Legislature(2009 - 2010)BELTZ 211

04/08/2009 01:30 PM Senate HEALTH & SOCIAL SERVICES

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Heard & Held
Heard & Held
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Heard & Held
            SB  66-MENTAL HEALTH PATIENT GRIEVANCES                                                                         
1:37:01 PM                                                                                                                    
CHAIR DAVIS announced consideration of SB 66.                                                                                   
1:37:13 PM                                                                                                                    
TOM OBERMEYER,  staff  to Senator  Davis, sponsor  of SB 66,  read                                                              
the sponsor  statement. He  explained that SB  66 replaces  a one-                                                              
paragraph   mental    health   grievance   procedure    under   AS                                                              
47.30.184(7)   with  a   much  more   comprehensive  process.   It                                                              
recognizes   and   protects  to   a   much  greater   extent   the                                                              
constitutional right  of due process  to an aggrieved  patient who                                                              
is  undergoing  treatment  at  a   public  or  private  evaluation                                                              
facility or mental health unit.                                                                                                 
Because  of   the  exceptional  circumstances  under   which  such                                                              
patients are  admitted and treated,  due process  requires special                                                              
safeguards. SB 66  provides a reasonable opportunity  for informal                                                              
or  formal  resolution  of  concerns  or  grievances  with  timely                                                              
written  complaints,  responses  and appeals,  department  review,                                                              
maintenance  of records  and reporting.  It covers  all state  and                                                              
private mental health  facilities or hospital mental  health units                                                              
licensed   in  this   state.  New   procedure  requires   detailed                                                              
complaint  forms,  written answers  by  an impartial  body  within                                                              
five days,  three levels  of appeal  including response  to urgent                                                              
grievances  within  24 hours.  The  timelines are  strict  because                                                              
many patients  are only in mental  health facilities for  a matter                                                              
of  days  and  grievances  or  appeals   cannot  be  heard  before                                                              
discharge. A  grievance may be filed  at any time, but  there is a                                                              
statutory  limitation  of year  after  being discharged  from  the                                                              
facility or unit.                                                                                                               
1:38:39 PM                                                                                                                    
SB 66  provides notice of  the grievance procedure  upon admission                                                              
to  the facility,  easy access  to  grievance forms  and a  secure                                                              
complaint box in  which to deposit the forms. The  contents of the                                                              
complaint box  are to be read each  day, and the original  copy of                                                              
the form  must be kept  in the patient  record. The  department is                                                              
charged with  reviewing all  grievances and responses.  Facilities                                                              
and units  must file quarterly reports  of the number and  type of                                                              
grievance  and   the  resolution   including  litigation.   SB  66                                                              
prevents mental  health facilities  or units from  "front loading"                                                              
or asking  patients to  go through  an informal complaint  process                                                              
before  filing a grievance.  In  this way grievances  in the  past                                                              
were reportedly were  seldom heard and there is  no written record                                                              
of a grievance on which to file an appeal.                                                                                      
The  bill  allows  for personal  representatives  to  act  in  the                                                              
interest  of the  patient  in the  grievance  process  as well  as                                                              
providing  an appointed  patient  advocate  in the  mental  health                                                              
facility or unit.                                                                                                               
He  noted that  the  department sent  over  some suggestions  that                                                              
include  adding a  definition of  "grievance."  He said  typically                                                              
there is  no record  of what is  going on and  many of  the people                                                              
who are  involved in  the process are  denied due process  because                                                              
they  are mentally  ill. He  explained that  due process  involves                                                              
deprivation  of life, liberty  or property,  and the main  problem                                                              
here  is a  lack of  liberty,  particularly  in those  who are  in                                                              
forced  civil commitments.  The  department  has  said maybe  this                                                              
bill  should  only  apply  to  those,   but  they  are  trying  to                                                              
recognize that  this state  doesn't have  a procedure  or standard                                                              
form  that allows  these  patients to  have  routine issues  dealt                                                              
with in a timely way.                                                                                                           
Finally, three  levels of appeal have  been set up. The  first two                                                              
levels go up to  the commissioner; no response is  needed. If they                                                              
want to  appeal to  the third level  - the administrative  hearing                                                              
officer, the  department is  asked to  intervene. This  means that                                                              
the  hearing  officer would  make  a  determination, and  then  it                                                              
would be  turned over to the  commissioner to accept or  make some                                                              
other  determination. At  that point,  the administrative  process                                                              
is  over  and  the  next  step  would  be  court.  This  does  not                                                              
anticipate  that  the  process  of criminal  law  will  not  apply                                                              
should the police  be called, but it ensures that  there will be a                                                              
record of what goes on throughout the process.                                                                                  
1:42:51 PM                                                                                                                    
SENATOR PASKVAN  moved to adopt the proposed  committee substitute                                                              
(CS)  to SB  66, labeled  26-LS0239\E,  as  the working  document.                                                              
There being no objection, version E was before the committee.                                                                   
SENATOR ELLIS joined the meeting.                                                                                               
1:44:07 PM                                                                                                                    
CHAIR  DAVIS asked  Mr. Obermeyer  to explain  the changes  in the                                                              
MR. OBERMEYER  said essentially  the CS ties  up some  loose ends.                                                              
"Formal grievance"  was replaced with "grievance" on  page 2, line                                                              
2, and  "written" was  added before  "notice" on  page 3,  line 2,                                                              
and "appeal"  before "procedure" on line  9. On page 3,  lines 12-                                                              
14  added  "a  written  response  to the  grievance  on  the  form                                                              
required by one  of the subsection within five  days after receipt                                                              
of the grievance and after each level of requested review."                                                                     
The written response  is supposed to include a list  of options to                                                              
resolve  the  grievance  including   a  level-3  appeal.  It  also                                                              
changed  the  time  frame  to  appeal   from  20  days  to  30  in                                                              
subsection 5(c)  on page 3, line  30. Page 4, lines 1-4  adds "the                                                              
hearing officer  shall make  findings and  recommendations  to the                                                              
commissioner  who  shall  make  a final  written  decision  on  or                                                              
before   the  5    day   after  the   commissioner  receives   the                                                              
recommendations."  This is to give  the department  an opportunity                                                              
to  resolve  the  matter  at  the  lowest  level,  and  if  it  is                                                              
determined it can't be resolved the patient can go to court.                                                                    
MR.  OBERMEYER  said  that  the  hearing  process  has  many  more                                                              
formalities and  it is truly an  independent body. One  of the big                                                              
concerns   in  the  process   is  that   impartiality  is   almost                                                              
impossible  unless  you  do get  to  an  impartial  administrative                                                              
hearing  officer;  however,  the  biggest  problem  is  that  most                                                              
grievances are not  ever heard and there is no  documentation that                                                              
they ever occurred.                                                                                                             
1:47:56 PM                                                                                                                    
MR.  OBERMEYER  said language  on  page  5,  lines 6-7,  says  the                                                              
facility  or  unit shall  make  a  good  faith  effort to  mail  a                                                              
response  to  a  grievant  that   has  been  discharged  from  the                                                              
facility. The facility  is defined to mean "hospital  or clinic in                                                              
which mental health  patients receive evaluation  or treatment and                                                              
for which public  funds are provided" on page 5,  line 26. Page 6,                                                              
lines  2-3 describes  a unit as  "a discrete  portion of  facility                                                              
dedicated  to  the  treatment  or   evaluation  of  mental  health                                                              
1:50:07 PM                                                                                                                    
BRENDA  KNAPP,  Program  Administrator,  Treatment  and  Recovery,                                                              
Division  of Behavioral Health,  Department  of Health and  Social                                                              
Services  (DHSS), said  they support  the spirit  of the bill  and                                                              
share  the  legislature's  desire  to ensure  that  mental  health                                                              
patients  in the  state are  treated  fairly, receive  appropriate                                                              
treatment  and  that their  concerns,  when  they have  them,  are                                                              
heard. But  they do have  some concerns  with the bill  as written                                                              
and those are in a memo.                                                                                                        
She  advised  that  first  of all,  there  are  already  grievance                                                              
policies  in   place.  Certainly  the  hospital   facilities  with                                                              
designated evaluation  and treatment facilities  and stabilization                                                              
facilities  are  all  accredited   by  the  joint  commission  are                                                              
required to have  and follow grievance procedures.  But within the                                                              
community system, which  would also be impacted by  this bill, any                                                              
grantee is  required as part of  their RFP procedure to  provide a                                                              
copy of  their grievance procedure  for consumer  complaints. That                                                              
has  to  be approved  by  the  department  in  order for  them  to                                                              
receive  funding.  She said  her  experience  is that  having  the                                                              
grievances resolved  at the  lowest level does  work. If  it can't                                                              
be resolved,  the department is  already required in  AS 47.36.060                                                              
to investigate and  respond to complaints made by a  patient or an                                                              
interested party on behalf of a patient.                                                                                        
Although the current  bill sets forth some new  requirements - one                                                              
of  them  being  the  three  levels of  review  -  the  third  one                                                              
requiring department  intervention,  it does nevertheless  require                                                              
that  copies of  all  grievance activity  and  the resolutions  of                                                              
those complaints  be provided to  the department. This would  be a                                                              
huge  volume  of  documentation,   and  the  department  would  be                                                              
required to review  all grievance documents that  are provided for                                                              
compliance with the section.                                                                                                    
1:53:41 PM                                                                                                                    
MS. KNAPP said  although they might only be required  to intervene                                                              
on  the  third   level,  all  levels  would  require   review  for                                                              
compliance.  Certainly if  something  was found  to be  mishandled                                                              
they would have  an obligation to investigate and  follow through.                                                              
So it  raises a  level of work  for the  department that  has been                                                              
handled at the  local level. They deal mostly  in communities with                                                              
non-profits  or with  municipal or  tribal entities  that do  have                                                              
their  own  governing boards  where  grievances  of any  sort  are                                                              
resolved. "We have that that works."                                                                                            
The  bill   also  requires  a  specific   form  to  be   used  for                                                              
grievances. At this  time the community programs have  to design a                                                              
form  and submit  it  to the  department  for  approval. They  are                                                              
given  models they  can use and  have some  latitude within  their                                                              
own structure to  tailor it to their own needs as  long as some of                                                              
the core  elements are there.  Certainly the Joint  Commission has                                                              
standards  regarding  what  the  grievance  procedure  and  policy                                                              
would  look like  for the  inpatient facilities.  The state  would                                                              
like  to move  toward accreditation  of  community facilities  but                                                              
that represents a lot of money to providers.                                                                                    
Another concerning  aspect of the bill is the  broad definition of                                                              
grievance.  Currently  it is  a  concern or  a  complaint that  is                                                              
unresolved. This  bill broadens it to include  "suggestions" which                                                              
widens the arena. It is too broad.                                                                                              
1:56:37 PM                                                                                                                    
MS. KNAPP  pointed out  that there are  other venues  for patients                                                              
and  recipients  of  community based  services  to  express  their                                                              
concerns without having  to fill out a form and wait  for a formal                                                              
procedure - organizations  such as the State Mental  Health Board,                                                              
the  Mental Health  Trust Authority,  the  Disability Law  Center,                                                              
Office  of Public  Advocacy and  the Ombudsman.  She concluded  by                                                              
saying they  are very willing to  work with the committee  on this                                                              
1:58:29 PM                                                                                                                    
CHAIR  DAVIS  asked  how  many grievances  have  come  before  the                                                              
department per year.                                                                                                            
MS. KNAPP  answered probably about  five actual grievances  in the                                                              
past five years.                                                                                                                
CHAIR DAVIS asked if that doesn't seem odd to her.                                                                              
1:59:10 PM                                                                                                                    
MS. KNAPP  said that  was not surprising,  because she  has worked                                                              
in the  community system for many  years and knows  how grievances                                                              
are handled.  It doesn't  surprise her that  they are  resolved at                                                              
the  level  in  which  they  occur.  If  a  grievance  involves  a                                                              
criminal act, of course, it is referred to law enforcement.                                                                     
SENATOR DYSON said  he thought this bill changes  what "grievance"                                                              
means and that more things might fall into it now.                                                                              
MS. KNAPP agreed.                                                                                                               
SENATOR DYSON  asked her to help  him understand the down  side of                                                              
this from the department's perspective.                                                                                         
MS. KNAPP  said if grievances can  be successfully handled  at the                                                              
level at  which they occur, it  seems appropriate to do  that, and                                                              
to  require  that  the  department  be  copied  on  all  documents                                                              
surrounding   that  seems  like   an  unnecessary   administrative                                                              
burden. They want staff to focus on real problems.                                                                              
SENATOR  DYSON   asked  if,   in  her   profession,  there   is  a                                                              
possibility    of    people   using    the    grievance    process                                                              
inappropriately out of spite.                                                                                                   
MS. KNAPP  replied that is true  in any field, but  all complaints                                                              
merit review.                                                                                                                   
2:03:16 PM                                                                                                                    
SENATOR DYSON asked  since she said she appreciated  the spirit of                                                              
the legislation  if she was  inferring that improvements  could be                                                              
made to the system.                                                                                                             
MS.  KNAPP said  that if  there is  the perception  of a  problem,                                                              
there is  a problem. So  it is important  to look at  the concerns                                                              
of  those who  perceive  the problem  and  find  what the  reasons                                                              
might be.                                                                                                                       
SENATOR  DYSON  asked  if  this department  had  been  audited  in                                                              
regard to this issue in recent history.                                                                                         
MS. KNAPP said she did not know.                                                                                                
CHAIR DAVIS asked her to find out.                                                                                              
CHAIR  DAVIS  said  Jean  Mischel,   drafting  attorney  for  this                                                              
legislation,  and they  should ask  her to address  the change  in                                                              
definition of "grievance" with her.                                                                                             
2:05:41 PM                                                                                                                    
MR. OBERMEYER  commented  that the definition  of "grievance"  was                                                              
intentionally  put into  the statute  because many  of the  issues                                                              
that  come before  these facilities  are often  changed from  what                                                              
might be a grievance  to a suggestion or a complaint.  So it gives                                                              
the facility  the opportunity to  talk the individual out  of what                                                              
they are  doing. This  recognizes the  problem of "front  loading"                                                              
and making a grievance disappear.                                                                                               
2:07:39 PM                                                                                                                    
JEAN  MISCHEL,  Attorney,  Legislative Legal  Services,  said  the                                                              
definition used  here is  very broad. Alaska  statue has  no other                                                              
definition of grievance;  so lacking that, the  courts would apply                                                              
the dictionary  definition. This change  goes beyond that,  and it                                                              
is a policy call for the legislature.                                                                                           
2:09:10 PM                                                                                                                    
JAMES  GOTTSTEIN,  President/CEO,   Law  Project  for  Psychiatric                                                              
Rights  (Psych Rights),  said he  was on the  Mental Health  Board                                                              
and strongly supported  SB 66. The board pushed  through standards                                                              
for grievances  and he wrote a letter  to the Chair on  2/16/09 on                                                              
this issue. He  said the administration didn't  appreciate the way                                                              
mental health  clients are marginalized  just by  being classified                                                              
as  mental health  clients.  So  whatever they  do  can easily  be                                                              
dismissed and  disregarded unless safeguards  are in place.  So it                                                              
is very important that this bill puts those safeguards in place.                                                                
Also, when he was  still on the board they pushed  for putting the                                                              
requirements  they   had  negotiated  with  the   department  into                                                              
regulations so that they would be more permanent.                                                                               
In   line  with   what   he  said   before   about  people   being                                                              
marginalized,  they  are  often   really  coerced  into  accepting                                                              
things,  and that's  another  reason why  there  really should  be                                                              
oversight of the process.                                                                                                       
MR.  GOTTSTEIN said  it  is  interesting that  the  administration                                                              
would complain  about the  huge amount of  paperwork if  this were                                                              
enacted  and at  the  same  time say  that  there  were only  five                                                              
grievances in  five years. It strains  credulity to say  only five                                                              
grievances  were  unresolved to  the  satisfaction  of clients  in                                                              
five years.  He thought  the current  process was suppressing  the                                                              
elimination of the problems that are going on.                                                                                  
2:13:24 PM                                                                                                                    
FAITH MEYERS, speaking  for herself, supported SB  66. The current                                                              
psychiatric  patient grievance  procedure  statute, AS  47.30.847,                                                              
does  not adequately  protect  patients and  their  rights.{ As  a                                                              
former psychiatric  patient, she said  she had been in  acute care                                                              
psychiatric   facilities,  evaluation   units  and  had   received                                                              
treatment as  an out-patient.  As an advocate,  she has  talked to                                                              
former  psychiatric   patients   and  their  newsletter   includes                                                              
results  of  a  recent  survey  that  shows  dissatisfaction  with                                                              
current psychiatric patient procedures.                                                                                         
She  stated that  10  different  categories of  clients  receiving                                                              
services from  the DHSS who are  not satisfied can file  an appeal                                                              
with the  department or with  an administrative law  judge. Alaska                                                              
may  be  the  only  state  that   does  not  allowing  psychiatric                                                              
patients to  file an  appeal to a  higher level. Even  individuals                                                              
in prisons  or jails  can file  an appeal  with the Department  of                                                              
Corrections, but  as of now all  psychiatric patients do  not have                                                              
a  clear  path   to  file  an  appeal  either  with   DHSS  or  an                                                              
administrative law judge. Either would be acceptable.                                                                           
MS.  MEYERS  said  the loopholes  in  the  current  statute  allow                                                              
psychiatric  facilities to  deny patients  their right  to file  a                                                              
grievance  at the time  of their  choosing. It  is important  that                                                              
patients receive  a written  copy of  the grievance procedure  and                                                              
associated rules,  get a written  response in a timely  manner, be                                                              
able to  file a grievance  when they choose  instead of  having to                                                              
through  the   facility  informal  complaint   resolution  process                                                              
first, be able  to appeal to a higher authority  when dissatisfied                                                              
with the  resolution, and  to have  grievance reporting  that will                                                              
be  looked at  by more  than one  person  within 24  hours for  an                                                              
emergency grievance. These are all rights given by SB 66.                                                                       
2:17:40 PM                                                                                                                    
DARENCE  COLLINS,  representing   himself,  supported  SB  66.  In                                                              
Maine,  he  said,  people  sued their  DHSS  equivalent  to  force                                                              
improvements   in   the  state   psychiatric   patient   grievance                                                              
procedure. In  the state of  Georgia, the legislature  stepped in,                                                              
in 2008 and revised  the grievance procedure statute  after it was                                                              
shown   that  their   equivalent   of   DHSS  was   not   properly                                                              
investigating  psychiatric patient  complaints or keeping  records                                                              
of them.                                                                                                                        
At ease at 2:18 p.m.                                                                                                            
MR. COLLINS  said the Alaska  Psychiatric Institute (API)  that is                                                              
managed by  DHSS in a 2006  report showed 256 complaints  filed by                                                              
patients  in  a   12-month  period;  not  one   was  considered  a                                                              
grievance, and not  one person received a written  response, which                                                              
is  a federal  requirement.  The loophole  and  inadequacy in  the                                                              
current  grievance  procedure statute  allowed  API  to treat  all                                                              
complaints informally.  He enumerated complaints  included safety,                                                              
sexual abuse,  and medications.  API has  made some  improvements,                                                              
but nothing  stops them from  going back  to their old  habits and                                                              
50 other facilities are still doing the same type of thing.                                                                     
2:22:19 PM                                                                                                                    
MR.  COLLINS said  two reports  from the  Ombudsman's Office  were                                                              
critical of  DHSS because  they did not  want to keep  statistics.                                                              
SB  66 will  require  DHSS to  keep  statistics.  The same  report                                                              
indicated that DHSS  has not investigated a  psychiatric complaint                                                              
in  many years  even  though they  are  required to  do  so by  AS                                                              
47.30.660.   The   department   cannot   by   law   delegate   its                                                              
responsibility of  investigating a  patient's complaint to  a non-                                                              
state entity,  but that  is exactly  what DHSS  is doing.  He said                                                              
that   revising  and   updating   psychiatric  patient   procedure                                                              
statutes is a national trend as is making them uniform.                                                                         
2:25:08 PM                                                                                                                    
SENATOR  PASKVAN asked  if  an internal  peer  review process  had                                                              
been performed at API, which is confidential.                                                                                   
RON ADLER, Director,  Alaska Psychiatric Institute,  Department of                                                              
Health  and Social  Services (DHSS),  said,  "We are  always in  a                                                              
continuous   state  of   continuous   quality  improvement."   All                                                              
complaints  and grievances  are  review by  both  himself and  the                                                              
medical  director;  they  have   a  Patients'  Rights  and  Ethics                                                              
Committee that  reviews these  and looks  at trends and  documents                                                              
them as  they are relevant.  The medical staff  at API has  a peer                                                              
review process that is confidential.                                                                                            
SENATOR  PASKVAN  asked how  many  of  those processes  have  been                                                              
completed on average per year.                                                                                                  
MR. ADLER responded that he could get that data for him.                                                                        
SENATOR  PASKVAN  said  he  wanted  to  see  if  any  of  the  256                                                              
complaints were addressed in the 2006 review.                                                                                   
MR. ADLER stated  that API deals with a number of  people who have                                                              
disturbances  of thoughts, and  he takes  exception to  anyone who                                                              
says  x  number  of  people  complain   of  sexual  misconduct  or                                                              
violence,  whatever. That  is just  the  kind of  thing they  hear                                                              
from  people who  are  incapacitated at  time  of admission.  Once                                                              
they  stabilize,   they  will  frequently  either   retract  their                                                              
complaint  or  not  acknowledge  that  it  was  going  on  out  of                                                              
2:29:34 PM                                                                                                                    
CHAIR DAVIS asked him to provide that information to her office.                                                                
SENATOR  DYSON asked  when  someone  has been  involuntarily  been                                                              
committed, has a guardian ad litem been appointed.                                                                              
MR. ADLER  answered that a "court  visitor" and a  public defender                                                              
come in and work  with the patient and represent  him in any legal                                                              
proceedings   that  are   relevant   to  commitment   status   and                                                              
medication orders.                                                                                                              
SENATOR DYSON  said he worries about  an organization that  is far                                                              
less professional  than API,  that is  just warehousing  folks and                                                              
may not  be properly caring for  people. If that  organization was                                                              
not  being professional,  how would  an outside  person ever  find                                                              
out and "blow the whistle?"                                                                                                     
2:31:40 PM                                                                                                                    
MR.  ADLER replied  that  the federally  funded  authority in  the                                                              
state  is the  Disability  Law  Center  that is  headquartered  in                                                              
Anchorage,  but has  offices  in Juneau  and  Fairbanks. They  are                                                              
very  active  with   API;  their  telephone  number   is  at  each                                                              
treatment unit,  and if  there is any  allegation of  violation of                                                              
human  rights they  are quick  to  investigate. The  scope of  the                                                              
Center's  authority goes  beyond that  of the  state hospital  and                                                              
includes the private sector.                                                                                                    
SENATOR DYSON asked  who has oversight of conduct at  the 50 other                                                              
MR. ADLER responded  that his impression is that Alaska  is a very                                                              
small state; the  Mental Health Board conducts  quarterly meetings                                                              
in various  parts of  the state  and spends a  great deal  of time                                                              
taking public  testimony and/or  holding town  halls to  get input                                                              
from  the  local  constituents  to  see  how  the  system  can  be                                                              
improved.  It's always  been amazing  to  him when  a consumer  of                                                              
services  makes  a  statement that  things  aren't  right  without                                                              
going into detail.  And then after testimony has  closed, a number                                                              
of people  who are  involved in  the system  engage the  person to                                                              
see  what is  wrong  and a  subcommittee  is  established to  make                                                              
changes. That is  the same process that started  when Faith Meyers                                                              
brought complaints about her treatment at API.                                                                                  
MR.  ADLER  said he  thinks  Alaska  has  a very  transparent  and                                                              
collaborative  process;  it is  very  difficult  for any  type  of                                                              
misconduct  to occur.  The things  that  need to  be changed  have                                                              
already  been   changed  through   a  process  of   oversight  and                                                              
collaboration  through the  variety  of stakeholder  meetings  and                                                              
public testimonies that go on throughout the year.                                                                              
2:35:32 PM                                                                                                                    
MS.  KNAPP added  that within  the community  system of  50 or  so                                                              
grantee programs,  these  are voluntary programs;  people  are not                                                              
"committed"  to them.  If  a person  is  deemed  not competent  to                                                              
manage her  own affairs,  a guardian would  be appointed.  If they                                                              
might be  a danger  to themselves  they might  be committed  for a                                                              
period  of time  so  they are  not  actually  locked down.  Family                                                              
members are often the guardians.                                                                                                
2:36:53 PM                                                                                                                    
SENATOR DYSON  said the inference is  that some of the  people who                                                              
are  complaining, if  indeed  it  was bad,  they  could leave.  He                                                              
assumed that people  who are involuntarily committed  are not free                                                              
to leave.                                                                                                                       
MS.  KNAPP  replied  yes;  that  would  be  if  they  are  in  the                                                              
psychiatric unit  under commitment at Bartlett Hospital,  which is                                                              
the  designated  evaluation and  treatment  facility.  But at  the                                                              
community  program like  Juneau  Alliance for  Mental Health  they                                                              
are free to leave.                                                                                                              
SENATOR  PASKVAN asked  if the results  of the  medical review  or                                                              
joint accreditation are confidential.                                                                                           
MR. ADLER  answered that  the joint  commission review  is public;                                                              
the peer and medical reviews are confidential.                                                                                  
2:38:52 PM                                                                                                                    
CHAIR  DAVIS  asked Ms.  Knapp  for  a  list  of grantees  and  to                                                              
identify  the  levels  of  care   provided  by  the  grantees  and                                                              
hospitals.  She  advised  that  the bill  will  probably  not  get                                                              
another  hearing this  session,  but she  was going  to appoint  a                                                              
subcommittee.  Her  feeling is  that  there is  a  reason for  the                                                              
bill, and  she appreciated  the department's  willingness  to work                                                              
with her on it.                                                                                                                 
MS. KNAPP agreed.                                                                                                               
SENATOR DYSON asked for any audits.                                                                                             
2:41:19 PM                                                                                                                    
CHAIR  DAVIS  said  if  one wasn't  available,  she  may  have  to                                                              
request  one.  She closed  public  testimony  and  held SB  66  in                                                              

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