Legislature(2017 - 2018)GRUENBERG 120

02/05/2018 01:30 PM JUDICIARY

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          HB 312-CRIMES AGAINST MEDICAL PROFESSIONALS                                                                       
1:31:26 PM                                                                                                                    
CHAIR CLAMAN announced that the  first order of business would be                                                               
HOUSE BILL NO. 312, "An Act  relating to arrest without a warrant                                                               
for assault in  the fourth degree at a health  care facility; and                                                               
relating  to an  aggravating factor  at sentencing  for a  felony                                                               
offense  against   a  medical  professional  at   a  health  care                                                               
1:32:15 PM                                                                                                                    
REPRESENTATIVE KOPP  noted that it  had been a privilege  to work                                                               
with  Chair Claman  on this  legislation over  the interim.   The                                                               
background,  he  related,  is  that  over  the  last  ten  years,                                                               
nationally  and  statewide,  there  has been  a  rising  tide  of                                                               
workplace  violence  occurring at  health  care  facilities.   He                                                               
related that throughout his years  in law enforcement he escorted                                                               
a number  of people  to emergency rooms,  stayed with  them while                                                               
they were being  treated, and once they were  stable, he escorted                                                               
them  to  whatever facility  they  were  going  to  next   It  is                                                               
interesting, he  commented, how things  have changed both  in the                                                               
health  care environment  and in  public safety,  with a  primary                                                               
drivers  being  the  sheer  numbers   of  people  showing  up  in                                                               
emergency  rooms  with  severe behavioral  health,  alcohol,  and                                                               
substance abuse issues, that contribute  to violent behavior.  In                                                               
the  event an  assault  occurs  on a  fire  fighter  or a  police                                                               
officer  outside  of the  emergency  room  doors, the  charge  is                                                               
assault.   Although, somehow after  entering the  emergency room,                                                               
the culture  has become that "you  get a free pass  on the health                                                               
care worker."   He explained that  currently, misdemeanor assault                                                               
has  an  exception  for  obtaining an  arrest  warrant  only  for                                                               
domestic   violence.     Therefore,   on   a  domestic   violence                                                               
misdemeanor level  of an assault,  an officer can make  an arrest                                                               
if they  determine who was  the principal aggressor and  they can                                                               
also  consider  other  factors   in  making  that  determination.                                                               
Except, he  pointed out, in the  event it is a  misdemeanor level                                                               
assault in an  environment, such as a health care  facility or an                                                               
emergency room, an  arrest warrant is required  unless the health                                                               
care provider  is willing  to place the  person under  arrest for                                                               
assault and  sign an  affidavit as  to everything  that occurred.                                                               
Consequently, he  said, it is  difficult for that arrest  to take                                                               
1:34:41 PM                                                                                                                    
REPRESENTATIVE KOPP advised that  this piece of legislation looks                                                               
at the  health care  facility as  an environment  the legislature                                                               
must protect  and keep safe  because the state  considers keeping                                                               
people safe in a home to be  a sacred duty.  This bill recognizes                                                               
that health care  facilities also rise to that level  of a sacred                                                               
place wherein the  patients who are already  admitted, the people                                                               
that work  there, and  the people  coming in,  need to  know that                                                               
they are in a  safe place.  In the event  violence occurs and the                                                               
police  are  summoned, at  their  discretion,  they can  make  an                                                               
arrest if  probable cause is  present to  charge a person  for an                                                               
assault  that  occurred  in the  health  care  work  environment.                                                               
Further,  he advised,  if the  assault is  at a  felony level  of                                                               
assault  where serious  physical injury  had occurred,  this bill                                                               
allows  that it  is an  aggravator at  sentencing if  the assault                                                               
occurred on  a medical health  professional during the  course of                                                               
their  duties, and  that  the person  knowingly  carried out  the                                                               
assault for  that purpose.   In summary, he explained,  this bill                                                               
addresses a real need to  protect workers in their workplace, and                                                               
that  Alaska's  health  care facilities,  above  all  facilities,                                                               
represents  health care  providers and  honors them  in the  same                                                               
manner in  which the legislature  would any other  person because                                                               
"there  is no  free  pass for  assaults in  a  workplace."   This                                                               
legislation balances  the need for  accountability with  the need                                                               
for  patient  protection  by  requiring  that  "the  health  care                                                               
professional  state that  they are  stable  for discharge  before                                                               
they go out the door."                                                                                                          
1:36:47 PM                                                                                                                    
LIZZIE KUBITZ,  Staff, Representative  Matt Claman,  Alaska State                                                               
Legislature, paraphrased the sectional analysis as follows:                                                                     
     Section 1                                                                                                                  
     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                                                                                                                  
     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                                                                                                                  
     AS   12.55.155(c)   -   Factors  in   aggravation   and                                                                    
     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.                                                                            
1:39:56 PM                                                                                                                    
REPRESENTATIVE LEDOUX stated that she  likes the idea of the bill                                                               
but  was  unsure about  the  exception  here  and noted  that  if                                                               
someone was dying  of a heart attack, it probably  would not be a                                                               
good  idea to  arrest the  person  at that  time.   There is  the                                                               
exception that if  that is going to cause death  or severe bodily                                                               
damage, to rather not have those exceptions.                                                                                    
MS.  KUBITZ  explained  that  in   creating  those  two  separate                                                               
incidents  of the  person not  seeking medical  treatment or  the                                                               
person  who was  stable  for discharge,  it  attempts to  capture                                                               
anyone  who comes  into that  facility,  whether a  patient or  a                                                               
family  member  of a  patient.    She  advised that  they  worked                                                               
closely with  Legislative Legal and  Research Services  to create                                                               
as much clarification as possible.                                                                                              
1:41:30 PM                                                                                                                    
REPRESENTATIVE  LEDOUX advised  that  she was  not following  Ms.                                                               
Kubitz' explanation.                                                                                                            
REPRESENTATIVE  KOPP explained  that  many of  the assaults  that                                                               
occur  in a  health care  facility are  "visitors on  health care                                                               
givers."   In  other  words,  the person  may  be accompanying  a                                                               
family member or  a spouse, and situations can be  volatile for a                                                               
variety of reasons,  such as a lack of understanding  as to why a                                                               
health  care   procedure  was  given   or  there  was   an  unmet                                                               
expectation.   He related that  violence can and does  occur, and                                                               
he  referred to  letters contained  in the  committee packet,  as                                                               
follows:   Jim  Lynch, CEO  of Fairbanks  Memorial which  advised                                                               
that just  this last  year it  had over 100  assaults on  its own                                                               
staff;  and  there was  a  letter  from Julie  Taylor,  Anchorage                                                               
Regional Hospital.   He expressed that [the problem]  is not just                                                               
the  patients who  come into  the hospital,  it can  also be  the                                                               
person that accompanies them.                                                                                                   
1:42:36 PM                                                                                                                    
REPRESENTATIVE  LEDOUX   agreed  that  Representative   Kopp  was                                                               
correct  in that  it  is not  just the  patients  going into  the                                                               
hospital.  Except,  to the extent it is a  patient, why would the                                                               
sponsor not  let the patient  be arrested  as long as  the arrest                                                               
would not cause death or severe bodily injury.                                                                                  
CHAIR CLAMAN  explained that  concerns were  raised, and  he used                                                               
the example of someone suffering  from an unstitched bleeding leg                                                               
wound that  continued to bleed,  thereby, causing a risk  to that                                                               
person's health.  In this  scenario, the arresting police officer                                                               
who started  transporting the  person to  jail is  now put  in an                                                               
untenable position because  the jail would say that  it could not                                                               
sew up  the wound and the  offender needs to go  to the emergency                                                               
room.   Yet, the police  officer is  left there saying  that they                                                               
just  left  the  emergency  room.    Therefore,  the  reason  for                                                               
definition,  "stable for  discharge" essentially  relates to  the                                                               
patients and the  police officer would wait to  arrest the person                                                               
until after  the doctor  in the emergency  room advised  that the                                                               
person was  stable for  discharge, stable enough  to take  to the                                                               
jail.  He  explained that law enforcement does not  want to be in                                                               
a  place  in  which  the health  care  professionals  release  an                                                               
unstable  for  discharge person  to  a  police officer,  and  the                                                               
police officer is left asking, "What do I do now?"                                                                              
1:44:12 PM                                                                                                                    
REPRESENTATIVE EASTMAN asked what  establishes whether someone is                                                               
seeking  medical treatment  at  the facility.    He related  that                                                               
sometimes paramedics  find people  who do want  medical treatment                                                               
but are  compelled into  treatment for their  own good  and asked                                                               
whether that person was seeking  medical treatment at a facility.                                                               
On the  other hand,  he related  that someone  decides to  slug a                                                               
doctor and has a bruised hand,  and says, "help my hand," whether                                                               
that person was seeking medical treatment.                                                                                      
MS. KUBITZ  answered that she  was unsure it mattered  either way                                                               
simply because  the legislation  does capture  everyone.   In the                                                               
event a  doctor presumes a  person was seeking  medical treatment                                                               
and it was the reason they  came to the hospital, then the person                                                               
falls under  the "stable for  discharge" language.  In  the event                                                               
the doctor assumed  the person was not  seeking medical treatment                                                               
and was accompanying someone with  a wound, the person could fall                                                               
under the first  category of not seeking medical  treatment.  She                                                               
reiterated  that   she  was  unsure  that   specification  really                                                               
mattered in  that she  would hope  the health  care professionals                                                               
would realize  who was,  and was  not, a  patient and  who needed                                                               
1:45:41 PM                                                                                                                    
CHAIR CLAMAN opened public testimony on HB 312.                                                                                 
1:46:05 PM                                                                                                                    
ANNE  ZINC,   Emergency  Medicine   Physician,  Matanuska-Susitna                                                               
Regional Hospital, advised that she  is the past president of the                                                               
Alaska College of Emergency Medicine  Physicians.  She noted that                                                               
as an  emergency medical provider,  this bill reads  "cleanly and                                                               
we're  doing this  on  a  regular basis  every  single day"  when                                                               
deciding  whether someone  is stable  for  discharge, stable  for                                                               
jail, stable  for transport,  and it fits  in nicely  with (audio                                                               
difficulties) and  will be  easy to  follow through  in practice.                                                               
She related  that she  hopes HB 312  passes quickly  and cleanly,                                                               
and as mentioned  previously there has been "a  huge increase" in                                                               
patients being served  with behavioral health needs.   During the                                                               
last  three years,  at the  Matanuska-Susitna Regional  Hospital,                                                               
there has been a four-fold  increase, and oftentimes the patients                                                               
are held  anywhere from  two days  to ten  days in  its emergency                                                               
department.   These patients are oftentimes  medically clear, but                                                               
the  hospital   is  awaiting  some  sort   of  behavioral  health                                                               
evaluation, and  many of  these patients  will act  out violently                                                               
because they are in an  unpredictable and chaotic environment for                                                               
a long  period of time.   Unfortunately, she pointed out,  in the                                                               
emergency department it  has become the norm to  be threatened or                                                               
attacked and  many physicians or  nurses have been  threatened or                                                               
personally attacked.   She stated that  it makes it hard  to care                                                               
for other patients when "I received  a black eye in the emergency                                                               
department and was held up against  the wall while trying to care                                                               
for a six-month  old who was really struggling to  breathe."  She                                                               
related that being able to get  these patients to a safer, calmer                                                               
place outside  of the emergency  departments allows the  staff to                                                               
care for  all of the  other patients in the  emergency department                                                               
who need  them at that time.   She expressed hope  that this bill                                                               
is  passed quickly  and  cleanly,  not only  for  the benefit  of                                                               
health  care workers  and the  other patients,  but that  it will                                                               
benefit the  violent patients because  they are often stuck  in a                                                               
chaotic uncontrolled  environment and  they do  better in  a more                                                               
controlled   environment,  such   as  jail   while  waiting   for                                                               
psychiatric treatment.                                                                                                          
1:48:07 PM                                                                                                                    
JULIE  TAYLOR, CEO,  Alaska Regional  Hospital, advised  that she                                                               
has been  a nurse over  30 years, and  has seen the  evolution of                                                               
what is being  dealt with today, including the spike  in the last                                                               
couple  of years,  because she  has had  a front  row seat.   She                                                               
offered concern  that people may  not want  to be in  the nursing                                                               
profession  any longer  due to  the  nurses feeling  unprotected,                                                               
wherein, it is  typical for nurses to be kicked  and spit at with                                                               
no consequences.   She pointed out  that when there is  really no                                                               
follow-up  to  the issues  she  had  identified when  asking  for                                                               
support, the  nurses are  getting used to  it and  becoming numb,                                                               
which is "really a problem."   There were 80 separate events in a                                                               
short  time  just  last  year,  she  advised,  and  those  events                                                               
continue  to  escalate  because   there  are  not  strong  enough                                                               
consequences or clear  lines as to how these patients  need to be                                                               
managed.     Without  question,  she  pointed   out,  nurses  are                                                               
compassionate, and  they want people  to receive the  health care                                                               
they require and  become stable to be discharged.   She expressed                                                               
that Dr.  Anne Zinc "nailed it  on the head" because  when people                                                               
are  held for  a  long period  of time  when  simply waiting  for                                                               
placement, they act out.  She  said she has had patients threaten                                                               
her nurses  by stating, "I'll figure  out where you live,"  so my                                                               
nurses have only  their first names on their  name badges because                                                               
they are  afraid to  have their  full name  listed, but  they are                                                               
concerned about their  first name being listed also.   The milieu                                                               
is not good for anyone and there  must be a way to send a message                                                               
stating  that,   "the  health  care   environment  needs   to  be                                                               
protected."  In response to  Representative LeDoux's comment, she                                                               
said, "To  me, these are  people that are putting  themselves out                                                               
there  (audio difficulties)  health care  workers and  supporting                                                               
the community."  She related that  the state needs to have a high                                                               
bar  in keeping  health  care  workers safe  because  if a  staff                                                               
member  is  distracted,  another  patient is  not  receiving  the                                                               
attention they deserve.  She  said that she echoes everything Dr.                                                               
Zinc  testified to  and added  that this  legislation is  for the                                                               
health and welfare of everyone.                                                                                                 
1:50:49 PM                                                                                                                    
BECKY HULTBERG, President/CEO, Alaska  State Hospital and Nursing                                                               
Home Association,  advised that  she represents the  Alaska State                                                               
Hospital  and Nursing  Home Association  and  offered its  strong                                                               
support for HB 312.   This legislation gives law enforcement "and                                                               
the judicials" new tools to  address workplace violence in health                                                               
care  facilities.   As Representative  Kopp noted,  hospitals are                                                               
sacred places  to help people  at some  of their most  joyful and                                                               
most  difficult times  in their  lives, and  they should  be safe                                                               
places  where people  can  receive  help in  an  emergency.   She                                                               
related that hospitals are also  a reflection of the community at                                                               
large, and unfortunately due to  a variety of factors, Alaska has                                                               
seen workplace  violence escalate  in hospital settings.   Health                                                               
care staff report that they  feel unsafe in the workplace because                                                               
far  too often  they are  kicked, punched,  spit on,  or verbally                                                               
threatened.    Violence should  not  be  an acceptable  workplace                                                               
hazard, she said,  except, for many nurses  and physicians, CNAs,                                                               
and  other  caregivers,  this  has  become  the  new  norm.    As                                                               
employers,  hospitals  have  a   responsibility  to  address  any                                                               
workplace  violence,  and  she  said she  wanted  to  assure  the                                                               
committee  that "we  are doing  our part"  and working  to ensure                                                               
there are  plans in place  to prevent, identify,  and de-escalate                                                               
violence  before  it gets  to  the  point where  law  enforcement                                                               
becomes  involved.    She  advised   that,  "We're  sharing  best                                                               
practices"  on preventing  and responding  to violence,  but when                                                               
law enforcement is  called, usually the situation  is serious and                                                               
sometimes the  individual must be  arrested and removed  from the                                                               
facility.  She commented that  there is an attitude that violence                                                               
is just part of the job in  health care, and she opined that that                                                               
is one  of the things  "we are  working to address"  through this                                                               
legislation.    Hospitals  simply   cannot  bear  the  burden  of                                                               
violence much longer,  "we are doing our part, but  we need help.                                                               
Our caregivers need help."  While  there are many things that can                                                               
be  done as  hospitals in  addressing workplace  violence, health                                                               
care workers need  the support and engagement  of the legislature                                                               
and the  criminal justice system, as  well.  She said  she wanted                                                               
to reassure the committee that  hospitals address violence daily,                                                               
and  they  understand  the  needs  of  vulnerable  patients  with                                                               
behavioral health or substance abuse  issues.  The intent of this                                                               
legislation is  not to  penalize those  who need  those treatment                                                               
services.   In fact, she  advised, it was carefully  designed not                                                               
to do  that, but it is  intended to give law  enforcement and the                                                               
judicial  system  new  tools  to help  address  the  epidemic  of                                                               
workplace  violence  in  Alaska's  hospitals.   She  urged  quick                                                               
consideration and passage of this bill as written.                                                                              
1:53:27 PM                                                                                                                    
REPRESENTATIVE  REINBOLD  commented  that "it  says  only  fourth                                                               
degree  here,"  and asked  whether  there  was  a reason  it  was                                                               
limited to fourth degree and whether to expand the definition.                                                                  
CHAIR CLAMAN advised  that a person can be arrested  for a felony                                                               
without a warrant, so there is no  need to change it for a felony                                                               
assault because law enforcement already has that authority.                                                                     
1:53:56 PM                                                                                                                    
REPRESENTATIVE  REINBOLD surmised  that  the  committee needs  to                                                               
keep the definition limited to what it is in the bill.                                                                          
CHAIR CLAMAN advised that the  only issue for law enforcement was                                                               
fourth  degree  assault,  it  does not  have  issue  with  first,                                                               
second, and third-degree assaults.                                                                                              
1:54:20 PM                                                                                                                    
CHUCK  BILL,  CEO,  Bartlett   Regional  Hospital,  advised  that                                                               
Bartlett Regional  Hospital provides health care  services to the                                                               
residents  of Juneau,  visitors  to Juneau,  and the  surrounding                                                               
communities.   He  acknowledged that  Bartlett Regional  Hospital                                                               
has  seen almost  the  exact  same increase  in  violence in  its                                                               
facility  as was  heard  from the  Fairbanks  and the  Matanuska-                                                               
Susitna  hospitals.   Weekly,  he  said,  the staff  is  punched,                                                               
kicked,  spit on,  and  that  is not  okay.    The most  dramatic                                                               
incident,  he  stressed, was  when  a  patient removed  their  IV                                                               
tubing  and tried  to strangle  one of  his nurses.   This  is an                                                               
important  bill  and  he  encouraged the  committee  to  move  it                                                               
forward,  while  emphasizing  that  the  hospital  believes  this                                                               
legislation  is  only a  part  of  the  solution to  the  ongoing                                                               
problem.   Bartlett  Regional Hospital  implemented  a number  of                                                               
programs  to really  start  doing  what it  can  to reduce  those                                                               
issues.   Most importantly,  he related is  the training  for all                                                               
staff  members,   which  includes:   escalation;  how   to  avoid                                                               
dangerous situations;  and so  forth.   In addition,  he advised,                                                               
Bartlett Regional  Hospital implemented  a software  system, that                                                               
has been implemented in the  emergency departments throughout the                                                               
state,  that flags  patients and  sends the  hospital a  heads up                                                               
when there  is a patient  with a  prior history, so  the hospital                                                               
can  be  prepared.     This  year,  he   remarked,  the  hospital                                                               
introduced "duress  buttons" wherein  the staff in  its emergency                                                               
room and  mental health facility can  push a button if  they feel                                                               
they  are in  a threatened  position, and  that button  will send                                                               
help  from all  over the  organization.   Finally, he  said, this                                                               
year  the  hospital doubled  its  security  force, which  is  not                                                               
something it  did lightly because  obviously, it takes  away from                                                               
its ability to hire nurses and  other staff.  Except, he said, it                                                               
was  an important  commitment for  the hospital  to make  for the                                                               
safety of its workers.                                                                                                          
1:56:29 PM                                                                                                                    
REPRESENTATIVE  REINBOLD referred  to the  increase in  incidents                                                               
and asked whether he had an inkling as to why the increase.                                                                     
MR. BILL  opined that, partially  it is the pervasiveness  of the                                                               
meth problem, and  partially it is in response to  the changes in                                                               
the law that made it harder  to "put people in" for misdemeanors.                                                               
While the  timing is suspicious,  he commented, he could  not say                                                               
that for  a fact, but  he was  pretty comfortable that  issue had                                                               
input into the problem.                                                                                                         
1:57:19 PM                                                                                                                    
JOAN  CLOOTIER,  RN,  Alaska   Native  Hospital  Emergency  Room,                                                               
advised that she  was assaulted last September by  a patient, she                                                               
was  punched  twice  in  the  face, kicked  up  against  a  wall,                                                               
repeatedly kicked  until security and a  behavioral health person                                                               
came to  her aide.   It was actually  a patient that  dragged her                                                               
free after suffering multiple injuries,  bruises, loss of a tooth                                                               
and, she  pointed out,  this is  "just one  of these  things that                                                               
just  seems  to  be   increasing  rampantly,  nationwide  assault                                                               
against  health care  workers  and nurses  in  particular."   The                                                               
emergency room  is a  hotbed, she  described, because  people are                                                               
seen at their  worst in all phases of strife  and stress, and "we                                                               
are" certainly  one of  the first  people to  get nailed  when it                                                               
comes to  assaults.   She opined  that one of  the big  cause for                                                               
assaults  is  that people  are  not  held accountable  for  their                                                               
actions.   Speaking as an  emergency room nurse of  27-years, she                                                               
advised the  committee that  this was probably  the 12th  or 15th                                                               
time she  had been assaulted as  a health care worker.   Assaults                                                               
on health  care workers are  horribly on  the rise and  she noted                                                               
that  she  has been  assaulted  twice  in  the last  six  months.                                                               
Clearly, drugs and alcohol are  increasing but, she stressed, the                                                               
lack of  accountability has  also increased  in this  country and                                                               
people  are not  receiving consequences  for their  actions.   Be                                                               
that as it may, she said,  the person who assaulted her last fall                                                               
served 90-days,  "she tried to  get out going through  the mental                                                               
health  part  of  it."     Ms.  Clootier  related  that  she  was                                                               
persistent  because  it  required  her  being  persistent,  while                                                               
unfortunately,  not   all  of  her  co-workers   are  persistent.                                                               
Something must be  done to stop the assaults  against the nurses,                                                               
she expressed.                                                                                                                  
1:59:37 PM                                                                                                                    
REPRESENTATIVE REINBOLD asked whether 90  days was enough time to                                                               
serve for what the offender did to her.                                                                                         
MS. CLOOTIER responded that she  absolutely did not believe [that                                                               
was justice] because she is  still recovering from the attack and                                                               
has  to  pay  $1,000 out  of  her  own  pocket  to have  a  tooth                                                               
REPRESENTATIVE  KREISS-TOMKINS  advised  Ms.  Clootier  that  the                                                               
Victims'  Crime Compensation  Board  might be  something to  look                                                               
into in terms of the $1,000 tooth replacement.                                                                                  
2:00:43 PM                                                                                                                    
REGENA  DECK, RN,  Emergency  Room,  Bartlett Regional  Hospital,                                                               
offered testimony as follows:                                                                                                   
     I've lived  in Juneau for  three years and  have worked                                                                    
     on  the  East Coast  in  a  variety of  emergency  room                                                                    
     situations, including  inner city.  And,  I've not seen                                                                    
     the  amount of  violence that  we have  here in  Alaska                                                                    
     against  health care  professionals.   In Pennsylvania,                                                                    
     one of  the emergency rooms  that I have worked  in, it                                                                    
     is  already  a felony  assault,  there  is no  question                                                                    
     about it, and when you  say, "What's the difference?" I                                                                    
     look at  my co-workers and  we have conversations  on a                                                                    
     daily basis, whether it is  the security guard, whether                                                                    
     it's a fellow nurse, we come  out of a room and we say,                                                                    
     "Wow, that person really scared  me, they threatened to                                                                    
     kill me, they know my  cousin, they know where I live."                                                                    
     And, those  are the  kinds of things  that if  this was                                                                    
     raised  to a  felony, it  would take  that piece  of us                                                                    
     having to  enforce it ourselves  out of it.   As people                                                                    
     who are kind  and caring, it is our job  to try to heal                                                                    
     and  figure out,  'why was  he angry  with me.'   We're                                                                    
     almost in  an abusive life situation,  where instead of                                                                    
     saying, 'Wow, I  just got punched in the  face, we look                                                                    
     at it as  'what did I do, what did  he really need from                                                                    
     me?'   And,  it is  unacceptable.   I was  a victim,  I                                                                    
     moved  to   Juneau  and  three  months   after,  I  was                                                                    
     strangled in  the emergency department ...  I feel that                                                                    
     I've ... that gentleman  has since been prosecuted, but                                                                    
     not after a lot of work  on our behalf.  That gentleman                                                                    
     is now serving  three years in prison, but  much of the                                                                    
     trial process  was him trying  to get the  three felony                                                                    
     counts   in   addition   to  his   misdemeanor   (audio                                                                    
     difficulties) to  a misdemeanor.  His  people, speaking                                                                    
     on his  behalf, including mental  health professionals,                                                                    
     said  'Well, ER  nurses have  to expect  it, it's  your                                                                    
     job, it's what  you do.'  To which I  say, 'I doubt it,                                                                    
     I definitely won't say to my  family, Hey, I need to go                                                                    
     to work as a nurse today,  I hope I don't die.'  That's                                                                    
     not what  I do for  work.  In  Juneau, we see  more and                                                                    
     more  of  a prevalence,  not  only  of drug  addiction,                                                                    
     homelessness, things that  drive people to desperation,                                                                    
     but also  a disregard for  the repercussions.   We have                                                                    
     people that come  in with knives and guns  on them, and                                                                    
     anecdotally, they just say, 'Oh  yeah, I guess you want                                                                    
     to hold this while I go  to x-ray.'  As a nurse, that's                                                                    
     unnerving.  I  get you might be a hunter,  you might be                                                                    
     qualified to carry  that, but I work  in an environment                                                                    
     where  not only  am I  now  being strangled  by my  own                                                                    
     equipment  and being  left  with  the ramifications  of                                                                    
     that, as  have my  fellow staff and  my husband.   But,                                                                    
     now I  have to worry that  every patient is out  to get                                                                    
     me and  that is not  the kind of care  I give.   I also                                                                    
     happen  to be  a  professor who  is  teaching the  next                                                                    
     group of  nursing students here  in Juneau, and  it's a                                                                    
     fine  road to  hoe to  take  away the  fantasy of,  I'm                                                                    
     going  to  go  forth  and help  people  and  make  them                                                                    
     better.   But,  I have  to be  worried that  they don't                                                                    
     kill me  first.  So, I'm  hoping that this bill  ... in                                                                    
     this  gentleman's case,  he had  been  reported to  the                                                                    
     police and  reported to security on  numerous occasions                                                                    
     before this  happened.  And that  anecdotal information                                                                    
     didn't come out until after my  event.  So, had it been                                                                    
     a felony, he wouldn't have  had the opportunity to have                                                                    
     37  crimes listed  on his  rap sheet  before strangling                                                                    
2:04:17 PM                                                                                                                    
[CHAIR CLAMAN and Representative Reinbold discussed criminal                                                                    
justice reform.]                                                                                                                
REPRESENTATIVE  REINBOLD asked  whether  Ms.  Deck believes  that                                                               
three years was  justice for the event, that includes  all of the                                                               
time and  energy she has had  to put in  on it and the  trauma on                                                               
her life.                                                                                                                       
2:05:25 PM                                                                                                                    
MS. DECK responded as follows:                                                                                                  
     The reality  was, or  my misunderstanding  watching too                                                                    
     much  t.v. was,  he  was given  his  sentence and  then                                                                    
     walked out.   He  walked out of  the courtroom  and was                                                                    
     going to be  free on appeal.  He went  back into prison                                                                    
     only  by his  own  choice because  he  didn't have  any                                                                    
     place  else to  live.   So, he  chose to  go back  into                                                                    
     prison, but  after having  been convicted,  after being                                                                    
     in court with  his family, who can now  identify me and                                                                    
     made  a point  of staring  at me  in the  courtroom, he                                                                    
     then was  let walk.  And,  that's the part for  me that                                                                    
     was the  most scary.   Three years  ... I don't  have a                                                                    
     number that will  make it go away, it'll  be a lifetime                                                                    
     for myself and  the follow workers who were  there.  As                                                                    
     well as my  husband who has to deal with  the idea that                                                                    
     he can't  protect his wife  while she's at work.   And,                                                                    
     of  course,   I  think  somebody  mentioned   that  our                                                                    
     inclination is then to say,  'Don't work there.'  Okay,                                                                    
     well, I'm sure that many  of you having an emergency or                                                                    
     a  trauma   would  be   appreciative  of   nurses  with                                                                    
     experience,  but I  think we're  scaring  them out  the                                                                    
     door.   So,  I  don't  know how  much  would have  been                                                                    
     enough, but three years doesn't seem enough.                                                                               
2:06:30 PM                                                                                                                    
REPRESENTATIVE KOPP referred to the  person who strangled her and                                                               
asked what charge the person received.                                                                                          
MS. DECK remarked  that originally, he had four charges.   He was                                                               
charged with  a class A  misdemeanor for negligent injury  with a                                                               
weapon; and he was also then  charged with class C felony for the                                                               
cause  of fear,  cause  of  death, and  attempt  to  harm with  a                                                               
dangerous weapon.                                                                                                               
2:07:22 PM                                                                                                                    
HAROLD SUNKEL,  RN, Emergency  Nurses Association,  Alaska Native                                                               
Medical  Center,  [audio  difficulties  throughout  Mr.  Sunkel's                                                               
testimony.]  described an  attack he  suffered when  a lady  came                                                               
into   the  hospital   crying  from   abdominal  pain.     (Audio                                                               
difficulties)  already verbally  abusing, was  uncooperative, and                                                               
would not  let anyone take  her vitals while  yelling profanities                                                               
at the staff.   She was given a private room,  so the staff could                                                               
close the  door and not  disturb anyone  else.  The  woman called                                                               
out slurs  toward the staff,  so Mr.  Sunken took over  her care.                                                               
After several attempts  to calm her down, she called  him "the N-                                                               
word"  with  homosexual  slurs.     (Audio  difficulties.)  After                                                               
refusing to  accept medication she  began yelling that  the staff                                                               
was not  helping her.   After several  requests for the  woman to                                                               
take her  medication, he  closed the  door and  walked out.   The                                                               
woman came out of  the room and spit in his  face, he was shocked                                                               
and put his  hand over his head (audio difficulties)  and she hit                                                               
the back of  his head twice.   As he was taught, he  then put her                                                               
hand behind her,  pushed her up against the wall,  and pushed her                                                               
face so she  could not continue spitting at him  of which she was                                                               
attempting, and finally he received  help.  He said that security                                                               
put her in a  room to watch her, the police  were called, and his                                                               
shift ended four  hours later.  The police officer  told him that                                                               
his hands  were tied because  there was no visible  bruising, and                                                               
no  charges  were  pressed (audio  difficulties).    The  woman's                                                               
consequence  was a  ride home  from the  police officer,  and her                                                               
defense was that Mr. Sunkel hit  her and slapped her, even though                                                               
he never  laid a  hand on her  except to keep  himself safe.   He                                                               
stressed that  these people  have no  consequences, and  when the                                                               
staff  tells  them they  will  be  arrested,  they laugh  in  the                                                               
staffs' face.                                                                                                                   
2:10:20 PM                                                                                                                    
AUDREY  BUMA,  RN,  Bartlett Regional  Hospital  Emergency  Room,                                                               
advised she has been a nurse  for 12-years and that not even once                                                               
in  nursing school  did they  teach the  nursing students  how to                                                               
defend themselves.   She advised  that during the last  4.5 years                                                               
at Bartlett Regional Hospital "we  have been assaulted verbally,"                                                               
physically assaulted,  kicked at, spit  at, things thrown  at the                                                               
staff, and  oxygen tanks have  become weapons.  Whereas  now, the                                                               
staff has to take  most things out of a lot of  the rooms just to                                                               
be safe.   These offenders know there are no  consequences and it                                                               
happens daily for  most people, especially the  verbal abuse and,                                                               
it is okay.  She related  that she believes this legislation will                                                               
help  protect  staff  a  little  bit  because  there  has  to  be                                                               
consequences  for their  actions.   Nurses  did not  go into  the                                                               
profession of  nursing to be abused,  she pointed out, and  it is                                                               
difficult  to go  to work  knowing something  could happen.   She                                                               
referred to Regina Deck's testimony  wherein it took two years of                                                               
a terrible  trial to  go through to  then see  some consequences,                                                               
yet this  person would still come  back on a weekly  basis, which                                                               
is difficult.   She asked the committee to please  pass this bill                                                               
to help the health care workers.                                                                                                
2:11:46 PM                                                                                                                    
REPRESENTATIVE  KREISS-TOMKINS asked  Ms.  Buma  to describe  the                                                               
verbally  abusive  people  being  treated  at  Bartlett  Regional                                                               
Hospital, and what  injuries or conditions they  have when coming                                                               
through the emergency room door.                                                                                                
MS. BUMA  answered that most of  the people come in  due to being                                                               
intoxicated with drugs, sometimes they may  be hurt, but a lot of                                                               
the time  they were taken  to the hospital for  medical clearance                                                               
before going to "sleep off," or to  jail.  Some of the people are                                                               
hurt, some  of the people  come to  the emergency room  for help,                                                               
but many times drugs and alcohol are involved.                                                                                  
2:12:29 PM                                                                                                                    
REPRESENTATIVE  KREISS-TOMKINS referred  to the  majority of  the                                                               
people  that go  to the  hospital due  to drugs  and alcohol  and                                                               
asked whether there would be an  active medical danger at hand if                                                               
the person was  not at an emergency room, such  that they may die                                                               
or suffer some type of injury.                                                                                                  
MS.  BUMA remarked  that  she  was sure  if  the  person was  too                                                               
intoxicated that  "they worry"  about them, or  with drugs.   The                                                               
hospital has  to be able to  clear these people and  sometimes it                                                               
is  hard to  even access  them because  they get  mad if  a nurse                                                               
wakes them up from sleeping; or  if they are not getting the pain                                                               
medicine they requested;  or is making them leave  when they have                                                               
been discharged.                                                                                                                
2:13:15 PM                                                                                                                    
REPRESENTATIVE KREISS-TOMKINS commented  that he understands that                                                               
the  people  who  are  heavily   intoxicated  should  go  to  the                                                               
emergency room,  especially if  other issues may  arise.   In the                                                               
event the emergency room was being  used as a place for people to                                                               
sleep  off a  high  or  sleep off  being  incredibly drunk,  that                                                               
appears to  be a misuse  of the facility.   He asked Ms.  Buma to                                                               
speak to the people she  encounters who are verbally abusive, and                                                               
whether  there would  be  any medical  harm if  they  were to  go                                                               
someplace else  that was more  secure with  appropriately trained                                                               
MS. BUMA remarked that that is a hard question to answer.                                                                       
2:14:07 PM                                                                                                                    
REPRESENTATIVE  REINBOLD  asked  whether  Ms. Buma  had  seen  an                                                               
increase [in workplace abuse] or  whether it has been steady over                                                               
the last 4.5 years.                                                                                                             
MS. BUMA  replied that  it has probably  increased over  the last                                                               
4.5 years, and  that she came from Washington  and Colorado where                                                               
it was a felony for assaulting  a health care worker.  She opined                                                               
that that made a difference  because people knew that health care                                                               
workers  could warn  them that  if they  assaulted a  health care                                                               
worker something  would happen, and  people would "sort  of" back                                                               
down.  She estimated that over  the last two years there has been                                                               
an increase in health care worker assaults.                                                                                     
2:15:25 PM                                                                                                                    
AMBER  MICHAEL, Alaska  Nurses  Association, [audio  difficulties                                                               
throughout  Ms.  Michael's  testimony.] (audio  difficulties)  in                                                               
support of HB  312.  (Audio difficulties) on  health care workers                                                               
a very real  and troubling (audio difficulties) all  areas of the                                                               
hospital,  not just  the emergency  department.   This  includes:                                                               
(audio  difficulties) progressive  care, medical/surgical  units,                                                               
and ICUs.   On a daily  basis workers experience violence  in all                                                               
forms,  including: spitting;  hitting;  kicking; pushing;  verbal                                                               
abuse;  and  in some  circumstances  gun  violence.   All  (audio                                                               
difficulties).   The lack of  (audio difficulties)  situations is                                                               
unacceptable.   A  police  officer should  be  equipped with  the                                                               
legal  authority to  arrest  someone  who is  a  threat to  those                                                               
around  them and  remove  them  from the  premises.   The  danger                                                               
(audio difficulties) when an altercation  occurs in a health care                                                               
facility  anyone  present   is  in  harm's  way.     Health  care                                                               
facilities,  for example,  (Audio  difficulties) increased  anger                                                               
and  even  great joy.    (Audio  difficulties)  and that  is  not                                                               
including those  who are intoxicated.   Nurses,  doctors, medical                                                               
assistants,  and other  personnel  can easily  become targets  of                                                               
violence  in these  situations.   (Audio difficulties)  having to                                                               
protect  ourselves under  (audio difficulties)  care.   The added                                                               
(audio difficulties) health care  worker (audio difficulties) and                                                               
the  hope  that  it  is   (audio  difficulties)  in  health  care                                                               
facilities.   She strongly  urged the  committee to  support this                                                               
2:17:25 PM                                                                                                                    
WENDY   SHACKELFORD,    [Audio   difficulties    throughout   Ms.                                                               
Shackelford's  testimony.] offered  her belief  that health  care                                                               
workers  who  want a  job  should  absolutely be  protected  from                                                               
physical injury while on the  job, and abuse is never respectable                                                               
behavior from patients or their visitors.   This is also to avoid                                                               
(audio  difficulties) clients  with behavioral  health or  trauma                                                               
driven behavior.   This  state has  worked hard  to decriminalize                                                               
the  institutionalized  (audio   difficulties)  criminal  justice                                                               
costs.  She  suggested that the resources may be  better spent in                                                               
beefing up  community based behavioral health  services so people                                                               
have  quicker   access.    She   then  offered   examples  (audio                                                               
difficulties) actual data  regarding physical arrests, physically                                                               
removing the person from the  hospital property to the Department                                                               
of Corrections  for assault in  the fourth degree on  health care                                                               
workers.   She asked the  actual data regarding  summons arrests,                                                               
for example, the  person left on the property and  issued a court                                                               
date is  actually an arrest for  assault in the fourth  degree on                                                               
health care workers.   She opined that police  agencies also have                                                               
policies and  procedures that  may dictate  whether they  issue a                                                               
summons or make a physical arrest  based on bail schedules set by                                                               
courts  and circumstances  (audio  difficulties) boundaries,  not                                                               
necessarily  whether  someone  wants   to  press  charges.    She                                                               
encouraged  the legislature  to  involve  law enforcement  (audio                                                               
difficulties)  they may  also all  be actual  data in  this area.                                                               
She  offered concern  that  there is  not  enough information  to                                                               
implement  new  legislation  and encouraged  the  cultivation  of                                                               
actual  data (audio  difficulties) that  still keeps  health care                                                               
workers safe.                                                                                                                   
2:20:20 PM                                                                                                                    
KATIE  BALDWIN-JOHNSON,  Senior  Program Officer,  Alaska  Mental                                                               
Trust  Health Authority,  advised  that the  Alaska Mental  Trust                                                               
Health  Authority is  in place  to  advocate on  behalf of  trust                                                               
beneficiaries,  and  prioritize   policy  practices  and  funding                                                               
toward strategies  that help improve the  lives of beneficiaries.                                                               
She explained that beneficiaries  include individuals with mental                                                               
illness,  chronic alcoholism,  substance abuse,  intellectual and                                                               
developmental  disabilities,  Alzheimer's   disease  and  related                                                               
dementias,  and traumatic  brain injury.   She  advised that  her                                                               
comments are specifically focused on  the impact on mental health                                                               
trust  beneficiaries, and  that  the trust  recognizes there  are                                                               
legitimate concerns  about hospital  workplace violence,  and the                                                               
safety  of  health  care providers  and  patients  seeking  care,                                                               
requiring the  implementation of a number  of targeted solutions.                                                               
She advised that the trust  has made long-term investments in the                                                               
areas of  disability, justice, and  criminal justice  reform with                                                               
the focus on  finding solutions with the fact  that mental health                                                               
trust beneficiaries are over-represented  in the criminal justice                                                               
system.  Approximately 40 percent  of incarcerations annually are                                                               
beneficiaries and  their stays at  both pre-trial  and sentencing                                                               
are  longer than  non-trust beneficiaries.    She described  that                                                               
trust beneficiaries  languish in correctional care  for a variety                                                               
reasons,  one  reason  is  that  some  beneficiaries  are  higher                                                               
utilizers  of emergency  services  and it  is  difficult to  find                                                               
adequate solutions in the current  system of (audio difficulties)                                                               
treat their  needs.  The  trust is concerned that  the unintended                                                               
consequences of this legislation  will result in additional trust                                                               
beneficiaries being  incarcerated, she  said.   Much of  what the                                                               
trust  focuses on  is targeted  toward preventing  the following:                                                               
identification  of community-based  solutions  that better  serve                                                               
and prevent  the incarceration of trust  beneficiaries; enhancing                                                               
access to  necessary substance abuse and  mental health treatment                                                               
services;  supporting opportunities  for  training and  practices                                                               
for  providers  to  work   effectively  with  complex  behaviors;                                                               
investing  in housing  solutions;  employment opportunities;  and                                                               
together with the trust's partners,  it addresses the gaps in the                                                               
community  continuum of  care that  shifts  reliance on  hospital                                                               
settings  and  unnecessary  incarceration, she  explained.    The                                                               
trust would  support, and  is interested in,  seeing some  of the                                                               
data  hospitals are  collecting  and its  analysis  of the  data,                                                               
thereby, assisting  the trust in understanding  how beneficiaries                                                               
inter-relate  with the  incidents that  are taking  place because                                                               
the trust and its partners can help to be part of that solution.                                                                
2:23:00 PM                                                                                                                    
REPRESENTATIVE  REINBOLD asked  whether  Ms. Baldwin-Johnson  was                                                               
opposed to this bill.                                                                                                           
MS.  BALDWIN-JOHNSON  responded  that  the  Alaska  Mental  Trust                                                               
Health Authority  was neutral, but  it would be difficult  to say                                                               
that  the trust  supports this  legislation without  knowing more                                                               
about its impact on its mental health trust beneficiaries.                                                                      
2:23:27 PM                                                                                                                    
REPRESENTATIVE  REINBOLD  asked   whether  Alaskans  with  mental                                                               
illness,  substance abuse,  Alzheimer's disease,  traumatic brain                                                               
injury are all beneficiaries of the trust.                                                                                      
MS. BALDWIN-JOHNSON  responded that  it depends upon  their level                                                               
of  functionality  because  the  trust is  in  place  to  prevent                                                               
beneficiaries from being incarcerated  or placed in higher levels                                                               
of institutional care.  In the  event an individual had a history                                                               
of drug or alcohol use and  was able to function independently in                                                               
the community, that individual would  not necessarily be deemed a                                                               
beneficiary, she said.                                                                                                          
2:24:04 PM                                                                                                                    
REPRESENTATIVE  REINBOLD   requested  the  percentage   level  of                                                               
CHAIR  CLAMAN  asked  whether  Ms.  Baldwin-Johnson  could  offer                                                               
statistics as to  who is eligible and what kind  of population is                                                               
being served.                                                                                                                   
REPRESENTATIVE REINBOLD  interjected that "functionality  is what                                                               
she said it was  stated on."  She then asked  whether it would be                                                               
better, "rather  than having  these people  running all  over the                                                               
place  with temptations  and alcohol,  and  everything," to  have                                                               
them  in a  confined setting,  such as  a prison  or a  treatment                                                               
program  where their  treatments would  be more  successful.   It                                                               
would seem,  she opined, that  Ms. Baldwin-Johnson  would support                                                               
treatment inside certain facilities.                                                                                            
MS. BALDWIN-JOHNSON  referred to  the functionality  question and                                                               
responded  that it  would  be a  description  of an  individual's                                                               
ability to  live independently and  successfully in  a community,                                                               
and  she  said   she  would  provide  the   committee  with  more                                                               
information.     Ms.   Baldwin-Johnson  then   referred  to   the                                                               
confinement  question  and  answered that  the  department  would                                                               
"absolutely  be an  advocate of  expanded treatment"  in services                                                               
both  within correction  settings  and certainly  community-based                                                               
settings.   The need  there, she  explained, is  that individuals                                                               
need  access to  their correct  treatments in  settings that  are                                                               
appropriate for their needs.                                                                                                    
2:25:50 PM                                                                                                                    
REPRESENTATIVE STUTES surmised that  the Mental Health Trust Fund                                                               
does not  directly help  these individuals,  but rather  it works                                                               
through the other agencies that help these individuals.                                                                         
MS.  BALDWIN-JOHNSON replied  that the  Mental Health  Trust Fund                                                               
funds through a variety of  avenues, and it supports some funding                                                               
to state  agencies to implement  mental health focus  services to                                                               
enhance those  opportunities to  better serve  its beneficiaries.                                                               
The Mental Health Trust Fund  also has authority to grant funding                                                               
to  community organizations  that are  working directly  with its                                                               
trust beneficiaries.   The trust  does have individual  grants it                                                               
can  directly impact  its beneficiaries  to help  them move  more                                                               
independently in the community, she offered.                                                                                    
REPRESENTATIVE  STUTES  asked  whether  Ms.  Baldwin-Johnson  was                                                               
saying  that  the  trust directly  supports  individuals  if  the                                                               
parameters are appropriate.                                                                                                     
MS. BALDWIN-JOHNSON  responded that  the trust has  a mini-grants                                                               
program  that  is  appropriate for  individuals  with  behavioral                                                               
health issues.   In the  event an organization applies  on behalf                                                               
of  that  individual  for  a "specific  thing"  to  support  that                                                               
individual  in living  independently,  or help  to improve  their                                                               
quality of life,  the trust can fund  an individual's beneficiary                                                               
grants,  she  explained.    Although, she  added,  the  funds  go                                                               
through an organization and not directly to an individual.                                                                      
2:27:37 PM                                                                                                                    
REPRESENTATIVE  STUTES surmised  that all  of the  trust's grants                                                               
and  dollars it  expends are  through a  third-party, one  way or                                                               
MS. BALDWIN-JOHNSON answered in the affirmative.                                                                                
2:27:55 PM                                                                                                                    
SARA  MARTIN,  Nursing  Director,  Fairbanks  Memorial  Hospital,                                                               
advised that  she is the  nursing director in the  emergency room                                                               
and the intensive  care unit at Fairbanks Memorial  Hospital.  As                                                               
had been previously testified, she  agreed that there has been "a                                                               
very, very sharp  increase" in patient violence  and acts against                                                               
health care workers in the last two years.                                                                                      
She pointed out that the  Fairbanks Memorial Hospital is there to                                                               
help  provide better  support for  its staff  and increase  their                                                               
feelings  of  security  and recognizing  that  these  things  are                                                               
happening  to them  in their  workplace.   She  advised that  the                                                               
Fairbanks  Memorial Hospital  has put  into place  many different                                                               
additional steps  in trying  to keep its  staff safe  because the                                                               
administration recognizes  that this legislation is  not the only                                                               
answer  to everything  the staff  has gone  through.   Ms. Martin                                                               
added that this  legislation would be a great step  in moving the                                                               
hospital  forward in  helping to  support its  staff and  keeping                                                               
them safe.                                                                                                                      
2:29:03 PM                                                                                                                    
JENNIFER MOORE,  Chief Quality  Officer, Mat-su  Regional Medical                                                               
Center,  advised that  she is  speaking on  behalf of  the Mat-Su                                                               
Regional  Medical  Center, and  that  the  medical center  is  in                                                               
support of HB 312, as it  helps to address the serious concern of                                                               
workplace  violence   in  health   care  facilities.     Alaska's                                                               
hospitals have experienced increased  workplace violence over the                                                               
past  year,  including  assaults and  physical  injuries  against                                                               
caregivers.   As a nurse  for more  than 20-years, she  said that                                                               
she has  personally been punched,  spit on, slapped,  kicked, and                                                               
grabbed so  hard the (audio  difficulties), as well  as countless                                                               
verbal threats, all while attempting  to treat and care for those                                                               
in need  of medical  attention.  Of  note, she  acknowledged that                                                               
she has  never been an emergency  room nurse, but this  abuse not                                                               
only  impacts that  unit because  it  impacts any  and all  units                                                               
within a  hospital.  She  pointed out that the  hospital's nurses                                                               
and providers  have experienced or  witnessed the  same workplace                                                               
violence or  worse, and they  are afraid to  come to work  due to                                                               
their fear  of assault.   Ms. Moore  said that she  remembers the                                                               
day  Dr.  Zinc  was  assaulted  and the  impact  it  had  on  the                                                               
emergency department and throughout  the entire hospital, and its                                                               
health  care workers  need to  know they  are supported  in their                                                               
time of  need especially  when they are  always there  to support                                                               
others in their  time of need.  Violence, she  argued, should not                                                               
be an  acceptable workplace habit,  and yet, for so  many nurses,                                                               
providers, and others, this has  become the new normal.  Clearly,                                                               
she pointed out, legislation is  not the only acceptable solution                                                               
to  this complex  problem and  in order  to successfully  address                                                               
this  problem,  each  facility  must  implement  a  comprehensive                                                               
strategy  (audio difficulties).    The Mat-Su  Medical Center  is                                                               
working  on  a   comprehensive  workplace  violence  preventative                                                               
program  that  includes a  program  called,  "Handle with  Care."                                                               
This program  teaches the  staff how  to de-escalate  a situation                                                               
with  specialized safety  techniques, such  as escape,  blocking,                                                               
and  how to  safely (audio  difficulties) an  aggressive patient.                                                               
This program  also teaches the  staff how to recognize  their own                                                               
tension triggers and how to  reduce personal tension.  The Mat-Su                                                               
Memorial Hospital continually emphasizes  to the staff that their                                                               
safety  is one  of  the  hospital's top  priorities  and it  will                                                               
support them  in whatever manner  they need.   She said  that the                                                               
Mat-Su  Memorial  Hospital  urges  the  committee  to  pass  this                                                               
legislation,  thereby,  sending  a   strong  message  to  nurses,                                                               
physicians, and  other caregivers,  that Alaska takes  this issue                                                               
2:31:15 PM                                                                                                                    
MATT  HALL,  Chief  Human Resources  Officer,  Bristol  Bay  Area                                                               
Health  Corporation, advised  that  the Bristol  Bay Area  Health                                                               
Corporation is in  support of HB 312, and noted  that the Bristol                                                               
Bay Area Health Corporation provides  all health care services in                                                               
the  Bristol   Bay  Region,  which  includes:   medical,  dental,                                                               
behavioral, and  environmental health.   He  added that  its care                                                               
includes a number of communities  around the region where it also                                                               
has  21 clinics.   The  Bristol  Bay Area  Health Corporation  is                                                               
aware that violence is never  an acceptable workplace hazard, and                                                               
he  related that  the  testimonies he  heard  today are  striking                                                               
examples  of   workplace  violence.    There   are  other  tribal                                                               
organizations  in   Nome,  and   the  Bristol  Bay   Area  Health                                                               
Corporation  has medical  providers out  in the  villages in  the                                                               
clinics,  as well.   When  crimes  are committed  in an  isolated                                                               
rural area,  the response time  sometimes does take a  bit longer                                                               
with more  effort, he  remarked.    Basically, he  offered, being                                                               
able  to  have  responders  (audio  difficulties)  fourth  degree                                                               
assault types  of charges and  those types of results  and having                                                               
that  opportunity to  respond far  more  quickly and  efficiently                                                               
would be  a "huge thing  for us."   He noted that  legislation is                                                               
only one  potential solution,  but it  is a  great start  and the                                                               
Bristol  Bay  Area Health  Corporation  welcomes  all avenues  in                                                               
helping its  providers become far  safer.  This region  of Alaska                                                               
is rural  in a land-locked  area and assuring that  its providers                                                               
are safe and  can go home safely  at night in a  small area where                                                               
many people  know each other professionally  and personally, that                                                               
type  of  a  safety  measure  would  be  a  wonderful  thing,  he                                                               
2:33:28 PM                                                                                                                    
REPRESENTATIVE LEDOUX  asked whether the meaning  given to health                                                               
care facility encompasses all of the facilities in rural areas.                                                                 
CHAIR  CLAMAN  explained  that  the statute  covers  all  of  the                                                               
facilities in the  rural areas, the only  two exempted facilities                                                               
under Title 18 are the Pioneer Homes and Alaska Veterans Home.                                                                  
2:34:45 PM                                                                                                                    
DAVID  SCORDINO, MD,  Alaska Regional  Hospital, advised  that he                                                               
supports HB 321 for a  variety of reasons.  (Audio difficulties.)                                                               
He said  that a couple  of months  ago an intoxicated  woman came                                                               
into  the  hospital,  she  did  not  have  a  psychiatric  (audio                                                               
difficulties)  exquisite abdominal  pain, and  she threatened  to                                                               
kill him, the nurses, security, and our families.  (Coughing)                                                                   
CHAIR CLAMAN interrupted  Dr. Sordino to ask whether he  was on a                                                               
speaker phone,  and Dr. Scordino  then advised  that he was  on a                                                               
cell phone.  (Audio difficulties.)                                                                                              
2:35:48 PM                                                                                                                    
DR.  SCORDINO   continued  his  testimony   (audio  difficulties)                                                               
strike, kick,  spit on  all members  of his staff,  but he  had a                                                               
legal obligation  to verify  that she did  not have  an emergency                                                               
medical condition.  The police  were activated but they could not                                                               
do  anything because  he  could  not discharge  her  to them  and                                                               
nothing  ended up  happening.   Ultimately, (audio  difficulties)                                                               
heard   through   all   of  this   is   a   complication   (audio                                                               
difficulties), he  has a  legal obligation,  (audio difficulties)                                                               
obligation because  if he missed  (audio difficulties)  which can                                                               
be a cause of bleeding  (audio difficulties) caused by acting out                                                               
or  bad behavior,  then  he has  missed that.    And, that  legal                                                               
obligation   to  him,   in  his   ability  (audio   difficulties)                                                               
discharging these  individuals without a thorough  evaluation can                                                               
put them in danger and; therefore,  the hospital has to keep them                                                               
sometimes longer than necessary due  to that obligation both from                                                               
a legal perspective  and a financial perspective  for his future.                                                               
(Audio  difficulties)  increased  medical  health  factor  (audio                                                               
CHAIR CLAMAN  asked Dr.  Scordino to email  his remarks  to Chair                                                               
Claman's office due to the audio difficulties.                                                                                  
DR. SCORDINO said he would email his remarks.                                                                                   
2:38:53 PM                                                                                                                    
CHAIR  CLAMAN,  after  ascertaining  no one  wished  to  testify,                                                               
closed public testimony on HB 321.                                                                                              
2:39:26 PM                                                                                                                    
REPRESENTATIVE  LEDOUX asked  why this  bill exempts  the Pioneer                                                               
Homes and the Alaska Veterans Home.                                                                                             
CHAIR  CLAMAN responded  that the  Pioneer Homes  and the  Alaska                                                               
Veterans  Home are  currently exempted  under that  definition of                                                               
health care  facility.  He  advised that more research  is taking                                                               
place as to  why an existing statute is  treated differently than                                                               
every  other medical  facility in  the state  and noted  that the                                                               
answer is unknown at this point.                                                                                                
2:40:04 PM                                                                                                                    
REPRESENTATIVE LEDOUX  surmised that under current  statute, if a                                                               
person  commits  an offense  at  a  Pioneer  Home or  the  Alaska                                                               
Veterans Home,  that person  can be arrested,  and it  takes that                                                               
person out of presumptive sentencing.                                                                                           
CHAIR CLAMAN  responded that  HB 321 allows  a police  officer to                                                               
arrest  the  person  who   allegedly  committed  a  fourth-degree                                                               
assault  offense without  obtaining  a sworn  affidavit from  the                                                               
complainant.  In the event it  was a felony assault anywhere, the                                                               
police officer could arrest the person, he said.                                                                                
He advised  that his  office is looking  into this  issue because                                                               
"what is the  incidence of fourth degree assaults  in the Pioneer                                                               
Homes as  distinct."  For  example, the committee has  only heard                                                               
testimonies  regarding issues  in emergency  rooms and,  he noted                                                               
that  the Pioneer  Homes  and  Alaska Veterans  Home  are not  an                                                               
emergency room  setting even though  the Pioneer Homes  provide a                                                               
degree of medical care.                                                                                                         
2:41:26 PM                                                                                                                    
REPRESENTATIVE LEDOUX surmised  that the bill not  only does what                                                               
Chair Claman described, but it  takes a person out of presumptive                                                               
sentencing.    She   then  referred  to  [HB  321,   Sec.  3,  AS                                                               
12.55.155(c)(36)] page 7, lines 7-14, which read as follows:                                                                    
               (36) the  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;  in                                                                
     this paragraph                                                                                                         
                         (A) "heath  care facility"  has the                                                                
     meaning given in AS 18.07.111;                                                                                         
                         (B)  "medical professional  has the                                                                
     meaning given in AS 12.55.135(k).                                                                                      
REPRESENTATIVE LEDOUX advised  that it takes a person  out of the                                                               
presumptive  sentencing.   The presumptive  sentencing guidelines                                                               
are at  AS 12.55.(c), and  it adds something  else so that  it is                                                               
now the 36th reason to get out of presumptive sentencing.                                                                       
CHAIR CLAMAN advised that those  are actually aggravating factors                                                               
in a felony that gives the court authority ...                                                                                  
REPRESENTATIVE LEDOUX commented that  she realized that, but that                                                               
she sees 36 ways in which  the judge can go above the presumptive                                                               
sentencing, but she did not  see, for example, workplace violence                                                               
for daycare centers.   She then referred  to AS 12.55.155(c)(35),                                                               
which read as follows:                                                                                                          
           (35) the defendant knowingly directed the                                                                            
      conduct constituting the offense at a victim because                                                                      
     that person was 65 years of age or older;                                                                              
REPRESENTATIVE LEDOUX noted  that it does not matter  if a person                                                               
"just slugs  a person who is  80," if the reason  was not because                                                               
the person  was 80  years of  age, and  "someplace else"  it says                                                               
that  a person  should know  about advanced  age.   She suggested                                                               
that  possibly   the  committee   should  re-think  all   of  the                                                               
exceptions   and   do   something  different   with   presumptive                                                               
sentencing.   This is a good  bill, she described, but  she asked                                                               
whether  it  would make  more  sense  to change  the  presumptive                                                               
sentencing guidelines  so that  they are  guidelines, but  that a                                                               
judge  in  their  discretion  may direct  a  sentence  above  the                                                               
guidelines, period.                                                                                                             
2:44:11 PM                                                                                                                    
CHAIR CLAMAN commented that that  is an interesting idea, but the                                                               
intent of  this legislation was  to address the  concerns brought                                                               
forward   by  medical   providers.     While,  he   related,  the                                                               
presumptive  sentencing structure  has  been in  place in  Alaska                                                               
since  1980,  it could  be  critiqued  in  that it  has  received                                                               
different  amendments in  different ways.   Except,  he remarked,                                                               
the sponsors are  not ready to take that on  because the goal was                                                               
to simply identify a specific need.                                                                                             
2:44:39 PM                                                                                                                    
REPRESENTATIVE  EASTMAN  asked  that  law  enforcement  help  the                                                               
committee understand  the gap in arrest  authority currently, and                                                               
what is  it about these  fourth-degree assault type  charges that                                                               
causes difficulty in arresting.                                                                                                 
2:46:01 PM                                                                                                                    
DAN  LOWDEN,  Captain,  Alaska  State  Troopers,  responded  that                                                               
essentially, law  enforcement is  allowed to arrest  for felonies                                                               
not  committed in  the presence  of law  enforcement if  there is                                                               
probable  cause.    However,  he added,  if  law  enforcement  is                                                               
dealing  with  a  misdemeanor  offense,  that  person  cannot  be                                                               
arrested  without  a warrant  if  it  was  not committed  in  the                                                               
presence of  law enforcement.   As the  committee is  well aware,                                                               
there are  exceptions for domestic violence,  assaults, DUIs, and                                                               
so forth.   Therefore, he pointed out, the gap  this bill appears                                                               
to address is  with regard to a misdemeanor  offense wherein many                                                               
times  law  enforcement  does  not witness  the  offense  in  the                                                               
emergency room and arrives after the  fact.  This bill would give                                                               
law  enforcement the  authority, as  in DUIs,  domestic violence,                                                               
and assault, to arrest someone  for this misdemeanor assault that                                                               
was  not  committed  in  the  presence  of  law  enforcement,  he                                                               
2:47:32 PM                                                                                                                    
REPRESENTATIVE  EASTMAN asked  whether the  ability to  arrest in                                                               
these types of fourth-degree assaults  would be beneficial to law                                                               
enforcement outside of a health care setting.                                                                                   
CAPTAIN DAN  LOWDEN answered that  most law  enforcement officers                                                               
would appreciate  being able to  arrest for most  misdemeanors at                                                               
any time necessary.                                                                                                             
2:48:15 PM                                                                                                                    
REPRESENTATIVE  REINBOLD commented  that  if the  intent of  this                                                               
legislation  is to  make an  assault to  a health  care worker  a                                                               
felony, then this bill is unnecessary.                                                                                          
CAPTAIN DAN LOWDEN  commented that if the  committee made assault                                                               
on  a  health care  worker  a  felony,  this  bill would  not  be                                                               
necessary to  address the issue it  is trying to address,  but it                                                               
is a policy call for the legislature.                                                                                           
2:49:09 PM                                                                                                                    
REPRESENTATIVE  REINBOLD asked  the  bill  sponsors whether  they                                                               
would accept an amendment allowing for  a felony on an assault of                                                               
a  health  care worker  because  it  appeared more  logical  than                                                               
having a bill.                                                                                                                  
REPRESENTATIVE KOPP responded  that a felony assault  on a health                                                               
care  worker can  and  does occur  currently,  even without  this                                                               
bill.   He pointed out  that the previously  described strangling                                                               
offense is at  least a felony assault, and  possibly that assault                                                               
should  have been  charged as  attempted murder.   On  a domestic                                                               
violence  offense,  strangling  often  is  charged  as  attempted                                                               
murder and  this bill would  not change any of  those provisions.                                                               
This bill, he explained, amends the  law so that on a misdemeanor                                                               
assault  where there  is  no serious  physical  injury, there  is                                                               
still  an   injury  because  there   is  real  fear,   which  was                                                               
articulated to  the committee.   Those types of assaults  now can                                                               
be arrested  without a warrant,  this legislation relates  to the                                                               
lower level of assaults.  He  noted that the committee could make                                                               
a policy  call and  make every  assault a  felony.   Although, he                                                               
said,  when considering  that  the ultimate  goal  is to  protect                                                               
health  care workers,  accountability, (audio  difficulties) want                                                               
there to  be an immediate  consequence.  The sponsors  are trying                                                               
to achieve  the right balance  wherein the bill  simply addresses                                                               
the  lower level  misdemeanor assault  wherein an  arrest can  be                                                               
made without a warrant, which  leaves the health care environment                                                               
safe to continue to work.                                                                                                       
REPRESENTATIVE  REINBOLD noted  that currently,  assaults in  the                                                               
first, second, and third degree  are felony assaults, and assault                                                               
in  the fourth  degree is  a  misdemeanor.   This bill  basically                                                               
allows law  enforcement to arrest  for fourth degree  assaults of                                                               
health care workers, which is important, she said.                                                                              
2:51:27 PM                                                                                                                    
REPRESENTATIVE KREISS-TOMKINS surmised  from the testimonies that                                                               
emergency  rooms are  more of  a dumping  ground for  undesirable                                                               
people  who  are  not in  a  condition  to  be  in society.    He                                                               
commented that perhaps  there is a need for  enhanced drunk tanks                                                               
for those  who are incredibly  drunk or high  to sleep it  off or                                                               
let  it wear  off.   While recognizing  there has  been a  recent                                                               
increase in  drug and alcohol abuse,  he asked how the  state has                                                               
gotten   to   this   point  and   requested   an   off-the-record                                                               
conversation or further testimony regarding his question.                                                                       
CHAIR CLAMAN  recommended that  the folks  with thoughts  on that                                                               
subject to follow up with Representative Kreiss-Tomkins.                                                                        
CHAIR CLAMAN referred  to the indeterminate fiscal  note from the                                                               
Alaska Psychiatric  Institute (API), and noted  to Randall Burns,                                                               
Division  of Behavioral  Health,  that the  fiscal note  suggests                                                               
this  bill would  increase  the need  for  competency exams  when                                                               
allowing  for  an arrest  without  a  warrant  in a  health  care                                                               
facility for  fourth-degree assault.   He asked how often  in the                                                               
last five-years  has API had  to perform a  competency evaluation                                                               
on someone charged with fourth degree assault in any location.                                                                  
2:54:19 PM                                                                                                                    
RANDALL   BURNS,  Director,   Division   of  Behavioral   Health,                                                               
Department of  Health and Social Services  (DHSS), responded that                                                               
he was not aware of the  number of competency evaluations off the                                                               
top of  his head.   The major concern,  he related, is  that this                                                               
bill  may create  a  situation wherein  a  significant number  of                                                               
additional  individuals would  claim their  mental illness  was a                                                               
contributor to their arrest, thereby,  creating a situation where                                                               
even   more  competency   evaluations   were   required.     More                                                               
importantly,  he  added,  if  the  individual  was  found  to  be                                                               
incompetent, then  being asked to  perform more restoration.   He                                                               
commented  that,   obviously,  API   and  its   staff  completely                                                               
understand  the  injuries  and   the  situations  other  hospital                                                               
nursing staff  are under, and  he opined  that "As long  as we're                                                               
able to  put on the  record now that  we are concerned  about the                                                               
potential  ramifications  on  the forensic  capabilities  of  the                                                               
department and the  division, that we would submit  a fiscal note                                                               
for now because  there obviously is very little  data coming from                                                               
the hospital to assist us in  reaching what might actually be the                                                               
results in  the next year."   He related that that  is the reason                                                               
for the indeterminate fiscal note,  and he believes it would make                                                               
sense  to  submit  a  zero   fiscal  with  the  disclaimer  that,                                                               
depending  on  the  increase,  they   may  have  to  then  submit                                                               
additional budget support in the coming fiscal year.                                                                            
CHAIR CLAMAN  offered concern that  the questions  are legitimate                                                               
but  that  the  actual  number  of  misdemeanor  cases  in  which                                                               
competency exams are  performed are quite small  and, in speaking                                                               
with  others, most  of the  competency evaluations  involve folks                                                               
charged with  more serious crimes.   This bill does not  make any                                                               
more serious  crimes, it simply gives  law enforcement additional                                                               
arresting authority, he pointed out.                                                                                            
[The committee treated public testimony on HB 312 as closed.]                                                                   
[HB 312 was held over.]                                                                                                         

Document Name Date/Time Subjects
HB312 ver O 2.5.18.PDF HJUD 2/5/2018 1:30:00 PM
HJUD 2/7/2018 1:00:00 PM
HB 312
HB312 Sponsor Statement 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Sectional Analysis ver O 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Additional Document-EMTALA Interpretive Guidelines - Stable for Discharge Definition 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Supporting Document-Letters of Support 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Supporting Document-Teamsters Local 959 Letter 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Supporting Document-Fairbanks Memorial Hospital Letter 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Supporting Document-Alaska Regional Hospital Letter 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Fiscal Note LAW-CRIM 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB312 Fiscal Note DHSS-API 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 312
HB129 ver D 1.29.18.pdf HJUD 2/5/2018 1:30:00 PM
HJUD 2/7/2018 1:00:00 PM
HJUD 2/9/2018 1:00:00 PM
HB 129
HB129 Additional Document-ACS FY18 Q2 Collections Memo 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 129
HB129 Fiscal Note DPS-AWT 1.29.18.pdf HJUD 1/29/2018 1:30:00 PM
HJUD 1/31/2018 1:30:00 PM
HJUD 2/5/2018 1:30:00 PM
HB 129
HB129 Updated Fiscal Note DFG-CO 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 129
HB129 Fiscal Note DOA-SSOA 2.5.18.pdf HJUD 2/5/2018 1:30:00 PM
HB 129