HB 183-ALASKA PSYCHIATRIC INSTITUTE  4:32:19 PM CHAIR ZULKOSKY announced that the final order of business would be HOUSE BILL NO. 183, "An Act relating to the duties of the Department of Health and Social Services; relating to the duties of the Department of Labor and Workforce Development; and relating to staffing and wage standards for the Alaska Psychiatric Institute." 4:32:29 PM REPRESENTATIVE SPOHNHOLZ moved to adopt the proposed committee substitute (CS) for HB 183, Version 31-LS1211\S, Marx, 3/3/20, as the working draft. 4:32:44 PM CHAIR ZULKOSKY objected for the purpose of discussion. 4:32:55 PM REPRESENTATIVE ZACK FIELDS, Alaska State Legislature, as prime sponsor of HB 183, gave a PowerPoint presentation. Referencing slide 2 of the PowerPoint, he explained that HB 183 would address staffing and capacity issues in order to provide safe conditions at the Alaska Psychiatric Institute (API). The proposed legislation would also address the need in the community for public safety and a cost-effective healthcare system by addressing staff retention and correcting wage disparities that currently exist. A low, but necessary, floor had been set for maintaining bed counts, according to Representative Fields. Bed count statistics were included in slides 3 and 4 of the presentation. He said HB 183 would also require an annual report by the Department of Health and Social Services (DHSS) on related activities, including staffing standards. In terms of bed counts, Representative Fields said even 80 beds would be a lower amount than several decades ago. At lower bed counts, API was full or almost full most of the time, he related. Moving on to slide 4, he pointed out that the bed count in the Adolescents Acute Care level was zero, which was a big problem for public safety in the broader community as well as for Alaskans who needed safe treatment. 4:35:26 PM REPRESENTATIVE FIELDS said he had heard from health care providers how dangerous it was when a lack of capacity at API forced hospitals to hold psychiatric patients in the ER, often for days, if not weeks. When that happened, he related, the patients required one-on-one guards, which was not safe for medical providers or Alaskans headed to the emergency room (ER) for different issues. The costs were then passed on directly to private health insurance payers including the state itself, he added. He said providers were not only unable to get reimbursed for these costs, but the administration was passing on more costs to private payers, in this case the state. Situations that created uncompensated care got passed directly back to the state, he explained, which put pressure on premium cost growth and made it more difficult to find sustainable fiscal solutions. REPRESENTATIVE FIELDS, directing attention to slides 6 through 9, addressed the problem of ER holds for psychiatric patients, a result of inadequate capacity at API, which was a problem in Southcentral, Southeast, and the Interior. He highlighted the importance of adequate staffing and related the story of assault on an aide in 2019. He said the state department recognized the lack of adequate staff when it issued a very large fine. According to Representative Fields, the problems of violence continued to grow. 4:38:20 PM REPRESENTATIVE FIELDS said there was a disconnect between staff inadequacies not being addressed and belief in the mission of API among the same staff. In this way staff were making a sacrifice to work at API as they put themselves in harm's way, he related. According to slide 10, staff left API because of bad management and mishandling of safety concerns, and staff were also concerned about constant changing of management including CEOs and doctors. He said the least employees deserved was fair compensation as they would be safer working elsewhere where they would be paid fairly. Referencing slide 11, he said HB 183, in its attempt to deal with staffing and capacity issues, was consistent with the 2019 Ombudsman's report and the 2017 feasibility study. He noted that staffing issues had been addressed in the past, but, echoing what Mr. Metcalfe had said, they were not addressed in such a way that sufficed to meet the real needs at API. 4:39:57 PM REPRESENTATIVE TARR asked about the prevailing rate of wages for similar work and, since there was only one state-run facility, whether North Star Behavioral Health System ("North Star") was the comparison. She asked whether there was potential to limit the ability of the union to negotiate for something better or whether it was "not less than" language. REPRESENTATIVE FIELDS replied it would be a new policy to establish a prevailing wage; however, prevailing wages were nothing new. He confirmed "not less than" language ensured a prevailing wage floor was consistent with collective bargaining agreements, and if the state and unions wanted to set wages higher for comparable positions due to API's challenging work environment, then that would be the state's and union's prerogative. In terms of comparable positions, the prevailing wage language was based on comparable positions in other sectors. He added that other prevailing wages in the broader market should be looked at, not just North Star and API. 4:42:11 PM REPRESENTATIVE SPOHNHOLZ pointed out the disparity for wages, referencing psychiatric nurses at Providence Health & Services being paid $12 per hour more than those at API. She asked how the number of 55 beds was reached, as 50 beds were currently operational, but the facility had capacity for 80 beds. REPRESENTATIVE FIELDS answered that the lowest and most conservative number was decided upon based on a look back at the need for occupied beds. He questioned whether a higher number would be safer for the community and said the lower number was chosen in order to determine the number of patients who would be able to be treated at API instead of at less appropriate facilities. REPRESENTATIVE SPOHNHOLZ opined that the staffing ratios should be appropriate, and she indicated that forcing slots to be open when there was no capacity to fill them was what led to the current staffing issue. She added that API needed to work toward functioning at its full capacity, as there used to be 160 inpatient beds; considering population growth, anything less than full capacity could not be justified. REPRESENTATIVE FIELDS said that he would be supportive and defer to the will of the committee regarding the correct number of beds. Addressing Representative Tarr's question, he said DHSS had contended prevailing wages would conflict with collective bargaining agreements, and that unions that represent employees have stated that was not their view. 4:45:22 PM REPRESENTATIVE TARR commented things become more expensive when they were not done right the first time. She indicated that this is a time for not being "penny wise, ... pound-foolish" when there is a choice to have a high-functioning facility with adequate staffing. 4:45:58 PM BESSE ODOM, Staff, Representative Zack Fields, Alaska State Legislature, on behalf of Representative Fields, prime sponsor, presented the Sectional Analysis for HB 183, beginning with AS 18.05.020, the statute regarding submission of an annual report by DHSS to the legislature. Under HB 183, the report must include: the number of employees who vacated positions during the reporting period; the number of funded positions that are vacant; a description of efforts made to recruit and retain employees; the number and cost of additional positions if additional positions are deemed necessary; and the amount and purpose of additional funding if additional funding is deemed necessary. MS. ODOM related that Section 2 amended AS 23.10.055(b), the statute regarding employee compensation rate, with conforming language that reflected Section 3 of HB 183. Version S would amend the language to "hospital employee" rather than "health care provider", she explained. Section 3 amends AS 47.30.660 to increase and maintain bed counts, implement staffing standards, and establish wages as determined by the Department of Labor and Workforce Development (DLWD). Section 4 would define applicability of HB 183 to contracts entered, amended, extended, or renewed on or after the effective date. 4:47:36 PM CHAIR ZULKOSKY removed her objection to the motion to adopt the proposed committee substitute (CS) for HB 183, Version 31- LS1211\S, Marx, 3/3/20, as the working draft. There being no further objection, Version S was before the committee. 4:47:50 PM MARK REGAN, Legal Director, Disability Law Center of Alaska (DLC), said DLC was the plaintiff in one of the lawsuits that led to the requirement there be a plan for fixing problems in the civil commitment evaluation system. He informed the committee he was there to testify as to API's role regarding the decision whether folks needed longer-term commitments. For DLC, the problem got bad in Fall 2018 when there was the report of working conditions at API followed by a collapse in the capacity of the facility, which had been up around 80 and included 70 civil beds and 10 forensic beds and had gone down to about half of that very quickly amid a myriad of problems. Mr. Regan related one of the problems was that word had gone out from API and from DHSS what would need to happen was when someone potentially dangerous to self or to others was picked up, that person, if in Southcentral Alaska, would typically be taken to API for evaluation - but that API had been at capacity and not taking people. Then word went out from API that some people that fit the above description would have their liberties taken away from them and would have to stay either in a correctional facility such as the Anchorage Correctional Complex or even in jail with people who had been accused of crimes until a place opened at API and they could be evaluated there. MR. REGAN stated there was no problem in transferring the patients; there was a real problem with API being unable to evaluate them and they were forced to sit in a hospital ER. The lawsuit was regarding what the law said should be done with people experiencing these types of problems. He said DLC thought it was the responsibility of the state government, and principally DHSS, to care for and minimize the length of time people would be required to stay in jails and ERs. 4:52:40 PM MR. REGAN stated what would happen with HB 183 was there would be a requirement that staffing would be at 55 civil beds, for a total of 65 with the 10 forensic beds, which would be better than what it was now, as only 40 were available for civil patients at the time of his testimony. The question from DLC's perspective, according to Mr. Regan, was whether it would be enough to solve the problem such as the one that arose in the fall of 2018. He answered it would probably not be and offered some alternatives for the committee to consider: DLC had proposed to the court that DHSS send evaluators to locations people were to determine whether they would need civil commitment. He also mentioned, as an alternative, an off-site Crisis Now facility, which would enable a place that was not API to conduct evaluations in a non-institutional setting. Together with a rebuilding of capacity at API, DLC believed that the problem of people being stuck in jail or in hospital emergency rooms could be reduced. Mr. Regan added that according to the way the law was written, evaluation was supposed to take place immediately. He added that the problem did not start in Fall 2018 but had been happening sporadically for many years. 4:56:08 PM CHAIR ZULKOSKY said the committee would return to invited testimony on HB 183 at its next meeting. CHAIR ZULKOSKY announced that HB 183 was held over.