BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | SB 1296| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: SB 1296 Author: Correa (D) Amended: 4/7/10 Vote: 21 SENATE PUBLIC SAFETY COMMITTEE : 7-0, 4/20/10 AYES: Leno, Cogdill, Cedillo, Hancock, Huff, Steinberg, Wright SENATE APPROPRIATIONS COMMITTEE : 10-0, 5/27/10 AYES: Kehoe, Alquist, Corbett, Denham, Leno, Price, Walters, Wolk, Wyland, Yee NO VOTE RECORDED: Cox SUBJECT : Peace officer training: traumatic brain injury: post- Traumatic stress disorder SOURCE : Department of Veterans Affairs DIGEST : This bill: (1) requires the Commission on Peace Officer Standards and Training (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) provides that if the commission determines that there is an unfulfilled need for training on TBI and CONTINUED SB 1296 Page 2 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 emergency situations; (3) requires 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) requires 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) requires 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. ANALYSIS : Existing law provides that POST establish and keep updated various training programs to maintain the level of competence of various law enforcement officers. This bill requires 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 TBI and 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, if the commission determines that there is an unfulfilled need for training on TBI and PTSD, requires 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, if the commission determines that there is an unfulfilled need for training on TBI and PTSD, requires 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 SB 1296 Page 3 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 requires the training course to be developed by the commission in consultation with the Department of Veterans Affairs and appropriate community, local, or other state 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 further requires 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 requires 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. Background What are TBI and PTSD ? An article in the Journal of Rehabilitation Research & Development describes TBI and PTSD as follows: Posttraumatic Stress Disorder: Criteria and Symptoms SB 1296 Page 4 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 one 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 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 SB 1296 Page 5 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 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.) TBI in California SB 1296 Page 6 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 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: 1. 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. 2. 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 SB 1296 Page 7 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. In FY 2009-2010 the fund total was $1.05 million. This finances seven Traumatic Brain Injury Services of California centers 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. 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. SB 1296 Page 8 Meeting the goal of providing care for these service members will require system level 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 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. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: No According to the Senate Appropriations Committee: Fiscal Impact (in thousands) Major Provisions 2010-11 2011-12 2012-13 Fund POST training development $88-150$88-150 likely minor General SUPPORT : (Verified 5/27/10) Department of Veterans Affairs (source) American Legion AMVETS California Brain Injury Association Vietnam Veterans of America ARGUMENTS IN SUPPORT : According to the author's office: 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 SB 1296 Page 9 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. 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. RJG:nl 5/28/10 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END ****