SB 44-MINORS & PSYCHIATRIC HOSPITALS  4:30:52 PM CHAIR DUNBAR reconvened the meeting and announced the consideration of SENATE BILL NO. 44 "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." 4:31:33 PM SENATOR MATT CLAMAN speaking as sponsor of SB 44 stated that in 2022, the United States Department of Justice (DOJ) investigated Alaska's behavioral health care system for youth and found an overreliance on institutionalization to treat minors with behavioral health disabilities. In response to the DOJ's findings, the Department of Health launched the Behavioral Health Roadmap project for Alaska youth in the fall of 2023. He acknowledged and appreciated the efforts made by the department, behavioral health providers, and stakeholders who contributed to regional meetings and the drafting of the report. He expressed hope that through continued collaboration, meaningful progress could be made to provide care for Alaska's youth in the most appropriate settings along a full continuum of care. 4:32:22 PM SENATOR CLAMAN emphasized the urgent need for transparency and increased parent or guardian involvement at psychiatric hospitals that serve Alaskan youth with behavioral health needs. He explained that Senate Bill 44 aims to enhance and protect the rights of these young patients and outlined its four main objectives. First, the bill ensures youth patients have access to at least one hour of communication with a parent or legal guardian each week. Second, it requires the Department of Health to conduct biannual, unannounced inspections of facilities providing residential psychiatric treatment for youth, during which 50 percent of all youth patients must be interviewed about their experiences. Third, the bill mandates that any use of seclusion or restraint on a youth patient must be reported within 24 hours to both the Department of Health and the patient's parent or guardian. Fourth, it enhances transparency by requiring the Department of Health to publish an annual report on minors in psychiatric hospitals and make it publicly accessible. 4:33:40 PM BREANNA KAKARUK, Staff, Senator Matt Claman, Alaska State Legislature, Juneau, Alaska, provided the sectional analysis for SB 44: [Original punctuation provided.] Senate Bill 44  Sectional Analysis Version A Section 1 AS 47.30.840 Right to privacy and personal possessions; other rights. Adds a new section to ensure a minor undergoing evaluation or inpatient treatment at a psychiatric hospital has the right, unless otherwise prohibited by law or court order, to have confidential video communication at least once each week for at least one hour with the minor's parent or legal guardian, which will be facilitated by the psychiatric hospital. Section 2  AS 47.32.030 Powers of the Department of Health and the Department of Family and Community Services; delegation to municipality. Adds a new subsection (e) and (f). Subsection (e) requires the Department of Health to prepare an annual report regarding minors in psychiatric hospitals, to publish the report on the department's website, submit to the Senate Secretary and Chief Clerk of the House of Representative, and notify the Legislature of its availability. Subsection (f) requires the Department of Family and Community Services to collect data on minors who receive residential psychiatric care at psychiatric hospitals and to submit it to Department of Health for their report.  Section 3 AS 47.32.110 Right of access and inspection. Amends subsection (c) to authorize the officer or employee of a department with licensing authority to enter for any purposes described in new subsection (d). Section 4 AS 47.32.110 Right of access and inspection. Adds a new subsection (d) to require a designated agent or employee of the Department of Health to conduct, at least twice a year, unannounced inspections of each psychiatric hospital where minors undergo evaluation or inpatient treatment in which a minor has spent more than three nights in the preceding year. At these inspections, the designated agent or employee must interview at least 50 percent of the patients. Section 5 AS 47.32.200 Notice required of entities. Adds a new subsection (g) to require a psychiatric hospital to send written notification of each use of seclusion or restraint on a minor, including the use of a chemical, mechanical, or physical restraint, to the Department of Health and the minor's parent or guardian within one business day after the use of seclusion or restraint. Section 6 Sets the effective date of July 1, 2025 4:36:00 PM SENATOR TOBIN asked a question regarding the definition of "physician" in SB 44, page 2, line 1, which mentions the overseeing physician. She said she was unclear whether this definition includes clinical psychologists or advanced nurse practitioners with psychiatric training who may be responsible for overseeing care in these facilities. She asked whether the definition is inclusive of those professionals who might also be involved in monitoring the treatment of youth patients. 4:36:53 PM SENATOR CLAMAN asked for clarification of the question. He stated the question asked is not specifically about the definition of "physician" itself, but rather about the meaning of the term "overseeing physician" as modified by the word "overseeing." He sought to confirm whether the question was focused on that modifier and its implications for who qualifies as overseeing care. SENATOR TOBIN clarified her question by referencing the phrase "approved by the overseeing physician" in SB 44. She asked what is meant by "overseeing physician" and what the definition includes. She wanted to know whether it is inclusive of all professionals who might be identified as overseeing care in treatment facilities, such as a clinical psychologist who may be responsible for treatment oversight. She noted that such individuals are not necessarily licensed under the State Medical Board but may instead be licensed under the State Board of Psychologists and Psychological Associate Examiners. She asked whether those individuals are included in the definition. 4:37:43 PM SENATOR CLAMAN responded that this may be an area where further discussion is needed. He explained that, as currently drafted, the term "overseeing physician" in the bill likely refers to the physician in charge of medical care at the facility level, rather than the individual overseeing the care of a specific patient. For example, at the Alaska Psychiatric Hospitalone of the facilities to which this legislation would applythe overseeing medical professional has historically been a physician. He clarified that while clinical psychologists or other providers may be responsible for direct care of individual patients, the bill appears to require that any decision to restrict a youth's communication with their parent would need to be approved by the physician overseeing the facility's operations, not just the provider managing day-to-day care. He added that if there is interest from the committee in allowing a mid-level clinical provider who supervises a specific patient's care to make that determination, it would be a reasonable consideration. However, as drafted, the bill assigns that authority to the physician in charge of the facility. 4:39:21 PM SENATOR TOBIN explained that she raised the question because SB 44, page 1, line 11, the language states that the "overseeing physician" may determine whether communication with a parent is "therapeutically unadvisable." In her interpretation, that decision would likely come from someone directly overseeing the child's caresomeone with firsthand insight into the therapeutic needs of the patient. She noted that this person might not necessarily hold an MD degree but could hold another other degrees. 4:39:53 PM SENATOR GIESSEL noted that about four or five years ago, the state expanded the types of clinicians authorized to provide care in psychiatric hospitals to include physician assistants and advanced nurse practitioners. She suggested reviewing the definition of "physician" in SB 44, and if the intent is to limit it to physicians only, an amendment could be offered. SENATOR CLAMAN stated that he would look into the definition issue further. He emphasized that while he is not committed to requiring approval from the physician overseeing the entire facility, he supports having a higher-level sign-off when a treatment provider deems parental contact therapeutically inadvisable. He noted this would serve as a check and balance, ensuring such decisions are not made routinely or without thorough consideration. 4:41:32 PM SENATOR HUGHES questioned the rationale for limiting youth communication with parents or guardians to no more than four occasions per week in SB 44. She asked whether this restriction would prevent more frequent contact, such as daily video communication, if recommended by the supervising provider. She sought clarification on the intent behind the statutory limit. SENATOR CLAMAN clarified that the language in SB 44 sets a minimum standard for youth communication with parents or guardians, not a maximum. He stated that care providers could allow more frequent contact if appropriate. The intention is to ensure that youth receive at least the minimum required contact. SENATOR HUGHES said she understands that the one-hour requirement is intended as a minimum but expressed concern that the phrase "over not more than four occasions" imposes a limit. She questioned whether this language would prevent a clinician from allowing more frequent contact, such as daily communication. She suggested that the limiting phrase be removed to avoid unintended restrictions. 4:43:01 PM SENATOR DUNBAR said he may be misinterpreting the language, but noted that on line 10 the SB 44 grants the minor "the right," which he interpreted as a minimum or floor. He stated that, as written, the bill gives the minor the right to at least one hour or four occasions but does not prevent the facility from allowing more contact. He asked if Senator Claman has the same interpretation. SENATOR CLAMAN replied he was in exact agreement but acknowledged it was worth further discussion offline. He stated that everyone seemed aligned on the intent. He agreed with Senator Hughes that the language should not imply a maximum number of visits or establish a ceiling for communication allowed by the facility. 4:43:45 PM SENATOR HUGHES asked about the practicality of the requirement in Section Four, page three, for unannounced inspectors from the Department of Health to interview at least 50 percent of minor patients. She noted the value of the information that could be gathered but questioned whether some youth, particularly those who are severely traumatized, would be in a condition to participate in interviews. She asked if providers had been consulted and whether meeting this requirement would be reasonable. SENATOR CLAMAN said that in developing the SB 44 similar laws in other states were reviewed and providers were consulted. He stated that interviewing 50 percent of current patients appears reasonable, emphasizing that the requirement applies only to those in the facility and not those in the facility over the course of the year. He noted it is unlikely that a majority of youth in a facility would be in such an acute psychiatric state that they could not communicate at all. He acknowledged that some may have communication challenges but said it is rare for 50 percent to be entirely unable to participate. 4:45:31 PM SENATOR HUGHES said it would be helpful to hear from someone with direct experience working in a psychiatric hospital on the practicality of interviewing patients. She referred to Section 5 and noted the sponsor's statement cited 261 incidents of restraint within three months, which she described as startling. She acknowledged the concern families may have and the importance of ensuring restraints are only used when appropriate. She asked whether current procedures require video documentation during such incidents, whether parents have a right to view that footage, and whether video access could help confirm that restraints were used appropriately and not abusively. SENATOR CLAMAN said further research is needed to determine the current use of video monitoring during restraints. He noted that in psychiatric treatment environments, constant camera surveillance could pose clinical concerns, particularly for patients experiencing paranoia. He acknowledged the potential complications and stated interest in hearing directly from providers on the issue. He agreed to follow up with more information. 4:47:55 PM SENATOR TOBIN referenced earlier testimony related to the Indian Child Welfare Act (ICWA) and tribal children in psychiatric systems. She highlighted language in SB 44 on page two, line one, regarding "other adults" and asked whether the bill ensures that, in cases involving unaccompanied minors who are tribal members, a tribal representative or designated tribal authority would have access to the child. She requested clarification on whether ICWA responsibilities are reflected in the bill. 4:48:29 PM SENATOR CLAMAN expressed willingness to talk more about the concern. 4:48:52 PM CHAIR DUNBAR announced invited testimony on SB 44. 4:49:12 PM AMANDA METIVIER, Co-founder, Facing Foster Care in Alaska, Anchorage, Alaska, testified by invitation on SB 44. She stated that Facing Foster Care in Alaska, a youth-led nonprofit, supports SB 44 and that the bill addresses long-standing issues faced by minors in residential psychiatric treatment. She explained that many foster youth, particularly Alaska Native and American Indian children under the Indian Child Welfare Act (ICWA), are impacted by psychiatric placement, often far from their communities and with limited external communication. She emphasized that access to phone contact can be restricted as punishment or incentive, and that chemical and physical restraints, including sedation, are commonly reported. 4:54:31 PM MS. METIVIER supported SB 44's transparency measuresincluding inspection requirements and communication rightsas a critical step toward reform and urged the committee to pass the bill. 4:56:03 PM CAROLINE BROWN, representing self, Fairbanks, Alaska, testified by invitation on SB 44. She expressed strong support for SB 44 and shared her personal experience as a foster and adoptive parent of a child with significant behavioral health needs. She described the challenges of navigating psychiatric care, including residential treatment, and emphasized the critical role of regular communication between children and their families during hospitalization. She noted that while her family has generally maintained contact with their son, this access often required intense advocacy, which not all families can provide. She highlighted the bill's provision for timely notification of seclusion or restraint, underscoring how important it is for parents to be informed in order to help their children process those experiences. 4:59:21 PM SENATOR DUNBAR concluded invited testimony on SB 44 and [held SB 44 in committee.]