HB 52-MINORS & PSYCHIATRIC HOSPITALS  3:21:01 PM CHAIR MINA announced that the first order of business would be 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." [Before the committee, adopted as a working document on 3/25/25, was the proposed committee substitute (CS) for HB 52, Version 34-LS0399\N, Radford, 3/24/25 ("Version N").] 3:21:25 PM REPRESENTATIVE MAXINE DIBERT, Alaska State Legislature, as prime sponsor, provided a brief recap of HB 52, Version N. She explained that Version N would include three straightforward reforms: expand rights of parents to communicate with their children receiving care; require unannounced thorough inspections by state public health officials twice annually; and ensure that facilities are transparent about their use of physical and chemical restraints and seclusion. 3:25:00 PM MATTIE HULL, Staff, Representative Maxine Dibert, on behalf of Representative Dibert, prime sponsor, answered questions regarding HB 52, Version N, from the previous hearing on the bill. He said that Version N would not be duplicative, but expansive, of current patients' rights while in psychiatric treatment facilities. He said that 35 students would be interviewed from two different facilities twice a year. He added that inspections under HB 52, Version N, would be unannounced to ensure the authenticity of their results. 3:28:41 PM REPRESENTATIVE GRAY asked about medications that are being used as both restraints and medications and how that would affect the need for substance use to be reported. MR. HULL responded that chemical restraints are drugs used on a patient for discipline or convenience but not required to treat medical systems. He added that he would be willing to clarify this distinction through an amendment to Version N. REPRESENTATIVE GRAY expressed a concern that Version N would allow facilities to do something and not report it, such as overprescribing a drug that a child already takes. 3:32:23 PM KIM SWISHER, Deputy Director, Office of Children's Services (OCS), Department of Family and Community Service (DFCS), responded that she may not be the best to answer the question from Representative Gray. 3:32:48 PM ROBERT NAVE, Division Operations Manager, Division of Health Care Services (DHCS), Department of Health (DOH), responded that there should be a record of all drug administration at the facility. 3:33:28 PM REPRESENTATIVE RUFFRIDGE asked what current inspections of these facilities look like and if unannounced inspections, under HB 52, Version N, would replace current inspections. MR. HULL responded that all hospital inspections are unannounced, according to Medicaid standards. However, hospitals are allowed to contract out private agencies to conduct these inspections. He does not know the frequency of current inspections. MR. NAVE added that the unannounced inspections under the proposed legislation would be in addition to current inspections of the facilities. REPRESENTATIVE RUFFRIDGE asked again if current inspections are unannounced. MR. NAVE responded that that is correct. REPRESENTATIVE RUFFRIDGE asked when the last time the psychiatric facilities underwent inspections. MR. NAVE responded that he does not have the last date of the inspections. REPRESENTATIVE RUFFRIDGE asked about the frequency of current inspections. MR. HULL responded that the inspections occur at least annually. REPRESENTATIVE RUFFRIDGE asked about the safety of interviewers if they are required to conduct interviews alone. MR. HULL responded that he would work to clear up that concern. 3:37:50 PM REPRESENTATIVE FIELDS said that the mistreatment of children in hospitals has cost the state much more money than it would cost to keep these vulnerable patients safe. 3:38:55 PM REPRESENTATIVE SCHWANKE asked about who would approve communication between patients and their families. MR. HULL responded that treatment plans are not always overseen by a physician but by other high-level staff, who could approve of this communication. REPRESENTATIVE SCHWANKE asked for clearer language regarding who can approve communications. CHAIR MINA explained that the original language of the bill seemed too restrictive. 3:41:33 PM MR. NAVE said that less restrictive language would include mental health clinicians, psychiatrists, and other healthcare professionals. REPRESENTATIVE SCHWANKE expressed concern regarding a broad range of individuals being allowed to approve or deny communications. 3:42:38 PM CHAIR MINA asked if Version N would have more restrictive rights for minors, limiting length of video calls with families. MR. HULL responded that the proposed legislation would not set a maximum number of communications per week but would set a minimum of one hour per week. 3:44:38 PM REPRESENTATIVE GRAY asked what the facility is responsible for if a patient does not want to spend one hour in communication with their family. REPRESENTATIVE DIBERT responded that she is not sure how that situation would look and she would have to investigate that question more deeply. 3:47:07 PM MS. SWISHER responded that currently, if a youth does not want to speak with their family, then the facility does not force it. 3:47:41 PM REPRESENTATIVE GRAY emphasized that he does not want a facility to be able to say communication did not happen because the child did not want to, whether the child truly said that or not. 3:48:43 PM REPRESENTATIVE RUFFRIDGE emphasized that HB 52, Version N, would give the right, not the requirement, of a child to have communication with their guardian. He suggested also giving parents and guardians the right to communicate with their children in psychiatric facilities. MR. HULL responded that the rights of parents are also very important and he would like to encourage parents to reach out to their children in psychiatric facilities. 3:50:57 PM REPRESENTATIVE GRAY emphasized cases of nonverbal children, who may not be able to ask for the opportunity to communicate with their guardian. 3:51:57 PM CHAIR MINA returned to her question regarding restrictions that HB 52 would place on the rights to communicate that currently exist under psychiatric rights law. MR. HULL responded that the language Chair Mina referred to is present in both current statute on psychiatric rights and HB 52, Version N. CHAIR MINA asked if providers currently have the ability to restrict the number of calls made by a psychiatric patient. 3:53:49 PM MR. NAVE responded that facilities can put some limits on access to communication. 3:54:21 PM REPRESENTATIVE FIELDS agreed that language regarding limits on communication should be amended. 3:54:33 PM REPRESENTATIVE GRAY said that he disagrees and said that children in psychiatric hospitals should not have unlimited access to phone calls. 3:55:17 PM CHAIR MINA said that if facilities can already restrict access to communication, the proposed legislation would not need to further restrict access. 3:56:00 PM REPRESENTATIVE FIELDS said that existing language in Version N could be misconstrued and further limit access to communication. 3:56:33 PM MR. HULL said that Version N of HB 52 would set a floor, not a maximum, of communication. 3:57:18 PM SETH GREEN, MD, Behavioral Health Clinical Supervisor, Aleutian Pribilof Islands Association, advised that cutting off communication and connections to home increases loneliness for children in psychiatric facilities. He said that having access to communication increases the long-term benefits of psychiatric treatment. He added that he supports unannounced and unexpected inspections of psychiatric facilities. He emphasized that reducing the use of restraint is essential for positive outcomes of psychiatric treatment. 4:01:03 PM REPRESENTATIVE PRAX asked if the Aleutian Pribilof Islands Association provides residential or out-patient care. DR. GREEN responded that they only provide out-patient care. 4:02:05 PM REPRESENTATIVE PRAX asked if psychiatric facilities are currently inspected annually with their license renewals. MR. NAVE responded that that is correct. REPRESENTATIVE PRAX asked if that inspection is announced or unannounced. MR. NAVE said that it is an unannounced inspection. REPRESENTATIVE PRAX asked if, under HB 52, Version N, there would be three unannounced inspections per year. MR. NAVE responded that is correct. REPRESENTATIVE PRAX asked if the accrediting agency also performs inspections and, if so, whether they are unannounced, as well. MR. NAVE responded that those inspections are also unannounced. REPRESENTATIVE PRAX asked if DOH reviews the results of the accrediting agency's inspections. MR. NAVE responded that DOH does review the findings. 4:04:28 PM REPRESENTATIVE GRAY described his experience with unannounced inspections at the hospital he worked at. He explained that although inspections were unannounced, they occurred within a predictable timeline, allowing the hospital to prepare in advance for the inspection. He asked whether the proposed legislation should include random unannounced inspections to prevent this ability to prepare. MR. NAVE responded that the additional inspections under Version N would fall outside of the predictable timeline that currently exists. 4:06:30 PM CHAIR MINA asked if there are any gaps in data collection currently being missed that would be included under the reports required under HB 52, Version N. MR. HULL responded that the inspections would only inspect the in-state populations, even though the majority of Alaska children in psychiatric hospitals are sent to out-of-state facilities. 4:08:08 PM MS. SWISHER responded that current reporting captures youth at both in-state and out-of-state facilities. She said she is unaware of any gaps in current data reporting. CHAIR MINA asked if the annual report, under Version N, would reference the children in out-of-state facilities. MS. SWISHER responded that the annual report would encompass the reporting that already exists, regarding both children at in- state and out-of-state facilities. CHAIR MINA asked if there is an existing report in DFCS related to children that are sent out of state. MS. SWISHER responded that there is an existing quarterly report. 4:10:18 PM REPRESENTATIVE GRAY asked what would prevent the state from doing unannounced visits to out-of-state facilities where Alaska children are residing. MR. HULL responded that he is not entirely sure but could help to find that information. MS. SWISHER responded that OCS occasionally does perform unannounced visits to out-of-state facilities, and she is not sure of any non-budgetary restrictions. REPRESENTATIVE GRAY asked if Ms. Swisher goes to Utah. MS. SWISHER responded that OCS does transfer children to out-of- state facilities when necessary. 4:13:01 PM REPRESENTATIVE SCHWANKE asked what the benefit would be from posting annual reports of facilities online. MR. HULL responded that HB 52 would ensure transparency as well as the anonymity of the patients. REPRESENTATIVE SCHWANKE expressed concern regarding publishing the full report online. 4:15:38 PM MR. HULL responded that psychiatric facilities have increasingly used medications improperly and that the state needs to protect children from this abuse. He said that full transparency is essential in this endeavor. 4:17:09 PM REPRESENTATIVE RUFFRIDGE asked who is responsible for the deficiencies found in these facilities. He asked about accreditation agencies' responsibility. MR. HULL responded that he would love to see more federal oversight of these facilities. He said that many states are increasing protections for the children in their psychiatric facilities. MR. NAVE responded there are multiple layers of oversight and jurisdiction over these facilities. He said that each layer has different jurisdiction and different focuses. 4:21:03 PM REPRESENTATIVE PRAX said that he is concerned about over- reporting. MR. NAVE responded that the State of Alaska has a very broad definition of restraint, which he does not want to further restrict. He said that he would rather see more than less reporting. REPRESENTATIVE PRAX asked if there are any Health Insurance Portability and Accountability Act (HIPAA) restrictions to be concerned about when reporting. MR. NAVE responded that any reports published online would be de-identified. REPRESENTATIVE PRAX asked if there is a problem with reporting to the state if a child is not in the custody of the state. MR. NAVE answered that that would not be a HIPAA violation. 4:24:47 PM REPRESENTATIVE GRAY named some of the main drugs used as restraints in psychiatric facilities and expressed his concerns regarding the more addictive substances. He said he wants to know if addictive substances are being used as restraints when there are other options for restraint. REPRESENTATIVE SCHWANKE responded that she does not question the need for the report, especially to families and to the legislature. She said she wonders if publishing the report online would create more problems and questions for DOH. 4:27:45 PM REPRESENTATIVE PRAX considered whether the House Health and Social Services Standing Committee should be required to read the report. [HB 52, Version N, was held over.]