HB 312-CRIMES AGAINST MEDICAL PROFESSIONALS  2:11:36 PM CHAIR COGHILL announced the consideration of HB 312. 2:12:01 PM REPRESENTATIVE CHUCK KOPP, Alaska State Legislature, Juneau, Alaska, sponsor of HB 312, explained that he and Representative Claman were each contacted by the Alaska Nurses Association, the Alaska Hospital Nurses Association, and emergency room physicians with requests for help with the rising tide of violence in health care facilities. He and Representative Claman each had legislation drafted and subsequently decided to work together. 2:13:27 PM REPRESENTATIVE MATT CLAMAN, Alaska State Legislature, Juneau, Alaska, sponsor of HB 312, said he was in the Anchorage LIO and would let Representative Kopp take the lead introducing HB 312. REPRESENTATIVE KOPP said things have changed dramatically in emergency rooms and health care facilities generally since the opioid crisis hit. They have become trauma zones for staff. It's not just from people presenting for treatment, but also visitors and family accompanying them. Some of the violence is opioid driven and some is behavioral health issues. Regardless of the reason, health care staff are not combat medics trained to survive in high-threat environments. They are health care professionals who traditionally treat people in very safe and secure environments. It's come to the point where the law needs to address the situation. House Bill 312 addresses the issue by allowing a warrantless arrest for a fourth-degree misdemeanor assault in a health care facility. The perpetrator can be removed from the facility if they are stable for discharge. If probable cause is established after interviewing witnesses, the responding officer can make a misdemeanor arrest. The bill also adds an aggravator to the felony assault statute when the assault is knowingly perpetrated against a medical professional who is working. He noted that the packets contain letters of endorsement from nearly every hospital in the state. 2:21:01 PM CHAIR COGHILL asked for confirmation that a health care worker who witnesses an assault could be a party to a lawsuit that may arise. REPRESENTATIVE KOPP said that's correct; the probable cause would be based on their witness statement so they would be a party to any civil or criminal action. CHAIR COGHILL said he brought it up because the assault occurs within a health care facility and that becomes an issue. REPRESENTATIVE KOPP said the health care facility is an important issue because it is a sacred space for every worker and patient. 2:23:33 PM LIZZY KUBITZ, Staff, Representative Matt Claman, Alaska State Legislature Juneau, Alaska, paraphrased the following sectional analysis for HB 312: Section 1  [Amends] AS 12.25.030(b) - Grounds for arrest by private person or peace officer without a warrant. Establishes that a peace officer may arrest a person without a warrant when the peace officer has probable cause for believing that the person has committed an assault in the fourth degree at a health care facility and the person was not seeking medical treatment at the facility or was stable for discharge. The term "stable for discharge" comes from the federal Emergency Medical Treatment and Labor Act, also known as EMTALA. EMTALA requires anyone coming to an emergency department be stabilized and treated, regardless of their insurance status or ability to pay. The federal government has published guidelines that describes the responsibilities of hospitals in emergency cases. The guidelines provide: "a patient is considered stable for discharge?when, within reasonable clinical confidence, it is determined that the patient has reached the point where his/her continued care, including diagnostic work-up and/or treatment, could be reasonably performed as an outpatient or later as an inpatient, provided the patient is given a plan for appropriate follow-up care with the discharge instructions." In addition, "? 'Stable for discharge' does not require the final resolution of the emergency medical condition." Section 2  [Amends] AS 12.25.030 - Grounds for arrest by private person or peace officer without a warrant. Establishes that the definition for "health care facility" has the meaning given in AS 18.07.111. Section 3  [Amends] AS 12.55.155(c) - Factors in aggravation and mitigation. Adds an aggravator to Alaska's felony assault statute when a defendant committed the offense at a health care facility and knowingly directed the conduct constituting the offense at a medical professional during or because of the medical professional's exercise of professional duties. Section 4  Uncodified law This section contains applicability provisions. CHAIR COGHILL asked for the definition of health care facility. REPRESENTATIVE KOPP read the definition in AS 18.07.111(8)(A) and (B). CHAIR COGHILL said he wanted that exact definition brought into the open. SENATOR COSTELLO asked if a warrantless arrest is constitutional. REPRESENTATIVE KOPP said the legislature has the authority to place exceptions in the law. The arrest warrant requirement in the Fourth Amendment is the law of the land but the courts have given state legislatures the authority to implement that in a reasonable manner. The current exceptions are crimes relating to domestic violence. CHAIR COGHILL advised that Title 47 holds are allowed in circumstances of life and safety. REPRESENTATIVE CLAMAN added that both the Alaska Supreme Court and the U.S. Supreme Court have addressed the topic of exceptions to the warrant requirement in the context of misdemeanors. The courts have typically found that the legislature has the authority to craft narrow exceptions when there are good legislative findings. HB 312 was crafted with that case law in mind; the exception is narrow. 2:31:34 PM BECKY HULTBERG, President/CEO, Alaska State Hospital and Nursing Home Association, Anchorage, Alaska, said she was testifying on behalf of Alaska's hospitals and skilled nursing facilities to express strong support for HB 312. It gives police and the judicial system new tools to address violence in health care facilities. She said hospitals are sacred places and they should also be safe places. Unfortunately, as violence has increased in some communities, it has spilled over into hospitals. In the last year hospitals have reported an increase in workplace violence and staff report feeling unsafe in the workplace. Violence should not be an acceptable workplace hazard but for many health care workers it has become normal. There are many contributing factors to the increase in violence, including the opioid crisis and a shortage of psychiatric and detox beds. As employers, hospitals have an obligation to address workplace violence and they are working to ensure that plans are in place to prevent, identify, and de-escalate violence before the police need to be involved. Because workplace violence is a complex problem with many causes, it will require multiple solutions to address. HB 312 is one of those tools. MS. HULTBERG said hospitals clearly understand the need to differentiate between an intentional and unintentional assault. Reporting an assault by a patient is not something caregivers do lightly. But hospitals do report that when health care workers call the police to report an assault, the police sometimes leave the individual at the hospital rather than arresting them. HB 312 gives police new tools to arrest for fourth degree assault without a warrant. Hospitals address violence daily and understand the needs of vulnerable populations. The intent of HB 312 is not to penalize those who need behavioral health or substance abuse treatment. In fact, it is carefully designed not to do that. It is intended to give police and the judicial system additional tools in dealing with serious physical violence when it is creating an unsafe environment for caregivers and patients. The legislation is also clear that patients that need medical treatment belong in the hospital. Hospitals understand that obligation. MS. HULTBERG stressed that hospitals cannot bear the burden of community violence much longer. Caregivers need help and passing HB 312 tells everyone that violence in health care facilities is not acceptable. She encouraged the committee to act favorably on the legislation. CHAIR COGHILL asked which hospital departments are primarily affected by workplace violence. MS. HULTBERG said a significant amount of the violence takes place in the emergency room, but labor and delivery and the general medical floors can also be very volatile. 2:38:47 PM CHAIR COGHILL found no questions. He asked if Pioneer and Veteran Homes have been part of the discussion. REPRESENTATIVE KOPP said those are primarily residential, not health care facilities. They weren't intentionally excluded but staff haven't reported problems in those facilities. Similarly, private physician offices didn't seem to have the same level of problem as in hospitals, but there wasn't an overt attempt to exclude them. SENATOR WIELECHOWSKI directed attention to the new language on page 2, lines 16-17, regarding violating AS 11.41.230. He asked if this includes the sidewalk and parking lot outside the facility. REPRESENTATIVE KOPP said he would defer to the definition, but his guess is it may apply to the campus, not just within any four walls on the campus. REPRESENTATIVE CLAMAN said he agrees with everything Representative Kopp said. SENATOR WIELECHOWSKI stated that he would interpret this to mean within the four walls the health care facility plus the sidewalk and the parking lot. "That's my intent in passing this legislation." CHAIR COGHILL said he didn't know that anyone on the committee would disagree. REPRESENTATIVE KOPP thanked the committee for hearing the bill. 2:43:10 PM CHAIR COGHILL held HB 312 in committee for future consideration.