BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  SB 1296|
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                                 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





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          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  







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          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  








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          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  







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          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
           







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          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  







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               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.







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          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  







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               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

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