Legislature(2015 - 2016)BELTZ 105 (TSBldg)
03/11/2015 01:30 PM Senate JUDICIARY
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| Audio | Topic |
|---|---|
| Start | |
| Inmate Deaths in the Alaska Prison System | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
ALASKA STATE LEGISLATURE
SENATE JUDICIARY STANDING COMMITTEE
March 11, 2015
1:35 p.m.
MEMBERS PRESENT
Senator Lesil McGuire, Chair
Senator John Coghill, Vice Chair
Senator Mia Costello
Senator Bill Wielechowski
MEMBERS ABSENT
Senator Peter Micciche
COMMITTEE CALENDAR
LEGISLATIVE HEARING: INMATE DEATHS IN THE ALASKA PRISON SYSTEM
- HEARD
PREVIOUS COMMITTEE ACTION
No previous action to record
WITNESS REGISTER
RON TAYLOR, Commissioner
Department of Corrections
Anchorage, Alaska
POSITION STATEMENT: Participated in the discussion on in-
custody deaths in the Alaska Prison System.
LAURA BROOKS, M.S., L.P.A
Health Care Administrator
Department of Corrections
POSITION STATEMENT: Participated in the discussion on in-
custody deaths in the Alaska Prison System.
CHET WILLIAMS, representing himself
Anchorage, Alaska
POSITION STATEMENT: Participated in the discussion on in-
custody deaths in the Alaska Prison System.
JOHN R. SCOTT, representing himself
Anchorage, Alaska
POSITION STATEMENT: Participated in the discussion on in-
custody deaths in the Alaska Prison System.
ACTION NARRATIVE
1:35:29 PM
CHAIR LESIL MCGUIRE called the Senate Judiciary Standing
Committee meeting to order at 1:35 p.m. Present at the call to
order were Senators Wielechowski, Coghill, Costello, and Chair
McGuire.
^Inmate Deaths in the Alaska Prison System
Inmate Deaths in the Alaska Prison System
CHAIR MCGUIRE announced the business before the committee would
be a discussion on inmate deaths in the Alaska Prison System.
1:36:31 PM
RON TAYLOR, Commissioner, Department of Corrections (DOC)
thanked the committee for calling the hearing. He talked about
the public being interested whenever a death occurs in a prison
and the tremendous impact it has throughout the system. It does,
however, provide an opportunity to review procedures and ask
what could have been done differently to have a better outcome.
He stressed that no one should have to worry because a family
member or friend is under DOC's custody and care. Responding to
the four deaths or serious incidents that occurred since
December when he became commissioner, he asked for all data on
deaths inside a facility over the past five years. The intent is
to look at whether policies and procedures are being followed
and if there might be better processes because even one death
that occurs inside a facility is one too many.
LAURA BROOKS, M.S., L.P.A, Health Care Administrator, Department
of Corrections (DOC), discussed the primary reasons that DOC
can't provide an immediate answer when an inmate death occurs.
First, DOC relies on the state medical examiner to perform an
autopsy before drawing any conclusions. If a toxicology report
is ordered, it can take 4-6 weeks to get the results. Second,
DOC has to follow the privacy laws which means that personal
information cannot be released to anyone until the court has
appointed a personal representative of the estate.
She noted that she was asked to discuss how inmates access care
while in custody. She explained that inmates go through a health
care screening when they're arrested and DOC relies heavily on
the inmate's oral history. She noted that an inmate can put in a
health request anytime they have a health concern. If it's more
urgent, the correction's officer on the floor can make a
referral to medical or call for emergency care. She also
described the sick call procedure that is available in all the
facilities. In the smaller facilities 10-15 inmates might be
seen each day and 50-60 per day in the larger facilities. There
are also referrals for mental health and dental, and outside
referrals are made if needed. In smaller communities this
generally means the inmate will be triaged at the ER. She
explained that DOC also has a number of release planning
programs, a medical social worker, and mental health staff who
work every day to ensure that the transition from the
correctional center back to the community is as seamless as
possible.
CHAIR MCGUIRE asked how many remands there are.
MS. BROOKS replied there are 38,000 per year.
COMMISSIONER TAYLOR added that represents 22,000 individuals.
1:48:33 PM
SENATOR WIELECHOWSKI asked if there is a constitutional
obligation to provide medical care for inmates.
MS. BROOKS confirmed that inmates have a constitutional right to
health care.
SENATOR WIELECHOWSKI asked how much that costs.
MS. BROOKS reported that DOC's inmate health care budget is
about $43 million a year.
SENATOR WIELECHOWSKI asked if there is coordination with
Medicare or Indian Health Care if the inmate is eligible.
MS. BROOKS explained that, by federal regulation, inmates are
not eligible for either Indian Health Care or VA benefits. DOC
becomes the payer of first resort and the federal government
becomes the payer of last resort. The coordination is for
continuity of care.
SENATOR WIELECHOWSKI asked about Medicare and Medicaid coverage.
MS. BROOKS explained that Medicare doesn't pay for services for
an inmate, and there are limited categories by which an offender
could qualify for coverage under Medicaid. She said that may
change if Medicaid expansion happens because it will change the
type of inmate who would be eligible for Medicaid. It would be
more income-based instead of by those specific and limited
categories.
SENATOR WIELECHOWSKI asked if she had an estimate of how much
Medicaid expansion would save.
MS. BROOKS said looking at the data from the past three years
and based on the categories that would apply for Medicaid
expansion, it appears that about $7 million could have been
billed to Medicaid. The caveat is that the inmate health care
budget is fluid depending on the kind of offender and their
medical issues. She called it a fair assessment because the
inmate population probably won't get healthier or smaller.
1:52:16 PM
SENATOR WIELECHOWSKI asked if substance abuse treatment would be
covered under Medicaid expansion.
MS. BROOKS explained that none of the services that DOC provides
and none of the specialty out-patient services would be paid for
by Medicaid. An inmate would have to be in a hospital for 24
hours before Medicaid could be billed.
SENATOR COSTELLO said she was surprised to learn that Indian
Health Service coverage doesn't extend to an individual once
they're incarcerated. It becomes the responsibility of the
state. She expressed interest in resolving that drop in coverage
because of the benefit in continuing the relationship between
the doctor and patient.
COMMISSIONER TAYLOR advised that DOC was interested in working
with her office and DHSS on that matter.
SENATOR COGHILL commented on the potential for a zero sum gain
if more people qualified for Medicare but no longer qualified
under the hold harmless provision for welfare.
SENATOR WIELECHOWSKI asked for an explanation.
SENATOR COGHILL elaborated:
We have a hold harmless provision that says under
certain requirements you get welfare. You get
incarcerated, instead of having you lose your
eligibility the state will hold you harmless by paying
cash in that particular event. That way they can stay
enrolled; they don't have to reenroll when they get
out. The state picks that up to a tune of about $43
million a year, I think.
SENATOR WIELECHOWSKI asked if the state is paying welfare to
people who are in prison.
SENATOR COGHILL replied "the eligibility and many times it's
because of the families." He suggested it's a question for DHSS.
1:56:08 PM
SENATOR COGHILL asked if there is a determining protocol for
health care screenings to keep people from gaming the system.
MS. BROOKS explained that inmates are triaged and then evaluated
along the way to head that off, but DOC will err on the side of
seeing the inmate. She noted that the most common request is for
pain medication and while someone may have received the
medication when they were in the community, they may not receive
it when they're in custody. The medical staff uses their
professional judgement and has the advantage of being able to
observe the inmate on a 24/7 basis.
SENATOR COSTELLO asked if it would be correct to assume that the
majority of inmate deaths are a result of an emergency or
suicide.
MS. BROOKS relayed that since 2000 about 17 percent of the in-
custody deaths were suicides. The majority were illness related,
but there isn't a particular trend in any one area.
SENATOR COSTELLO asked if there is a process in the event of an
emergency to ensure that a call for help doesn't go unanswered.
MS. BROOKS said the officers are trained to respond to
emergencies and medical is called immediately. If there isn't
nursing staff on site the officers will render emergency
response and call 911.
SENATOR COSTELLO asked if the legislature could sign a
confidentiality agreement in order to look at a description of
the deaths, because it seems there is a compelling state
interest in light of the fact that 12 inmates died in custody in
2014.
MS. BROOKS suggested consulting the Department of Law (DOL)
because she didn't know.
COMMISSIONER TAYLOR agreed it was a conversation to have with
the Department of Law and stressed that the information would
not be available to the public.
2:05:49 PM
CHAIR MCGUIRE said Senator Costello makes a good point because
the legislature wants to know what it can do better to reduce
the incidence of death. She asked if he had more to share on the
five inmate deaths that have occurred since he became
commissioner.
COMMISSIONER TAYLOR said the investigations are ongoing for each
of those cases, but they're not seeing any trends. Some were
surprising because they were the first death in a particular
institution since DOC started keeping these statistics.
CHAIR MCGUIRE expressed interest in receiving more information
and continuing the dialog to help identify particular issues
such as resource allocation.
COMMISSIONER TAYLOR agreed to continue to dialog and share the
information to the extent possible.
CHAIR MCGUIRE said this committee is looking at all aspects of
the corrections system because it's disconcerting to know that
somebody could be incarcerated on a DUI or pretrial hearing and
not survive. The legislature wants to support and partner with
DOC to reduce these deaths.
COMMISSIONER TAYLOR reiterated that this is an opportunity for
DOC to talk about what it goes through when a death occurs in an
institution and cautioned he would not ask for additional
resources before he's gotten a full and complete staffing
analysis.
SENATOR WIELECHOWSKI asked if there is an appeal process for an
inmate who requests and is denied treatment.
MS. BROOKS said there is a grievance process that is answered
within the facility. If the inmate still isn't satisfied he/she
can file a grievance appeal that goes to the medical advisory
committee. Inmates also have access to the Ombudsman's Office
and the Disability Law Center.
2:15:31 PM
SENATOR COSTELLO asked if other states apply a different process
for death investigations.
MS. BROOKS said different jurisdictions use the attorney
general's office, the state attorney's office, an internal
affairs unit, or the sheriff's office. But it appears that the
investigations that are done by another agency are those where
foul play is suspected. She reminded the committee that not only
does DOC conduct an internal investigation when a death occurs
in a facility, but also the Medical Examiner's Office and the
Alaska State Troopers.
SENATOR COSTELLO asked if an agency other than DOC signs off
when the investigation is completed.
MS. BROOKS explained that DOC adds those reports to the internal
investigation and presents it to the Attorney General's Office
and the division directors within the system.
2:17:54 PM
CHAIR MCGUIRE said she'd like a legislative research report that
looks at the structure of investigations in other jurisdictions,
because it may be a fundamental structural flaw for a state to
investigate its own department of corrections.
COMMISSIONER TAYLOR clarified that DOC's internal investigations
are limited to looking at whether or not policies and procedures
were followed.
2:21:25 PM
MS. BROOKS reviewed the 2000-YTD2015 in-custody deaths by year,
and noted that there were two years that higher than usual
number of deaths. In 2002 a motor vehicle accident accounted for
4 of the 16 deaths. Deaths also spiked to 15 in 2008; over half
were due to liver disease, which speaks to lifestyle.
CHAIR MCGUIRE asked how DOC handles detoxification.
MS. BROOKS explained that DOC's policy is to send extremely
intoxicated individuals to the hospital. They aren't returned to
prison or jail for booking until medical personnel clears them
for treatment in an out-patient setting. The prison then has
procedures to make sure the inmate doesn't deteriorate.
She reviewed the 2000-YTD2015 in-custody deaths by facility, and
noted the 70 death spike at the Anchorage Correctional Complex
(ACC). In part that's because ACC is the medical hub; it has a
concentrated population of high risk medical cases, palliative
care, and hospice services. The higher numbers of deaths at the
out of state facilities and Spring Creek reflect long-term
sentenced facilities and an aging population.
CHAIR MCGUIRE asked for a more detailed breakdown on the
Anchorage Correctional Complex, because that has been the source
of many of the complaints.
MS. BROOKS agreed to provide the information.
SENATOR COSTELLO asked for a breakdown on the age of the people
who died while in custody.
2:26:40 PM
MS. BROOKS reviewed pie charts of the 2000-YTD2015 in-custody
deaths by cause. They show that 76 percent of the deaths were
natural causes, 17 percent by suicide, 4 percent by trauma, and
3 percent by homicide. She noted that these numbers are fairly
consistent with national numbers. The natural causes breakdown
shows 9 percent substance abuse, 17 percent cancer, 22 percent
cardiovascular/pulmonary disease, 13 percent end stage liver
disease, 2 percent end stage renal disease, 3 percent
gastrointestinal bleeding, 4 percent infectious disease, and 6
percent unknown. She noted that liver disease is high in Alaska
overall and higher yet in the prison population. In Alaska the
statistics show 11 deaths per 100,000 from liver disease and in
DOC it's 15 deaths per 100,000.
MS. BROOKS directed attention to a graph of the U.S. and Alaska
offender mortality rates per 100,000 offenders. Nationally, the
mortality rate is 243 per 100,000, whereas in Alaska it is 118
deaths per 100,000 inmates.
SENATOR WIELECHOWSKI asked what the overall mortality rate is
for Alaska and the U.S.
MS. BROOKS said the overall mortality rate in Alaska is 543
deaths per 100,000 people.
SENATOR WIELECHOWSKI observed that people are less likely to die
in prison.
MS. BROOKS agreed.
MS. BROOKS displayed a quote from a parent of an inmate.
When incarceration is the best a parent can hope for,
something is very wrong.
She said she completely agrees that jail should never be the
first place where someone receives mental health treatment,
prenatal care, or substance abuse treatment, but the majority of
inmates haven't had consistent medical and they're generally in
poor health. Relative to the general population, inmates
represent an exceptionally ill and complex population. For
example, Alaska has an overall rate of hepatitis of 1 percent;
in DOC the rate is 30 percent. DOC provides considerably more
care than these offenders received on the outside, but it's not
possible to reverse the years of compounded hard living.
SENATOR WIELECHOWSKI asked what percentage of offenders commit a
crime to have a place to sleep or get medical treatment.
MS. BROOKS said she doesn't have any data but it does happen.
SENATOR WIELECHOWSKI said he didn't mean to turn this into a
discussion on Medicaid expansion, but it would be extremely
helpful to know that if 5 percent more of the population had
access to medical care than the inmate population would drop
five percent, because they wouldn't need to go back to jail to
get medical treatment.
2:33:11 PM
COMMISSIONER TAYLOR clarified that people come in for a host of
reasons in addition to medical issues. Some people simply need a
place to stay or food, which is one reason there are spikes in
the winter. Although it's cause for concern, it's cyclical; the
population drops again in April and May when seasonal work and
subsistence activities start.
SENATOR WIELECHOWSKI expressed interest in seeing overall inmate
populations charted on a bell curve to stimulate discussion on
this critical issue.
CHAIR MCGUIRE agreed and requested information about the
incidence of traumatic brain injury in the inmate population.
COMMISSIONER TAYLOR acknowledged the request.
2:35:41 PM
MS. BROOKS displayed a pie chart showing 2000-YTD2015 in-custody
deaths by age. She noted that inmates age 56 and older account
for 27 percent of the deaths but represent just 9 percent of the
population. This is a reflection on the aging population, she
said. About one-third of the inmate deaths were someone under
age 40, which points to the fact that irrespective of age,
inmates are generally not healthy. She noted that the breakdown
of inmate deaths by gender mirrors the inmate population as a
whole, whereas the breakdown of inmate deaths by race was a
little surprising. It shows 53 percent of the deaths were
Caucasian when the inmate population is only 46 percent
Caucasian. African Americans represent 9 percent of the deaths,
which is consistent with the overall population of 10 percent,
but the Alaska Native percentages are not consistent. The inmate
population is 37 percent Alaska Native while 28 percent of the
in-custody deaths were Alaska Natives.
MS. BROOKS reviewed the roster that makes up a death
investigation. She explained that a team goes onsite and
interviews staff and inmates, reviews videos and files, and
collects all the documents related to the inmate's
incarceration. A timeline and summaries of the security and
medical response is prepared and copies of the autopsy and
police reports are collected and recommendations are made. The
findings are given to the attorney general, the division
directors, and the commissioner so that changes can be made
quickly if need be.
2:39:40 PM
COMMISSIONER TAYLOR discussed recent changes within the
facilities to ensure due diligence. He noted that the DOC
performance review specifically focused on the deaths looking at
whether or not the policies and procedures were applicable. He
reiterated that the department takes the concerns raised about
inmate deaths very seriously.
CHAIR MCGUIRE asked her to discuss the policy change for death
of a prisoner.
MS. BROOKS explained that the biggest change was made in 2012
when the process was formalized. DOC now sends a team onsite to
do a full review and a final report is written and sent to the
attorney general. DOC also added specific things such as what
the superintendent collects, what the medical director looks
for, who the information is shared with, and how the scene is
blocked off.
2:44:57 PM
CHET WILLIAMS, representing himself, said he is the shift
commander at the Anchorage Correctional Complex and has been in
the department for 22 years. He recounted a story to illustrate
how quickly someone can attempt suicide. An inebriated female
was remanded to custody and placed alone in a cell. When
officers weren't looking, she wrapped the hem of her shirt
around her neck and tied a knot. Her face was purple by the time
that officers reached her. Fortunately, the ligature was cut in
time.
He explained that the Anchorage Jail was designed as a direct
supervision concept jail, which places 1 officer in a module to
supervise 64 prisoners. He received training to run this type of
jail and he in turn trained others. Initially the direct
supervision training was 32 hours. It subsequently dropped to 16
hours and the last training was 2 hours. He opined that training
and education is key for officers and prisoners to reduce
suicide, PREA incidents, and recidivism in general. Prisoners
should be offered incentives to attend AA meetings, anger
management classes, and other programs while they're
incarcerated, he said. Responding to a question about training,
he clarified that there is no longer any direct supervision
training. Training now consists of basic suicide prevention,
CPR, and "read and sign" training.
CHAIR MCGUIRE asked if he believes that fewer incidents occurred
when there was more training.
MR. WILLIAMS said it seems there is more assaultive behavior
today, but suicides have remained about the same.
3:00:02 PM
JOHN R. SCOTT, representing himself, said he retired 18 months
ago after working almost 21 years at the Anchorage Correctional
Complex. His greatest concern was lack of training. When he was
working ACC was about 3 years behind on suicide prevention
training because of staffing shortages. Training for first aid
and CPR was 3-4 years behind. He said he believes that staffing
levels have a large bearing on suicide rates.
CHAIR MCGUIRE asked how he would describe the changes in
training over the course of his career.
MR. SCOTT said that when he retired last October, training had
plunged to virtually nothing because there weren't enough
officers to cover the night shift and conduct training at the
same time. There was no direct supervision training whatsoever
for the last five years that he worked.
CHAIR MCGUIRE asked if he saw any correlation between the number
of hours of training officers receive and the conditions within
the jail.
MR. SCOTT said conditions were better when more training
occurred. He related that one night shift officer doing security
checks on almost 400 inmates isn't adequate, and is stressful
for both officers and inmates. He shared that the lack of
training was a primary reason he retired.
3:07:38 PM
CHAIR MCGUIRE thanked the presenters for their service.
SENATOR COSTELLO thanked Senator McGuire for holding the
hearing.
3:08:53 PM
There being no further business to come before the committee,
Chair McGuire adjourned the Senate Judiciary Standing Committee
meeting at 3:08 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| 13 SB 41 Letter - Paul Craig 4 10 2015.pdf |
SJUD 3/11/2015 1:30:00 PM |