BILL ANALYSIS �
SB 60
Page 1
Date of Hearing: July 5, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 60 (Evans) - As Amended: May 31, 2011
SENATE VOTE : 40-0
SUBJECT : Mental health: state hospitals.
SUMMARY : Requires the Department of Mental Health (DMH) to
conduct a security and violence risk assessment, as specified,
of each patient upon admission to a state hospital.
Specifically, this bill :
1)Directs DMH to evaluate each patient, upon admission to a
state hospital, to determine the security and violence risk
that the patient presents to other patients and staff and the
risks to the patient's safety and security that he or she
faces upon admission to the facility.
2)Requires the risk assessments in 1) above to be completed by
both security and clinical personnel and to include a review
of the patient's criminal history, psychological factors, and
incidents of aggression or escape since being incarcerated or
committed.
EXISTING LAW :
1)Charges DMH with managing the care and treatment of mentally
ill patients at California's five state mental hospitals:
Atascadero; Coalinga; Metropolitan; Napa; and, Patton State
Hospitals.
3)Provides for the involuntary commitment of mentally ill
persons to a state mental hospital pursuant to various
provisions of the Penal Code, such as the patient is deemed
Not Guilty by Reason of Insanity (NGI) or Incompetent to Stand
Trial (IST); or the patient is a mentally disordered offender
(MDO).
4)Requires DMH, prior to admission of a patient committed as IST
or NGI to Metropolitan or Napa State Hospital, to evaluate
each patient for risk.
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5)Designates Napa and Metropolitan State Hospitals to only treat
low-to-moderate risk patients and requires high-risk patients
to only be treated at Atascadero or Patton State Hospitals, a
correctional facility, or other secure facility.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 Fund
DMH conduct new or augmentlikely in the hundreds of thousands
ofGeneral
existing assessments dollars annually
COMMENTS :
1)PURPOSE OF THIS BILL . The author states that this bill seeks
to improve worker, patient, and public safety at
DMH-administered state hospitals. The author notes that there
has been a profound change in the composition of the patient
population at state hospitals since Napa State Hospital was
established 137 years ago. According to the author,
facilities such as Napa were initially situated in park-like
settings to care for mentally ill patients who were wards of
the state; today, however, over 90% of all patients have been
committed by way of the criminal justice system and fewer than
500 individuals in the entire system do not come from jails,
prisons, or criminal proceedings.
The author asserts that the tragic murder of psychiatric
technician Donna Gross at Napa State Hospital by a patient
last fall and the ongoing daily occurrence of dozens of
assaults upon workers and patients reflect the failure of both
state law and state hospitals' operations to evolve in
response to the new reality of the population these facilities
now serve. The author states that this bill addresses this
new reality by requiring an individual placed in a state
hospital to be evaluated upon admission with regard to his or
her criminal history, psychological factors, and propensity
for violence. The author contends that the common sense
approach in this bill provides an important first step in
creating a safe environment for both patients and staff.
2)CURRENT STATE HOSPITAL POPULATION . DMH oversees the operation
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of the five state hospital campuses as well as two acute
psychiatric programs at the California Medical Facility in
Vacaville and the Salinas Valley State Prison. According to
information from the Senate Budget and Fiscal Review
Committee, the total patient caseload for 2011-12 is of 6,342
patients, which includes 5,558 patients in state hospitals and
766 patients at the two psychiatric programs. Of the total
patient caseload, only 471 have been committed pursuant to
Section 5150 of the Welfare and Institutions Code, which
governs the involuntary detention of persons deemed a danger
to themselves, to others, or gravely disabled. Patients
admitted to state hospitals are generally either civil (5150)
commitments or forensic (Penal Code) commitments.
DMH uses a protocol for establishing priorities for forensic
placements at state hospitals due to the lack of secure beds
available to accommodate all patients. This priority system
also overlaps with the correctional system administered by the
California Department of Corrections and Rehabilitation
(CDCR). The protocol is as follows:
a) Sexually violent predators have the utmost priority
because of the public safety threat they pose.
b) MDO patients have the next priority. These patients are
former CDCR inmates who have completed their sentence but
have been deemed to be too violent to parole directly into
the community without mental health treatment.
c) NGI patients have the next priority. These individuals
are deemed NGI because they are incapable of knowing or
understanding the nature and quality of their act or they
are incapable of distinguishing right from wrong.
d) IST patients receive the last priority. There are
approximately 250 to 300 IST individuals presently residing
in county jails because of the current bed shortage with
the state hospital system.
The Governor's May Revision of the 2011-12 State Budget (May
Revise) proposes to eliminate DMH and create a new Department
of State Hospitals, effective July 2012. The Governor's
Administration states that a new and separate department is
needed to administer these facilities in order to
comprehensively focus on mitigating significant health and
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public safety issues, centralize administrative functions, and
address core patient population management and fiscal
administration. It is unknown how these May Revise proposals
will interact with this bill.
3)CURRENT ASSESSMENT PROCESS . According to DMH, the current
screening process focuses on a patient's risk of escape. It
is a one page worksheet that is completed by admissions staff
and is not a formal clinical assessment. The worksheet poses
a number of questions and then staff assigns the patient a
risk score based on answers to the questions. Placement of
the patient depends on his or her score. For example,
patients with a high risk of escape are not admitted to Napa
and Metropolitan State Hospitals.
An assessment specific to violence risk would have to be added
to the current process as a result of this bill. DMH notes
that expanding the current assessment process to include
violence risk may entail the development and use of a
screening tool based on what factors are known to be the best
predictors of violence. This would require the agency or
institution referring the patient to a state hospital to
supply the hospital with adequate information about the
patient's recent history of violence, including information
from police reports and the patient's rap sheet. According to
DMH, hospital staff currently requests this information for
each patient who is referred by a correctional institution but
often does not receive it. DMH states that, should this be
enacted and the hospitals continue to receive incomplete
information from referring institutions, the hospitals'
ability to perform accurate risk assessments would be
compromised.
4)INCIDENCES OF VIOLENCE . As the patient population at state
psychiatric hospitals has changed from a civilly committed
population to a 93% forensic population, incidents of violent
and aggressive behavior have increased. The well-publicized
death of psychiatric technician, Donna Gross, at Napa State
Hospital in October 2010 has focused attention on the
increased number of assaults on state hospital staff and
patients. According to data that DMH is required to provide
to the federal Department of Justice, patients at Napa
committed 75 physically aggressive acts against staff during
the first six months of 2009. During that same time period in
2010, there were nearly four times as many patient-on-staff
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assaults and situations involving patient-on-patient
aggression more than doubled. The data also indicate that
violent incidents at both Atascadero and Patton State
Hospitals, which exclusively treat high risk mentally ill
offenders, increased by 36%.
5)DMH SECURITY REPORT . DMH issued a 2010 report of security
needs throughout its hospital facilities in April of this year
in response to the tragic fatality that occurred at the Napa
facility. The general recommendations in the report address
issues associated with patient count, visitor control, patient
property, key control and locking devices, and safety and
security improvements. DMH states that, as a result of the
employee death at the Napa facility, many of the
recommendations have been or are being implemented using
existing, redirected resources. Some recommendations will
require additional funds for staffing, capital outlay,
equipment, and operational costs. To that end, DMH has
requested an increase of $9.5 million General Fund in the May
Revise to specifically address security concerns arising from
the open campus environments at the Napa, Metropolitan, and
Patton facilities. These funds would be used to implement
teams of staff to monitor hospital grounds, including
psychiatric technicians to monitor patient behavior and
hospital police to address security and law enforcement.
Additionally, the report recommends establishing specialized
treatment units at each facility to house the small number of
chronically aggressive patients who have not responded to
treatment and identifies a number of other facility-related
needs such as enhancing video surveillance equipment to
monitor patients and prevent escape; upgrading alarm systems
and keyboard controls; installing new doors with windows for
patient monitoring; purchasing "no throw" furniture; and,
providing security and safety awareness training for staff.
According to DMH, many of these recommendations have already
been implemented while others are being incorporated into
security planning going forward.
6)RELATED LEGISLATION . AB 30 (Hayashi), which would have
expanded existing requirements governing hospital safety and
security plans to prevent violence against health care
personnel, died on the Assembly Appropriations Committee
Suspense File.
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7)PREVIOUS LEGISLATION .
a) AB 1083 (John A. P�rez), Chapter 506, Statutes of 2009,
requires hospital security and safety assessments to be
conducted and updated at least annually and provides that
hospital security plans may additionally include efforts to
cooperate with local law enforcement regarding violent acts
at the facility.
b) SB 391 (Solis), Chapter 294, Statutes of 1997, provides
for patient risk assessments for inmates committed to Napa
or Metropolitan State Hospitals for certain Penal Code
violations and requires patients subject to assessments who
are determined to be a high security risk to be treated in
the most secure state hospital facilities.
c) AB 508 (Speier), Chapter 936, Statutes of 1993, requires
hospitals to conduct security assessments, develop security
plans, and have sufficient personnel to provide security,
and directs hospitals to report any act of assault against
on-duty personnel to a local law enforcement agency within
a specified time frame.
8)CONCERN . Napa County is concerned that patients at these
facilities may be transferred to county jails as a result of
the violence risk assessments mandated by this bill. Napa
County states that if these patients are sent to county jails,
where there are different rules governing medication, they are
likely to decompensate while in county custody, in some cases
becoming more violent and more ill. Napa County contends that
these patients would present a host of safety and health
concerns for county employees and would be more appropriately
placed in facilities, such as the psychiatric program at
Vacaville, that have the right kind of equipment and safety
features to better and more safely manage violent persons.
Napa County is requesting that this bill include affirmative
language that ensures that these types of patients remain in
state custody even when they commit new crimes.
9)SUPPORT . The sponsor of this bill, the California Statewide
Law Enforcement Association (CSLEA), which represents state
hospital police officers, states that CSLEA officers are
trained in spotting gang activities and tattoos, and in
identifying threatening, violent, and predatory behavior;
therefore, they should have a voice in assessing a patient's
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propensity for violent or dangerous acts. The sponsor
contends that, under the current system, many of the less
functioning patients cannot receive the necessary treatment
because they are often victimized by higher functioning
predatory, violent, and dangerous individuals. The California
Association of Psychiatric Technicians adds that mandating
assessments of patients for their aggressive or violent
behavior upon placement will ensure that DMH facilities are
able to provide a more secure working environment for staff in
a manner that enables them to better treat individuals.
REGISTERED SUPPORT / OPPOSITION :
Support
California Statewide Law Enforcement Association (sponsor)
California Association of Psychiatric Technicians
Service Employees International Union, Local 1000
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097