Committee Meeting Information

July 31 and August 1, 2008

Central Wyoming Counseling Center

Casper, Wyoming

 

Committee Members Present

Senator Pat Aullman, Cochairman

Representative Keith Gingery, Cochairman

Senator Ken Decaria

Senator Rae Lynn Job

Senator Wayne Johnson

Senator Ray Peterson

Representative Patrick Goggles (July 31 only)

Representative Tim Hallinan

Representative Jerry Iekel (July 31 only)

Representative Jack Landon

 

 

Committee Members Absent

Senator Bob Fecht

Representative Patrick Goggles (August 1 only)

Representative Jerry Iekel (August 1 only)

Representative Jane Warren

 

Legislative Service Office Staff

John H. Rivera, Senior Staff Attorney

Joy N. Hill, Associate Research Analyst

 

Others Present at Meeting

Please refer to Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.

 

 

 

Executive Summary

The Committee met for two days at the Central Wyoming Counseling Center in Casper.  The Committee considered and approved for sponsorship draft legislation on the costs of emergency detentions and involuntary hospitalizations; mental injuries relating to workers' compensation; forensic evaluations at the State Hospital; involuntary administration of psychotropic medications; and an omnibus appropriations bill for mental health and substance abuse services.  The Committee also considered and approved a draft memorandum to the Joint Appropriations Interim Committee summarizing the work the Select Committee has done since its inception in 2005.  

 

The Committee has completed its work for the 2008 interim.

 

Call To Order (July 1, 2008)

Chairman Gingery called the meeting to order at 8:30 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

09LSO-0064.W1, Costs of emergency detention and hospitalization

Chairman Gingery stated that this bill was presented at the 2008 Budget Session by Representative Warren and is now being considered for sponsorship by the Select Committee.  He explained the process used by hospitals to recover the costs of emergency detention before they can bill the state or county for the detention.  The bill would limit the number of contacts a hospital can make with the patient or his family to recover such costs, provided the patient is below 200% of the federal poverty level and he is suspected of having a serious and persistent mental illness.  Chairman Gingery suggested deleting the criteria and simply limiting the hospital to 3 contacts with the patient or his family.  He added that, under Title 25, the person didn't chose to be hospitalized, yet is being forced to pay for the hospitalization.

 

Deputy Director McDaniel, Administrator, Mental Health and Substance Abuse Services Division (the Division), Wyoming Department of Health (WDH), advised he is aware of 6 complaints made about hospitals attempts to collect costs from patients in the 1½ years he has been with the Division.  He agreed with Chairman Gingery's proposal to delete the criteria, but if the criteria remains in the statute, perhaps it would be better to prohibit any contacts with the patient who meets that criteria.  Ms. Carol Day, WDH, said her survey indicates that the bill-collection process hinders cooperation with the Title 25 emergency hospitalization process because some counties are filing liens against the patient in an effort to collect costs, even though it was the county which probably initiated the detention.  Dr. Sherard, Director, WDH, clarified that Medicaid eligibility is set at 133% of the federal poverty level.

 

Senator Decaria moved, seconded by Representative Goggles, for Committee sponsorship of the bill.  After an amendment was adopted, the motion carried on a roll call vote of 5 ayes, 4 nays, with 3 excused.  Senators Aullman, Decaria and Peterson and Representatives Goggles and Gingery voted aye. Senator Job and Representatives Hallinan, Iekel and Landon voted no. Senators Fecht and Johnson and Representative Warren were excused.  The bill will be processed as a Senate File.

 

09LSO-0075.W1, Mental injury-workers' compensation

Senator John Hastert explained that staff had drafted a bill under the Committee's name that was identical to his bill (09LSO-0053.W1) presented at the June meeting of the Select Committee.  Since that time, he had revised his bill and asked the Committee to consider his revised bill (09LSO-0053.W2) as a substitute for the Committee's bill.  He proceeded to explain his revised bill and the reasons for the revisions.  Representative Iekel advised the addition of "duly qualified mental health practitioners" to diagnose a mental injury was made to distinguish among the mental health practitioners who would be qualified to diagnose a mental injury.   To address the issue mentioned about "opening the floodgates" if mental injury can be covered without physical injury he distributed Appendix 3, containing the revisions to his original draft bill.  The linkage between physical injury and mental injury was adopted in 1994 as a knee jerk reaction to lawsuits being filed in California relating to mental injury for hostile work environments.  He did not have an objection to reinserting the burden of proof standard that the bill proposed removing relating to clear and convincing evidence of the mental injury. 

 

Chairman Gingery called for public comment on the bill.

 

Mr. Gary Child, Director, Department of Employment, and Mr. Steve Czoschke, Administrator, Workers' Safety and Compensation Division, testified on behalf of the Workers' Compensation Program.  Mr. Child advised that the bill may have significant fiscal impact if enacted into law.  Additional claims analysts and a psychiatric nurse would be required to review claims.  He will provide an estimated fiscal impact for the Committee.  Most states that allow compensation for mental injury without physical injury use a standard of "sudden, distinct and identifiable" with respect to  a compensable mental injury.  Care must be taken to ensure that the physical impairment ratings are not implicated.  If the injured worker has both a physical and mental injury, most states have a pro rata provision to apportion reimbursement based on each injury.  The Workers' Compensation Program could provide temporary total disability or permanent total disability without having to deal with permanent partial impairment or permanent partial disability ratings.

 

Dr. Art Merrell, M.S., supports delinking physical and mental injuries.  He believes mental injuries should have parity with physical injuries, even without a precipitating physical injury.  He opposes listing in statute what stressors would constitute the source of the mental injury, because post-traumatic stress syndrome is triggered in different ways for different individuals. 

 

Mr. Jonathan Downing, Wyoming Contractors' Association, expressed his support for Senator Hastert's revised bill and stated he would be willing to work with this Committee or the Joint Labor, Health and Social Services Interim Committee if the bill proceeds further.

 

Ms. Marcia Shanor, Wyoming Trial Lawyers' Association,  agreed that delinking physical injuries from mental injuries would be positive.  She questioned why the current standard of proof in the statute remains clear and convincing when in many other statutes the standard that must be met is merely a preponderance of the evidence.  She advised the clear and convincing standard was originally inserted to control the "floodgates" that never appeared.  She would not like to see the only benefit for a mental injury to be medical care because injured workers as a result of mental injury are often as unable to work as workers with physical injuries.

 

Representative Landon moved, seconded by Senator Job, for Committee sponsorship of the bill.  After amendments were adopted, the motion carried on a roll call vote of 9 ayes, 1 nay, with 2 excused.  Senators Aullman, Decaria, Job, Johnson and Peterson and Representatives Goggles, Iekel and Landon and Gingery voted aye. Representative Hallinan voted no. Senator Fecht and Representative Warren were excused.  The bill will be processed as a Senate File.

 

The following amendments were adopted:

Page 2-line 13   After stricken "is" insert "situation or condition arising out of or in the course of employment that is of greater magnitude than the day-to-day stresses and tensions all employees usually experience.  A mental injury shall be".

Page 2-lines 14  through 18     Reinsert stricken language.

Page 2-line 19   Reinsert stricken "Psychiatric Association.".

Page 2-line 23   Delete all new language.

Page 3-lines 2 and 3     Delete entirely.

Page 3-line 4     Delete "employees usually experience" insert "Benefits provided under W.S. 27-14-401, 27-14-404 and 27-14-406 shall be the only benefits provided for a mental injury".

 

09LSO-0059.W1, Criminal procedure-mental evaluations

Chairman Gingery explained the nomenclature of criminal forensic evaluations, i.e., W.S. 7-11-303 competency to stand trial and not guilty by reason of mental illness (NGMI).  The Legislature passed an amendment to the statute last year that was believed to have fixed the problems created by courts ordering both evaluations at the outset of a criminal proceeding, but the permissive language of the statute may have been too nebulous for the courts.

 

Ms. Amber Martines, Wyoming State Hospital (WSH), explained the bill which separates the evaluations into different statutory sections to clarify that the evaluations are for different purposes and should occur at different times during a criminal case.

 

Representative Iekel moved, seconded by Senator Aullman, for Committee sponsorship of the bill.  The motion carried on a roll call vote of 10 ayes, 0 nays, with 2 excused.  Senators Aullman, Decaria, Job, Johnson and Peterson and Representatives Goggles, Gingery, Hallinan, Iekel and Landon voted aye. Senators Fecht and Representative Warren were excused.

 

09LSO-0068.W1, Criminal procedure-administration of antipsychotic drugs

Chairman Gingery explained that the accused kidnappers of Elizabeth Smart in Utah have not been brought to trial, because they have refused the medications that could stabilize their mental conditions to proceed with trial.  That case illustrates the need for the proposed legislation, which Dr. Golding recommended at the last meeting, based on the U.S. Supreme Court decision in Sell v. U.S., 539 U.S. 166 (2003), which provides standards for the involuntary administration of antipsychotic medications to persons charged with a serious crime.  The proposed bill incorporates the standards outlined by the U.S. Supreme Court.

 

Ms. Martines explained how the administration of antipsychotic drugs would be handled at the WSH. Currently, the WSH does administer drugs to involuntary patients, and uses a peer review process to ensure such administration is necessary and performed safely.

 

Senator Aullman moved, seconded by Senator Peterson, for Committee sponsorship of the bill.  After adoption of an amendment, the motion carried on a roll call vote of 7 ayes, 3 nays, with 2 excused.  Senators Aullman, Decaria, Johnson and Peterson and Representatives Gingery, Iekel and Landon voted aye. Senator Job and Representatives Goggles and Hallinan voted no. Senators Fecht and Representative Warren were excused.  The bill will be processed as a House Bill.

 

The following amendment was adopted:

Page 3-line 13  After "treatments" delete balance of line.

Page 3-line 14  Delete "authority,".

 

Committee tour of new substance abuse treatment residential treatment facility

Mr. Mike Huston, Director, Central Wyoming Counseling Center (CWCC), distributed Appendix 4 consisting of the floor plan and data of the new substance abuse residential treatment facility that is about to be completed at the CWCC.  He advised the facility has experienced delays and should have a grand opening in mid-September.  Committee members will receive an invitation to the grand opening.  The Committee adjourned at 3:45 p.m. to take a tour of the facility.

 

 

 

Call to Order (August 1, 2008)

Chairman Aullman called the meeting to order at 8:40 a.m.  The following sections summarize the Committee proceedings by topic.  Please refer to Appendix 2 to review the Committee Meeting Agenda.

 

 

09LSO-0074.W2, Mental health and substance abuse appropriations

Chairman Aullman advised the Committee that the bill was drafted pursuant to a request from the cochairs to staff who was directed to work with Mr. McDaniel to prepare the bill.  She then asked Mr. McDaniel to explain the contents of the bill.

 

Mr. McDaniel said the bill is based on appropriations that began funding the regionalization model in 06HB0091 and 07SF0076. Those previous bills were examined to determine which services needed to be expanded to complete the regionalization model throughout the state.  The Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC) reviewed the proposed appropriations and requested the funding amounts be increased by 10% to account for inflation since the original appropriations were authorized.  Mr. McDaniel explained that the amounts specified in sections 2 and 3 of the bill could be reduced by the transfer of $3 million from the WSH's budget that has been saved as a result of the initial pilot project in the southeast region of the state.

 

Mr. Mark Russler, President, WAMHSAC, said there is at least one supported independence program (SIP) in each region.  The purpose of the SIPs is to help clients seek housing and other supportive services.  With respect to the salary increases for the direct care staff, Mr. Russler said these increases would be better if provided as increases in the cost of doing business, but he isn't ready to make a proposal until the rate study is completed later this year.  He added that the results of the pilot project in the southeast region demonstrates very well that the regionalization model works and can save money if funded on a statewide basis.  If it is necessary to pare down the proposals in the bill, he would prefer that the crisis stabilization proposal remain intact.  All the other proposals after that are of equal importance.

 

Dr. Sherard advised the direction from the Governor was to address these issues in the exception budget and only deal with emergencies by seeking one-time funding.

 

Mr. Bob Peck, Chief Financial Officer, WDH, reiterated that the funding proposals in sections 2 and 3 of the bill would be dependent on diverting $3 million from the WSH and making that diversion permanent.  This could be done by a footnote to the budget bill, the Governor agreeing to move the funds, or by making the transfer permanent through this bill.

 

After Chairman Aullman called for other public comment, Ms. Peggy Nikkel, UPLIFT, expressed concern that a gap still exists for children's services in the bill.  Community-based, wrap-around systems of care such as described by the SAGE project at the June Committee meeting are needed and she proposed the Committee include $750 thousand in the bill to funds such programs by a competitive bid basis to avoid expensive out-of-state placements of children.  Representative Gingery said the current cost of the bill is about $14 million per year or $28 million for a biennium, so it may be better to plan better for next year regarding children's wrap-around services projections.

 

Ms. Anna Edwards, NAMI Wyoming, stated that all proposals in the bill are important to persons with mental illness in the state, but she agreed that crisis stabilization is critical. She has also been hearing throughout the state that there is a significant need for funding of co-occurring treatment also.

 

Representative Gingery moved, seconded by Senator Job, for Committee sponsorship of the bill.  After adoption of amendments, the motion carried on a roll call vote of 8 ayes, 0 nays, with 4 excused.  Senators Aullman, Decaria, Job, Johnson and Peterson and Representatives Gingery, Hallinan and Landon voted aye. Senators Fecht and Representatives Goggles, Iekel and Warren were excused.  The bill will be processed as a House Bill.

 

The following amendments were adopted:

Renumber section 4 as section 1; renumber section 5 as section 2; leave section 3 as is; renumber section 2 as section 4; and, renumber section 1 as section 5.

Replace the term "facility" with the term "program" wherever it exists throughout the bill.

Page 9-lines 24 through page 10-line 8            Reword the section using the language contained in 07SF0076 to clarify the early intervention specialists are intended to work with children.

Page 11-line 4  Delete "one-".

Page 11-line 5  Delete "time funding and shall not".

Page 12-line 1  Delete "one-time funding and shall not be".

Page 12-line 18            Delete "one-time".

Page 13-line 1  Delete "funding and shall not be".

Page 13-lines 9 through 17      Insert the names of the counties included within the specified regions.

 

 

Review of proposed Committee memorandum to Joint Appropriations Interim Committee on oversight activities of the Select Committee

Representative Gingery explained that he had prepared a memorandum summarizing the Select Committee's activities since its inception.  The initial draft was then distributed to members of the Select Committee for comment and suggested changes.  Representative Warren, who could not attend this meeting because of a conflict, nevertheless provided significant changes to the bill which staff incorporated into the draft that is being considered by the Committee at this meeting.  He proceeded to explain the memorandum, then asked if Committee members had any changes they wanted to make to the memorandum before it is sent to the Joint Appropriations Interim Committee. 

 

Representative Landon suggested that the last sentence of the memorandum was worded too strongly and perhaps should either be deleted, or reworded.  After discussion, the Committee agreed that the sentence should be reworded to make a recommendation to the Legislature that it should consider authorizing and funding a building to serve geriatric psychiatric patients at the WSH.  With that change, the Committee approved the Cochairs sending the memorandum to the Joint Appropriations Interim Committee.

 

Chairman Aullman advised that this would be the final meeting of the Committee for this interim and she thanked Committee members, WDH and WAMHSAC for their cooperation and assistance in addressing the important needs of persons in the state who have mentally illness or substance abuse problems.

 

 

Meeting Adjournment

There being no further business, Chairman Aullman adjourned the meeting at 12:50  p.m.

 

Respectfully submitted,

 

 

 

 

Senator Pat Aullman, Cochairman                               Representative Keith Gingery, Cochairman

 

 

 

 

 

 

 

 

 

Appendix		Appendix Topic		Appendix Description		Appendix Provider
1		Committee Sign-In Sheet		Lists meeting attendees		Legislative Service Office
2		Committee Meeting Agenda		Provides an outline of the topics the Committee planned to address at meeting		Legislative Service Office
3		Copy of revised language for 09LSO-0053.W1		Provides alternative language for Senator Hastert's bill to provide workers' compensation benefits for mental injuries		Senator John Hastert
4		Floor Plans for Central Wyoming Counseling Center's new residential treatment facility		Provides the floor plans and relating information  on the new residential treatment facility for substance abuse patients of the Central Wyoming Counseling Center		Mr. Mike Huston, Director, Central Wyoming Counseling Center