Legislature(2003 - 2004)

04/10/2003 03:35 PM Senate STA

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
        SB 159-PAROLE FOR MEDICAL / COGNITIVE DISABILITY                                                                    
CHAIR  GARY STEVENS  asked for  a motion  to adopt  the committee                                                               
substitute (CS) as the working document.                                                                                        
SENATOR  GRETCHEN GUESS  made a  motion  to adopt  work draft  \D                                                               
Luckhaupt  4/9/03  as  the  working   document.  There  being  no                                                               
objection, it was so ordered.                                                                                                   
SENATOR  LYDA GREEN,  sponsor  of SB  159,  paraphrased from  the                                                               
sponsor statement:                                                                                                              
     SB  159   gives  the  Alaska  Board   of  Parole  (ABP)                                                                    
     flexibility  to   grant  or  deny  medical   parole  to                                                                    
     applicants. Thus the board will  be better able to meet                                                                    
     the  needs   of  the  prisoners,  the   department  and                                                                    
     The ABP  has a proven  track record in  their decision-                                                                    
     making abilities.  Over the past  seven years,  the ABP                                                                    
     has granted  parole to approximately 45  percent of all                                                                    
     the  discretionary parole  applicants. Less  than eight                                                                    
     percent   of  these   parolees   have  violated   their                                                                    
     conditions  (i.e.  missed  a   meeting  with  a  parole                                                                    
     officer) and approximately one  percent has committed a                                                                    
     new  offense. This  number  is particularly  compelling                                                                    
     when  compared  to  the  77   percent  return  rate  of                                                                    
     mandatory parole violators.                                                                                                
     This  bill will  allow the  ABP and  the Department  of                                                                    
     Corrections   to   work   together  to   determine   an                                                                    
     appropriate and  cost effective release plan.  The cost                                                                    
     of  health care  to the  Department of  Corrections has                                                                    
     significantly increased  over the last few  years. Some                                                                    
     of the factors causing these increases are:                                                                                
        · The increased population of terminally ill                                                                            
        · The recent Seward Highway accident on November                                                                        
          19, 2002                                                                                                              
        · Hospitalization   of   prisoners   for   long-term                                                                    
          assisted care                                                                                                         
     When making a determination for medical parole                                                                             
     the following are considered:                                                                                              
        · Department of Correction medical report                                                                               
        · The seriousness of the criminal offense                                                                               
        · Release plan                                                                                                          
        · Parole officer/DOC recommendation                                                                                     
     Passage  of this  proposed legislation  will allow                                                                         
     the ABP to use its  endowed power and authority to                                                                         
     make  responsible  decisions   regarding  all  the                                                                         
     factors mentioned  above, while  still considering                                                                         
     the safety of the community.                                                                                               
CHAIR GARY  STEVENS said he  has visited several  prisons in                                                                    
the last  several months  and has  learned that  because the                                                                    
state  is   fully  responsible  for  the   individual  while                                                                    
incarcerated, the state may  face enormous medical expenses.                                                                    
This bill would allow those  seriously ill inmates to return                                                                    
home  or move  to a  facility that  provided less  expensive                                                                    
SENATOR FRED DYSON  noted the original law  didn't allow for                                                                    
parole for  someone who was  convicted and  incarcerated for                                                                    
sexually abusing  a minor. He  asked if it was  correct that                                                                    
this bill removed that provision.                                                                                               
SENATOR  GREEN said  it did;  that is  what the  language on                                                                    
page 1, line 12 does.                                                                                                           
SENATOR  DYSON  asked for  the  reasoning  for removing  the                                                                    
prohibition for paroles for those  guilty of sexual abuse of                                                                    
a minor.                                                                                                                        
JACQUELINE  TUPOU, staff  to  Senator  Green, explained  the                                                                    
inmates  that   are  considered   for  medical   parole  are                                                                    
physically  incapacitated. Also,  not  all medical  parolees                                                                    
would simply  be released; many  would move to  other secure                                                                    
SENATOR COWDERY  asked where these  inmates would  be placed                                                                    
and would the type of crime come under consideration.                                                                           
MS. TUPOU  said the bill  provides flexibility so  each case                                                                    
would    receive    individual   consideration    and    the                                                                    
determinations would  be different. Some inmates  would move                                                                    
to  another secure  facility and  others might  go home.  If                                                                    
parole  would  diminish the  seriousness  of  the crime  the                                                                    
inmate would be disqualified from consideration.                                                                                
CHAIR GARY STEVENS asked the department to come forward.                                                                        
LARRY  JONES,  Executive Director  of  the  Alaska Board  of                                                                    
Parole,  said the  Parole Board  sees this  as a  corrective                                                                    
bill  because  the 1995  legislation  is  overly tight.  The                                                                    
department can't legitimately bring  inmates to the board to                                                                    
implement  the  decision  making  process.  When  a  special                                                                    
medical parole applicant meets the  criteria, the board must                                                                    
act  quickly because  the person  is close  to death.  Since                                                                    
1996 they  have granted just  nine medical paroles  and have                                                                    
considered  just 14  cases. Most  died within  two to  three                                                                    
months of their parole. These  inmates are so critically ill                                                                    
they aren't  the same  person that  committed the  crime for                                                                    
which they were incarcerated.                                                                                                   
In his judgment,  this bill would not  impact public safety.                                                                    
Every  year  the  board   makes  hundreds  of  discretionary                                                                    
decisions;   this  would   simply  provide   them  increased                                                                    
flexibility.  Medical   paroles  require  that  a   plan  be                                                                    
established  for each  parolee; inmates  wouldn't be  tossed                                                                    
"into  the  gutter."  These  people   are  still  under  the                                                                    
supervision  of the  Department of  Corrections just  as any                                                                    
other parolee would be.                                                                                                         
Whether  a  parole would  diminish  the  seriousness of  the                                                                    
crime is always  a consideration and never  taken lightly by                                                                    
the  board. The  Board of  Parole  stands as  a very  strong                                                                    
proponent of  victim's rights. Victims  are notified  of the                                                                    
hearings and they may participate.                                                                                              
CHAIR GARY  STEVENS asked him  for an explanation of  who is                                                                    
on  the Parole  Board, the  associated responsibilities  and                                                                    
the connection with the department.                                                                                             
MR. JONES  replied it is complex  and he would like  to hear                                                                    
the  question posed  more frequently.  The  Alaska Board  of                                                                    
Parole is an autonomous board  with five members that report                                                                    
to the governor. There is  a certain judicial requirement so                                                                    
there is  a geographic representation. Ethnicity  and gender                                                                    
are also considerations for  appointment. Members serve five                                                                    
year  staggered  terms  and   legislative  approval  is  not                                                                    
necessary. Members typically serve for more than one term.                                                                      
The  board  travels  to the  hearing  sites,  which  entails                                                                    
considerable  travel.  They   don't  hear  mandatory  parole                                                                    
cases, but 96  percent of their hearings  are the revocation                                                                    
hearings  for  those  mandatory   paroles.  When  the  board                                                                    
travels  this includes  five board  members, two  staff, the                                                                    
parolee and attorney, the state  parole officer, the victims                                                                    
and the witnesses.                                                                                                              
SENATOR COWDERY asked how many  inmates might take advantage                                                                    
of a special medical parole.                                                                                                    
MR. JONES deferred to Mr. Tupou.                                                                                                
LEITONI  TUPOU, Special  Assistant  to  the Commissioner  of                                                                    
Corrections,   explained   the   board   would   review   13                                                                    
applications if the bill passes.                                                                                                
SENATOR COWDERY asked if that would save $500,000.                                                                              
MR. TUPOU replied it would.                                                                                                     
MR. JONES  added the  savings would be  greater in  the long                                                                    
MR. TUPOU  referred to  a spreadsheet to  show how  much the                                                                    
state currently spends on those  inmates. Under current law,                                                                    
the board would not hear these cases.                                                                                           
SENATOR  COWDERY  asked  if  the  savings  would  come  from                                                                    
transferring the inmates from their present location.                                                                           
MR. JONES said that is correct.                                                                                                 
SENATOR COWDERY asked if the $500,000 is a medical savings.                                                                     
MR. JONES  said the impact of  this bill is a  matter of who                                                                    
is bearing the cost.                                                                                                            
4:00 pm                                                                                                                         
KEVIN  HENDERSON,   Eligibility  Program  Officer   for  the                                                                    
Division of  Medical Assistance,  advised the  department is                                                                    
generally supportive  of the bill.  Part of the intent  is a                                                                    
cost shift  because many  of these  inmates will  be looking                                                                    
for  a  way   to  pay  for  continuing   medical  care.  The                                                                    
department  sees Medicaid  as the  likely recipient.  At the                                                                    
state level it  makes sense to put these  people on Medicaid                                                                    
and  get federal  matching money  for at  least part  of the                                                                    
costs. As long  as they are incarcerated the  state pays 100                                                                    
percent of the health care costs.                                                                                               
He pointed to  the fiscal notes and cautioned  it was likely                                                                    
only nine of  the 13 would qualify for  Medicaid. Some would                                                                    
probably qualify  for expensive long-term care  and some for                                                                    
adult public  assistance. The  bill is a  good idea  for the                                                                    
state  but  it's  important  to   clearly  look  at  careful                                                                    
discharge planning  for each individual  to ensure  they are                                                                    
provided for.                                                                                                                   
SENATOR  LYMAN HOFFMAN  made reference  to  the fiscal  note                                                                    
from Health  and Social Services  and asked if  they believe                                                                    
Medicaid  expenditures would  grow at  just ten  percent per                                                                    
year. If that's  true, he asked how that fits  with the data                                                                    
on page 1 of the fiscal note.                                                                                                   
MR. HENDERSON replied the fiscal  note reliability after two                                                                    
years is difficult.  They made some assumptions  that may or                                                                    
may not be true.                                                                                                                
Historically  Medicaid costs  have  been  increasing at  ten                                                                    
percent or more  per year. That rate has nothing  to do with                                                                    
the 13 Alaska  inmates; it's just the rate  that health care                                                                    
is increasing. An assumption was  made that the nine inmates                                                                    
identified  as  likely to  be  eligible  for Medicaid  would                                                                    
continue to live and that there  would be a linear growth of                                                                    
nine   new  Medicaid   recipients   each  year   thereafter.                                                                    
Admittedly, those people are  medically fragile and probably                                                                    
wouldn't survive for years, but  he was reluctant to project                                                                    
just how  long they  would live. They  were unsure  how many                                                                    
inmates would be  medically paroled every year  or the level                                                                    
of care that might be needed.                                                                                                   
SENATOR  HOFFMAN noted  FY09 costs  would  be $2.7  million,                                                                    
which  would be  $2.2 million  over and  above the  $500,000                                                                    
MR. HENDERSON advised him to look at the GF Match line.                                                                         
SENATOR HOFFMAN  observed the breakeven point  ends in FY06;                                                                    
after which it would cost the state.                                                                                            
MR.  HENDERSON replied  the numbers  were probably  high and                                                                    
the  Department of  Corrections would  likely make  the case                                                                    
that all the parolees would not live five years.                                                                                
SENATOR HOFFMAN rhetorically questioned  how many would have                                                                    
to not live that long for it to make sense.                                                                                     
ROBERT  BRIGGS,  staff  attorney  with  the  Disability  Law                                                                    
Center  of  Alaska,  reported   they  provide  services  for                                                                    
Alaskans with disabilities  including those in institutions.                                                                    
With the  closure of the  Harborview institution  in Valdez,                                                                    
they  now  provide  protection  and  advocacy  services  for                                                                    
nursing  homes,   prisons  and  mental   institutions.  They                                                                    
believe  the bill  makes sense  in terms  of saving  general                                                                    
fund dollars.                                                                                                                   
He  suggested   amending  the  bill  to   require  discharge                                                                    
planning that  would address the  basic life domains  of the                                                                    
prisoner.   Because  the   intended   population  would   be                                                                    
functionally impaired,  a plan needs  to be in  place before                                                                    
they  are released.  Both Montana  and Rhode  Island require                                                                    
medical discharge  planning in the statute  that is parallel                                                                    
to what  this bill would do.  Appropriate discharge planning                                                                    
would also address the safety concerns.                                                                                         
Cost shifting  is good because  institutional costs  are the                                                                    
highest costs.  Some of these  individuals are likely  to be                                                                    
eligible  for home  and community  based  waivers meaning  a                                                                    
family member  could provide care  for the  individual. Care                                                                    
coordination  could  certainly   be  provided  cheaper  than                                                                    
services in a nursing home.                                                                                                     
Representative Berkowitz  pointed out  the language  on page                                                                    
3,  line 17  appears  to limit  the concept  of  who can  be                                                                    
discharged to those  who have a cognitive  condition that is                                                                    
impaired due  to irreversible dementia. The  medical officer                                                                    
for  the correctional  system testified  he  had no  problem                                                                    
eliminating  the  phrase  "due  to  irreversible  dementia."                                                                    
Based on  his testimony,  the House State  Affairs Committee                                                                    
eliminated the phrase.                                                                                                          
DR.  JOHN ROBERTSON,  Medical Director  and Health  Services                                                                    
Administrator  for the  Department  of Corrections,  advised                                                                    
the inmates selected  for medical parole would  be likely to                                                                    
live less  than a year.  Although there has been  mention of                                                                    
cost  shifting,  all  ways  have  not  been  addressed.  For                                                                    
instance, some  inmates would  qualify for  veteran benefits                                                                    
if  they   were  out  of   the  state  system.   While  this                                                                    
legislation would  give the department and  the parole board                                                                    
more   flexibility,  each   applicant  would   be  carefully                                                                    
scrutinized and  wouldn't be  considered for  medical parole                                                                    
without adequate discharge planning.                                                                                            
SENATOR HOFFMAN  asked what he estimated  the annual savings                                                                    
to be if parolees lived between  six months and a year after                                                                    
DR. ROBERTSON admitted he assisted  in drafting the numbers.                                                                    
When he  reviewed actual costs  for the last three  years he                                                                    
found the state spent from  $20,000 to $500,000 depending on                                                                    
the  medical condition.  Statistically medical  expenses are                                                                    
the greatest at the end stage  of life and it isn't uncommon                                                                    
to accrue  a $200,000 bill  in the  last two weeks  of life.                                                                    
Another cost to  the department that isn't  reflected in the                                                                    
numbers is that while  the inmate is institutionalized there                                                                    
are associated officer costs. For  every day that someone is                                                                    
in  a   hospital  or  nursing   home  rather  than   in  the                                                                    
correctional system there would be  a salary savings for one                                                                    
or two officers.                                                                                                                
SIDE B                                                                                                                          
4:25 pm                                                                                                                         
ANNA  FAIRCLOUGH  from   Anchorage  expressed  concern  that                                                                    
sexual  assault offenders  might be  considered for  medical                                                                    
parole   under  SB   159.  The   proposal  is   particularly                                                                    
indefensible  with regard  to those  who committed  offenses                                                                    
against  minors.  She  questioned  whether  any  of  the  13                                                                    
inmates  that  might  be eligible  for  medical  parole  had                                                                    
sexually assaulted a minor.                                                                                                     
CHAIR GARY STEVENS  called Ms. Tupou forward  to address the                                                                    
SENATOR  DYSON asked  Ms. Fairclough  whether she  heard the                                                                    
response when he asked that question.                                                                                           
MS.  FAIRCLOUGH replied  she interpreted  his question  more                                                                    
globally  as  confirmation  that   they  were  revoking  the                                                                    
inability  to  release  sexual  perpetrators.  Her  question                                                                    
specifically asked  whether there  was a  sexual perpetrator                                                                    
in the group of thirteen under discussion.                                                                                      
MS.  TUPOU replied  one  inmate was  convicted  of a  sexual                                                                    
offense of a minor.                                                                                                             
MS.  FAIRCLOUGH  urged  members  to  be  aware  that  sexual                                                                    
offenders are  high repeaters  and even  though they  are on                                                                    
their death  bed they might  still present a  danger because                                                                    
they aren't  "hard wired" the  same. If they are  exposed to                                                                    
children  or  have  any opportunity  they  will  repeat  the                                                                    
offense. She  supported a discharge  plan and  asked whether                                                                    
there was a  definition in state statute  for corrections to                                                                    
use for "severely medically disabled."                                                                                          
She asked Senator Dyson to  pay particular attention to this                                                                    
bill because  it would be a  step in the wrong  direction to                                                                    
allow a sex offender back on the street.                                                                                        
CHAIR GARY STEVENS remarked he  was certain that was not the                                                                    
intention of the department.                                                                                                    
He asked  Ms. Tupou to  respond to the  proposed amendments.                                                                    
For  discussion  purposes  he  labeled  the  discharge  plan                                                                    
amendment #1 and the irreversible dementia amendment #2.                                                                        
MS.  TUPOU explained  the sponsor  has  no specific  problem                                                                    
with either amendment. She opined  amendment #1 is redundant                                                                    
since  the new  regulations  became effective  on March  29,                                                                    
CHAIR GARY STEVENS advised the  bill would go to the Finance                                                                    
Committee and  he would be  comfortable passing it  along in                                                                    
the  present  form giving  the  sponsor  the opportunity  to                                                                    
address the amendments there.                                                                                                   
SENATOR  GUESS  stated  she  would like  to  hear  from  the                                                                    
Disability  Law Center  whether they  were comfortable  with                                                                    
the new  regulations. She  added Ms.  Tupou didn't  speak to                                                                    
amendment #2.                                                                                                                   
CHAIR GARY STEVENS  asked Mr. Briggs to  comment on adopting                                                                    
the amendments or passing the  bill in the present form with                                                                    
the recommendation  that the  sponsor carefully  review them                                                                    
in the Finance Committee.                                                                                                       
MR.  BRIGGS had  no  problem passing  the  bill without  the                                                                    
amendments.  That  the  new  published  regulations  require                                                                    
discharge planning,  he would take as  represented. Further,                                                                    
the point that Dr. Robertson  made that a medical officer be                                                                    
charged  to  ensure  there   is  appropriate  continuity  of                                                                    
service is reasonable and makes his job easier.                                                                                 
There were no further questions.                                                                                                
CHAIR  GARY STEVENS  asked for  a  motion to  move the  bill                                                                    
without amendments.                                                                                                             
SENATOR DYSON  made a motion  to move SB 159  from committee                                                                    
with attached fiscal notes with individual recommendations.                                                                     
SENATOR  GUESS   added  the   points  Ms.   Fairclough  made                                                                    
regarding sex offenders were valid  and she would appreciate                                                                    
the sponsor's attention on the issue.                                                                                           
There being no objection, SB 159 moved from committee.                                                                          

Document Name Date/Time Subjects