BILL ANALYSIS Ó
AB 386
Page 1
Date of Hearing: May 3, 2011
Counsel: Sandy Uribe
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
AB 386 (Galgiani) - As Amended: April 27, 2011
As Proposed to be Amended in Committee
SUMMARY : Declares legislative findings on the use of
telehealth in the California's prisons. Requires the California
Department of Corrections and Rehabilitation (CDCR) to include
protocols within its existing guidelines for determining when
these services are appropriate. Requires CDCR to have
telehealth programs in operation at all prisons by January 1,
2016. Specifically, this bill :
1)Makes the following legislative findings and declarations:
a) States legislative intent to require CDCR to implement
and maintain the use of telehealth in state prisons.
b) Declares that telehealth improves inmates' access to
health care by enabling correctional systems to expand
their provider network to include physicians located
outside the immediate vicinity of prisons, particularly for
inmates housed in remote areas of the state with shortages
of health care.
c) Finds that the prison telehealth program began as a
pilot project in 1997 for mental health inmates at Pelican
Bay State Prison and was successful at improving the access
of these inmates to mental health care. CDCR then decided
to expand the program to provide mental health as well as
medical specialty services at other prisons. Currently,
all state prisons are equipped to provide these services.
2)Defines "telehealth" as "the mode of delivering health care
services and public health via information and communication
technologies to facilitate the diagnosis, consultation,
treatment, education, care management, and self-management of
a patient's health care while the patient is at the
originating site and the health care provider is at a distant
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site."
3)Requires CDCR to include, within existing guidelines and by
January 1, 2013, protocols for determining when telehealth
services are medically appropriate and in the best interest of
the health and safety of the inmate patient.
4)Requires CDCR to have an operational telehealth services
program at all adult institutions, by January 1, 2016, that
includes:
a) Specific goals and objectives for maintaining and
expanding services provided by the telehealth services
program, including "store and forward" telehealth
technology;
b) An information technology support infrastructure that
will allow telehealth to be used at each adult prison;
c) Guidelines for determining when and where telehealth
would be the preferred delivery method for health care;
and,
d) Guidelines for appropriate use and expansion of store
and forward telehealth technology, as defined, in state
prisons.
5)Requires CDCR to schedule a patient for evaluation with a
distant physician via telehealth if, and when, it is
determined that it is medically necessary.
6)Requires CDCR to utilize telehealth only when it is in the
best interest of the health and safety of the inmate patient.
7)Requires CDCR to ensure that telehealth is not used to
supplant civil service physician and dental positions.
8)Permits CDCR to contract with the San Joaquin General Hospital
for telehealth services.
9)Requires CDCR to report, each year from March 1, 2013 to March
1, 2018, to specified Assembly and Senate committees the
extent to which the objectives of the program were achieved,
and the most significant reasons for achieving or not
achieving those objectives; the extent to which a statewide
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program is being operated, as well as the most significant
reasons for achieving or not achieving that objective; and a
description of planned and implemented initiatives necessary
to accomplish the objectives for the following year.
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. (Business and Professions Code Section
2290.5.)
2)States legislative intent that CDCR operate in the most
cost-effective and efficient manner possible when purchasing
health care services for inmates. ÝPenal Code Section
5023(a).]
FISCAL EFFECT : Unknown
COMMENTS :
1)Author's Statement : 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.
"California Prison Health Care Services uses telemedicine for
medical specialty consultations and psychiatric services.
Today, telemedicine is available for medical specialty
services at all CDCR institutions. Psychiatric telemedicine
is provided at four institutions. The use of telemedicine
benefits California by: 1) avoiding medical guarding and
transportation costs associated with transporting
patient-inmates off-site to receive specialist services not
available on-site; 2) avoiding public safety risks associated
with transporting patient-inmates off-site to receive
services; and 3) improving access to care by providing a
broader pool of medical and psychiatric providers available to
treat patient-inmates. As the use of telemedicine expands, it
will further benefit the State by reducing staff physician and
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psychiatric vacancies in remote locations. 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. Store and forward telemedicine technology can
be used to reduce costs associated with diagnostic services.
"Assembly Bill 386 states that it is the intent of the
Legislature to require the prison system to utilize a
cost-effective telemedicine system within correctional
institutions. This bill will ensure that the progress made
expanding telemedicine will continue. Furthermore, AB 386
will result in significant cost avoidance and savings, improve
public safety, and improve access to care for patient-inmates.
California Prison Health Care Services expects to have a cost
avoidance of $5 million a year from the utilization of
telemedicine."
2)Does CDCR Have the Authority to Implement the Provisions of
this Bill ? In 2001, California prisoners filed a class action
law suit to challenge deficiencies in prison medical care that
allegedly violated the Eighth Amendment and the Americans with
Disabilities Act. (See Plata v. Schwarzenegger (9th Cir.
2010) 603 F.3d 1088, 1090-1091.) In February 2006, the United
States District Court for Northern California appointed a
receiver to control the delivery of medical services for
prisoners in California because the court agreed the medical
care in California's adult prisons violates the Eighth
Amendment's proscription against cruel and unusual punishment.
The court found that on average an inmate died needlessly
every six to seven days due to inadequate medical care. (Id.
at pp. 1091-1092.) In April 2010, the Ninth Circuit affirmed
putting CDCR into receivership with respect to medical care
for California inmates. (Id. at p. 1098.)
The receiver is charged with taking over the operations the
state's prison medical-care system and bringing the
medical-care system up to constitutional levels. Due to the
appointment of the federal receiver, CDCR has more limited
authority in the area of making healthcare decisions. The
provisions of this bill require CDCR to make policy decisions
in the area of healthcare. That authority has been
effectively handed over to the receiver for the foreseeable
future. Arguably, under federal law, the California
Legislature has no authority to place requirements upon the
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receiver.
3)Who Determines when Telehealth is Used ? This bill mandates
that telehealth should only be used "when it is in the best
interest of the health and safety of the inmate patient" and
also requires CDCR to schedule a telehealth evaluation "if and
when it is medically necessary." This bill does not specify
who is to make these decisions. Is this an administrative
decision, or one made by qualified medical personnel? This
ambiguity should be clarified in the statute.
4)Prior Legislation :
a) AB 1785 (Galgiani), of the 2009-10 Legislative Session,
would have required CDCR to establish a telemedicine
program at all state prisons by January 1, 2015. AB 1758
was never heard by the Assembly Appropriations Committee.
b) AB 1289 (Galgiani), of the 2009-10 Legislative Session,
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 was held on the Assembly Appropriations Committee's
Suspense File.
REGISTERED SUPPORT / OPPOSITION :
Support
None
Opposition
None
Analysis Prepared by : Sandy Uribe / PUB. S. / (916) 319-3744