HOUSE BILL NO. 52 "An Act relating to the rights of minors undergoing evaluation or inpatient treatment at psychiatric hospitals; relating to the use of seclusion or restraint of minors at psychiatric hospitals; relating to a report published by the Department of Health; relating to inspections by the Department of Health of certain psychiatric hospitals; and providing for an effective date." 4:16:46 PM REPRESENTATIVE MAXINE DIBERT, SPONSOR, thanked her staff for their work on the bill. She relayed that the bill focused on improving child psychiatric care in Alaska. She expressed gratitude to the committee for hearing the legislation. The bill was designed to better protect children receiving care in psychiatric care hospitals in Alaska by reinforcing parental rights and increasing transparency during treatment. The bill accomplished the goals through three straightforward reforms. Representative Dibert reviewed the three steps the state could take to protect its most vulnerable citizens. First, the bill expanded the rights of parents and guardians to communicate with their children while they were receiving psychiatric care. The bill ensured regular access to telephone and video communication. She relayed that many of the children were placed in facilities hundreds of miles from their homes and maintaining connection was critical to their wellbeing. She stated that in a previous hearing the committee heard directly from former patients who were now adults who shared that as children, they went months without any contact with their guardians despite repeated requests. She underscored that a lot of work was needed and the situation was unacceptable. Representative Dibert addressed the second action taken by the bill. The legislation required unannounced thorough inspections of the facilities to be done by state public health officials. Currently, inspections took place only once every 36 months. The gap had allowed some facilities to fall short of the standard of care children deserved. Reports of neglect, abuse, and sexual assault made it clear the state was not doing enough and it was their duty to ensure children were protected. Third, the bill brought much needed transparency to the use of all forms of restraint in psychiatric hospitals including chemical restraints. The bill defined the practices clearly in statute and required detailed documentation of their use, along with the use of physical restraint and seclusion. She shared that a lot of work had been done in the House Health and Social Services Committee to help with the specific section. She explained that with the rising rates of restraint used in psychiatric hospitals, there were serious concerns that measures were being misused to punish patients rather than to treat them, ultimately harming a child's ability to heal and reintegrate into their communities. She stressed that a youth should never come out of treatment worse than when they entered. She stated that the bill was not a silver bullet, but it was an important first step bringing Alaska closer to compliance and paving the way for better outcomes for children in psychiatric care. She requested to hear the sectional analysis from her staff. Co-Chair Foster noted that people had been waiting for some time for public testimony so he would move to that first. Representative Dibert noted there should be a second [invited] testifier online. She noted that Ben Mallot with the Alaska Federation of Natives (AFN) should be available. Co-Chair Foster confirmed that Mr. Mallot was online. He moved to invited testimony. 4:22:19 PM MATEO JAIME, COMMUNITY RELATIONS LIAISON, FACING FOSTER CARE, ANCHORAGE (via teleconference), shared that he entered foster care when he was 15 in 2017 and made his way from Texas to Alaska because of the Indian Child Welfare Act (ICWA). He shared that he had switched placement due to rampant abuse. There had been no foster homes in Anchorage; therefore, his caseworker sent him to North Star [Behavioral Health System]. He explained that the entry process had been very difficult, and he was not allowed to have his own clothes. The doctor told him he would be there for two weeks, which turned into two months. He shared that he witnessed a lot of medical abuse during his time at North Star, including staff that physically attacked patients who were much smaller. He detailed that "so called" therapy sessions involved North Star trying to send patients to long-term out-of-state facilities. He relayed that the facility did not listen or help patients learn how to navigate their issues. He shared that he did not have any mental health issues, despite going through long-term trauma. He explained that staff at North Star tried to put him on medications even though he did not need them. He provided additional testimony [indecipherable due to poor audio]. He stressed the importance of transparency in psychiatric institutions. He thanked the committee for the time to speak. Representative Hannan asked if Mr. Jaime graduated from the University of Alaska the previous week with honors. Mr. Jaime responded affirmatively. He shared that he graduated magna cum laude with a Bachelor of Arts in legal studies. Representative Hannan replied that it had been a privilege to see Mr. Jaime's growth and maturity over the past several years. She wished him the best and thanked him for testifying. 4:26:08 PM BENJAMIN MALLOTT, PRESIDENT AND CHIEF EXECUTIVE OFFICER, ALASKA FEDERATION OF NATIVES, ANCHORAGE (via teleconference), shared information about AFN. He thanked Representative Dibert for her leadership on the bill. He congratulated Mr. Jaime on his graduation and wished him the best of luck. He relayed that AFN supported the bill for many reasons. First, rural Alaska mental healthcare was very limited for options. Most often when youth were in mental crisis they were sent to facilities that were far from home. The bill would allow more access for parents and/or families to contact children in distress or in facilities. The bill also allowed the state to have better care and management of the facilities including two annual unannounced inspections. The bill provided more transparency in the use of sometimes very traumatizing restraints for youth in facilities. Overall, the bill was a step in the right direction for the care of youth in facilities. He thanked Representative Dibert for her leadership ensuring youth had the access to care they deserved. He thanked the committee, Gunalchéesh. 4:28:31 PM Co-Chair Foster OPENED public testimony. 4:28:53 PM STEVEN PEARCE, DIRECTOR, CITIZENS COMMISSION ON HUMAN RIGHTS, SEATTLE (via teleconference), shared that the commission is a psychiatric watchdog organization. The commission supported the bill. The organization believed the reforms the bill brought to reduce abuse, strengthen family connections, and improve transparency of Alaska psychiatric hospitals was a move in the right direction. He referenced a recommendation by the Disability Law Center about reviewing the current approach using powerful, mind altering psychiatric drugs by moving to a new focus of treatment in providing a noncoercive drug-free approach to move youth towards recovery of health. He underscored that psychiatric drugs were not cures and they often led to long-term disability. He stated that the bill addressed some of the issue of treating youth better, but involuntary treatment for youth must evolve beyond being a chemical restraint or deterrent for youth in emotional crisis. He stated that testimony clearly showed that people were not treated with respect and dignity that should have been provided. The organization urged that the bill should go further and suggested language specifying that patients had the right to be treated with dignity as a human being. He reiterated support for the bill. 4:31:00 PM Co-Chair Foster CLOSED public testimony for HB 52. Co-Chair Foster CLOSED public testimony for SB 39. Co-Chair Foster asked for a review of the fiscal notes for HB 52. 4:31:52 PM BRODIE ANDERSON, STAFF, REPRESENTATIVE NEAL FOSTER, reviewed the zero fiscal note from Department of Family and Community Services (DFCS), OMB component 3314, control code JbxmK. The department specified in the note that it could provide the necessary data with no fiscal impact. The second zero fiscal note was from DFCS, OMB component 3321, Odoim. The data to be collected and tracked would come at no additional cost to the department. The third fiscal note was from the Department of Health, OMB component 2944, control code Otlnx. The fiscal note included an FY 26 cost of $172,100 in personal services, $35,000 services, and $5,000 in commodities, for a total operating cost of $212,100 in unrestricted general funds for a full-time position. The department would also be required to do some regulation review. He provided a cost breakdown including one new nurse consultant 1 position, annual services of $20,000 for office space, phone number, and reimbursable services, and $15,000 for two annual trainings for the position. Additional costs were $2,000 for office supplies and a one-time commodity cost of $3,000 in FY 26. 4:35:11 PM Co-Chair Josephson asked how the communication feature would be applied if a youth was transferred out of state to Utah for example. Representative Dibert replied that the bill only focused on youth in Alaska. She hoped that further legislation in the future could help with youth who were out of state. Co-Chair Josephson asked if Representative Andrew Gray had a similar bill. Representative Dibert agreed that Representative Gray had a similar bill. She deferred the question to her staff for detail. 4:36:36 PM MATTIE HULL, STAFF, REPRESENTATIVE MAXINE DIBERT, responded that the bill submitted by Representative Gray interacted with foster care populations. He relayed that of the 213 applicable Medicaid psychiatric patients, 66 were in foster care. He explained that it was a different population. The bill helped many [youth] that were in foster care, but it pertained to psychiatric children and not foster children. Representative Bynum observed the bill was written so the minor in care had the right to the communications aspect. He wondered if there was something that protected the parent's right to communicate with the minor in care. He did not see it in the bill and wondered if it was already established in law. Mr. Hull answered that he was not aware of anything in statute. The bill would establish the right for a parent to create a request for communication. He noted that he may be incorrect. Representative Bynum asked where the information was located in statute or within the bill. He was amenable to receiving the response at a later time if needed. Mr. Hull responded that Section 1 on page 2 established that the minor's parent or legal guardian or another adult approved by the person in charge may request the confidential communication. He noted that the language had been added in the bill. Representative Bynum asked Mr. Hull to repeat the section and location in the bill. Mr. Hull answered that the language was on Section 1, page 2, line 1 of the bill. He restated the bill language. Representative Bynum observed that page 1 of the bill stated that a minor had the right unless prohibited by a court order or law to have confidential communication. He thought page 2 made it sound like a parent had to request to have the confidential communication. He wanted to ensure the parent had the right to confidential communication. He was amenable to receiving clarification on his question at a later time. 4:40:37 PM Representative Hannan asked for verification the bill would impact two hospitals including Alaska Psychiatric Institute (API) and a private hospital. She believed they were the only two hospitals currently treating minors in closed custody psychiatric care. Representative Dibert replied affirmatively. Representative Hannan asked if the sponsor had explored making the bill slightly broader to include hospitals with closed psychiatric units. She wondered whether they had been excluded because they did not take kids for the long- term or if there was another legal reason. Representative Dibert responded that the bill focused on psychiatric hospitals and she had not looked into expanding beyond that. She thought it was something to be explored as legislators learned more on how to help youth in the facilities. She appreciated the thought. Representative Hannan stressed the importance of the bill. She wanted to ensure they were capturing as many circumstances as possible where kids would be impacted. She considered it may be that the state licensure of treatment facilities could cover it in regulatory processes versus statute. She referenced separate legislation that would stand up alternative treatment facilities like group homes. She noted the bill had not yet passed and regulations had not been written. She wanted to ensure the same legal protections in HB 52 would be applied to any additional facilities that may open in the future. She noted she was jumping ahead to the vision where there would be treatment facilities to bring home kids who were currently not able to be treated in Alaska. Representative Dibert replied that she appreciated Representative Hannan's remarks. She requested to hear a response from the Department of Health. 4:44:07 PM ROBERT NAVE, DIVISION OPERATIONS MANAGER, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH (via teleconference), stated his understanding that the initial reason for the bill focusing solely on psychiatric hospitals was due to findings in a Department of Justice report on Alaska. He relayed that it would be possible to look into expansion if it was needed in the future and it may require an additional fiscal note. Representative Bynum stated that Section 4 of the bill addressed the right to have access to inspections and set standards for interviews of patients [50 percent of patients], and the number of times inspections could occur. He asked if there was an established guideline that informed the specific portion of the bill. Alternatively, he wondered if the language had been selected because it had been determined to be a good thing to do. Mr. Hull responded that the origin of the number came from other states that had instituted the requirement. He believed 30 other states had implemented some form of instate inspection. The 50 percent originated from Montana and a number of states had stepped up to ensure instate child psychiatric standards of care were rising. Representative Bynum highlighted that the fiscal note added personnel to the Department of Health (DOH). He observed there would be an elevated need in order to fulfil the requirements of the law. He wondered if there would be any negative impact if the department was unable to hire for the position. Mr. Nave responded that currently the Health Care Facility Licensing and Certification program was at critical mass with regard the current need and staffing. He stated that if the department was unable to hire the new position, it would be difficult to impossible to meet the requirements of the bill. Representative Bynum surmised that language in Section 4 provided the right for DOH to perform the activities, but it would not necessarily mean the state would be in breach of law or requirement if it was unable to fulfil two [inspections] per year and [interview] 50 percent [of the minor patients in a facility]. He asked if his understanding was accurate. Mr. Hull responded that to his knowledge there was no punishment language for not fulfilling the items [set out in Section 4 of the bill]. 4:48:34 PM Representative Dibert added that if there was a body to collect data from the institutions, there would be a report which would be provided to the legislature at the end of the year. She explained that it could provide information on the transparency of the system in the state. She remarked that if there was no one providing the data, a substantial amount of work was needed in the area. Representative Bynum supported the language in Section 4, specifically the requirement for unannounced inspections. He noted that hospitals had requirements where a survey was done, which was usually unannounced at least once a year. He pointed out that the language used in the bill stated DOH shall do the work. His only concern was about the state's ability to fill positions, and he thought the position under the bill would require technical competencies that may be difficult. He wanted to make sure it did not result in a noncompliant situation that may put the state in jeopardy. 4:50:09 PM Co-Chair Foster noted that he intended to take a recess for dinner. Representative Jimmie highlighted that traveling from rural Alaska to urban areas was extremely hard on a child. She believed the inability for a child to communicate with their parents would contribute to a worsening of the child's condition. Representative Dibert appreciated the comments from Representative Jimmie. She agreed that children were being sent far from home and the bill was aiming to protect them. She thanked Representative Jimmie, Enaa baasee'. Co-Chair Foster set an amendment deadline for Friday, May 16 at 5:00 p.m. HB 52 was HEARD and HELD in committee for further consideration. 4:52:18 PM RECESSED 6:45:32 PM RECONVENED