SB 48-PSYCH. EVALUATION/TREATMENT FOR STUDENTS CHAIR WILSON announced that the next order of business would be CS FOR SENATE BILL NO. 48, "An Act relating to recommending or refusing psychotropic drugs or certain types of evaluations or treatments for children." 3:28:17 PM SENATOR BETTYE DAVIS, Alaska Legislature, introduced committee substitute (CS) for CSSB 48, as sponsor, outlining the cooperating entities who provided input for the CS. 3:29:35 PM REPRESENTATIVE ANDERSON moved to adopt HCS CSSB 48,Version 24- LS0208\X, Mischel, 5/5/06, as the working document. There being no objection, Version X, was before the committee. RICHARD BENAVIDES, Staff to Senator Bettye Davis, Alaska Legislature, presented HCS CSSB 48, on behalf of Senator Davis, sponsor, and highlighted the alterations incorporated into Version X. He directed attention to page 1, line 11, which were rewritten to allow the school personnel to discuss with the parents the need for a child to continue administration of a prescribed medication. Moving to page 2, he pointed out that the Version S, paragraph (6), was rewritten and incorporated into the language of Version X, on page 3, lines 1-4, to clarify that school personnel are considered mandatory reporters. Continuing with Version X, page 2, paragraph (6), subparagraph (C) was removed, which required the psychiatric or behavioral health evaluation of a child; found in Version S, on page 2, line 11. Finally, Version X, page 3, lines 5-8, defines the compliance with federal education law, rewritten from Version S, page 3, lines 1-2. 3:34:28 PM REPRESENTATIVE ANDERSON inquired whether there is opposition to this legislation, following these changes. CHAIR WILSON suggested that the committee propose its amendments, prior to debate, and said that everyone may be satisfied following that process. 3:35:16 PM REPRESENTATIVE GARDNER referred to page 1, line 12, she read "when, in the opinion of the child's treating physician", and asked: If I were a parent and I decided that ... [I] wanted to discontinue [my child's medication], I'd ... go to another doctor, get another opinion, [and] which opinion would the school use. REPRESENTATIVE GARDNER related a personal experience from her work as a guardian ad litem, to illustrate her point. 3:37:13 PM SENATOR DAVIS stated that SB 48 does not require a parent to medicate a child in order to have that child attend school. 3:37:52 PM REPRESENTATIVE GARDNER directed attention to page 2, line 5, paragraph (4), and stated that a teacher should be able to use their expertise and experience to recommend a specific professional who could be of help to a particular child. 3:39:28 PM REPRESENTATIVE CISSNA added that in this specific instance only one community, Anchorage, could even provide a list of resources for psychiatric help. She expressed her concern for language that would be in accord with services actually available in Alaskan communities. 3:40:26 PM SENATOR DAVIS pointed out that legislative bills do not meet the requirements for every area of the state. Also, she disagreed with the statement that a teacher would have the expertise to make a recommendation for specialized health care. 3:41:27 PM REPRESENTATIVE ANDERSON provided a hypothetical scenario of a teacher who may also have a background in specialized health care, and asked how such expertise could be accessed, even for referral purposes. 3:42:27 PM REPRESENTATIVE GARDNER stated: I understand teachers are not psychiatrists, they ... can't recommend treatments or [a] course of treatments, but ... if we tie peoples hands where they cannot use their best judgment when they have something to offer and if I as a parent, [ask the teacher] "can you recommend somebody," I don't want to put [a] teachers back up against a wall where they don't know what they're allowed to do. SENATOR DAVIS maintained her position stating that there is a possibility that even though a teacher may have the best intentions by making a recommendation, "the parent could then go out and say to someone else, the teacher told me this is where I should take my child." However, she said this discussion is in the hands of the committee now. 3:44:33 PM REPRESENTATIVE GATTO emphasized that parents ask for advice routinely from school personnel, sometimes calling them at home. Also, teachers may find themselves dealing with parents who are at odds with each other, and the teacher's recommendation may serve to exacerbate the situation. 3:48:00 PM SENATOR DAVIS provided that there is nothing in the bill to preclude someone from providing advice. Further , she said that school nurses are only allowed to provide medications that were prescribed by a doctor who has made a determination. REPRESENTATIVE GATTO maintained that advice is frequently sought and given. SENATOR DAVIS stated that there is nothing in SB 48 which would disallow such advice. 3:49:35 PM CHAIR WILSON advised the committee of four pending amendments that the school district would like the committee to consider. 3:50:12 PM REPRESENTATIVE GARDNER explained that the law stipulates that a mandated child abuse reporter must make a declaration of suspected harm, founded or not, for the Office of Children's Services (OCS) to investigate. However, she pointed out that paragraph (6), page 2, line 10, "puts a sidebar on the mandate to make a report of harm." She opined that although the intent is clear, the language may hinder a teacher from making a report. 3:52:26 PM CHAIR WILSON concurred and added that if a person in a position requiring them to be a mandated reporter, if they have any inkling of abuse, they are bound to provide a report to OCS and allow the division to take appropriate action. She reminded the committee that this is in accordance with state and federal laws. 3:53:04 PM REPRESENTATIVE GARDNER moved Amendment 1, as follows: Page 2, Delete lines 10-15 There being no objection, Amendment 1 was adopted. 3:54:24 PM SENATOR DAVIS asked for clarity of the intent behind Amendment 1. REPRESENTATIVE GARDNER provided that this makes clear that teachers are mandated reporters without limitations. She stated: As I understand it, the way that the bill addresses a teacher's obligation to report suspected harm, is ... that a teacher is not allowed to do it based on a parent or guardian refusing to give signed consent. ... There's nothing in our [Child In Need of Aid (CINA)] statutes that says .... SENATOR DAVIS asked, "But where do you see that in this bill ... that they have to have a signed consent." 3:55:53 PM CHAIR WILSON directed attention to page 1, line 7, and read: "'they may not, unless'", and [page 2, line 10] (6) says ... they 'make a report of suspected child abuse or neglect to authorities, ....'" SENATOR DAVIS acknowledged that a teacher must, or should, make a report. CHAIR WILSON maintained that under the circumstances stipulated in the bill, a report could not be made. MR. BENEVIDES offered that the intent in paragraph (6) [page 2, line 10] is not to preclude teachers from making a report which should be made. Rather, he said it is to ensure that the report is not based solely on subparagraphs (A) or (B). He pointed out that the language on page 3, lines 1-4, was written to clarify the mandatory reporting aspect. CHAIR WILSON explained that it causes confusion and difficulty, when one part of a bill stipulates an allowable action and another section reads as a denial. 3:57:30 PM REPRESENTATIVE GARDNER offered that Amendment 1, as passed, is to prevent a teacher from being inhibited in making a decision on whether to file a report of harm. She opined that a teacher should not be hampered with concern regarding CINA compliance, other than to know that they are mandated reporters. Further, she said that if a teacher has a suspicion of child abuse, it is important that they not be worried when making a report of harm that they will suffer repercussions or disciplinary action for alerting OCS. 3:58:26 PM CHAIR WILSON moved Amendment 2, as follows: Page 3, line 2, following "of" Insert "subsection (1) of" 3:59:32 PM CHAIR WILSON moved Amendment to Amendment 2, as follows: Page 3, line 2, following "AS 47.17.020" Insert "," and following "or" Insert "subsection (2)" REPRESENTATIVE GATTO removed his objection to the amendment. CHAIR WILSON announced that there being no objection, Amendment to Amendment 2 was adopted, and there being no objection, Amendment 2, as amended, was adopted. CHAIR WILSON proposed Amendment 3, as follows: Page 4, Delete lines 4-5 Insert "an employee violating AS 14.30.171-14.30.176  maybe subject to disciplinary action." 4:02:11 PM REPRESENTATIVE ANDERSON moved Amendment 3, as proposed. There being no objection, Amendment 3 was adopted. 4:03:56 PM CHAIR WILSON moved Amendment 4, as follows: Page 3 Delete lines 13-14 REPRESENTATIVE SEATON objected for discussion. 4:04:22 PM CHAIR WILSON read page 3, lines 5-8 and lines 13-14, paragraph (3), and explained that this duplication of federal law, within the bill creates confusion. 4:05:01 PM REPRESENTATIVE GARDNER clarified that federal law does allow a behavioral health evaluation of a child with the appropriate guardianship consent. REPRESENTATIVE SEATON removed his objection. There being no objection, Amendment 4 was adopted. CHAIR WILSON opined that the intent of the bill was not affected by the amendments which the committee adopted. CHAIR WILSON suggested reviewing Amendment 2. 4:06:03 PM REPRESENTATIVE SEATON moved to rescind Amendment 2, as amended. There being no objection, Amendment 2, as amended, was rescinded. The committee took an at-ease from 4:07:02 PM to 4:11:48 PM. 4:11:48 PM REPRESENTATIVE SEATON moved New Amendment 2, as follows: Page 3, Delete lines 13, 14 and Page 3, Line 2, following "of" Insert subsections "(a) and (b) of" There being no objection, Amendment 4 was adopted. 4:12:42 PM REPRESENTATIVE CISSNA moved Conceptual Amendment 5: Page 3, Line 29, following "services" Insert ", and psychiatric specialists" CHAIR WILSON objected for discussion, and stated that her understanding is that "mental health services" would be inclusive of "psychiatric specialists", thus preempting the need to make such a specification necessary. REPRESENTATIVE CISSNA maintained that this would provide a benefit to parents seeking appropriate guidance, and also allows the school authorities to clearly respond to parental inquiries. 4:14:57 PM CHAIR WILSON said that the amendment would serve to imply a limitation, where the intent is not to create such a limit. REPRESENTATIVE CISSNA disagreed. 4:15:15 PM REPRESENTATIVE GATTO supported Amendment 5, and said that the language "mental health services" appears to refer to organizations, and by inserting "specialists", individual practitioners are then inferred. 4:15:36 PM MR. BENEVIDES pointed out that the continuing lines 30-31 [page 3], and page 4, lines 1-2, encompass any type of entities that may be included on a list for the welfare of the parent. Additionally, he maintained that creating and offering a list is optional to a school district. 4:16:53 PM CHAIR WILSON maintained her objection. 4:17:09 PM REPRESENTATIVE GARDNER opined that the existing language appears to be inclusive. A roll call vote was taken. Representatives Gatto, Anderson, and Cissna voted in favor of Amendment 5. Representatives Kohring, Seaton, Gardner, and Wilson voted against it. Therefore, Amendment 5 failed to be adopted by a vote of 3-4. 4:18:31 PM REPRESENTATIVE ANDERSON moved to report HCS CSSB 48, Version 24- LS0208\X, Mischel, 5/5/06, as amended, out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, HCS CSSB 48(HES) was reported from the House Health, Education and Social Services Standing Committee.