Legislature(2017 - 2018)BELTZ 105 (TSBldg)

03/19/2018 01:30 PM JUDICIARY

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSSB 122(JUD) Out of Committee
Moved HB 312 Out of Committee
-- Public Testimony --
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
          HB 312-CRIMES AGAINST MEDICAL PROFESSIONALS                                                                       
1:49:51 PM                                                                                                                    
CHAIR   COGHILL  reconvened   the  meeting   and  announced   the                                                               
consideration of HB 312. He opened public testimony.                                                                            
1:50:47 PM                                                                                                                    
DAWN ELLIOTT,  Emergency Room  Nurse, Providence  Medical Center,                                                               
Anchorage, Alaska, testified  in support of HB 312.  She said the                                                               
emergency  room at  Providence sees  about  70,000 patients  each                                                               
year.  Health care  workers seldom  hear thank  you but  physical                                                               
violence, verbal  abuse, and  being treated  like garbage  is the                                                               
norm.  Every day  she fears  another assault.  She described  the                                                               
last  assault   she  experienced  to  demonstrate   the  lack  of                                                               
accountability. She opined  that there needs to  be immediate and                                                               
lifelong  consequences for  individuals who  assault health  care                                                               
1:52:22 PM                                                                                                                    
CHUCK  BILL, CEO,  Bartlett  Regional  Hospital, Juneau,  Alaska,                                                               
testified in support  of HB 312. He described  the legislation as                                                               
an important component to protect  staff from workplace violence.                                                               
The  violence in  hospitals  has increased  50  percent the  last                                                               
couple of years. He described  an incident this past weekend when                                                               
three security guards and one  nurse were assaulted. The hospital                                                               
has  implemented several  safety  measures such  as doubling  the                                                               
security  workforce and  extensive training  on deescalating  and                                                               
avoiding  these   situations.  HB   312  will  help   the  police                                                               
department to  better partner  with staff  when needed.  He urged                                                               
passage of the bill without amendment.                                                                                          
1:54:35 PM                                                                                                                    
AMBER MICHAEL,  Legislative Chair, Alaska Nurses  Association and                                                               
registered nurse,  Fairbanks, Alaska, testified in  support of HB
312. She said  the threat of violence on health  care workers and                                                               
other  staff occurs  in  all areas  of the  hospital  on a  daily                                                               
basis. It ranges  from hitting and spitting to  gun violence. The                                                               
lack  of  power that  the  police  have  in these  situations  is                                                               
unacceptable. Health care facilities  are a magnifier of emotions                                                               
and  can  explode  in  stressful situations  and  anyone  in  the                                                               
vicinity can  become a target.  However, health care  workers and                                                               
other personnel  are limited in  how they can  protect themselves                                                               
while giving care. She said  the added aggravator when assaulting                                                               
a health  care worker  in a  health care  facility is  a positive                                                               
move and hopefully will reduce  assaults. She urged the committee                                                               
to support HB 312.                                                                                                              
1:56:22 PM                                                                                                                    
DANNY  ROBINETTE,  Chief   Medical  Officer,  Fairbanks  Memorial                                                               
Hospital, Fairbanks, Alaska,  testified in support of  HB 312. He                                                               
reported that in  the past 18 months they  have experienced about                                                               
182 incidents with  violence or a significant  threat of violence                                                               
to hospital  staff. Some  estimates show  that just  one-third of                                                               
incidents are  reported, which  suggests they  have had  over 500                                                               
incidents   in    that   timeframe.   Violence    is   increasing                                                               
significantly both  at Fairbanks Memorial and  statewide. This is                                                               
not acceptable. HB  312 will be a significant help,  but it isn't                                                               
the only  solution. Fairbanks  Memorial is  taking steps  such as                                                               
nonviolent  crisis  intervention  training  for  clinical  staff,                                                               
expanding   security  presence,   and  developing   processes  to                                                               
identify patients that  are high risk for violence.  He urged the                                                               
committee to support HB 312.                                                                                                    
1:58:18 PM                                                                                                                    
BRUCE   RICHARDS,  Director   of   Government  Affairs,   Central                                                               
Peninsula Hospital, Soldotna, Alaska,  testified in support of HB
312. He  described the  incident in 2008  when a  former employee                                                               
entered  the  hospital  and  shot and  killed  a  supervisor  and                                                               
injured another  before taking his  own life. Employees  have not                                                               
forgotten that  event. Employees  at the hospital,  nursing home,                                                               
and  hospital-based clinics  experience  workplace violence  more                                                               
frequently than in the past.  It originates from patients, family                                                               
members, domestic disputes  and even people who  have no official                                                               
business   at   the   hospital.  The   National   Institute   for                                                               
Occupational  Safety and  Health  defines  workplace violence  as                                                               
"any  physical assault,  threatening  behavior,  or verbal  abuse                                                               
occurring  in the  work place."  He  cited data  points from  the                                                               
agency   that  accredits   and  certifies   21,000  health   care                                                               
organizations  nationwide.  From a  sample  of  3,700 nurses,  21                                                               
percent  report being  physically assaulted  and over  50 percent                                                               
were  verbally  abused  in  a  12-month  period;  12  percent  of                                                               
emergency  room  nurses  experienced  physical  violence  and  59                                                               
percent experienced  verbal abuse  in the  last 7-day  period. He                                                               
agreed  with previous  testimony  that violence  in hospitals  is                                                               
increasing.  Central   Peninsula  Hospital  has  a   code  for  a                                                               
situation involving  violence that  anyone can initiate  over the                                                               
paging system. He described some of  the things he's seen when he                                                               
responded to the call for  help. Their staff support allowing law                                                               
enforcement to  arrest someone for misdemeanor  assault without a                                                               
warrant in these situations. This  will take care of the existing                                                               
issue where  the perpetrator  remains in  the facility  after the                                                               
police have left. He urged the committee to pass HB 312.                                                                        
2:01:32 PM                                                                                                                    
REGENA  DECK, representing  self,  Juneau,  Alaska, testified  in                                                               
support  of HB  312.  She  said she  is  an emergency  department                                                               
nurse, the professor  of nursing for UAA in Juneau,  and a victim                                                               
of violence  as a  direct result  of her  job. She  described the                                                               
physical assault she experienced by  a patient. Her assailant was                                                               
charged  with  misdemeanors   and  felonious  assault,  including                                                               
assault with a deadly weapon. He  had been reported to the police                                                               
before and  they said their  hands were tied. Some  nurses didn't                                                               
bother to report him because  nothing would be done. Other nurses                                                               
view this  as part of  the job. It makes  her sad and  angry that                                                               
her injury  and trauma  could have been  prevented if  the police                                                               
had  stronger  tools available.  HB  312  will  make it  so  that                                                               
nurses'  reports   of  violence  will  be   taken  seriously  and                                                               
hopefully prevent further  acts of violence. It will  also send a                                                               
message to  the public that  there is zero tolerance  for violent                                                               
behavior. She encouraged the committee to support HB 312.                                                                       
2:04:15 PM                                                                                                                    
JENNIFER  MOORE, Chief  Quality Officer,  MatSu Regional  Medical                                                               
Center, Palmer, Alaska, testified in  support of HB 312. She said                                                               
that as  a nurse of  over 20  years she has  experienced assaults                                                               
while attempting  to treat  patients. All  units in  the hospital                                                               
are affected. Some  nurses are afraid to go to  work because they                                                               
fear  assault.  Health  care  workers   need  to  know  they  are                                                               
supported  in their  time of  need just  as they  help others  in                                                               
their  time  of  need.  Violence  should  not  be  an  acceptable                                                               
workplace hazard, but for many this is the new norm.                                                                            
Legislation is  not the  only solution  to this  complex problem.                                                               
Every facility needs to implement  a comprehensive strategy using                                                               
evidence-based  practices.   MatSu  Regional  is  working   on  a                                                               
comprehensive  workplace violence  preventative program  to teach                                                               
staff  how  to deescalate  a  situation,  use specialized  safety                                                               
techniques,  and how  to  escort an  aggressive  person. It  also                                                               
teaches staff how to recognize  their tension triggers and how to                                                               
reduce personal tension.  She urged the committee to  pass HB 312                                                               
and send  a strong message  to health care providers  that Alaska                                                               
takes this issue very seriously.                                                                                                
2:06:40 PM                                                                                                                    
JOANNA CAHOON,  Member, Alaska Mental  Health Board  and Advisory                                                               
Board  on   Alcoholism  and  Drug   Abuse  and   Staff  Attorney,                                                               
Disability  Law Center,  Anchorage, Alaska,  discussed unintended                                                               
consequences related to  HB 312. She said the  boards believe the                                                               
violence that HB 312 seeks  to address is egregious. Her comments                                                               
are areas  of drafting that  may lead to  unintended consequences                                                               
beyond the  targeted violence  the bill  tries to  address. There                                                               
are  two ways  that  the current  language could  unintentionally                                                               
criminalize the actions of persons in need of psychiatric care.                                                                 
First,  people that  are transported  to  a psychiatric  facility                                                               
often  refuse treatment.  They can  appear belligerent,  yelling,                                                               
and demanding  to leave.  They may  not be  deemed to  be seeking                                                               
medical treatment,  but the boards'  experience is that  it's not                                                               
always a  straightforward call. The  second issue relates  to the                                                               
idea that  being deemed stable for  discharge is straightforward.                                                               
There are  certain populations that show  up to ERs that  may not                                                               
be  admitted  because  they  need  support  but  not  necessarily                                                               
medical   treatment.   Examples   include  a   person   with   an                                                               
intellectual  disability  that  is  co-occurring  with  a  mental                                                               
illness or  an adult child  that experiences  autism and is  in a                                                               
meltdown and  is violent.  Those individuals  are in  crisis, but                                                               
they  may   not  be   admitted.  The   bill  may   capture  those                                                               
individuals, perhaps unintentionally.                                                                                           
In the  boards' experience,  difficult psychiatric  patients have                                                               
sometimes been  inappropriately deemed  stable for  discharge. On                                                               
occasion  they have  seen Emergency  Medical Treatment  and Labor                                                               
Act (EMTALA)  violations. That  is the  law that  requires anyone                                                               
going to an emergency department  to be deemed stable before they                                                               
are discharged.                                                                                                                 
MS. CAHOON advised  that a similar bill was adopted  in Idaho and                                                               
patients with the conditions she  described were caught up in the                                                               
criminal justice system, although that  was not the intent of the                                                               
bill. She thanked the committee  for the opportunity to point out                                                               
the potential for unintended consequences.                                                                                      
2:11:23 PM                                                                                                                    
BENJAMIN SHELTON, MD, President,  Alaska Chapter American College                                                               
of  Emergency   Physicians,  said  he  works   at  Providence  in                                                               
Anchorage.  He is  testifying in  support  of HB  312 that  helps                                                               
address  workplace violence  in health  care facilities.  This is                                                               
necessary.  Violence  in the  emergency  department  seems to  be                                                               
worsening. This  should not  be accepted  as a  workplace hazard,                                                               
but for many  it has become the normal. Many  of the assaults are                                                               
in the  category of  fourth degree assault  for which  an officer                                                               
must have  a warrant to make  an arrest. After a  staff member is                                                               
assaulted,  the  police  take  a   report  and  often  leave  the                                                               
individual  on premises.  This sends  the unfortunate  message to                                                               
the  care giver  that their  safety  is not  important. The  bill                                                               
gives police  officers the same  ability to remove  the assailant                                                               
from  the scene  without a  warrant. This  is the  same authority                                                               
that law  enforcement has to  remove an assailant from  the scene                                                               
in domestic violence situations.                                                                                                
All  emergency  providers  are   responsible  for  EMTALA.  Every                                                               
patient that  comes in is cared  for and stabilized. HB  312 does                                                               
not change that. If someone comes  in with an acute mental health                                                               
crisis,  they're  psychotic,  or  high  on  methamphetamine,  the                                                               
emergency department's responsibility is  to treat them. He urged                                                               
the committee to  pass HB 312 and send a  strong message to those                                                               
providing health care that Alaska takes this issue seriously.                                                                   
2:14:19 PM                                                                                                                    
KIM  MCDOWELL,  Emergency  Room Director  and  registered  nurse,                                                               
Bartlett Regional Hospital, Juneau,  Alaska, testified in support                                                               
of HB  312. She reported  that in the  last six months  they have                                                               
had 18 incidents  of nurses being assaulted. This  has become the                                                               
rule rather than  the exception. This would not  be acceptable in                                                               
any other  place of  business. She  urged passage  of HB  312, so                                                               
health care providers  can do their jobs safely  and without harm                                                               
to themselves or other people.                                                                                                  
CHAIR  COGHILL  asked if  she  believes  the bill,  as  currently                                                               
drafted,  provides  enough  discretion to  deal  with  behavioral                                                               
health issues.                                                                                                                  
MS.  MCDOWELL  said  that  as professionals  they  all  have  the                                                               
ability  to   make  that  discretionary  decision.   There  is  a                                                               
difference between an individual with  autism who may not be able                                                               
to  control their  behavior as  opposed to  an individual  who is                                                               
assaulting staff but  does have the means to  know the difference                                                               
between right and wrong.                                                                                                        
CHAIR COGHILL asked Ms. Cahoon to address the same question.                                                                    
2:17:08 PM                                                                                                                    
MS. CAHOON said  she isn't questioning anybody's  ability to make                                                               
an appropriate  professional call.  The boards' concern  is based                                                               
on  seeing the  intention of  what other  states passed  and what                                                               
happened. The  law in  Idaho intended to  capture the  actions of                                                               
patients or  non-patients who could understand  their actions but                                                               
were drunk or angry. It  had an exemption for people experiencing                                                               
mental illness, but that provision  was removed and patients with                                                               
mental illness or  autism were caught up in  the criminal justice                                                               
system. This may not  be an issue most of the  time, but there is                                                               
some vagueness  between seeking medical treatment  and stable for                                                               
discharge.  She suggested  that a  definition or  exemption might                                                               
make it clear in those situations  that don't fall in the norm so                                                               
that situations like in Idaho and Washington are avoided.                                                                       
CHAIR COGHILL  commented that the  bill appears broad  enough for                                                               
the rule, but  not the exception. He said he  didn't know that he                                                               
was willing  to slow  the bill to  find out how  best to  make an                                                               
exception  when  is  seems  that there  is  discretion  with  the                                                               
officer and health care provider.                                                                                               
2:19:31 PM                                                                                                                    
SENATOR  WIELECHOWSKI  asked  if  the sponsor  was  available  to                                                               
respond to Ms. Cahoon's testimony.                                                                                              
CHAIR COGHILL said that was  discussed in House Judiciary and the                                                               
sponsor is  satisfied that the  discretion given to  the officers                                                               
and health  care professionals is sufficient.  He reiterated that                                                               
he believes there is enough discretion.                                                                                         
SENATOR WIELECHOWSKI said okay.                                                                                                 
2:20:38 PM                                                                                                                    
SENATOR  COSTELLO  moved  to  report  HB  312,  version  O,  from                                                               
committee  with individual  recommendations  and attached  fiscal                                                               
2:20:53 PM                                                                                                                    
CHAIR  COGHILL announced  that without  objection,  HB 312  moved                                                               
from the Senate Judiciary Standing Committee.                                                                                   

Document Name Date/Time Subjects
SB 214 - Version A.PDF SJUD 3/19/2018 1:30:00 PM
SB 214
SB 214 - Sponsor Statement.pdf SJUD 3/19/2018 1:30:00 PM
SB 214
SB 214 - Sectional Summary (ver. A).PDF SJUD 3/19/2018 1:30:00 PM
SB 214
SB 122 - Version O.pdf SJUD 3/19/2018 1:30:00 PM
SB 122
SB 122 - Summary of Changes (ver. J to ver. O).pdf SJUD 3/19/2018 1:30:00 PM
SB 122