SENATE BILL NO. 53 "An Act relating to involuntary civil commitments." 10:21:22 AM Co-Chair Olson relayed that the committee had first heard SB 53 on April 19, 2023, and had taken public testimony at the time. The committee had worked with the bill sponsor and the affected agencies and had reached an agreement on sections of the bill, especially to reduce the fiscal notes. The committee would consider a Committee Substitute (CS). Senator Kiehl MOVED to ADOPT proposed committee substitute for SB 53, Work Draft 33-LS0172\O (Dunmire, 5/2/23). Co-Chair Olson OBJECTED for discussion. 10:22:13 AM KEN ALPER, STAFF, SENATOR DONNY OLSON, explained that the sponsor had worked with agencies on the CS. He discussed a Summary of Changes document (copy on file): 1) Section 4 from version P is deleted in its entirety. This section extended the competency restoration period for a person found incompetent to stand trail from one year to two years. This change was to prevent extending the restoration waitlist at Alaska Psychiatric Institute and will reduce the fiscal note from the Department of Family and Community Services. Mr. Alper explained that removing the change was important because it would have created more of a backlog at the Alaska Psychiatric Institute (API), which he thought had constituted a large portion of a fiscal note. He noted that there were four fiscal notes for the bill that had added up to a little less than $2.4 million. The largest note had been from API at $1.2 million, and it was hoped that the change would reduce or eliminate the note. He continued to address the document: 2) Section 5 in version O, which was section 6 in version P, is amended to add the words "before the charges are dismissed." This is to ensure that all individuals who meet the bill's standard of dangerousness are seamlessly transitioned to involuntary civil commitment proceedings. 3) Section 7 in version O, which was Section 8 in version P, is amended to clarify that victims of dismissed criminal charges who receive notice under this section are not entitled to attend the civil commitment hearings if the respondent has elected to have the hearing closed. 4) Adds a new Section 8, which was previously subsection 6(e). Separating and clarifying this language, which describes the procedure for providing civil commitment records to the original criminal prosecutor, was at the request of the Civil Division of the Department of Law. 5) Adds a new subsection (b)(5) to Section 9, to ensure that a longer period of commitment is necessary to protect the public. This was added by request from the Disability Law Center. 6) Rewrites Section 11 to clarify the procedures for discharge from involuntary commitment. The professional person in charge may discharge the respondent after a court order terminating the commitment, and after the prosecutor receives notice. Also, the respondent may petition the court for early discharge with evidence demonstrating that they are no longer likely to cause serious harm. An early discharge petition may only be filed once every 180 days, a change from once per year in the previous version. 7) Adds a conforming new Section 13 to establish that records releases to the Criminal Division, described in Section 8 of the bill, are confidential. 10:26:42 AM SENATOR MATT CLAMAN, SPONSOR, relayed that he was supportive of all the changes presented in the CS, which he had discussed with the co-chairs office and other stakeholders. Co-Chair Olson WITHDREW his OBJECTION. There being NO OBJECTION, it was so ordered. The CS for SB 53 was ADOPTED. 10:27:32 AM DR. KRISTY BECKER, CHIEF CLINICAL OFFICER, ALASKA PSYCHIATRIC INSTITUTE, DEPARTMENT OF FAMILY AND COMMUNITY SERVICES, relayed that she was available to answer questions about API and specifically about competency restoration. She reminded that API was an 80-bed facility, and there were 60 beds available for adult civil commitments, as well as 10 available beds for competency restoration. She shared that at present, API was piloting two projects. Fiscal notes would include an outpatient competency restoration program that would be designed for approximately 10 defendants that were low-level misdemeanants without crimes against people. Ms. Becker explained that the hospital was also attempting to open a jail-based restoration program in partnership with the Department of Corrections (DOC), which would likely start with 10 defendants before growing in the future. For the program, clinicians would go into DOC and provide restoration services to individuals that were incarcerated and awaiting a bed in API. The individuals would receive treatment as usual from DOC in terms of mental health and medical needs. Dr. Becker explained that API was hoping that the two projects would reduce some of the pressure. She cited that the waitlist for competency restoration was 40, and the waitlist for admissions to the civil side of the hospital was 14 with 2 in the community for a total of 16. She encouraged members to consider the pressure that API was facing as it had grown out of regulatory difficulties it had experienced in 2018 and 2019. She noted that the hospital was almost at full capacity. She thought there was potential that some things in the bill could put pressure on capacity but noted that the removal of the two-year commitment period was significant in terms of zeroing the fiscal notes and benefitting API. 10:30:20 AM Senator Wilson asked if Dr. Becker felt that the current version of the legislation would continue to lengthen the time of people at API, thus creating the need for more beds in outgoing years. Dr. Becker relayed that the five-year commitment period did have the potential (in a few cases) to lengthen the period of stay for individuals by a lot. She relayed that there were between 9 and 10 individuals that she referred to as not competent, not restorable, and not safe to return to the community. The individuals were currently committed on rotating 180-day commitments. The longest-standing individual to fit the criteria had been in the facility for 9 years. She affirmed that individuals that fit the criteria were already committed for fairly lengthy periods of time if needed. Senator Wilson referenced the continual 180-day opportunities to be re-committed. He asked if the practice was improved by the legislation or if the process worked. Dr. Becker relayed that at present she believed, along with API's attorney, that the process worked. If individuals became stabilized and could be released by the facility, it was possible to do so. She had an appreciation for the ongoing oversight and the process of checking in on the cases while continuing to evaluate the need for ongoing commitment. She thought the bill, with the five-year period, would reduce some procedural issues because of the lack of need for recurring legal processes, but she saw value in the recurring oversight. Senator Wilson commented that there had not been a clinical perspective offered earlier. He apologized for the oversight. He thought the CS would create a two-tier system by which people could enter into a 6-month or 5-year involuntary commitment. He wondered if Dr. Becker found any inequity in the structure. 10:33:55 AM Dr. Becker relayed that API initially committed individuals for 72 hours without any criminal offense, after which a determination was made if the commitment should be longer. She acknowledged that there would be a two-tier system. She relayed that clinically speaking, API would follow the law however it was written. She qualified that committing people for five-year or 180-day periods did create a clinical complexity for the hospital because there was not great programming for long-term stays. She mentioned long- term effects of people committed to the hospital without a two-tiered clinical program. She relayed that the hospital was working on such a program and would continue to do so in preparation for any individuals committed for a five- year period. Co-Chair Olson asked if Dr. Becker needed legislative oversight to move to a two-tiered system, or if the hospital could do it on its own. Dr. Becker thought that API could eventually move to a two- tier system on its own. She cited the difficulty of housing at the physical plant, where short-term and long-term commitments were residing in the same unit. She mentioned regulatory guidelines, which were not consistent with long- term stays. She pondered that the pertinent question was how to marry the regulatory guidelines with the longer-term stay patients. Senator Wilson shared a fear that the bill as changed would change the fiscal note as stated, considering the complexities listed by Dr. Becker. He thought a person that was under a five-year civil commitment would have less rights than a person serving five years in a DOC facility. He pondered potential civil lawsuits by having a two-tier system. He shared concerns about lack of due process. 10:38:28 AM JOHN SKIDMORE, DEPUTY ATTORNEY GENERAL, CRIMINAL DIVISION, DEPARTMENT OF LAW, relayed that he would highlight three items in the proposed CS. He cited that the bill created an obligation for prosecutors to file the initial petition for a civil evaluation for an individual that had been charged with a certain crime and found incompetent. He highlighted that the new version of the bill expressly stated that the petition must be filed and ruled on before charges were dismissed. The determination of incompetence was a legal determination by the court supported by the evaluation of professionals. He continued that whether or not the courts would ultimately say that a person was incompetent was not known until the ruling. Mr. Skidmore thought he would be remiss not to point out that the vast majority (or 95 percent) of cases, the courts would agree with API's assessment of incompetence. He thought the remaining 5 percent highlighted the point that it was incumbent upon prosecutors to anticipate, when someone may be found incompetent, to file the petitions in advance and have rulings on them. He highlighted the responsibility that would fall on those in the criminal division. He thought the requirement for the prosecutors to engage in the conduct prior to the dismissal supported the concept in the fiscal note. 10:42:00 AM Co-Chair Olson asked how many of the five percent of cases would be a detriment to society. Mr. Skidmore clarified that the five percent of cases was in reference to people that had received an evaluation from API that had deemed them incompetent, and despite the opinion the court had found the person competent and continued with prosecution. Co-Chair Olson asked if there was a difference between the medical evaluation and the courts evaluation. Mr. Skidmore answered yes. Co-Chair Olson asked if Mr. Skidmore was saying there was no detriment to society if the two competency findings were different. Mr. Skidmore did not believe there was a detriment to society because in the instances in which a doctor had found a person incompetent and the court did not concur, the criminal conduct for which the person was charged was being addressed by prosecution. He reminded that the bill was contemplating whether or not the 90 to 95 percent of people which the court found incompetent were automatically released or whether there was a petition for them to be evaluated should they be committed civilly. 10:43:45 AM Co-Chair Stedman wanted to hear whether Mr. Skidmore supported the CS or recommended changes. Mr. Skidmore addressed a third provision of the proposed CS pertaining to required victim notifications. He explained that in the instances of a victim injured by a person, the person that was harmed did not currently have any rights or authority to know what happened to the perpetrator if the criminal case was dismissed. The bill required provision of notice to the victim as to the date and time of the hearing, the outcome of the hearing, and whether or not the person was committed or discharged. The bill did not provide the ability to attend the hearings nor the ability to find out more information about the perpetrator. Mr. Skidmore felt that for a victim to have the ability to attend the hearings of a perpetrator was a policy call for the legislature. He explained that the CS it was made clear that the bill was not meant to give the victim the right to attend the hearing unless the person that caused the harm agreed. Mr. Skidmore relayed that the administration had not taken an overall position on the bill nor the CS. He explained that trying to close the gap between individuals having a criminal case dismissed for incompetency and trying to initiate a civil commitment was a concept supported by the administration. 10:47:44 AM Co-Chair Stedman pondered that the committee might hear from the sponsor as to why the bill did not give more rights to victims and victims families. Co-Chair Olson referenced people in bush Alaska, many of whom did not have public safety readily available. He referenced incidents in Golovin in which people were wounded. He asked what to tell the residents of his district in terms of whether the bill would make people safer. Mr. Skidmore restated that he believed SB 53 took steps to close the gap between criminal incompetence and civil commitment. He thought it was an open question as to whether all the gaps were filled. Senator Bishop asked for Co-Chair Olson's intention with regard to bill action. Co-Chair Olson relayed that the committee would also address the bill in the afternoon. 10:50:17 AM NANCY MEADE, GENERAL COUNSEL, ALASKA COURT SYSTEM, shared that the Court System did not have a view on the bill. She agreed with the criminal division that the bill made the effort to address the gap that occurred when a criminal defendant was found incompetent to stand trial and the case was dismissed if the defendant was unable to be restored to competency. She thought the bill would segue the defendant directly into getting an evaluation for a mental commitment to determine if the person should be held for an evaluation and further mental commitments. She understood what the sponsor was trying to accomplish in the bill by addressing the gap. She considered that there were provisions, as Mr. Skidmore had mentioned, about whether the victim in a criminal case should have a right to attend the hearing when the mental issues were being discussed. She noted that there was a current statute that indicated a respondent could choose whether to have a hearing open or closed. She thought the matter needed to be clarified in the bill. Co-Chair Olson thought SB 53 was significant and that it was important to take whatever time was necessary to discuss the bill. 10:53:06 AM Ms. Meade discussed a provision in Section 4 and Section 5 that provided for moving a case (with a person accused of a crime and thereafter found incompetent) that was about to be dismissed into the mental commitment arena, and thought it would be helpful and would fill a gap. She thought the provision would probably be helpful to Alaskans. She thought there were a few provisions that would take some work on the part of the Court System. She estimated that API would have about 100 more individuals to evaluate with 3-day short-term evaluations in order to see if they needed to be held for a full mental commitment. She referenced Dr. Beckers testimony about limited numbers of beds and thought there could be logistical issues. She did not think evaluation would create a significant issue but would increase case load. Ms. Meade thought the five-year commitment would take up more beds at API, which judges would be aware of. She did not anticipate very many people receiving a five-year commitment and did not think it would be a significant pull on the courts resources. Co-Chair Olson relayed that the committee would consider amendments to the bill at the afternoon meeting. SB 53 was HEARD and HELD in committee for further consideration. Co-Chair Olson discussed the agenda for the afternoon meeting.