commissions in no way reflects individual members' approval or
disapproval of the appointees; the nominations are merely
forwarded to the full legislature for confirmation or rejection.
1:48:46 PM
CHAIR WILSON found no objection and Agnes Moran's name was
forwarded to a joint session for consideration.
1:48:50 PM
At ease.
SB 124-MENTAL HEALTH FACILITIES & MEDS
1:50:37 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of SENATE BILL NO. 124 "An Act relating to
admission to and detention at a subacute mental health facility;
establishing a definition for 'subacute mental health facility';
establishing a definition for 'crisis residential center';
relating to the definitions for 'crisis stabilization center';
relating to the administration of psychotropic medication in a
crisis situation; relating to licensed facilities; and providing
for an effective date."
He stated that the intent today is to finish the amendment
process, starting with Amendment 28.
1:51:22 PM
SENATOR REINBOLD moved to adopt Amendment 28, work order 32-
GS1730\B.19.
32-GS1730\B.19
Dunmire
3/15/22
AMENDMENT 28
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 2, line 12:
Delete "mental health professional"
Insert "physician [MENTAL HEALTH PROFESSIONAL]"
Page 2, line 30:
Delete "mental health professional"
Insert "physician [MENTAL HEALTH PROFESSIONAL]"
1:51:27 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD explained that the amendment is intended to
ensure that a physician informs the arresting officer that the
person they brought in is leaving the crisis center.
CHAIR WILSON asked if there was any discussion.
SENATOR HUGHES said she didn't support limiting the notification
to a physician because the physician likely was not the one who
was on the street.
CHAIR WILSON asked Senator Reinbold if she had any closing
remarks on the amendment.
SENATOR REINBOLD offered her belief that the bill had massive
loopholes. The amendment is an attempt to ensure that physicians
are involved in something as serious as a crisis stabilization
center.
1:53:34 PM
CHAIR WILSON asked for a roll call.
A roll call vote was taken. Senator Reinbold voted in favor of
Amendment 28 and Senators Begich, Hughes, and Wilson voted
against. Therefore, Amendment 28 failed on a 1:3 vote.
CHAIR WILSON announced that Amendment 28 failed on a 1:3 vote.
1:54:16 PM
At ease.
1:54:29 PM
CHAIR WILSON reconvened the meeting.
1:54:31 PM
SENATOR REINBOLD withdrew Amendment 29.
CHAIR WILSON found no objection and Amendment 29 was withdrawn.
1:54:48 PM
SENATOR REINBOLD moved to adopt Amendment 30, work order 32-
GS1730\B.21.
32-GS1730\B.21
Dunmire
3/15/22
AMENDMENT 30
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 3, line 31:
Delete "probable cause"
Insert "clear and convincing evidence [PROBABLE
CAUSE]"
1:54:49 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD explained that the amendment raises the
standard of proof to "clear and convincing evidence" to help
ensure that the bill isn't exploited by people with ill intent.
SENATOR HUGHES requested Captain Willson speak to how clear and
convincing evidence is used on the street.
CHAIR WILSON clarified for the record that he and Captain
Willson were not related.
1:56:06 PM
DAVID WILLSON, Captain, Central Office, Division of Alaska State
Troopers, Department of Public Safety, Anchorage, Alaska, stated
that clear and convincing evidence is a civil standard of proof
and troopers don't receive training to make that finding.
Troopers are trained to identify the circumstances to support a
probable cause finding. If this amendment were to pass, it would
take some time and additional training to adopt that language.
SENATOR HUGHES asked for an explanation of probable cause and
how it is used.
1:57:23 PM
CAPTAIN WILLSON said the general definition is that a reasonable
person would believe the evidence that the condition in question
exists. For example, that the person in question is gravely
disabled or suffering from mental illness. The reasonable person
standard is part of the probable cause determination that
Troopers are familiar with when applying for search warrants or
making arrest decisions. It's an evaluation that Troopers use
daily.
SENATOR HUGHES asked if a reasonable person would look for
evidence.
CAPTAIN WILLSON answered yes; the Trooper would look at the
totality of the circumstances including whether the person is:
disinterested, uninvolved when there's an emotional event, or
impaired by alcohol or drugs. The Trooper would also look at the
statements the person in question has made as well as the
witness statements before making a determination.
SENATOR HUGHES asked for confirmation that a probable cause
finding does involve evidence and that the decision is not made
on a whim.
1:59:06 PM
CAPTAIN WILLSON confirmed that there has to be evidence to meet
the probable cause standard. The evidence that is gathered is
often physical or testimonial. "Probable cause" is a higher
standard than "more likely than not," but it is not as high as
"beyond a reasonable doubt. It's difficult to meet the probable
cause standard without doing significant investigation and fact
finding. He noted that beyond a reasonable doubt is used in
court.
SENATOR HUGHES asked whether officers use standards other than
probable cause, depending on the alleged non civil crime.
CAPTAIN WILLSON answered no; probable cause is the primary
standard for an officer to take action, although the reasonable
suspicion standard is used in some cases to stop and search a
vehicle. Troopers are trained in probable cause and beyond a
reasonable doubt, which covers the majority of police contact.
2:00:52 PM
SENATOR REINBOLD asked if he said that probable cause is only
used for criminal conduct, except in court.
2:01:12 PM
CAPTAIN WILLSON answered that the two standards that are used
regularly are: 1) probable cause that is used in the field to
gather evidence for an affidavit for an arrest or search
warrant; and 2) beyond a reasonable doubt that is used to
ascertain whether or not an investigation is complete to move to
court. It's not always possible to meet the standard of beyond a
reasonable doubt before an arrest is made, because of the need
to weigh public safety and prevent damage from occurring. The
probable cause standard is used when there is an arrest but the
investigation doesn't necessarily stop there. It might continue
to a finding of beyond a reasonable doubt.
SENATOR REINBOLD opined that it is a big deal to take somebody
off the street and to a stabilization center. She pointed out
that the person potentially would be kept for some time and
injected with psychotropic medication. She offered her view that
probable cause is probably and another term would be better. She
also said that she was surprised to learn that a criminal case
could be based solely on probable cause. She voiced support for
Amendment 30, maintaining that it wouldn't be difficult for
Troopers to be trained to use the clear and convincing evidence
standard.
2:03:41 PM
CAPTAIN WILLSON responded that probable cause was currently used
and accepted, but if the law were to change to require a
different standard, the change would be made.
SENATOR REINBOLD summarized that he didn't think another word
could be used. She also asked him to restate the probable cause
standard.
2:04:54 PM
CAPTAIN WILLSON stated that he was only aware that probable
cause and beyond a reasonable doubt were the standards that are
used in the field for everyday business. He restated that
probable cause is the standard of evidence necessary for a
reasonable person to use based on the facts and circumstances
available under the existing condition such as that a person is
gravely ill or suffering from mental illness.
SENATOR REINBOLD asked how he would define mental illness.
2:06:00 PM
CAPTAIN WILLSON responded that if he were to detain somebody to
take them to a crisis stabilization center, his probable cause
finding would be that the person was gravely disabled or
suffering from mental illness and likely to cause serious harm
to self or others and that it was of such an immediate nature
that considerations of safety did not allow initiation of
involuntary commitment procedures. He cited examples from his
own experience.
SENATOR HUGHES highlighted that in a previous hearing the
committee clearly heard that an officer would be in full
violation if the officer were to arrest somebody because of
their political views. To the question about using probable
cause, she pointed out that Captain Willson said that there is a
lower standard. He also stated that for a finding of probable
cause, specific evidence would have to be identified at the
scene so a decision could not be made on a whim.
SENATOR HUGHES stated that she was comfortable using probable
cause.
SENATOR REINBOLD offered her personal experience with harassment
and probably cause. She also posited that a higher standard was
necessary for something as serious as removing somebody from the
street and taking them to a crisis center.
2:10:20 PM
CHAIR WILSON asked for a roll call vote on Amendment 30.
2:10:26 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 30 and Senators Begich, Hughes,
and Wilson voted against it. Therefore, Amendment 30 failed on a
1:3 vote.
2:10:41 PM
CHAIR WILSON announced that Amendment 30 failed on a 1:3 vote.
CHAIR WILSON listed the individuals available to answer
questions.
2:11:38 PM
SENATOR REINBOLD moved to adopt Amendment 31, work order 32-
GS1730\B.22.
32-GS1730\B.22
Dunmire
3/16/22
AMENDMENT 31
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 4, line 1, following "illness":
Insert "with an examination by a licensed
physician"
2:11:40 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD explained Amendment 31 ensures that a peace
officer's determination that a person is suffering from mental
illness is based on an examination by a licensed physician.
SENATOR HUGHES said she agrees that it is important to ensure
that people are not incorrectly taken to a crisis center, but
requiring an examination by a licensed physician to make such a
determination is not practical.
SENATOR BEGICH stated opposition to Amendment 31, and shared a
friend's experience of walking naked down the Glenn Highway.
There was no way to get a physician there for an examination,
but the Troopers got the person to Providence where an
examination was done in an appropriate setting.
2:13:34 PM
SENATOR REINBOLD said the amendment calls for the examination by
a physician prior to admission. She urged a yes vote.
2:14:01 PM
SENATOR HUGHES clarified that the statute is talking about
events before the person is taken into custody, not prior to
admission.
SENATOR REINBOLD pointed out that Section 13 adds a new Sec.
47.37.707 Admission to hold at a crisis stabilization center.
2:14:41 PM
CHAIR WILSON asked for a roll call vote.
2:14:45 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 31 and Senators Hughes, Begich,
Wilson voted against it. Therefore, Amendment 31 failed on a 1:3
vote.
2:15:01 PM
CHAIR WILSON announced that Amendment 31 failed on a 1:3 vote.
2:15:13 PM
SENATOR REINBOLD moved to adopt Amendment 32, work order 32-
GS1730\B.23.
32-GS1730\B.23
Dunmire
3/16/22
AMENDMENT 32
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 4, lines 7 - 8:
Delete "[FOR EMERGENCY EVALUATION]"
Insert "for emergency evaluation"
2:15:15 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD explained that her intention with Amendment 32
is to ensure that a person taken into custody is given an
accurate evaluation. It's in keeping with her view that the bill
needs to have more safeguards.
2:15:53 PM
CHAIR WILSON removed his objection; he found no further
objection and Amendment 32 was adopted.
2:16:04 PM
SENATOR REINBOLD moved to adopt Amendment 33, work order 32-
GS1730\B.24.
32-GS1730\B.24
Dunmire
3/16/22
AMENDMENT 33
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 4, line 22, through page 8, line 15:
Delete all material.
Renumber the following bill sections accordingly.
Page 13, lines 1 - 2:
Delete "secs. 1 - 27"
Insert "secs. 1 - 26"
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 22"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 22"
Page 14, line 7:
Delete "Section 28"
Insert "Section 27"
2:16:08 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD stated that Amendment 33 deletes Section 13 of
the bill.
2:16:23 PM
SENATOR HUGHES said that the status quo is that an officer takes
a person to jail or a hospital where the family does not have
access. By comparison, these crisis stabilization clinics will
offer an outpatient setting where family and/or a pastor could
visit. Section 13 is an improvement and if the bill were to
pass, a lot of the things that have been put on the record will
carry forward, including such things as not taking a person into
custody for political differences. Removing Section 13
essentially guts the bill and eliminates the opportunity for
crisis stabilization centers that offer an outpatient setting.
SENATOR HUGHES stated that she did not support Amendment 33.
CHAIR WILSON offered his view that Amendment 33 deletes the
purpose of the bill and continues with the status quo of using
the Department of Correction to house people who are in crisis.
It would not address the issue with the Disability Law Center.
SENATOR REINBOLD said she recently spoke with a chief of police
who didn't mind the status quo. She said she didn't mind dealing
with the issue with the Disability Law Center, but she believes
that some people would rather be charged than taken to one of
these crisis centers. People in jail have certain rights and
there isn't the potential that they will be injected with
psychotropic drugs. She reiterated her belief that Section 13
causes grave concerns.
2:19:38 PM
CHAIR WILSON asked for a roll call vote.
2:19:39 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 33 and Senators Begich, Hughes and
Wilson voted against it. Therefore, Amendment 33 failed on a 1:3
vote.
2:19:55 PM
CHAIR WILSON announced that Amendment 33 failed on a 1:3 vote.
2:20:00 PM
SENATOR REINBOLD moved to adopt Amendment 34 32-GS1730\B.25.
32-GS1730\B.25
Dunmire
3/16/22
AMENDMENT 34
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 8, line 28, following "has":
Insert "strong"
2:20:04 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD explained that Amendment 34 is a bookend to
ensure that somebody can't haphazardly decide a person is
mentally ill. There has to be a compelling reason for that
decision. She relayed that the intent of all her amendments are
to protect the patient.
CHAIR WILSON asked Steven Bookman for the legal definition of
compelling" and whether it works in this amendment.
2:21:18 PM
STEVEN BOOKMAN, Senior Assistant Attorney General, Human
Services Section, Civil Division Department of Law, Anchorage,
Alaska, explained reasonable suspicion, probable cause, clear
and convincing evidence, beyond a reasonable doubt, and a
preponderance of the evidence are all standards for burden of
proof. The term compelling is none of those and it's not clear
how it would be interpreted.
SENATOR HUGHES highlighted that its not the officer, but the
medical professional who would need to have a compelling reason
for their decision. She asked if anybody could speak to the
standard of reason that the medical professional would use.
2:22:31 PM
MR. BOOKMAN explained that when doctors talk about the medical
judgements they make, the court looks at whether they made the
decisions with a reasonable degree of medical certainty. The
other evidence standards that he mentioned are for judges.
SENATOR HUGHES asked if he was saying that a decision that is
based on a reasonable degree of medical certainty would not be a
willy-nilly decision. It would essentially be a compelling
reason.
MR. BOOKMAN answered yes.
SENATOR HUGHES asked if it would be a problem to have the word
compelling in the determination for the medical professional.
2:23:44 PM
MR. BOOKMAN opined that it would introduce a real degree of
confusion among medical professionals because there is no clear
definition for compelling. It would also make it less likely
that the bill would work as intended.
SENATOR HUGHES asked if he agreed that based on the standard of
medical certainty, the notion of compelling was already
embedded.
MR. BOOKMAN answered yes.
SENATOR HUGHES said she was comfortable with the language as is
because she wanted to avoid confusion for providers. Thus, she
would oppose Amendment 34.
2:25:12 PM
SENATOR REINBOLD asked Mr. Bookman what he sees as the intent of
the bill.
MR. BOOKMAN said he believes the idea is to provide less
restrictive and a broader spectrum of alternatives for mental
health care, so people aren't having to wait in places like
emergency rooms and jails to get their special needs met.
SENATOR REINBOLD argued that people could say that it's
inappropriate to hold people in these crisis stabilization
centers that she views as mental health mini jails. If it's
acceptable to add the words compelling or convincing, she said
the amendment should pass.
2:26:59 PM
CHAIR WILSON asked for a roll call vote.
2:27:01 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 34 and Senators Begich, Hughes,
and Wilson voted against it. Therefore, Amendment 34 failed on a
1:3 vote.
2:27:20 PM
CHAIR WILSON announced that Amendment 34 failed on a 1:3 vote.
2:27:26 PM
SENATOR REINBOLD moved to adopt Amendment 35, work order 32-
GS1730\B.26.
32-GS1730\B.26
Dunmire
3/16/22
AMENDMENT 35
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 9, line 7:
Delete "new subsections"
Insert "a new subsection"
Page 9, lines 8 - 11:
Delete all material.
Reletter the following subsection accordingly.
2:27:29 PM
CHAIR WILSON objected for purposes of discussion.
2:27:31 PM
SENATOR REINBOLD explained Amendment 35 deletes [subsection (c)]
of Section 15 relating to ex parte orders. The intent is to
ensure that a patient has representation.
SENATOR HUGHES said her reading is that the amendment would
remove the requirement for ex parte orders and it seems that
would remove protections that should remain in place.
2:28:43 PM
NANCY MEADE, General Counsel, Office of the Administrative
Director, Alaska Court System, Anchorage, Alaska, stated that
subsection (c) in Section 15 addresses circumstances where a
mental health professional sends a person in crisis either to a
hospital or a crisis center in an emergency situation and
without an ex parte court order. She agreed with Senator Hughes
that removing subsection (c) would remove any court involvement
because there would be no provision to bring the matter before a
judge.
CHAIR WILSON asked for confirmation that there is a requirement
for a court to hear the matter within 72 hours, so the person in
crisis could be held in the hospital or crisis stabilization
center indefinitely.
MS. MEADE answered yes; it would create a gap such that a person
could be detained without process. Subsection (c) is the
provision that requires a person to go before the court and get
the order they did not have time to get previously due to the
emergency situation.
2:30:18 PM
SENATOR REINBOLD said that was not intent of the amendment.
Rather, she wanted people in a mental health crisis situation to
always have representation.
SENATOR REINBOLD withdrew Amendment 35.
2:30:36 PM
CHAIR WILSON stated that Amendment 35 was withdrawn.
2:30:55 PM
SENATOR REINBOLD moved to adopt Amendment 36, work order 32-
GS1730\B.27.
32-GS1730\B.27
Dunmire
3/16/22
AMENDMENT 36
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 9, line 28:
Delete "petitioner's [PROSECUTING]"
Insert "prosecuting"
2:30:59 PM
CHAIR WILSON objected for purposes of discussion.
2:31:00 PM
SENATOR REINBOLD stated that she brought the amendment because
she wasn't clear about the difference and thus the reason for
changing the reference from the prosecuting attorney to the
petitioner's attorney. She asked if somebody could provide an
explanation.
MR. BOOKMAN explained that a prosecutor pursues a criminal case
and a petitioner is somebody who is asking the court for
something. Having the reference to a prosecuting attorney in
that sentence indicates that the respondent has committed a
crime.
SENATOR REINBOLD stated that she was withdrawing Amendment 36
because it didn't do what she intended which was to give
patients more power.
CHAIR WILSON stated that Amendment 36 was withdrawn.
2:32:39 PM
SENATOR REINBOLD moved to adopt Amendment 37, work order 32-
GS1730\B.28.
32-GS1730\B.28
Dunmire
3/16/22
AMENDMENT 37
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 10, line 27, through page 11, line 1:
Delete all material.
Renumber the following bill sections accordingly.
Page 13, lines 1 - 2:
Delete "secs. 1 - 27"
Insert "secs. 1 - 26"
Page 13, lines 27 - 28:
Delete "sec. 23"
Insert "sec. 22"
Page 13, line 29:
Delete "sec. 23"
Insert "sec. 22"
Page 14, line 7:
Delete "Section 28"
Insert "Section 27"
2:32:41 PM
CHAIR WILSON objected for purposes of discussion.
2:32:43 PM
SENATOR REINBOLD stated that Amendment 37 removes Section 18 of
the bill. Her reasoning was that it is one more opportunity to
detain people in crisis too long when they have not been charged
with a crime.
SENATOR HUGHES observed that this relates to previous
discussions about heart attacks and other situations where
medical professionals have to take action quickly to save a
person's life, so there is not time to talk to a spouse, parent,
or guardian beforehand. She said it's good to remember that when
medications are administered under these circumstances they are
as a last resort. Section 18 is talking about administering
medications as a last resort to keep a person from self-harm or
harming another person. If providers are not able to administer
these medications, the alternative is physical restraint, which
can also result in harm to the person in crisis. Providers have
to document all the steps leading up to the decision to
administer medication, so a spouse or parent or the court can
review the record. It is not a casual decision.
SENATOR HUGHES stated that she was comfortable with the existing
language in Section 18 and she would oppose Amendment 37.
2:35:08 PM
SENATOR REINBOLD recalled that the committee previously voted
down Amendment 17 that addressed using psychotropic drugs as a
last resort.
2:35:57 PM
SENATOR HUGHES asked for the record to clearly reflect whether
psychotropic drugs are administered as a last resort.
2:36:34 PM
HEATHER CARPENTER, Healthcare Policy Advisor, Department of
Health and Social Services (DHSS), Juneau, Alaska, confirmed
that, per statute, crisis medication is a last resort option
when somebody is in imminent danger of doing self-harm or
harming the provider who is giving care. All the previous
intervention efforts must be documented so it's clear that there
is no other safe alternative. She deferred further explanation
of the statute to Mr. Bookman.
SENATOR REINBOLD asked which statute she was citing.
2:37:40 PM
MR. BOOKMAN advised that AS 47.30.838(a)(1) states that the
staff response to the behavioral condition must be documented in
the patient's medical record and it must include an explanation
of the alternative responses to the crisis that the staff
considered or attempted, and why those were not sufficient.
SENATOR REINBOLD offered her view that the statute doesn't say
these drugs will be used as a last resort. She also relayed the
concern from some advocates that some of the existing statutes
won't apply to the new statutes. She reiterated that she wanted
the record to be clear that medical professionals in these new
facilities will only administer psychotropic drugs as a last
resort.
SENATOR HUGHES asked if the statutory language he read was
talking about the alternatives for treatment before medication
could be administered. She posited that the reason the committee
did not pass [Amendment 17] was perhaps because it was already
in statute that it is a last resort. She asked if he could read
the section of statute that says that the administration of
medication is a last resort.
2:39:38 PM
MR. BOOKMAN advised that AS 47.30.838(a) says a crisis
medication may be administered without informed consent, only if
certain conditions are met so the documentation must exist
before the crisis medication can be administered.
2:39:50 PM
SENATOR REINBOLD asked him to read the statute because she
wanted assurance that the intent of the bill is for psychotropic
medications to be used as the last resort.
2:40:41 PM
MR. BOOKMAN read AS 47.30.838(a)(1):
Sec. 47.30.838. Psychotropic medication in crisis
situations.
(a) Except as provided in (c) and (d) of this
section, an evaluation facility or designated
treatment facility may administer psychotropic
medication to a patient without the patient's informed
consent, regardless of whether the patient is capable
of giving informed consent, only if
(1) there is a crisis situation, or an impending
crisis situation, that requires immediate use of the
medication to preserve the life of, or prevent
significant physical harm to, the patient or another
person, as determined by a physician, physician
assistant, or advanced practice registered nurse; the
behavior or condition of the patient giving rise to a
crisis under this paragraph and the staff's response
to the behavior or condition must be documented in the
patient's medical record; the documentation must
include an explanation of alternative responses to the
crisis that were considered or attempted by the staff
and why those responses were not sufficient; and
2:41:55 PM
SENATOR REINBOLD asked if it was accurate to say that the intent
is that psychotropic drugs will be used as a last resort,
including in these new crisis facilities described in the bill.
MR. BOOKMAN answered yes; verbal de-escalation or other
techniques would always be used first.
SENATOR REINBOLD asked, "Is that a yes; psychotropic drugs are
the last intent
MR. BOOKMAN answered yes.
2:42:51 PM
CHAIR WILSON asked for a roll call vote on Amendment 37.
2:42:54 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 37 and Senators Hughes, Begich,
and Wilson voted against it. Therefore, Amendment 37 failed on a
1:3 vote.
2:43:09 PM
CHAIR WILSON announced that Amendment 37 failed on a 1:3 vote.
2:43:16 PM
SENATOR REINBOLD moved to adopt Amendment 38, work order 32-
GS1730\B.41.
32-GS1730\B.41
Dunmire
3/16/22
AMENDMENT 38
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 11, line 2:
Delete "a new section"
Insert "new sections"
Page 11, following line 4:
Insert a new section to read:
"Sec. 47.30.914. Health outcome metrics. (a)
Crisis residential centers, crisis stabilization
centers, and subacute mental health facilities shall
assess the severity of an individual's mental illness
each day and keep a record of the assessment. The
assessment shall use an objective scale relating to an
individual's ability to function in society and the
impact that the individual's mental health has on the
individual's daily life.
(b) Crisis residential centers, crisis
stabilization centers, and subacute mental health
facilities shall record the number of patients
involuntarily detained, the number of patients to whom
psychotropic medication is administered without
informed consent, the number of patients physically
restrained, patient complaints, patient injuries, and
traumatic events experienced by a patient.
(c) A crisis residential center, crisis
stabilization center, and subacute mental health
facility shall submit a quarterly report to the
division of the department responsible for behavioral
health services relating to aggregate assessment data
gathered under (a) and (b) of this section without
disclosing information that would identify an
individual.
(d) The division of the department responsible
for behavioral health services shall prepare a semi-
annual report compiling the quarterly aggregate
assessment data reports received under (c) of this
section. The division shall submit the report to the
senate secretary and the chief clerk of the house of
representatives and notify the legislature that the
report is available."
2:43:18 PM
CHAIR WILSON objected for purposes of discussion.
SENATOR REINBOLD stated that Amendment 38 adds a new section in
bill Section 19 related to health outcome metrics. She
paraphrased the language in subsections (a)-(d) and explained
that the intent is to ensure there is good reporting when people
are in crisis facilities. It's about patient advocacy.
SENATOR HUGHES referenced Section 26 that talks about the things
that will be included in the report to the legislature, one of
which is the data that has been collected. She asked if the idea
is that the department will develop a plan for data collection.
2:46:35 PM
MS. CARPENTER said yes. Advocates and others have requested more
ready access to information about psychiatric care in not just
these new crisis facilities but also hospitals and designated
evaluation and treatment (DET) facilities, and Section 26 is the
action plan for that. The department and the Alaska Mental
Health Trust Authority have one year to work with patient
advocates, providers of these services, the Disability Law
Center, and the Office of the Ombudsman to work on grievances,
how to put data collected on a public-facing dashboard, and ways
to improve patient outcomes as Mr. Gottstein suggested. The
intent is to work collaboratively and be as transparent as
possible to the public and the legislature, but in a way that
fits with providers' current flow, does not duplicate other
reports, and does not result in any unfunded mandate.
2:48:07 PM
SENATOR HUGHES asked if the recommendations for the data plan
would be due by the next legislature, if legislation would be
required, or if the department could move forward once that
stakeholder group comes to a decision.
MS. CARPENTER replied it will depend on what the group decides,
but there will be a robust public process and the report goes to
the legislature.
2:49:16 PM
SENATOR HUGHES asked whether the report to the legislature would
be just the plan or if it would include first-year data that was
gathered from the outpatient stabilizations.
MS. CARPENTER offered her belief that the department could
provide early data from the 1115 Medicaid waiver as well as any
Title 47 involuntary commitments that are tracked through the
courts. Any information provided would be deidentified.
SENATOR HUGHES noted that the first part of Amendment 38
requires providers to keep a record of the assessment of the
individual's mental illness. She asked if that would already
happen as part of the routine.
MS. CARPENTER replied that the behavioral health billings
indicate that these individuals are observed every 15 minutes,
so the daily record would be extensive.
2:51:12 PM
SENATOR BEGICH pointed out that even though the information
would be deidentified, the data collection called for in the
amendment could identify individuals in small rural areas.
MS. CARPENTER said yes, and the department is concerned about
Amendment 38 for that reason.
SENATOR REINBOLD opined that the things the report is required
to include or do is purely bureaucratic. She summarized items
(1)-(3). By contrast, Amendment 38 is patient-centered and deals
with health outcome metrics. The amendment provides that the
assessment shall use an objective scale to determine an
individual's ability to function. She asked if the reporting
called for in bill Section 26 includes an objective assessment.
2:53:51 PM
MS. CARPENTER answered that the department will look at scales
that are industry standard. She suggested that the language in
the amendment was a little confusing because it wasn't clear who
decides the scale that's used is objective. She reiterated that
the department would look at best practices and industry
standards so any recommendation is data-informed.
SENATOR REINBOLD expressed concern that the department didn't
want to use an objective scale. She read the requirements in
subsection (b) of Amendment 38 and asked if the department would
be documenting those things.
MS. CARPENTER responded that the report will look at the items
she referenced to see how the information can be provided
publicly. The department will look at a host of things,
including the things listed in the amendment, when it talks
about what to consider. One reason the department and trust
suggested doing this report to the legislature is to get it
right the first time.
2:56:30 PM
SENATOR REINBOLD said it sounds like the department will be
doing the things required in subsection (b) of Amendment 38. She
asked if that information would be available if she called to
ask for the report.
MS. CARPENTER clarified that the report will look at the items
listed in (b) and talk about how to move forward and provide the
information on a broad scale. Certainly the number of people on
an involuntary detention or hold will be documented and anytime
crisis medication is used it is well documented. Also, the
report on page 13 of version B talks about looking at instances
of restraint, complaints, and grievances as well as the changes
that need to be made to processes, how the information is
provided to the public, those tracking this work, and how it is
provided to the legislature.
CHAIR WILSON offered his understanding that the court system
also has data on involuntary commitments.
2:58:17 PM
SENATOR HUGHES agreed with Senator Begich that even if
information is deidentified, it would be easy in small
communities to figure out what individuals were receiving
medications and whether they were restrained. It's the kind of
private information that should not be available to the public.
She disagreed with Senator Reinbold that Section 26 is purely
bureaucratic. Rather, that section looks at patient rights and
grievances, and it requires the department to bring together a
diverse stakeholder group, including patient advocates. The
group collectively would be very concerned about upholding
patient rights. She opined that the stakeholder group would
bring good data forward and address concerns that have been
articulated.
SENATOR HUGHES stated that she would oppose Amendment 38.
CHAIR WILSON asked Nancy Meade to talk about the data the court
keeps on involuntary commitments.
3:00:02 PM
MS. MEADE stated that everything that comes into the Court
System is tracked, including the number of ex parte orders for
involuntary commitments lasting 3 days, 30 days, 90 days, and
longer.
SENATOR REINBOLD paraphrased the provisions in Amendment 38 and
emphasized how important it is to protect patients who are
detained.
3:02:04 PM
CHAIR WILSON asked for a roll call vote.
3:02:06 PM
A roll call vote was taken. Senator Reinbold voted in favor of
the motion to adopt Amendment 38 and Senators Hughes, Begich and
Wilson voted against it. Therefore, Amendment 38 failed on a 1:3
vote.
3:02:22 PM
CHAIR WILSON announced that Amendment 38 failed on a 1:3 vote.
3:02:28 PM
SENATOR REINBOLD moved to adopt Amendment 39, work order 32-
GS1730\B.42
32-GS1730\B.42
Dunmire
3/16/22
AMENDMENT 39
OFFERED IN THE SENATE BY SENATOR REINBOLD
TO: CSSB 124(HSS), Draft Version "B"
Page 8, line 1:
Delete "47.30.815"
Insert "47.30.865"
3:02:31 PM
CHAIR WILSON found no objection and Amendment 39 was adopted.
3:02:38 PM
CHAIR WILSON [held SB 124 in committee].
3:03:21 PM
There being no further business to come before the committee,
Chair Wilson adjourned the Senate Health and Social Services
Standing Committee meeting at 3:03 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| Agnes Resume AMHTA.pdf |
SHSS 4/7/2022 1:30:00 PM |
|
| SB 124 Letter Gottstein 3.29.22.pdf |
SHSS 4/7/2022 1:30:00 PM |
SB 124 |
| SB 124 Amend. 1-39 3.17.22.pdf |
SHSS 3/17/2022 1:30:00 PM SHSS 3/22/2022 1:30:00 PM SHSS 3/29/2022 1:30:00 PM SHSS 4/7/2022 1:30:00 PM |
SB 124 |
| Agnes Moran Application_Redacted.pdf |
SHSS 4/7/2022 1:30:00 PM |
Confirmations |
| SCF Crisis Now Legislation Letter of Support 4.6.22.pdf |
SHSS 4/7/2022 1:30:00 PM |
SB 124 |
| SB 124 Ammendments Considered 4.7.22.pdf |
SHSS 4/7/2022 1:30:00 PM |
SB 124 |