BILL ANALYSIS Ó
AB 386
Page 1
Date of Hearing: April 26, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 386 (Galgiani) - As Amended: March 31, 2011
SUBJECT : Prisons: telemedicine systems.
SUMMARY : Requires the California Department of Corrections and
Rehabilitation (CDCR) to have an operational telemedicine
services program at all adult institutions, as specified, by
January 1, 2016. Specifically, this bill :
1)Requires CDCR to include, within existing guidelines and by
January 1, 2013, protocols for determining when telemedicine
services are medically appropriate and in the best interest of
the health and safety of the inmate patient.
2)Requires CDCR to have an operational telemedicine services
program at all adult institutions, by January 1, 2016, that
includes:
a) Specific goals and objectives for maintaining and
expanding services and encounters provided by the
telemedicine services program, including store and forward
telemedicine technology;
b) An information technology support infrastructure that
will allow telemedicine to be used at each adult prison;
c) Specific guidelines for determining when and where
telemedicine would be the preferred delivery method for
health care; and,
d) Guidelines and protocols for appropriate use and
expansion of store and forward telemedicine technology, as
defined, in state prisons.
3)Requires CDCR to: schedule a patient for evaluation with a
distant physician via telemedicine if and when it is
determined that it is medically necessary; utilize
telemedicine only when it is in the best interest of the
health and safety of the inmate patient; and, ensure that
telemedicine is not used to supplant civil service physician
and dental positions.
4)Permits CDCR to contract with the San Joaquin General Hospital
for telemedicine services.
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5)Requires CDCR to report, each year from March 1, 2013 to March
1, 2018, to specified Assembly and Senate Committees:
a) The extent to which the objectives developed pursuant to
2) above were achieved, and the most significant reasons
for achieving or not achieving those objectives;
b) The extent to which a statewide telemedicine services
program is being operated, as well as the most significant
reasons for achieving or not achieving that objective; and,
c) A description of planned and implemented initiatives
necessary to accomplish the next 12 months' objectives for
achieving the goals developed pursuant to 2) above.
EXISTING LAW :
1)Establishes the Telemedicine Development Act for purposes of
overcoming significant barriers to access to health services
in medically underserved rural and urban areas and defines
telemedicine as the practice of health care delivery,
diagnosis, consultation, treatment, transfer of medical data,
and education using interactive, video, or data
communications.
2)Defines, in the Medical Practice Act, telemedicine as the
practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using
interactive audio, video or data communications.
3)Allows the use of telemedicine in the Medi-Cal Program, when
those services would be otherwise covered by the program when
appropriate, and when the contact between the health care
provider and the patient is real time or near real time.
4)Defines, for the purposes of Medi-Cal, "teleophthalmology and
teledermatology by store and forward" as transmission of
medical information to be reviewed at a later time and at a
distant site by a physician who is trained in ophthalmology,
optometry, or dermatology, where the physician at the distant
site reviews the medical information without the patient being
present in real time and allows these telemedicine services to
be reimbursed under the Medi-Cal Program. Existing law
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provides a sunset date of January 1, 2013 for these
provisions.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, telemedicine
has revolutionized the delivery of healthcare in the military,
the space program, at correctional institutions, and other
areas where difficulties exist in bringing medical providers
face-to-face with patients. The California Prison Health Care
Services uses telemedicine for medical specialty consultations
at all CDCR institutions and psychiatric telemedicine is
provided at four institutions. The author states that use of
telemedicine benefits the state by: a) avoiding medical
guarding and transportation costs associated with transporting
patient-inmates off-site to receive specialist services not
available on-site; b) avoiding public safety risks associated
with transporting patient-inmates off-site to receive
services; and, c) improving access to care by providing a
broader pool of medical and psychiatric providers available to
treat patient-inmates. The author further states that as the
use of telemedicine expands, it will further benefit the state
by reducing staff physician and psychiatric vacancies in
remote locations because these can be staffed centrally, and
patient-inmates at remote institutions can be treated using
telemedicine. Additionally, urgent care centers at
institutions can be staffed after-hours using telemedicine and
store and forward telemedicine technology can be used to
reduce costs associated with diagnostic services. The author
contends that this bill will result in significant cost
avoidance and savings, improve public safety, and improve
access to care for patient-inmates.
2)BACKGROUND . According to the Center for Connected Health
Policy telehealth is the use of telecommunications, health
information, and videoconferencing technologies to deliver
medical care, health education, and public health services, by
connecting multiple users in separate locations. Telehealth
encompasses a broad definition of technology-enabled health
care services. This definition includes telemedicine, which
is the diagnosis and treatment of illness or injury.
Telehealth services consist of diagnosis, treatment,
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assessment, monitoring, communications, and education.
Telehealth medical services are delivered in three main ways:
video conferencing, which is used for real-time
patient-provider consultations, provider-to-provider
discussions, and language translation services; patient
monitoring, in which electronic devices transmit patient
health information to health care providers; and, "store and
forward" technologies, which electronically transmit
pre-recorded videos and digital images, such as X-rays, video
clips and photos, between primary care providers and medical
specialists.
CDCR currently provides health care to its approximately
162,000 inmates in the form of primary care and specialty
services, which are generally provided by CDCR staff or
contract staff, and medical specialty care, which is provided
in prisons by health care staff during regularly scheduled
clinics. Inmates who need other medical specialty care are
transported to outside facilities, which requires
transportation and staffing costs to escort the patients.
3)TELEHEALTH IN CALIFORNIA PRISONS . According to its "Analysis
of the 2006-07 Budget Bill" the Legislative Analysts' Office
(LAO) states that California's telemedicine (now more commonly
referred to as telehealth) program began in 1997, with a pilot
program for mental health inmates (typically inmates with
schizophrenia and bipolar disorder) at Pelican Bay State
Prison. The pilot program improved inmates' access to mental
health care and CDCR later decided to expand the program to
other prisons. Correctional facilities have found
telemedicine / telehealth to be particularly beneficial for
the delivery of medicine, as it enhances public safety and
reduces costs by allowing inmates to receive treatment inside
prison rather than being transported to off-site medical
facilities. Additionally, telemedicine / telehealth enables
correctional systems to expand provider networks and lower
contract costs with physicians. CDCR's telemedicine /
telehealth program is currently administered by the Office of
Telemedicine Services, which is a unit of the Division of
Correctional Health Care Services. According to CDCR, this
program saves roughly $850 in transportation and medical
guarding costs for each outside medical visit that is avoided
because of the technology.
In its analysis, the LAO found that CDCR is not maximizing the
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benefits of telemedicine / telehealth. Based on CDCR's own
assessments, increased use of telemedicine / telehealth could
further reduce the number of outside medical visits by as much
as 20,000 per year, which would save up to $17 million
annually in transportation and guarding costs. The LAO found
that telemedicine / telehealth was underutilized because CDCR
does not require prison health care staff to utilize
telemedicine and it only offers a limited number of medical
specialties. In order to improve the utilization of
telemedicine / telehealth, the LAO recommended requiring
prisons to use the telemedicine / telehealth program for all
medical consultations that are appropriate its use, and that
CDCR establish guidelines concerning the conditions under
which telemedicine / telehealth should be used.
4)FEDERAL RECEIVER FOR CDCR . In February 2006, the U.S.
District Court for Northern California appointed a Receiver to
control the delivery of medical services for prisoners in
California. The receivership is the result of a class action
law suit in 2001, Plata v. Schwarzenegger (N.D. Cal. Oct. 3,
2005) No. C01-1351 THE, that found the medical care in
California's 33 adult prisons violates the Eighth Amendment of
the U.S. Constitution, which forbids cruel and unusual
punishment. The court found that on average an inmate died
needlessly every six to seven days due to inadequate medical
care. The Receiver is charged with taking over the operations
of the state's prison medical care system and bringing it up
to constitutional levels.
One of the Receiver's stated goals is to expand and improve
telemedicine/telehealth capabilities. In its most recent
tri-annual progress report, dated January 15, 2011, the
Receiver notes that its telemedicine program continues with
efforts to expand the use of telemedicine and upgrade CDCR's
telemedicine technology infrastructure. The Receiver
completed "Phase 2 of the Telemedicine Service Project," which
included expanding telemedicine services to six institutions
(North Kern State Prison, Kern Valley State Prison, Richard J.
Donovan Correctional Facility, Centinela State Prison,
California State Prison at Corcoran, and Substance Abuse
Treatment Facility). The Initiative resulted in a 14%
increase in telemedicine services at those institutions.
5)PREVIOUS LEGISLATION . Last year, AB 1785 (Galgiani) would
have required CDCR to maintain a statewide telemedicine
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services program, requires an operational telemedicine program
at each institution, and expands existing telemedicine
services and encounters. AB 1785 died in the Assembly
Appropriations Committee.
AB 1289 (Galgiani) of 2009 would have required CDCR to establish
guidelines and performance targets for the prison telemedicine
program and to require prisons to use telemedicine for all
medical consultations that are appropriate for telemedicine.
AB 1289 died on the Assembly Appropriations Committee Suspense
File.
AB 175 (Galgiani) Chapter 175, Statutes of 2009, expands, for
the purposes of Medi-Cal reimbursement, until January 1, 2013,
the definition of "teleophthalmology and teledermatology by
store and forward" to include services of a licensed
optometrist.
6)DOUBLE REFERRAL . This bill is double referred, should it pass
out of this committee, it will be referred to the Assembly
Committee on Public Safety.
7)SUGGESTED AMENDMENTS .
a) In order to conform language to the preferred term of
art, delete "telemedicine" and insert "telehealth"
throughout the bill
b) Delete an unnecessary reference, on page 3, lines 35 and
36
c) To make clarifying changes, on page 4:
(c) (1) On March 1, 2013, and each March 1 thereafter, the
department shall report all of the following to the Joint
Legislative Budget Committee, the Assembly Committee on
Appropriations, the Assembly Committee on Budget, the
Assembly Committee on Health, the Assembly Committee on
Public Safety, the Senate Committee on Appropriations, the
Senate Committee on Budget and Fiscal Review, the Senate
Committee on Health, and the Senate Committee on Public
Safety:
(A) The extent to which the department achieved the
objectives developed pursuant to set forth in this section,
as well as the most significant reasons for achieving or
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not achieving those objectives.
(B) The extent to which the department is operating a
statewide telemedicine services program, as set forth in
this section, that provides telemedicine services to every
adult prison within the department, as well as the most
significant reasons for achieving or not achieving that
objective those objectives .
(C) A description of planned and implemented initiatives
necessary to accomplish the next 12 months' objectives for
achieving the goals developed pursuant to set forth in this
section.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097