HB 312-CRIMES AGAINST MEDICAL PROFESSIONALS  1:49:51 PM CHAIR COGHILL reconvened the meeting and announced the consideration of HB 312. He opened public testimony. 1:50:47 PM DAWN ELLIOTT, Emergency Room Nurse, Providence Medical Center, Anchorage, Alaska, testified in support of HB 312. She said the emergency room at Providence sees about 70,000 patients each year. Health care workers seldom hear thank you but physical violence, verbal abuse, and being treated like garbage is the norm. Every day she fears another assault. She described the last assault she experienced to demonstrate the lack of accountability. She opined that there needs to be immediate and lifelong consequences for individuals who assault health care workers. 1:52:22 PM CHUCK BILL, CEO, Bartlett Regional Hospital, Juneau, Alaska, testified in support of HB 312. He described the legislation as an important component to protect staff from workplace violence. The violence in hospitals has increased 50 percent the last couple of years. He described an incident this past weekend when three security guards and one nurse were assaulted. The hospital has implemented several safety measures such as doubling the security workforce and extensive training on deescalating and avoiding these situations. HB 312 will help the police department to better partner with staff when needed. He urged passage of the bill without amendment. 1:54:35 PM AMBER MICHAEL, Legislative Chair, Alaska Nurses Association and registered nurse, Fairbanks, Alaska, testified in support of HB 312. She said the threat of violence on health care workers and other staff occurs in all areas of the hospital on a daily basis. It ranges from hitting and spitting to gun violence. The lack of power that the police have in these situations is unacceptable. Health care facilities are a magnifier of emotions and can explode in stressful situations and anyone in the vicinity can become a target. However, health care workers and other personnel are limited in how they can protect themselves while giving care. She said the added aggravator when assaulting a health care worker in a health care facility is a positive move and hopefully will reduce assaults. She urged the committee to support HB 312. 1:56:22 PM DANNY ROBINETTE, Chief Medical Officer, Fairbanks Memorial Hospital, Fairbanks, Alaska, testified in support of HB 312. He reported that in the past 18 months they have experienced about 182 incidents with violence or a significant threat of violence to hospital staff. Some estimates show that just one-third of incidents are reported, which suggests they have had over 500 incidents in that timeframe. Violence is increasing significantly both at Fairbanks Memorial and statewide. This is not acceptable. HB 312 will be a significant help, but it isn't the only solution. Fairbanks Memorial is taking steps such as nonviolent crisis intervention training for clinical staff, expanding security presence, and developing processes to identify patients that are high risk for violence. He urged the committee to support HB 312. 1:58:18 PM BRUCE RICHARDS, Director of Government Affairs, Central Peninsula Hospital, Soldotna, Alaska, testified in support of HB 312. He described the incident in 2008 when a former employee entered the hospital and shot and killed a supervisor and injured another before taking his own life. Employees have not forgotten that event. Employees at the hospital, nursing home, and hospital-based clinics experience workplace violence more frequently than in the past. It originates from patients, family members, domestic disputes and even people who have no official business at the hospital. The National Institute for Occupational Safety and Health defines workplace violence as "any physical assault, threatening behavior, or verbal abuse occurring in the work place." He cited data points from the agency that accredits and certifies 21,000 health care organizations nationwide. From a sample of 3,700 nurses, 21 percent report being physically assaulted and over 50 percent were verbally abused in a 12-month period; 12 percent of emergency room nurses experienced physical violence and 59 percent experienced verbal abuse in the last 7-day period. He agreed with previous testimony that violence in hospitals is increasing. Central Peninsula Hospital has a code for a situation involving violence that anyone can initiate over the paging system. He described some of the things he's seen when he responded to the call for help. Their staff support allowing law enforcement to arrest someone for misdemeanor assault without a warrant in these situations. This will take care of the existing issue where the perpetrator remains in the facility after the police have left. He urged the committee to pass HB 312. 2:01:32 PM REGENA DECK, representing self, Juneau, Alaska, testified in support of HB 312. She said she is an emergency department nurse, the professor of nursing for UAA in Juneau, and a victim of violence as a direct result of her job. She described the physical assault she experienced by a patient. Her assailant was charged with misdemeanors and felonious assault, including assault with a deadly weapon. He had been reported to the police before and they said their hands were tied. Some nurses didn't bother to report him because nothing would be done. Other nurses view this as part of the job. It makes her sad and angry that her injury and trauma could have been prevented if the police had stronger tools available. HB 312 will make it so that nurses' reports of violence will be taken seriously and hopefully prevent further acts of violence. It will also send a message to the public that there is zero tolerance for violent behavior. She encouraged the committee to support HB 312. 2:04:15 PM JENNIFER MOORE, Chief Quality Officer, MatSu Regional Medical Center, Palmer, Alaska, testified in support of HB 312. She said that as a nurse of over 20 years she has experienced assaults while attempting to treat patients. All units in the hospital are affected. Some nurses are afraid to go to work because they fear assault. Health care workers need to know they are supported in their time of need just as they help others in their time of need. Violence should not be an acceptable workplace hazard, but for many this is the new norm. Legislation is not the only solution to this complex problem. Every facility needs to implement a comprehensive strategy using evidence-based practices. MatSu Regional is working on a comprehensive workplace violence preventative program to teach staff how to deescalate a situation, use specialized safety techniques, and how to escort an aggressive person. It also teaches staff how to recognize their tension triggers and how to reduce personal tension. She urged the committee to pass HB 312 and send a strong message to health care providers that Alaska takes this issue very seriously. 2:06:40 PM JOANNA CAHOON, Member, Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse and Staff Attorney, Disability Law Center, Anchorage, Alaska, discussed unintended consequences related to HB 312. She said the boards believe the violence that HB 312 seeks to address is egregious. Her comments are areas of drafting that may lead to unintended consequences beyond the targeted violence the bill tries to address. There are two ways that the current language could unintentionally criminalize the actions of persons in need of psychiatric care. First, people that are transported to a psychiatric facility often refuse treatment. They can appear belligerent, yelling, and demanding to leave. They may not be deemed to be seeking medical treatment, but the boards' experience is that it's not always a straightforward call. The second issue relates to the idea that being deemed stable for discharge is straightforward. There are certain populations that show up to ERs that may not be admitted because they need support but not necessarily medical treatment. Examples include a person with an intellectual disability that is co-occurring with a mental illness or an adult child that experiences autism and is in a meltdown and is violent. Those individuals are in crisis, but they may not be admitted. The bill may capture those individuals, perhaps unintentionally. In the boards' experience, difficult psychiatric patients have sometimes been inappropriately deemed stable for discharge. On occasion they have seen Emergency Medical Treatment and Labor Act (EMTALA) violations. That is the law that requires anyone going to an emergency department to be deemed stable before they are discharged. MS. CAHOON advised that a similar bill was adopted in Idaho and patients with the conditions she described were caught up in the criminal justice system, although that was not the intent of the bill. She thanked the committee for the opportunity to point out the potential for unintended consequences. 2:11:23 PM BENJAMIN SHELTON, MD, President, Alaska Chapter American College of Emergency Physicians, said he works at Providence in Anchorage. He is testifying in support of HB 312 that helps address workplace violence in health care facilities. This is necessary. Violence in the emergency department seems to be worsening. This should not be accepted as a workplace hazard, but for many it has become the normal. Many of the assaults are in the category of fourth degree assault for which an officer must have a warrant to make an arrest. After a staff member is assaulted, the police take a report and often leave the individual on premises. This sends the unfortunate message to the care giver that their safety is not important. The bill gives police officers the same ability to remove the assailant from the scene without a warrant. This is the same authority that law enforcement has to remove an assailant from the scene in domestic violence situations. All emergency providers are responsible for EMTALA. Every patient that comes in is cared for and stabilized. HB 312 does not change that. If someone comes in with an acute mental health crisis, they're psychotic, or high on methamphetamine, the emergency department's responsibility is to treat them. He urged the committee to pass HB 312 and send a strong message to those providing health care that Alaska takes this issue seriously. 2:14:19 PM KIM MCDOWELL, Emergency Room Director and registered nurse, Bartlett Regional Hospital, Juneau, Alaska, testified in support of HB 312. She reported that in the last six months they have had 18 incidents of nurses being assaulted. This has become the rule rather than the exception. This would not be acceptable in any other place of business. She urged passage of HB 312, so health care providers can do their jobs safely and without harm to themselves or other people. CHAIR COGHILL asked if she believes the bill, as currently drafted, provides enough discretion to deal with behavioral health issues. MS. MCDOWELL said that as professionals they all have the ability to make that discretionary decision. There is a difference between an individual with autism who may not be able to control their behavior as opposed to an individual who is assaulting staff but does have the means to know the difference between right and wrong. CHAIR COGHILL asked Ms. Cahoon to address the same question. 2:17:08 PM MS. CAHOON said she isn't questioning anybody's ability to make an appropriate professional call. The boards' concern is based on seeing the intention of what other states passed and what happened. The law in Idaho intended to capture the actions of patients or non-patients who could understand their actions but were drunk or angry. It had an exemption for people experiencing mental illness, but that provision was removed and patients with mental illness or autism were caught up in the criminal justice system. This may not be an issue most of the time, but there is some vagueness between seeking medical treatment and stable for discharge. She suggested that a definition or exemption might make it clear in those situations that don't fall in the norm so that situations like in Idaho and Washington are avoided. CHAIR COGHILL commented that the bill appears broad enough for the rule, but not the exception. He said he didn't know that he was willing to slow the bill to find out how best to make an exception when is seems that there is discretion with the officer and health care provider. 2:19:31 PM SENATOR WIELECHOWSKI asked if the sponsor was available to respond to Ms. Cahoon's testimony. CHAIR COGHILL said that was discussed in House Judiciary and the sponsor is satisfied that the discretion given to the officers and health care professionals is sufficient. He reiterated that he believes there is enough discretion. SENATOR WIELECHOWSKI said okay. 2:20:38 PM SENATOR COSTELLO moved to report HB 312, version O, from committee with individual recommendations and attached fiscal note(s). 2:20:53 PM CHAIR COGHILL announced that without objection, HB 312 moved from the Senate Judiciary Standing Committee.