Vermont Legislature SmartTranscripts:

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Obviously you do because

[Senator Nader Hashim (Chair, Senate Judiciary)]: Realize. Good morning. We're back in the Senate Judiciary.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: And over here we want to speak to the

[Senator Nader Hashim (Chair, Senate Judiciary)]: amendment to S-one 193. Again, was the amendment presented by multiple members of the public welfare committee and institutions committee. We have Senator Lyons here and we have Senator Harrison who just arrived, both the respective chairs of those committees. We And are still we are going to hear from the Legis Council in a little bit whenever they get off the floor but wanted to provide an opportunity for the chairs to share their perspectives on you.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Well, thank you. Thank you for the opportunity actually for our committee to take time with this. Obviously we worked on this last session for a long time. The bill passed the Senate, passed the House. So what we have done here is to look at, within our jurisdiction, the clinical needs of the folks who are being committed to a forensic facility, to a secure facility, who have committed a crime with a life sentence and are found to be incompetent to stand on file. Keeping the overall sections about people who are And within the we haven't changed your language. We began our amendment with section four on page 11 of the bill as you pass it out of the committee here. And then so within section four little b, we've taken out, if you look at that on line eight, we take, we keep the forensic facility shell and then we take out the rest of that sentence there, and then we add in our language that ensures that there is a therapeutic recovery oriented and trauma informed environment comparable to community based residential treatment setting while maintaining appropriate levels of safety and security. We left in some language that was in the underlying bill. Overall the goal is to ensure that when people are found not guilty by reason of insanity and are incompetent to stand trial that we provide a place for them that is appropriate for their clinical needs and we've been through this in our committee many times and I know you've been through it many times so I don't know how detailed you like us to be but really if you look at the amendment, I better look at the one that you're looking at and you go to page, Senator Baruth has pointed out an important element to them that I think the Department of Mental Health should respond to, as well as others, and perhaps Senator Harrison as well on the including the possibility, so provide the safe housing and then continues on by making sure that it could be segregated by sex or otherwise address clinical safety, operational considerations as appropriate including the possible operation of multiple facilities if required by the clinical needs of transfer first that one is thank you for pointing that out and so department of mental health the way in department of corrections the way in but we felt that there may be reason I can leave that.

[Senator Nader Hashim (Chair, Senate Judiciary)]: If I can just interject a little quick here, we did bring this up a bit earlier and had a conversation, brief conversation about it. One the ways that at least I interpret it is, you know, we created the less restrictive environment. Provisions for the two categories and that could entail an individual being committed to a place that isn't a correctional facility. And so I'm So it would seem that if somebody is committed to a psychiatric hospital, they could also be receiving the competency restoration services there even though they are still under the category of being somebody who was held without bail in charge of a life sentence. So that's my take on it but

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Yeah no I think that fits. I didn't introduce myself. I'm Senator Jenny Mullins. Anyway, but yeah you're right and I'm sure you'll be looking at that further. So what we want to be sure is that clinical services are provided and we know that the WellPath contract will need to be inclusive of the services that are, that's on page two, and then also define staff qualifications, licensure training, supervision requirements for appropriate care, clinically appropriate treatment care services. And then we did add in, ensure that a registered licensed nurse or a physician are available to provide, should one of them or the other of those should be available seven days a week, twenty four hours a day. So should there be a need for someone in the middle of the night there's a call available to have that care delivered. And then the other number seven on page two, that as soon as the person is transferred to the facility that within seventy two hours that they have reviews and their clinical needs are evaluated at that point as they come into the facility so they know what is needed for the patients. And then, your definitions of forensic facilities are included and then we have a report back annually on or annually, so we have an annual report in here, January 15, DOC, Dale and DMH in Independent Living, but Dale will provide a written report to our committees about the use of the forensic facility who was placed in the previous calendar year, the types of clinical services and treatment provided during This that will be important for us. I know there are very few people we're talking about. We understand that, but it's important to understand how they're being taken care of. They do have specific heart states. And then we have rule making around the forensic facility and that does include the comments about, again, clinically appropriate standards, quality assurance, improvement, clinical oversight, documentation, reporting, all the things that would be required, think, should be required and any other provisions necessary to ensure safe and effective and clinically appropriate implementation, and that's with DMH and DOC working together and Dale Disabilities working together to apply those rules. And then the interim report coming in in October to our committees from those folks about progress and the status and anticipated timeline for the adoption of rules. Ordinarily we think of rules taking about eighteen months so that we'll find out where they are with those. And then the forensic facility planning process, and we've asked for this before, I understand this is like a redundancy redundant part, but we will ask for what is happening, the space considerations, design elements and the institutions committee and our committee work together on some of this stuff. The design elements necessary to support the provision of therapeutic services and security of the proposed location and the timing for any necessary fit up. So how long is it gonna take, where are we in that planning process, and initial staffing considerations and so on. And then the dates and Katie can explain the date a different way you have there. So that's our proposal of amendment to your bill and I understand your question on the first page, that sounds like it's gonna be

[Senator Philip Baruth (Member, Senate Judiciary)]: And if I invite, again, that last subsection off page one, I'm wondering, did we eliminate the last clause so that it read, provide for the safe housing and management of persons, including any ability to separate the population by sex and otherwise address the claim to same to your operation and considerations as appropriate. Period. Period. Well, semicolon because we're addressing. Yes. With that.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: I'm fine with that and I think my company will be fine with us.

[Senator Philip Baruth (Member, Senate Judiciary)]: Because, I mean, we can always, this is describing this one facility, we can also, anytime, talk Yeah. About

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Okay. And DMA should weigh in on that as well. Did

[Senator Nader Hashim (Chair, Senate Judiciary)]: you, with your recommendation, adding a semicolon and that's it?

[Senator Philip Baruth (Member, Senate Judiciary)]: Where is the semicolon at the end of that sentence?

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: He's just saying end it at facilities with a semicolon but cross out the last phrase.

[Senator Philip Baruth (Member, Senate Judiciary)]: Ended as appropriate. Ended at appropriate with the semicolon and then striking out

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Oh, I hear it. Well, multiple facilities are also included

[Senator Nader Hashim (Chair, Senate Judiciary)]: in that on striking that, but let me sorry.

[Senator Philip Baruth (Member, Senate Judiciary)]: And my apologies. This is if you go up to line nine, it's a description of this facility. And then in three, one of the characteristics of this facility is somehow that it will suddenly involve multiple facilities. As appropriate. Right, but based on the clinical needs of transferred persons, to me that means over the ambiguity that now we're talking about two or three facilities.

[Senator Nader Hashim (Chair, Senate Judiciary)]: So how does one facility operate in multiple facilities? And why are

[Senator Philip Baruth (Member, Senate Judiciary)]: we even talking about that since this is to outline, describe, and bring online a facility?

[Senator Nader Hashim (Chair, Senate Judiciary)]: Vyhovsky, Senator Senator Vyhovsky.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: I mean, I think I share the chair's concerns removing that. Just, I feel like if the clinical needs are there, we should be obligated to do what is clinically necessary.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Right. It's the This is going

[Senator Philip Baruth (Member, Senate Judiciary)]: be a very expensive proposition. If we're then saying dependent on needs, now it's doubled in cost. It's it's I would like to be clear on what we're greenlighting and this just seems to open it up because we've talked from the beginning about a facility, mean for years, and now in one clause we're introducing multiple facilities and it's in a shell statement. So I don't know, it seems unnecessarily ambiguous.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: So I would go along with the clinical needs piece, taking that last phrase out beginning with itch, but including the possible alteration of mental processing facilities, Vina and I would consider that and that you'll have to talk with Karen Barber and others. There are, we're talking about a cohort of different types of people here. We're talking about substance use disorder, we're talking about IDD and developmental disability, we're talking about mental health and we're talking about traumatic brain injury. So each of those cohorts has a different clinical need and so we can take out the clinical need but they each have different, each different. And so it might be that folks with substance use disorder who've presented a crime with a life sentence can be restored to competency faster in a different way from those with mental health issues or IDE. And in that sense you might find that they can go to a different facility from the other folks. So I'll leave it, that's the way I look at this right here, but I think I'm going to phone a friend and when you have Katie McLint, I think that's it.

[Senator Philip Baruth (Member, Senate Judiciary)]: And Windham just suggested I could go along with? So in other words ending the line at including the possible operation of multiple facilities? I can do that. Because it's not then modified by it's being required by the condition of the person.

[Senator Nader Hashim (Chair, Senate Judiciary)]: I was just going to mention another possibility, a grammatical change that I think might get to the ambiguity here which is instead of including the possible operation of multiple facilities so on we say including the coordination between multiple facilities so that if you're having somebody who's committed to sovereign state and based on the process and old circumstances, it now makes more sense for them to be committed to the Berlin psychiatric hospital or a different facility somewhere else. That's a possibility.

[Senator Philip Baruth (Member, Senate Judiciary)]: I mean, I hate to harp on this, but the language is strange because it's saying this new forensic facility shall be involved in the operation of multiple facilities. The forensic facility, the new one, isn't going to operate other facilities. We're talking about the Department of Health might operate. So I don't know, it's in a list of things characterizing this facility and then suddenly it's saying one of the characteristics of this facility is that it will operate other facilities.

[Senator Nader Hashim (Chair, Senate Judiciary)]: I get your point. Yeah. That's why I'm thinking it's important to multiple facilities, but also the DMA, the DOC, or Senator Harrison. Does anybody else have a bit more?

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: I'll just say, I'm just happy striking that last phrase and then you guys can wordsmith, you know, you want to express it based on what you hear from us. Yes. Do you have any other questions before I make this up? No problem.

[Senator Nader Hashim (Chair, Senate Judiciary)]: I think maybe the rest of our question should be for Eric and other folks. So if you're pressed for time, I think you've a committee for

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: all this. So just to let you know, our committee worked very hard on this, on current experiences that we had with our legislation last year and also with, I've been working with the judiciary on this, and as you know, with reducing the competency backlog that we've had, we've worked on that. We still have this issue with people who have not yet been adjudicated, who are incompetent to stand trial, and it is a real tough nut to crack. So I appreciate the work that you've done on the bill.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Thank you. And likewise, believe mendment. Yes. Okay,

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: I'm getting out of this seat. But if you, my question for you is this, I mean, rather than have amendment on top of an amendment, if you find that there are some little changes that everyone is agreeable to, I'm hanging across to do that, and Katie can do that on our behalf, and if you want to sign on to the proposed amendment, that would be great. So just let me know. Okay. Thank you. Senator Harrison, did you want to testify on

[Senator Nader Hashim (Chair, Senate Judiciary)]: the whole thing or did you want to just respond to that one piece?

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: I was. I don't, it doesn't matter to me what order you go in.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Okay. Let's, so DMH, did you want to respond to that one little piece and then we should have Senator Harrison testify to the whole thing?

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Right, but I also do want to respond to that one little

[Senator Nader Hashim (Chair, Senate Judiciary)]: Okay, let's do DMH first. Yeah, Senator Harrison that's for the whole thing.

[Vermont Department of Mental Health representative]: I think from our perspective,

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: we would support the proposed change.

[Vermont Department of Mental Health representative]: I think the idea of what AHS had asked for was maximum flexibility to allow the Department of Corrections in collaboration with the agency of human services to really have the opportunity itself to determine what made the most sense for talking about a very small population. And so having a lot of specific guardrails around that makes it difficult for DOC to kind of really actually look at its facility, look at the people and determine what is most politically appropriate. And so the idea is to allow us that flexibility. I will say that there, I think this came out of a concern that gets raised quite often, which is can we mix populations? And what I would say to that, and what I've said before is that we can and we do, mix populations all the time. People are retrieving or receiving treatment mixed together for lots of different things. And so in our world, there's this kind of need to separate someone who's got a substance use disorder necessarily from someone who's getting treated because most of the time there's co occurring disorders and so it makes sense to do it together. I think the language as you've suggested makes sense. And I think the idea really is just to make sure we're able to make decisions that aren't clinically appropriate and give us

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: the flexibility to do so.

[Senator Nader Hashim (Chair, Senate Judiciary)]: The language proposed of striking it or saying we're coordinating

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: all of the sentence.

[Vermont Department of Mental Health representative]: I think that's very interesting. Just right, you want to keep the operation.

[Vermont Department of Corrections representative]: Affirmative. So striking from the phrase beginning with the word on page one of draft number 4.1 on page one line 19 striking from if through the end of line 20. So the phrase is striking the phrase if required by the clinical needs of transferred persons. That would be fine in the beginning.

[Senator Nader Hashim (Chair, Senate Judiciary)]: And it would correct, yes ma'am. It would end with a semicolon word after the phrase of multiple facilities. Multiple facilities, semicolon leading to boring. And then, and then keeping including the possible operation of multiple facilities in a semicolon?

[Vermont Department of Corrections representative]: Yeah, before the semicolon, yes. And again, we already operate multiple facilities.

[Vermont Department of Mental Health representative]: Your point, Senator Nissi, I think

[Senator Nader Hashim (Chair, Senate Judiciary)]: that,

[Vermont Department of Mental Health representative]: Rashim, If someone was going to BPCH, they would fall under this anyway, so there's not necessarily a need to coordinate in that way that maybe you are envisioning because they would be eligible for this facility if they needed to go to DMH. They would simply be in DMH custody. Does that address your concern? Yeah. Okay.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Senator Harris. How about I start with that?

[Senator Nader Hashim (Chair, Senate Judiciary)]: Yeah, that would be good.

[Senator Wendy Harrison (Chair, Senate Institutions)]: Okay, I think it's relatively efficient. There's another way to look at it with, oh, I'm sorry, Wendy Harrison, I represent the Windham District and Chair of Institutions. And thank you very much for working with us on this amendment and we do work with health and welfare. And I have comments on things that are specifically relative to institutions. So corrections is one of possibly, it may be the only institution in the state that does distinguish between men and women. There is actually a gender bill coming to us from the house where we'll discuss this more, but the facilities are segregated by sex. And we actually talked about the word sex versus gender and we decided not to change it yesterday because we didn't want to have too many changes to this. But right now, we do have What we've heard is that folks who are in these categories, in this category of a forensic facility, are already in the prisons. They are in the women's prison as well as in the men's prison. So there are two facilities already being used for I that think when you started this, I wasn't part of it, but you were looking at a forensic facility not in a prison and that kind of facility, if it was run by damage or similar, that could have men and women and other sorts of different populations. So I think that's where the disconnect came from, is that this, the section three, paragraph three, has to do with the So I agree that having the period after multiple facilities on line 19, that makes sense.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Correct. Having the period there?

[Senator Wendy Harrison (Chair, Senate Institutions)]: Correct. Or a semicolon, sorry.

[Senator Nader Hashim (Chair, Senate Judiciary)]: And still striking if required by clinical needs.

[Senator Wendy Harrison (Chair, Senate Institutions)]: Yes, yes, because it could be required for multiple reasons. I mean, actually makes it more flexible if we take that out. And

[Senator Nader Hashim (Chair, Senate Judiciary)]: do you prefer keeping the word, the language of possible operation of multiple facilities rather than the possible coordination between multiple facilities, does that matter?

[Senator Wendy Harrison (Chair, Senate Institutions)]: It doesn't matter As long as you all are. We collaborated well with two departments.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Yeah, I know you want to keep yes. Okay, yes.

[Senator Wendy Harrison (Chair, Senate Institutions)]: So I'll highlight the paragraphs that my committee was particularly interested in. On page two, six, ensure that our registered nurse or physicians are available. And that's just for safety of the units, because right now there are, we're over capacity in the prisons and understaffed, so there is, they are very delicate operations and our concern is that they not be, that they'd be able to operate well and that facility doesn't cause a disturbance. And one way to do that is to make sure that the medical books are there. Then on page three, that's where I can do that, rule making, line 19, standards for quality assurance and improvement, clinical oversight, safety and risk management protocols, and more specifically, and mechanisms for monitoring compliance. And we did discuss in institutions, I think it was yesterday, that role making doesn't have to take HCC because it could progress that way quicker. And then on page four, the first paragraph, it says any other provisions necessary. So specifically, requiring provision of a forensic facility service in a unit that is separate from other correctional populations. Right now, the amount of folks is minimal, as you've discussed. We don't know what the complete population is going to be. The prison warrant designed for this, so it's good to have this flexibility in the rule making. And the interim report, also on that page, line 17, the planning, planning specific proposed locations, space considerations, design elements, that's really important. And then on page five, lines one through four, initial staffing considerations, anticipated staff levels. It's really something that we need to know about because, again, we're understaffed now. And then timelines to make sense. Thanks.

[Senator Philip Baruth (Member, Senate Judiciary)]: I'm

[Senator Wendy Harrison (Chair, Senate Institutions)]: wondering if you could help me understand why you said your committee had conversations about sex versus gender, I'm a little concerned actually that we're suggesting separation by sex and not gender, because to me that indicates that someone who is a transgender woman or a transgender man could be placed in the wrong facility. That's, the suggestion to change actually came from the, director of communications, of communications, excuse me. So, we would be fine with that change. At that point in our conversation, we were looking at not having more changes to things. We wanted to finish this up, but our committee is fine to change sex to gender. We would support that.

[Vermont Department of Corrections representative]: I may, the reason I raised the issue is that this would make this very small population different from every other population in our custody. We do not separate anyone merely by sex or gender is a component of the decision making process. It is true that the vast majority of all the 13 people in our custody right now I believe are separated by sex, but that is not the sole component. It's the totality of circumstance in each individual case. And I cannot speak whether or not any of the individuals who are currently in our custody fit the parameters of this proposed language and statute are among those 13. I don't know for sure.

[Senator Nader Hashim (Chair, Senate Judiciary)]: So just so I understand, if we were to say sex and gender, it wouldn't have an impact then on how you already do this? Affirmative. Okay.

[Vermont Department of Corrections representative]: If you were to state sex or gender, sex and gender, whichever you prefer.

[Senator Wendy Harrison (Chair, Senate Institutions)]: And our committee is fine with that. Any

[Senator Nader Hashim (Chair, Senate Judiciary)]: other questions? Or did I see a hand from DMH?

[Vermont Department of Mental Health representative]: Oh, no, I'm sorry. Oh, okay. I'm sorry.

[Senator Philip Baruth (Member, Senate Judiciary)]: Okay. So

[Senator Nader Hashim (Chair, Senate Judiciary)]: I have a feeling Eric is, yes, detained on the board right now. And I don't want to, take a straw poll with four out of five members and without having heard from Legion Council. We'll wait on this. We'll make the recommendations to Senator Lyons and to relay the recommendations to Katie regarding sex or gender and then striking the second half of lines 19 through 20, where it starts if required by the clinical needs and so And then, is there anything else? Any last testimony from DMA for DOC on this? All right, great. Thank you.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Thank you, Rachel.

[Senator Nader Hashim (Chair, Senate Judiciary)]: Appreciate it.

[Senator Ginny Lyons (Chair, Senate Health and Welfare)]: Appreciate it. All right. Thanks. Okay.

[Senator Nader Hashim (Chair, Senate Judiciary)]: So we will wrap this up in hopefully next week.