HB 36-FOSTER CHILDREN PSYCHIATRIC TREATMENT  3:31:45 PM CHAIR DUNBAR announced the consideration of HOUSE BILL NO. 36 "An Act relating to the placement of foster children in psychiatric hospitals; relating to the care of children in state custody placed in residential facilities outside the state; and amending Rule 12.1(b), Alaska Child in Need of Aid Rules of Procedure." 3:32:05 PM REPRESENTATIVE ANDREW GRAY, District 20, Alaska State Legislature, Juneau, Alaska, sponsor of HB 36. He stated that the bill strengthens due process protections for foster children placed in acute psychiatric facilities. HB 36 requires a judicial hearing within seven days of admission, mandates court- appointed legal representation for the child, allows virtual participation, and requires case reviews every 30 days for any long-term placement. HB 36 also adds reporting on the number of foster children placed in out-of-state residential facilities to an existing annual legislative report. He stated that the legislation responds to past failures in oversight that resulted in foster children being held far longer than medically necessary without timely hearings. Citing court rulings and documented cases, HB 36 ensures foster children receive timely judicial review and advocacy, aligning rights more closely with constitutional due process standards and preventing prolonged, unnecessary institutionalization. 3:38:15 PM KYLE JOHANNSON, Staff, Representative Gray, Alaska State Legislature, Juneau, Alaska, provided the sectional analysis for HB 36: [Original punctuation provided.] Section 1  Non substantive statutory construction Section 2  Defines "acute psychiatric hospital" as suggested in Kwinhagak v State of Alaska Defines "contemporaneous two-way video conference" to expedite due process Section 3  New subsection e) Allows the State to place child in an acute hospital if it's the least restrictive option, the child is gravely disabled/mentally ill and placement would improve the condition of the child with treatment or deteriorate the condition of the child without treatment. f) Requires all parties of the case to be notified of placement within 24 hours g) Requires a court review of placement within 7 days. Gives the court the option to extend the court review up to 14 days if necessary to secure attendance of case participants. Allows for contemporaneous two- way video conferencing. h) Requires case review each 30 days or by a "good-cause" request by the child or interested party. Section 4  Adds "The number of children placed in residential facilities providing care for children outside the state' to the required annual report to the Legislature on employee recruitment and retention, including a five year plan, for the division. Section 5  Amends Court Rule 12.1 (b) Alaska Child in Need of Aid Rules of Procedure to mandate the court appointment of an attorney for a child who has been placed in an acute psychiatric hospital. 3:41:35 PM SENATOR CLAMAN said that in adult cases, a hearing is held within 72 hours, often with less than 24 hours of notice. He asked why HB 36 requires a hearing within seven days rather than the same 72-hour standard. REPRESENTATIVE GRAY replied this is a compromise agreement. Not its first iteration. 3:43:00 PM NANCY MEADE, General Counsel, Alaska Court System, Juneau, Alaska, answered questions on HB 36. She responded that the Supreme Court concluded that a 72-hour hearing is not workable in these cases. Unlike adult mental commitments, a child cannot simply be released if criteria are not met or reports are incomplete, because the child may have no safe alternative placement. She said the Court also recognized the complexity of child-in-need-of-aid cases, which involve multiple attorneys, Office of Children's Services (OCS) staff, and facility representatives, making expedited scheduling difficult. While 30 days was deemed too long, the Court found three days impractical, with courts generally aiming for hearings closer to seven days. SENATOR CLAMAN asked whether this was the Sitka case. MS. MEADE replied that this case was called Native Village of Kwinhagak versus State of Alaska, decided in February 2024. If the child was in Sitka, this may be the case being referenced. 3:45:19 PM CHAIR DUNBAR stated that Representative Gray noted that an attorney is usually already appointed for the child. He asked for clarification on HB 36, Section 5, specifically regarding who typically serves in that role, whether an OPPA attorney, a private attorney, or a Department of Law attorney, and who the statute envisions appointing. 3:45:46 PM MS. MEADE responded that the Office of Public Advocacy appoints an attorney to represent children in these types of situations. CHAIR DUNBAR noted that the fiscal note estimates 110 additional one-hour court hearings, with attorney costs of $107 per hour, totaling $18,700. He asked for clarification on whether these costs assume OPPA attorneys, private attorneys, or Department of Law attorneys, and whether the department plans to hire additional counsel, contract externally, or absorb the work within existing staff. 3:46:45 PM KIM SWISHER, Deputy Director, Office of Children's Services, Anchorage, Alaska, answered questions on HB 36. She responded that the fiscal note reflects costs incurred by OCS for its own representation and participation in additional court hearings. These costs are billed hourly by the Attorney General's office. 3:47:12 PM CHAIR DUNBAR noted that he didn't see a fiscal note from the Office of Public Advocacy and asked for an explanation from Ms. Meade on how that works. 3:47:22 PM MS. MEADE stated that she could not speak for the Office of Public Advocacy and noted that HB 36 does not materially change the existing court rule. She said under current rules, courts must appoint an attorney when a child age ten or older does not consent to psychiatric placement, which occurs frequently, and courts often appoint counsel even when the child does consent due to the high stakes involved. As a result, HB 36 is not expected to significantly increase the number of attorney appointments. 3:48:35 PM SENATOR HUGHES asked for an explanation of what happens when a foster child is hospitalized. She asked whether foster parents may visit or maintain contact, or whether OCS assumes the parental role with limited involvement from foster parents. 3:49:28 PM REPRESENTATIVE GRAY answered that in most cases, once a child is transferred to an acute psychiatric facility, they do not return to the prior foster home, requiring OCS to find a new placement. He said when no immediate placement is available, the psychiatric facility effectively becomes the placement, leading to prolonged stays at a cost of nearly $1,000 per night. These situations often involve children with significant behavioral distress, and it is uncommon for foster parents to remain involved during this period. 3:51:00 PM SENATOR HUGHES asked whether the cutoff between a foster child and foster family during psychiatric hospitalization is required by law, regulation, or standard practice. She asked whether this approach serves the child's best interests. She suggested that even in cases of mental health crises, maintaining contact with a stabilizing foster family may be beneficial and propose that an evaluation be considered to determine whether continued engagement is appropriate. 3:52:08 PM REPRESENTATIVE GRAY replied that in most cases, foster parents do not want the child returned to the foster family's home. This is not about being denied access; rather, foster parents are often overwhelmed and unsure how to manage the situation. 3:53:07 PM SENATOR CLAMAN noted that HB 36 defines acute psychiatric hospital and asked if that included the emergency room. REPRESENTATIVE GRAY answered that HB 36 does not include the emergency room. SENATOR CLAMAN referenced a family friend who had a foster child that went to the ER and spent 7 to 10 days in a padded cell. He asked how such situations are addressed, since the bill's definition of an acute psychiatric hospital does not appear to include emergency room placements. 3:53:56 PM REPRESENTATIVE GRAY responded that HB 36 doesn't cover that. Research indicates that in Alaska over the past 20 years, extended holds without due process have occurred in acute psychiatric facilities, not emergency rooms. He said acute psychiatric facilities function similarly to psychiatric emergency rooms. In cases like Kwinhagak, children may be temporarily held in a local ER until transfer to a facility. He said the exact legal status and when the timeline for hearings begins after an ER evaluation is unclear and would require legal clarification. 3:55:35 PM CHAIR DUNBAR suggested the committee finish the conversation after invited testimony. 3:55:49 PM CHAIR DUNBAR announced invited testimony on HB 36. 3:56:16 PM AMANDA METIVIER, Co-Founder, Facing Foster Care in Alaska, Anchorage, Alaska, testified by invitation on HB 36. She referenced experiences in foster care and being a foster parent. She noted that many youth in foster care are placed in acute psychiatric hospitals unnecessarily or while awaiting other care. HB 36 responds to foster youth requests by ensuring timely judicial review to assess care needs, identify relatives or placements, and convene legal parties. She said HB 36 strengthens existing efforts to protect the rights of foster youth, aligns with recent court rulings that 30 days is too long, and is feasible given current practices in child-need cases. HB 36 complements prior legislation promoting ongoing contact with previous foster families, siblings, and important connections. 4:00:06 PM SENATOR CLAMAN asked why the hearing timeline is set at seven days instead of 72 hours, given that it was mentioned that hearings can currently be scheduled within 72 hours. 4:00:24 PM MS. METIVIER responded that the original request from youth was for a 72-hour hearing, however the seven-day timeline reflects a compromise, primarily due to concerns from state agencies about coordinating all legal parties. Similar scheduling occurs in other child-need-of-aid cases. 4:00:49 PM SENATOR CLAMAN asked for clarification that she said another need of child of aid cases in Alaska. MS. METIVIER replied yes, when children are removed from homes, hearings occur within 72 hours. She said this brings together all relevant legal parties, including parents and attorneys, the child (if represented), a guardian ad litem, tribal representatives if applicable, OCS, and OCS's attorney. 4:01:23 PM SENATOR CLAMAN asked if she means removal from home not placement in a psychiatric ward. MS. METIVIER replied yes, in OCS removal cases, hearings occur within three days and include all relevant legal parties, similar to acute psychiatric cases, though typically without the hospital clinician or facility representative. 4:02:09 PM REPRESENTATIVE GRAY stated that the seven-day hearing timeline was chosen after considering the Supreme Court's guidance that 72 hours is too short, and 30 days is too long. Input from an OCS nurse indicated that seven days allows sufficient time to assess children's behavioral and mental health needs. Unlike the 72-hour proposal, seven days faced little resistance and was seen as a practical, logical compromise, though the sponsor remains open to adjustment. 4:04:04 PM CHAIR DUNBAR said HB 36 applies only to acute psychiatric facilities, not traditional emergency rooms. He asked if there was a practical reason why including, or not including, emergency rooms might be necessary. 4:04:46 PM MS. METIVIER answered that she did not consider emergency rooms when drafting HB 36. Typically, a foster child is taken to an ER for behavioral issues, where the hospital determines whether to transfer the child to an acute psychiatric facility. She said in urban areas, this transfer usually happens quickly, often the same day. She said she is less familiar with rural Alaska's timelines. 4:05:46 PM CHAIR DUNBAR asked Senator Claman if he wanted to ask the drafter the same question. 4:06:09 PM SENATOR HUGHES stated that she heard earlier from the sponsor that acute psychiatric placements often occur because foster parents are overwhelmed and do not want the child returned. She asked whether, in the rare cases where a caring foster family wishes to remain involved until a permanent placement is found, maintaining that connection might better serve the child rather than an automatic cutoff. 4:07:18 PM MS. METIVIER answered that HB 36 does not address contact outside of hearings, attorney appointment, and notice. Decisions about contact are made by the caseworker acting as the child's guardian. She said OCS uses team decision-making meetings for any placement change, which include legal parties and often foster parents and other connections, providing existing opportunities to maintain relationships. 4:08:39 PM KXLO STONE, Board Member, Statewide Youth Leadership, Facing Foster Care Alaska, Anchorage, Alaska, testified by invitation on HB 36. She referenced her background as a former foster youth, a current guardian to siblings, and a member of a foster youth leadership board. She described systemic failures in Alaska's foster care system, including lack of communication, inadequate advocacy, language barriers, and prolonged placements of youth in acute psychiatric facilities without appropriate therapeutic support. She argued that such placements should not be treated as punishment or a one-size-fits-all solution. She urged a shift toward timely evaluation, stronger due process, family engagement, and community-based mental health services that prioritize youth well-being and long-term recovery. 4:13:11 PM SENATOR CLAMAN raised concerns about the 2024 Supreme Court Kwinhagak case, "Sitka case," noting that the youth spent about 18 days in the Sitka Hospital before being transferred to North Star. He asked when the hearing timeline would begin under HB 36 and whether excluding emergency rooms would leave children in similar situations without protection during prolonged ER stays. 4:14:33 PM MARGRET BERGERUD, Counsel, Legislative Legal Services, Juneau, Alaska, answered questions on HB 36. She answered that the bill would not apply in that situation. The definition was crafted to include facilities like North Star. She said with it focused on hospital units providing diagnosis and short-term mental health treatment, at this time it does not encompass emergency room admissions. 4:15:23 PM REPRESENTATIVE GRAY asked whether HB 36 could be easily amended so that the seven-day hearing timeline begins when a child is diagnosed in the emergency department as needing transfer, rather than upon admission to an acute psychiatric facility. 4:15:58 PM MS. BERGERUD replied that legal could draft an amendment for the language to say when the child is admitted at the emergency room. SENATOR HUGHES suggested emergency room padded area instead of emergency room. 4:16:47 PM SENATOR CLAMAN asked how the phrase "acute psychiatric hospital" is understood today; to which hospitals does it apply in Alaska. REPRESENTATIVE GRAY replied that acute psychiatric hospitals in Alaska are API and Northstar. 4:17:20 PM SENATOR CLAMAN asked whether the reporting requirement on page 4, regarding the number of children placed in out-of-state residential facilities, applies only to children in OCS custody or also to children in private placements. REPRESENTATIVE GRAY replied that it would apply only to state custody children. SENATOR HUGHES asked if there were any foster children being placed in acute psychiatric hospitals outside of Alaska. 4:18:04 PM REPRESENTATIVE GRAY answered that they would need to have transitioned from an acute psychiatric facility to a residential psychiatric facility. He said he is unaware of any child in an acute psychiatric facility outside of Alaska. 4:18:33 PM SENATOR HUGHES asked if the child is outside of residential, then does the review period apply. 4:18:41 PM REPRESENTATIVE GRAY replied that existing statutes already govern placements in residential facilities and require regular reviews, typically every 30 days, for children in OCS custody. HB 36 addresses the statutory gap related to acute psychiatric facilities, which previously lacked clear oversight. 4:19:20 PM MS. SWISHER agreed that HB 36 fills a statutory gap regarding acute psychiatric facilities. She noted that OCS does facilitate contact with foster families when appropriate, though HB 36 primarily addresses youth who cannot safely return to a foster home or treatment facility due to being a danger to themselves or others. The seven-day hearing timeline allows sufficient time for evaluation and for the acute hospital to make informed recommendations on the appropriate level of care or potential return to the foster home. 4:21:16 PM SENATOR CLAMAN asked why a new definition of acute psychiatric facility is needed if the current statutory definition of psychiatric hospital already covers two facilities and requests a follow-up explanation later. 4:22:01 PM CHAIR DUNBAR held HB 36 in committee.