BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                  AB 1114|
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                                 THIRD READING


          Bill No:  AB 1114
          Author:   Bonnie Lowenthal (D)
          Amended:  8/15/11 in Senate
          Vote:     21

           
           SENATE PUBLIC SAFETY COMMITTEE :  7-0, 06/28/11
          AYES:  Hancock, Anderson, Calderon, Harman, Liu, Price, 
            Steinberg

           SENATE APPROPRIATIONS COMMITTEE  :  8-0, 08/15/11
          AYES:  Kehoe, Walters, Alquist, Emmerson, Lieu, Pavley, 
            Price, Steinberg
          NO VOTE RECORDED:  Runner

           ASSEMBLY FLOOR  :  75-0, 05/26/11 (Consent) - See last page 
            for vote


           SUBJECT  :    Mentally ill inmates:  involuntary medication

           SOURCE  :     California Department of Corrections and 
          Rehabilitation


           DIGEST  :    This bill defines a new procedure under which 
          the California Department of Corrections and Rehabilitation 
          (CDCR) may obtain an order from an administrative law judge 
          to authorize involuntary administration of psychotropic 
          medication to a mentally ill inmate. 

           ANALYSIS  :    Existing law provides that a person 
          incarcerated in a state prison or a county jail pursuant to 
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          Penal Code section 1170, subdivision (h), may be deprived 
          of such rights, and only such rights, as is reasonably 
          related to legitimate penological interests.  (Pen. Code § 
          2600.)

          Existing law only permits the involuntary administration of 
          psychotropic medication to a prisoner where the process 
          specified in the permanent injunction in the matter of 
           Keyhea v. Rushen  (1986) 178 Cal. App. 3d 526, has been 
          followed.  (Pen Code § 2600.)  The  Keyhea  injunction does 
          and provides the following:

                 Permits psychotropic medication to be administered 
               to an inmate without his or her informed consent on an 
               emergency basis for no more than 3 days.

                 Prohibits the administration of involuntary 
               medication to inmates in excess of 3 days unless such 
               individuals are provided with certain due process 
               protections, including notice of certification, as 
               specified.

                 Prohibits the administration of involuntary 
               medication to inmates in excess of 10 days after the 
               initial involuntary administration, unless such 
               individuals are additionally provided with a 
               certification review hearing, as specified.  The 
               hearing officer will determine if there is probable 
               cause to support the certification, and if such 
               determination is made, the inmate may be involuntarily 
               medicated for 21 additional days beyond the end of the 
               initial 3-day involuntary medication period.

                 Prohibits the administration of involuntary 
               medication to inmates in excess of 24 days after the 
               initial involuntary administration, unless such 
               individuals are additionally provided with a formal 
               judicial hearing before an administrative law judge 
               (ALJ), as specified, in which they are entitled to 
               legal counsel, appointed or otherwise.

                 The court order authorizing involuntary medication 
               expires in 180 days (approximately six months) if the 
               inmate is found to be a danger to self or others, or 

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               one year if the inmate is found to be gravely disabled 
               and incompetent to refuse medication.

                 Provides that nothing in these procedures is 
               intended to prohibit a physician from taking 
               appropriate action in an emergency, including the 
               administration of involuntary medication but subject 
               to these time limitations. 

          This bill deletes the provision of state law that expressly 
          requires CDCR, in administering involuntary psychotropic 
          medication to inmates, to abide by the permanent injunction 
          in  Keyhea v. Rushen  (1986) 178 Cal. App. 3d 526.

          This bill provides that if a psychiatrist determines that 
          an inmate should be treated with psychotropic medication, 
          but the inmate does not consent, CDCR may seek to initiate 
          involuntary medication of the inmate on a nonemergency 
          basis only if specified conditions are met, among which 
          are:

                 The inmate has a serious mental disorder, and that 
               as a result of that mental disorder, the inmate is 
               gravely disabled or is a danger to self or others; and 
               does not have the capacity to refuse treatment with 
               psychotropic medications.

                 The inmate is provided a hearing before an ALJ.

                 The inmate is provided counsel at least 21 days 
               before the hearing, which shall not be held more than 
               30 days after the filing of the notice of hearing. 

                 The inmate and counsel are provided with written 
               notice of the hearing, as specified, at least 21 days 
               prior to the hearing.

                 An administrative law judge determines that 
               involuntary medication is warranted by clear and 
               convincing evidence, as specified.

                 The history of the inmate's mental disorder shall 
               be considered by the ALJ.


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          This bill provides that nothing in this act is intended to 
          prohibit a physician from taking appropriate action in an 
          emergency, as specified below:

                 The medication shall only be that which is required 
               to treat the emergency and for only so long as the 
               emergency exists, but in no event for longer than five 
               days after the inmate has been given counsel and 
               notice of the action, unless CDCR first obtains an 
               order from an ALJ authorizing the continuance of 
               medication beyond five days.

                 An order may be issued ex parte (without presence 
               of the other party) upon a showing that in the absence 
               of the medication the emergency is likely to recur, 
               and provides that if an order is issued, the 
               psychiatrist may continue the administration of the 
               medication until the formal administrative law hearing 
               is held, as specified.

                 CDCR must serve the inmate and counsel written 
               notice within 72 hours of commencing medication, 
               except as provided.

                 A hearing before an ALJ must commence within 21 
               days of the filing of the service of the notice, with 
               the same due process protections required for inmates 
               contesting involuntary administration on a 
               nonemergency basis.

          This bill provides that the involuntary medication of an 
          inmate, either on an emergency or nonemergency basis, must 
          discontinue one year from the date of determination, unless 
          the inmate gives his or her informed consent, or CDCR 
          follows specified procedures for a renewal hearing.

          This bill provides that to obtain a renewal order, CDCR 
          shall provide the same due process protections required 
          under for inmates contesting involuntary administration on 
          a nonemergency basis.

          This bill provides that an inmate is entitled to file one 
          motion for reconsideration following a determination that 
          he or she may receive involuntary medication, and may seek 

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          a hearing to present new evidence, upon good cause shown.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes   
          Local:  No

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

           Major Provisions                2011-12     2012-13    
           2013-14  Fund
           New procedures for                                     
          Potential savings of up to $2,200                      
          General
          involuntary administration annually ongoing to CDCR
          of psychotropic medication

           SUPPORT  :   (Verified  8/16/11)

          California Department of Corrections and Rehabilitation 
          (source) 
          American Federation of State, County and Municipal 
          Employees
          California Association of Psychiatric Technicians
          California Coalition for Women Prisoners
          California Correctional Peace Officers Association
          California Probation Parole and Correctional Association
          California Psychiatric Association
          Legal Services for Prisoners with Children
          National Alliance on Mental Illness

           ARGUMENTS IN SUPPORT  :    According to the author's office:

               In the 1986  Keyhea  decision, the court issued an 
               injunction directing that prisoners subject to 
               involuntary administration of psychotropic medication 
               be afforded the same rights as non-prisoners.  At that 
               time, no statutes defined the rights of non-prisoners 
               concerning involuntary medication.  Therefore, the 
               court adopted the procedures used when a court civilly 
               commits a person as gravely disabled or a danger to 
               self or others.  These procedures include increasingly 
               stringent reviews and hearings depending on the length 
               of the commitment.  The  Keyhea injunction also adopted 

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               statutes that define terms utilized to determine 
               whether a person should be removed from society for 
               commitment to a mental hospital.  California Penal 
               Code Section 2600 was amended in 1994 to place the 
                Keyhea  injunction in statute.

               AB 1114 codifies, and in some cases strengthens, the 
               existing due process protections.  The bill ensures 
               that a prisoner is provided with appropriate mental 
               health treatment consistent with his or her rights, 
               including the right to counsel and the evidentiary 
               standard of clear and convincing evidence.   The 
               prisoner's mental health history will be considered on 
               the issues of whether or not the prisoner is gravely 
               disabled or a danger to self or others.  AB 1114 
               continues to authorize emergency administration of 
               medication, but requires CDCR to obtain an ex-parte 
               order if the emergency extends five days beyond 
               appointment of counsel.  Perhaps most important, 
               approval of involuntary medication will be shortened 
               from 47 days to no more than 30 days, thereby 
               improving outcomes for mentally ill inmates.


           ASSEMBLY FLOOR  :  75-0, 05/26/11 (Consent) 
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, 
            Bill Berryhill, Block, Blumenfield, Bonilla, Bradford, 
            Brownley, Buchanan, Butler, Charles Calderon, Carter, 
            Chesbro, Conway, Cook, Dickinson, Donnelly, Eng, Feuer, 
            Fletcher, Fong, Fuentes, Furutani, Beth Gaines, Galgiani, 
            Garrick, Gatto, Gordon, Grove, Hagman, Halderman, Hall, 
            Harkey, Hayashi, Roger Hernández, Hill, Huber, Hueso, 
            Huffman, Jeffries, Knight, Lara, Logue, Bonnie Lowenthal, 
            Ma, Mansoor, Mendoza, Miller, Mitchell, Monning, Morrell, 
            Nestande, Nielsen, Norby, Olsen, Pan, Perea, V. Manuel 
            Pérez, Portantino, Silva, Skinner, Smyth, Solorio, 
            Swanson, Torres, Valadao, Wagner, Wieckowski, Williams, 
            Yamada, John A. Pérez
          NO VOTE RECORDED:  Campos, Cedillo, Davis, Gorell, Jones


          RJG:nl  8/17/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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