BILL ANALYSIS SENATE COMMITTEE ON PUBLIC SAFETY Senator Mark Leno, Chair S 2009-2010 Regular Session B 1 2 9 SB 1296 (Correa) 6 As Amended: April 7, 2010 Hearing date: April 20, 2010 Penal Code SM:dl PEACE OFFICER TRAINING: PTSD AND TBI HISTORY Source: Department of Veterans Affairs Prior Legislation: SB 1531 (Correa) - Chap. 621, Statutes of 2008 Support: Unknown Opposition:None known KEY ISSUES SHOULD POST BE REQUIRED TO MEET WITH THE DEPARTMENT OF VETERANS AFFAIRS AND OTHER ORGANIZATIONS, AS SPECIFIED, THAT HAVE EXPERTISE IN THE AREA OF TRAUMATIC BRAIN INJURY (TBI) AND POST-TRAUMATIC STRESS DISORDER (PTSD) TO ASSESS THE TRAINING NEEDED BY SPECIFIED PEACE OFFICERS, ON THE TOPIC OF RETURNING VETERANS OR OTHER PERSONS SUFFERING FROM TBI OR PTSD? SHOULD THE COMMISSION, IF IT DETERMINES THAT THERE IS A NEED FOR TRAINING ON TBI AND PTSD, BE REQUIRED TO CREATE AND MAKE AVAILABLE ON DVD A COURSE ON HOW TO RECOGNIZE AND INTERACT WITH (More) SB 1296 (Correa) PageB RETURNING VETERANS OR OTHER PERSONS SUFFERING FROM TBI OR PTSD DESIGNED FOR, AND MADE AVAILABLE TO, PEACE OFFICERS WHO ARE FIRST RESPONDERS TO EMERGENCY SITUATIONS, AS SPECIFIED? (CONTINUED) SHOULD THE COMMISSION BE REQUIRED TO DEVELOP THE TRAINING COURSE IN CONSULTATION WITH THE DEPARTMENT OF VETERANS AFFAIRS AND APPROPRIATE ORGANIZATIONS THAT HAVE EXPERTISE IN THE AREA OF TBI AND PTSD AND TO MAKE THE COURSE AVAILABLE TO LAW ENFORCEMENT AGENCIES IN CALIFORNIA? SHOULD THE COMMISSION BE REQUIRED TO DISTRIBUTE, AS NECESSARY, A TRAINING BULLETIN VIA THE INTERNET TO LAW ENFORCEMENT AGENCIES PARTICIPATING IN THE COMMISSION'S PROGRAM ON THE TOPIC OF TBI AND PTSD? SHOULD THE COMMISSION BE REQUIRED TO REPORT TO THE LEGISLATURE, NO LATER THAN JUNE 30, 2012, ON THE EXTENT TO WHICH PEACE OFFICERS ARE RECEIVING ADEQUATE TRAINING IN HOW TO INTERACT WITH PERSONS SUFFERING FROM TBI OR PTSD? PURPOSE The purpose of this bill is to (1) require POST to meet with the Department of Veterans Affairs and other organizations, as specified, that have expertise in the area of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) to assess the training needed by peace officers, who are first responders in emergency situations, on the topic of returning veterans or other persons suffering from TBI or PTSD; (2) provide that if the commission determines that there is an unfulfilled need for training on TBI and PTSD, require the commission to determine the appropriate training format, as specified and, upon the next regularly scheduled review of a training module relating to persons with disabilities, create and make available on DVD a course on how to recognize and interact with returning veterans or other persons suffering from TBI or PTSD designed for, and made available to, peace officers who are first responders to (More) SB 1296 (Correa) PageC emergency situations; (3) require the commission to develop the training course in consultation with the Department of Veterans Affairs and appropriate organizations that have expertise in the area of TBI and PTSD and to make the course available to law enforcement agencies in California; (4) require the commission to distribute, as necessary, a training bulletin via the Internet to law enforcement agencies participating in the commission's program on the topic of TBI and PTSD; and (5) require the commission to report to the Legislature, no later than June 30, 2012, on the extent to which peace officers are receiving adequate training in how to interact with persons suffering from TBI or PTSD. Existing law provides that by July 1, 2006, the Commission on Peace Officer Standards and Training (POST) shall establish and keep updated a continuing education classroom training course relating to law enforcement interaction with mentally disabled persons. The training course shall be developed by the commission in consultation with appropriate community, local, and state organizations and agencies that have expertise in the area of mental illness and developmental disability, and with appropriate consumer and family advocate groups. In developing the course, the commission shall also examine existing courses certified by the commission that relate to mentally disabled persons. The commission shall make the course available to law enforcement agencies in California. The course shall consist of classroom instruction and shall utilize interactive training methods to ensure that the training is as realistic as possible. The course shall include, at a minimum, core instruction in all of the following: the cause and nature of mental illnesses and developmental disabilities; how to identify indicators of mental disability and how to respond appropriately in a variety of common situations; conflict resolution and de-escalation techniques for potentially dangerous situations involving mentally disabled persons; (More) SB 1296 (Correa) PageD appropriate language usage when interacting with mentally disabled persons; alternatives to lethal force when interacting with potentially dangerous mentally disabled persons; community and state resources available to serve mentally disabled persons and how these resources can be best utilized by law enforcement to benefit the mentally disabled community; and the fact that a crime committed in whole or in part because of an actual or perceived disability of the victim is a hate crime, as specified. (Penal Code 13515.25(a-b).) Existing law provides that the commission shall submit a report to the Legislature by October 1, 2004, that shall include all of the following: a description of the process by which the course was established, including a list of the agencies and groups that were consulted; information on the number of law enforcement agencies that utilized, and the number of officers that attended, the course or other courses certified by the commission relating to mentally disabled persons from July 1, 2001, to July 1, 2003, inclusive; information on the number of law enforcement agencies that utilized, and the number of officers that attended, courses certified by the commission relating to mentally disabled persons from July 1, 2000, to July 1, 2001, inclusive; and an analysis of the Police Crisis Intervention Training (CIT) Program used by the San Francisco and San Jose Police Departments, to assess the training used in these programs and compare it with existing courses offered by the commission in order to evaluate the adequacy of mental disability training available to local law enforcement officers.(Penal Code 13515.25(c).) Existing law states that the Legislature encourages law (More) SB 1296 (Correa) PageE enforcement agencies to include the course created in this section, and any other course certified by the commission relating to mentally disabled persons, as part of their advanced officer training program. (Penal Code 13515.25(d).) Existing law states that it is the intent of the Legislature to reevaluate, on the basis of its review of the report required in subdivision (c), the extent to which law enforcement officers are receiving adequate training in how to interact with mentally disabled persons. (Penal Code 13515.25(e).) This bill would require POST to meet with the Department of Veterans Affairs and community, local, or other state organizations and agencies that have expertise in the area of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) in order to assess the training needed by peace officers, who are first responders in emergency situations, on the topic of returning veterans or other persons suffering from TBI or PTSD. This bill would, if the commission determines that there is an unfulfilled need for training on TBI and PTSD, require the commission to determine the training format that is both fiscally responsible and meets the training needs of the greatest number of officers. This bill would, if the commission determines that there is an unfulfilled need for training on TBI and PTSD, require the commission, upon the next regularly scheduled review of a training module relating to persons with disabilities, to create and make available on DVD and may distribute electronically, or provide by means of another form or method of training, a course on how to recognize and interact with returning veterans or other persons suffering from TBI or PTSD. This course shall be designed for, and made available to, peace officers who are first responders to emergency situations. This bill would require the training course to be developed by the commission in consultation with the Department of Veterans Affairs and appropriate community, local, or other state (More) SB 1296 (Correa) PageF organizations and agencies that have expertise in the area of TBI and PTSD. The commission would be required to make the course available to law enforcement agencies in California. This bill would further require the commission to distribute, as necessary, a training bulletin via the Internet to law enforcement agencies participating in the commission's program on the topic of TBI and PTSD. This bill would require the commission to report to the Legislature, no later than June 30, 2012, on the extent to which peace officers are receiving adequate training in how to interact with persons suffering from TBI or PTSD. This bill provides that its requirement for submitting a report is inoperative on June 30, 2016, as specified. This bill requires that the report is to be submitted as a printed copy to both the Legislative Counsel and the Secretary of the Senate, and as an electronic copy to the Chief Clerk of the Assembly, and made available to the public in compliance with the Government Code, as specified. RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION The severe prison overcrowding problem California has experienced for the last several years has not been solved. In December of 2006 plaintiffs in two federal lawsuits against the Department of Corrections and Rehabilitation sought a court-ordered limit on the prison population pursuant to the federal Prison Litigation Reform Act. On January 12, 2010, a federal three-judge panel issued an order requiring the state to reduce its inmate population to 137.5 percent of design capacity -- a reduction of roughly 40,000 inmates -- within two years. In a prior, related 184-page Opinion and Order dated August 4, 2009, that court stated in part: "California's correctional system is in a tailspin," the state's independent oversight agency has reported. . . . (Jan. 2007 Little Hoover Commission Report, (More) SB 1296 (Correa) PageG "Solving California's Corrections Crisis: Time Is Running Out"). Tough-on-crime politics have increased the population of California's prisons dramatically while making necessary reforms impossible. . . . As a result, the state's prisons have become places "of extreme peril to the safety of persons" they house, . . . (Governor Schwarzenegger's Oct. 4, 2006 Prison Overcrowding State of Emergency Declaration), while contributing little to the safety of California's residents, . . . . California "spends more on corrections than most countries in the world," but the state "reaps fewer public safety benefits." . . . . Although California's existing prison system serves neither the public nor the inmates well, the state has for years been unable or unwilling to implement the reforms necessary to reverse its continuing deterioration. (Some citations omitted.) . . . The massive 750% increase in the California prison population since the mid-1970s is the result of political decisions made over three decades, including the shift to inflexible determinate sentencing and the passage of harsh mandatory minimum and three-strikes laws, as well as the state's counterproductive parole system. Unfortunately, as California's prison population has grown, California's political decision-makers have failed to provide the resources and facilities required to meet the additional need for space and for other necessities of prison existence. Likewise, although state-appointed experts have repeatedly provided numerous methods by which the state could safely reduce its prison population, their recommendations have been ignored, underfunded, or postponed indefinitely. The convergence of tough-on-crime policies and an unwillingness to expend the necessary funds to support the population growth has brought California's prisons to the breaking point. The state of emergency declared by Governor (More) SB 1296 (Correa) PageH Schwarzenegger almost three years ago continues to this day, California's prisons remain severely overcrowded, and inmates in the California prison system continue to languish without constitutionally adequate medical and mental health care.<1> The court stayed implementation of its January 12, 2010 ruling pending the state's appeal of the decision to the U.S. Supreme Court. That appeal, and the final outcome of this litigation, is not anticipated until later this year or 2011. This bill does not appear to aggravate the prison overcrowding crisis described above. COMMENTS 1. Need for This Bill According to the author: Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) have been identified as the "signature injuries" and "silent epidemics" affecting an increasing number of veterans returning from recent military conflicts. It has been estimated that 300,000 Iraq and Afghanistan war veterans are afflicted with PTSD. Persons with TBI are often referred to as the "walking wounded." Their injuries, mostly unnoticeable at first sight, pose certain challenges to those who come in contact with them. TBI and PTSD symptoms can sometimes include behaviors of anger, hostility, and aggression. ---------------------- <1> Three Judge Court Opinion and Order, Coleman v. Schwarzenegger, Plata v. Schwarzenegger, in the United States District Courts for the Eastern District of California and the Northern District of California United States District Court composed of three judges pursuant to Section 2284, Title 28 United States Code (August 4, 2009). (More) SB 1296 (Correa) PageI SB 1296 will provide the necessary tools for peace officers who are first responders to emergency situations to recognize and interact with returning veterans or other persons suffering from TBI and PTSD. 2. What are PTSD and TBI ? An article in the Journal of Rehabilitation Research & Development describes PTSD and TBI as follows: Posttraumatic Stress Disorder Criteria and Symptoms As defined in the Diagnostic and Statistical Manual (DSM)-Fourth Edition-Text Revised (DSM-IV-TR), PTSD is an anxiety disorder comprising four major criteria: 1. Exposure to or witnessing an event that is threatening to one's well-being and responding with intense fear, helplessness, or horror. 2. Symptoms of re-experiencing, such as recurrent and intrusive memories, nightmares, a sense of reliving the trauma, or psychological and physiological distress when reminded of aspects of the trauma. 3. Avoidance of thoughts, feelings, or reminders of the trauma, and the inability to recall parts of the trauma, withdrawal, and emotional numbing. 4. Arousal increases, as manifested in sleep disturbance, irritability, difficulty concentrating, hypervigilance, or exaggerated startle response. These symptoms must cause marked impairment in functioning and persist for at least 1 month after the trauma. PTSD also has accompanying cognitive effects that include impaired concentration and decision making, memory impairment and confusion; behavioral symptoms of increased relational conflict resulting in social withdrawal, alienation, reduced relational intimacy and impaired work and school performance; and (More) SB 1296 (Correa) PageJ somatic complaints of exhaustion, insomnia, headaches, startle response, hyperarousal, and cardiovascular, gastrointestinal, and musculoskeletal disorders.(Posttraumatic Stress Disorder and Posttraumatic Stress Disorder-LikeSymptoms and Mild Traumatic Brain Injury, 895 JRRD Volume 44, Number 7, 2007, Pages 895-920, Journal of Rehabilitation Research & Development.) Traumatic Brain Injury Mechanisms and Criteria TBI may arise from physical damage by external blunt or penetrating trauma to the head, skull, dura, or brain or from acceleration-deceleration movement such as whiplash or coup-contrecoup, resulting in tearing or shearing of nerve fibers and bruising or contusion of the brain against opposite sides of the skull. Scraping of the brain across the rough bony base of the skull can cause contusion and can also affect the olfactory, oculomotor, optic, and acoustic nerves, leading to anosmia (total loss of the sense of smell, reduction of taste), double and/or blurred vision, and dizziness and/or vertigo. These symptoms usually remit after days and weeks as the damaged axons in those nerves recover or grow back to reinnervate the sensory receptors or muscles. * * * * * * * Symptoms With most TBIs, a set of postconcussive symptoms occur immediately after brain injury and can include cognitive deficits in memory, attention, and concentration; physical or somatic complaints of fatigue, disordered sleep, dizziness, and headache; and affective complaints of irritability, anxiety, and depression. In evaluating the symptoms associated with TBI, clinicians should account for multiple factors related to the characteristics of the individual (More) SB 1296 (Correa) PageK injured, severity of the injury, and the time interval from injury to evaluation that can influence the level of functional and cognitive performance [14]. Mild TBI can cause cognitive deficits not only in speed of information processing, attention, and memory in the immediate postinjury period but also in motor skills and new problem-solving and general intellectual skills [15]. Fortunately, good recovery of postconcussive deficits can be expected over a time ranging from 4 to 12 weeks for the majority of patients with mild TBI cases. However, some patients may recover much more slowly, with symptoms lingering for several more months [16] or even years [17]. In terms of the emotional sequelae of TBI, Rao and Lyketsos state the most common post-TBI anxiety symptoms include "free-floating anxiety, fearfulness, intense worry, generalized uneasiness, social withdrawal, interpersonal sensitivity and anxiety dreams" [18]. These symptoms are also similar to characteristic PTSD symptoms and therefore can be a problematic overlap in considering PTSD incidence rates in those persons with mild TBI. (Id.) 3. TBI in California In January 2010, the Senate Office of Research prepared an "Overview of Traumatic Brain Injury in California," for the Senate Health Committee. It found: The Centers for Disease Control estimate 1.4 million Americans receive Traumatic Brain Injuries annually. TBI is an injury sustained after birth from an external force to the brain or any of its parts that results in psychological, neurological or anatomical changes in brain functions. Nationwide, the CDC identifies 5.3 million Americans as having long-term or lifelong disabilities associated with TBI, including 350,000 Californians. Approximately 50,000 (More) SB 1296 (Correa) PageL people die annually from TBI. Medical and indirect costs, such as lost productivity, totaled $60 billion nationally in 2000. More than a quarter of the TBI cases result from falls, another 20 percent are the result of vehicle accidents and 30 percent are from either assaults or blows. Additionally, there are two, recent, high-profile population TBI patients: 4 Athletes, especially football players. Spurred by a June 2009 study at a brain trauma research center based at Boston University that showed six of six ex-NFL football players had extensive TBI from playing the sport, a controversy has continued to play out through the fall about whether concussions in sports lead to lifelong brain trauma. 4 Iraqi and Afghanistan war veterans. The U.S. Department of Veteran's Affairs, which established a TBI administration after the Gulf War, noted that while 14 percent of previous war veterans had TBI, this war's brain injured veterans is "much higher." Some providers estimate that 60 percent of injured vets also have TBI. Long term symptoms of Traumatic Brain Injury include memory loss, physical aggression, depression, difficulty expressing thoughts or understanding others, seizures, impaired social skills and inappropriate sexual activity, inability to accept limitations and heightened risk of Alzheimer's. In California, funds from traffic and other motor vehicle fines are diverted into a variety of funds, including a Traumatic Brain Fund.<2> In FY 2009-2010 the fund total was $1.05 million. This finances seven Traumatic Brain Injury Services of California centers ---------------------- <2> California Penal Code Section 1464(f)(8)(A) directs 0.66 percent of fees be transferred into the Traumatic Brain Injury fund. (More) SB 1296 (Correa) PageM throughout the state, which provide referrals and written materials to TBI survivors. With 350,000 TBI survivors, California has the highest number of any state. Yet, according to a 2004 summary of state TBI trust funds, California allocates fewer total dollars to its TBI trust fund than many states, including Kentucky, Louisiana, New Mexico and Oklahoma. *************** (More) 4. Our Responsibility to the Injured A 2008 RAND Corporation study of the effects of these hidden types of injuries on service members concluded: Treating the Invisible Wounds of War Addressing PTSD, depression, and TBI among those who deployed to Afghanistan and Iraq is a national priority. But it is not an easy undertaking. The prevalence of such wounds is high and may grow as the conflicts continue. And long-term negative consequences are associated with these conditions if they are not treated with evidence-based, patient-centered, efficient, equitable, and timely care. The systems of care available to address these wounds have been improved significantly, but critical gaps remain. The nation must ensure that quality care is available and provided to military veterans now and in the future. As a group, the veterans returning from Afghanistan and Iraq are predominantly young, healthy, and productive members of society. However, about a third are currently affected by PTSD or depression, or report exposure to a possible TBI while deployed. Whether the TBIs will translate into any lasting impairments is unknown. In the absence of knowing, these injuries cause great concern for servicemembers and their families. These veterans need our attention now to ensure successful adjustment post-deployment and full recovery. Meeting the goal of providing care for these service members will require systemlevel changes, which means expanding the nation's focus to consider issues not just within DoD and the VA, from which the majority of veterans will receive benefits, but also across the overall U.S. health care system, in which many will (More) SB 1296 (Correa) PageO seek care through other, employer-sponsored health plans and in the public sector (e.g., Medicaid). System-level changes are essential if the nation is to have the resources it needs to meet its responsibility not only to recruit, prepare, and sustain a military force but also to address Service-connected injuries and disabilities. ARE PERSONS SUFFERING FROM TBI OR PTSD MORE LIKELY TO HAVE DIFFICULT ENCOUNTERS WITH LAW ENFORCEMENT? WOULD IT BE HELPFUL TO LAW ENFORCEMENT AND THE PUBLIC TO BE FAMILIAR WITH THE SYMPTOMS OF THESE CONDITIONS AND HOW TO REACT TO THEM? SHOULD THE POST COMMISSION BE REQUIRED TO DETERMINE, AS SPECIFIED, IF ADDITIONAL TRAINING FOR PEACE OFFICERS IS NEEDED IN DEALING WITH PERSONS WITH PTSD OR TBI? SHOULD THE COMMISSION BE REQUIRED, IF IT DETERMINES THAT ADDITIONAL TRAINING IS NEEDED, TO DEVELOP AND MAKE AVAILABLE THAT ADDITIONAL TRAINING, AS SPECIFIED? **************