BILL ANALYSIS                                                                                                                                                                                                    Ó







                      SENATE COMMITTEE ON PUBLIC SAFETY
                            Senator Loni Hancock, Chair              S
                             2011-2012 Regular Session               B

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          SB 557 (Kehoe)                                              
          As Introduced February 17, 2011 
          Hearing date:  March 29, 2011
          Penal Code
          JM:mc

                                FAMILY JUSTICE CENTERS:

                             COORDINATED VICTIM SERVICES  


                                       HISTORY

          Source:  Family Justice Center Alliance

          Prior Legislation: SB 733 (Leno) - 2010, vetoed
                       AB 1669 (Leno) - 2007, vetoed
                       AB 50 (Leno) - Ch. 884, Stats. 2006
                       AB 1768 (Committee on Public Safety) - 2005, vetoed 
           

          Support: California Probation, Parole and Correctional 
                   Association; Crime Victims United of California; 
                   California Catholic Conference

          Opposition:California Public Defenders Association (unless 
          amended)


                                        KEY ISSUES
           
          SHOULD LOCAL GOVERNMENT ENTITIES BE AUTHORIZED IN STATE LAW TO 
          ESTABLISH "FAMILY JUSTICE CENTERS," WITH ENUMERATED PURPOSES,   




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          DEFINITIONS, STAFF MEMBERS, CONFIDENTIALITY PROVISIONS, AND RELATED 
          SPECIFICATIONS? 
           
          SHOULD THE NATIONAL FAMILY JUSTICE CENTER ALLIANCE BE AUTHORIZED TO 
          MAINTAIN AGGREGATE, NON-IDENTIFYING DATA ON CLIENTS OF THE FAMILY 
          JUSTICE CENTERS AUTHORIZED BY THIS BILL, SUBJECT TO AUTHORIZATION 
          FROM INDIVIDUAL VICTIMS?


                                       PURPOSE

          The purposes of this bill are to 1) authorize local government 
          entities to establish a  multiagency, multidisciplinary family 
          justice center to provide services to victims of domestic 
          violence, sexual assault, human trafficking and elder abuse, as 
          specified; and 2) authorize the National Family Justice Center 
          Alliance to maintain, and a family justice center to provide, 
          nonidentifying, aggregate data on victims receiving services 
          from family justice centers and the outcomes from the services 
          provided, and to report findings and outcomes to the Legislature 
          annually, as specified.   

           Existing law  includes standards for programs for drug endangered 
          children.  Statute provides that the needs of children exposed 
          to narcotics crime scenes are best served by written policies 
          encouraging the arrest of an individual for child endangerment 
          where there is probable cause that an offence has been committed 
          and coordination with an appropriate investigation of that 
          child's welfare by child protective services.  Protocols that 
          encourage dependency hearings, along with law enforcement 
          investigation, are in the best interests of the child.  (Pen. 
          Code § 13978.80, subd. (b).)

           Existing law  includes a program for interagency domestic 
          violence death review teams, composed of professionals such as 
          coroners, forensic pathologists, prosecutors, domestic violence 
          center staff members, county health department staff, child 
          abuse agency staff members and others.  (Pen. Code 
          §11163.3-11163.6.)




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           Existing law  provides that information developed by or shared 
          among members of domestic violence death review teams shall 
          remain confidential, as specified.  (Pen. Code §11163.3, subds. 
          (e)-(g).)

           Existing federal law  includes the Health Insurance Portability 
          and Accountability Act of 1996 (HIPAA) which, subject to 
          specified exceptions and procedures, provides that medical 
          information shall be confidential.  (Pub. Law 104-191; 45 CFR 
          160, 164.)
          
           This bill  authorizes a city, county or city and county to 
          establish a multiagency, multidisciplinary family justice center 
          to assist victims of domestic violence, sexual assault, elder 
          abuse and human trafficking, as defined and specified. 

           This bill  states that family justice centers should ensure that 
          victims of such crime can access needed services in one 
          location, thereby enhancing victim safety and increasing 
          offender accountability.  

           This bill  states that staff members of family justice centers 
          shall be drawn from public and private agencies and may include, 
          but are not limited to:

                 Law enforcement personnel.
                 Medical personnel.
                 Prosecutors and civil legal assistance providers.
                 Victim-witness personnel.
                 Domestic violence shelter staff.
                 Rape crisis center staff.
                 Social service and child welfare professionals.
                 County health department staff.
                 City or county welfare and public assistance workers.
                 Trained volunteers.
                 Nonprofit agency counseling professionals.

           This bill  provides that family justice centers are encouraged to 




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          maintain an informed consent process to authorize information 
          from victims to be appropriately shared among service providers 
          within the center structure.

           This bill  provides that information from victims accessing 
          services at family justice centers shall remain confidential for 
          purposes other than providing services within the center 
          framework.  In particular, victim information shall not be 
          provided to third parties absent authorization by the victim, or 
          as required by law or court order.  Confidentiality provisions 
          apply to individual staff members of family justice centers who 
          possess information from a victim.

           This bil  l provides that disclosure of information to a family 
          justice center by a victim shall not constitute a waiver of any 
          of statutory privileges, including lawyer-client, 
          physician-patient, psychotherapist-patient, counselor-victim, 
          sexual assault or domestic violence-victim.

           This bill  provides, subject to authorization from each victim, 
          that a family justice center may provide non-identifying, 
          aggregate information about victims to the National Family 
          Justice Center Alliance (NFJCA) and that the NFJCA may maintain 
          information on services provided and outcomes obtained through 
          services.  NFJCA may, for evaluation and monitoring, provide 
          such data to the Legislature annually by April 30th.

           This bill  provides that a staff member, volunteer or agency of a 
          family justice center shall be liable for maintaining 
          confidential victim information for the purpose of providing 
          non-identifying aggregate information to NFJCA on an annual 
          basis.  The immunity from liability applies only where the 
          family justice center maintains a formal training program for 
          all staff members, volunteers and agency professionals, as 
          specified.  

                    RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
          
          For the last several years, severe overcrowding in California's 




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          prisons has been the focus of evolving and expensive litigation. 
           As these cases have progressed, prison conditions have 
          continued to be assailed, and the scrutiny of the federal courts 
          over California's prisons has intensified.  

          On June 30, 2005, in a class action lawsuit filed four years 
          earlier, the United States District Court for the Northern 
          District of California established a Receivership to take 
          control of the delivery of medical services to all California 
          state prisoners confined by the California Department of 
          Corrections and Rehabilitation ("CDCR").  In December of 2006, 
          plaintiffs in two federal lawsuits against CDCR sought a 
          court-ordered limit on the prison population pursuant to the 
          federal Prison Litigation Reform Act.  On January 12, 2010, a 
          three-judge federal panel issued an order requiring California 
          to reduce its inmate population to 137.5 percent of design 
          capacity -- a reduction at that time of roughly 40,000 inmates 
          -- within two years.  The court stayed implementation of its 
          ruling pending the state's appeal to the U.S. Supreme Court.  

          On Monday, June 14, 2010, the U.S. Supreme Court agreed to hear 
          the state's appeal of this order and, on Tuesday, November 30, 
          2010, the Court heard oral arguments.  A decision is expected as 
          early as this spring.  

          In response to the unresolved prison capacity crisis, in early 
          2007 the Senate Committee on Public Safety began holding 
          legislative proposals which could further exacerbate prison 
          overcrowding through new or expanded felony prosecutions.     

           This bill  does not appear to aggravate the prison overcrowding 
          crisis described above.


                                      COMMENTS


           1.Need for This Bill
           




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               SB 557 defines family justice centers for the first 
               time in California law.  Family justice centers have 
               been identified as a "best practice" by the U.S. 
               Department of Justice.  They involve collaboration 
               among public and private non-profit agencies providing 
               intervention and prevention services to address 
               domestic violence, sexual assault and other forms of 
               abuse.  While each centers may vary by community, the 
               concept of providing all the services for victims 
               under one roof has been identified as an effective 
               approach to increase safety and offender 
               accountability by avoiding the need for victims to 
               travel from agency to agency, telling their story over 
               and over in order to receive help.  We now have 
               fifteen such centers in California and another fifteen 
               are planned.  The Family Justice Center Alliance is 
               the umbrella organization for family justice centers 
               around the United States.  The Alliance gathers 
               non-identifying, aggregate data from centers to 
               document outcomes.  It is time to define in statute 
               this innovative, multi-disciplinary approach to 
               meeting the needs of victims and their children.  
               There is no funding associated with the bill.  The 
               bill does not change any existing reporting 
               obligations or create any new confidentiality 
               privileges.  

               In particular, SB 557 does the following: 1) defines 
               Family Justice Centers; 2) requires informed consent 
               processes in all centers to allow clients to authorize 
               information sharing among agencies; 3) encourages 
               information sharing to help victims; 4) protects the 
               confidentiality of otherwise confidential information 
               from disclosure to third parties even after 
               information has been shared within centers; 5) allows 
               the Family Justice Center Alliance (FJCA) to gather 
               non-identifying, aggregate information in order to 
               track outcomes and report them to the Legislature (at 
               no expense to the taxpayers); and 6) provides immunity 




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               from liability for good faith sharing of information 
               among partner agencies and volunteers within a family 
               justice center when authorized by the client.

              2.   Confidentiality Issues, Including Federal HIPAA Medical 
               Privacy Rules
           
          California law includes relatively stringent medical privacy 
          rules.  Unless a specified exception applies, such as a court 
          order or warrant, medical information can only be disclosed with 
          the authorization of the patient.

          The federal Health Insurance Portability and Accountability Act 
          of 1996 (HIPAA) rules also require confidentiality of medical 
          information, with specified exceptions.  It appears that HIPAA 
          controls over any conflicting state laws.  Under HIPAA, covered 
          entities may disclose protected health information to law 
          enforcement officials for specified law enforcement purposes, 
          such as court orders, to identify suspects or witnesses, to find 
          missing persons, information about a crime victim, notice of 
          death and related matters.

          The services provided at a family justice center would often 
          include medical and counseling services that fall under medical 
          privacy rules.  It may be somewhat difficult to coordinate 
          medical privacy protections in the context of law enforcement 
          investigations and criminal prosecutions.

          HOW DO THE INFORMED CONSENT AND CONFIDENTIALITY PROVISIONS IN 
          THE BILL INTERACT WITH OR CONFORM TO FEDERAL HIPAA MEDICAL 
          PRIVACY RULES?

          DO THE CONFIDENTIALITY PROVISIONS IN THIS BILL ADEQUATELY COVER 
          CONFIDENTIALITY CONCERNS AND INTERESTS?

           3.Integrated Services for Crime Victims
           
          The Family Justice Center Initiative is the umbrella 
          organization for one of many programs begun in recent years to 




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          provide a single location for victims to interface with law 
          enforcement and victim services.  It appears that the family 
          justice center model is one of the most fully developed and 
          implemented programs in the country.  The family justice center 
          model specializes in sexual assault, domestic violence, child 
          abuse and abuse of the elderly.

          The University of California San Francisco Medical Center and 
          San Francisco General Hospital operate a program called the 
          Trauma Recovery Center to serve victims of all kinds of criminal 
          violence.  The TRC is also a one-stop center for comprehensive 
          and integrated victim services.  Studies of the TRC have shown 
          that victims who receive TRC have better outcomes (such as 
          keeping jobs and housing) and are more likely to cooperate with 
          law enforcement than other victims.  

          In 2005, Washington State released a Strategic Plan for Victim 
          Services.  The website of the Spokane Crime Victim Service 
          Center noted that the center offered crisis intervention, 
          medical referrals and assistance and legal assistance. 

          It appears that these programs recognize that crime causes harm 
          to entire communities, not simply individual victims.  (The 
          Culture of Control, Garland, Univ. of Chicago Press, 2001, pp. 
          11-12.)  Victims can lose employment because of their injuries 
          and psychological stress.  Psychological stress suffered by 
          crime victims can interfere with their ability to raise children 
          and support other family members.  Members may wish to consider 
          the role and value of comprehensive and timely services for 
          crime victims as part of the state's response to crime, and 
          whether these types of services could save the state resources 
          in the long run and create healthier and more productive 
          citizens and communities.

          SHOULD STATE LAW INCLUDE STANDARDS AND PROCEDURES FOR FAMILY 
          JUSTICE CENTERS WHICH PROVIDE COMPREHENSIVE SERVICES FOR VICTIMS 
          OF CHILD ABUSE, DOMESTIC VIOLENCE, SEXUAL ASSAULT, HUMAN 
          TRAFFICKING AND ABUSE OF THE ELDERLY?





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          4.  Background: The Effects of Abuse and Crime on Individual and 
          Public Health
           
          Increasingly, public health researchers and physicians have 
          begun to view criminal abuse, especially where children are 
          victims, as equivalent to a disease vector.  A well-known Kaiser 
          study (Relationship of Adverse Childhood Experiences to Adult 
          Health - ACE) found that abused children are much more likely to 
          suffer life-long physical illnesses, drug and alcohol abuse and 
          psychological disorders.  (The original ACE report was published 
          in May of 1998 in the American Journal of Preventive Medicine.  
          The study, however, is ongoing.)  Other studies have found that 
          such patterns of behavior and result spread through the 
          community over generations.  Researchers at Columbia, 
          Rockefeller and McGill Universities have found that early abuse 
          and stress can even produce changes to DNA in the brain.  These 
          changes can prevent the brain from properly regulating the 
          response to stress.  As one example, children exposed to high 
          levels of abuse and stress are likely as adults to have elevated 
          levels of C-reactive protein, a leading marker for 
          cardiovascular disease.  (The Poverty Clinic, Tough, The New 
          Yorker, March 21, 2011, pp. 28-30.)

          Dr. Nadine Burke, a San Francisco pediatrician who runs a clinic 
          in Hunters Point and who is familiar with research on abuse and 
          health, has noted:

               In many cases, what looks like a social situation is 
               actually a neurochemical situation.  You can trace the 
               pathology as it moves from the molecular level to the 
               social level.  You have a girl who grows up in a 
               household where there's domestic violence.  . . .  
               That triggers her fight-or-flight response, which 
               affects the way the hormone receptors in her brain 
               develop, and as she grows up her stress-regulation 
               system goes off track.  Maybe she overreacts to 
               confrontation, or maybe . . .  she feels comfortable 
               only around a lot of drama.  So she ends up with a 
               partner who's abusive.  Then the pathology moves from 




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               the individual level to the household level, because 
               that partner beats their kids, and then their son goes 
               to a school where ten out of thirty kids are 
               experiencing the same thing.  Those kids create in the 
               classroom a culture of ? fighting ? for all thirty 
               Ękids].  Then those kids get older . . . and they 
               behave violent and they beat their kids.  And it's 
               just accepted.  It becomes a cultural norm.  (Id, at 
               p. 30.)

          Research is also being done on the effect of violence and 
          traumatic stress on the brains of adults. For example, a very 
          recently published study from the San Francisco Veterans 
          Administration Hospital and UCSF considered adults who have 
          suffered post-traumatic stress (PTSD).  Victims of violent crime 
          often suffer PTSD.  The study found changes in the hippocampus 
          of PTSD sufferers.  The hippocampus is very important in memory. 
           (Biological Psychiatry, Apfel, Weiner, et al, March 15, 2011.)  
          Michael Weiner, MD, a co-author, said that the current study 
          "adds to the general body of knowledge that PTSD is associated 
          with significant changes in the brain, and is thus a biological 
          disorder." 





















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          5.  Argument in Opposition (unless the Bill is Amended)  

          The California Public Defenders Association argues that the bill 
          should be amended:

               While well-intentioned in concept, family justice 
               centers are often dominated by law enforcement 
               personnel and prosecutors.  The immediate availability 
               of community-based supportive services delivered by 
               domestic violence shelter staff, counseling 
               professionals, social workers and public health staff 
               are critical to ensuring that victims receive timely, 
               co-located services.

               However, the presence of law enforcement and 
               prosecutors may be coercive and tells victims that 
               they do not deserve services unless they cooperate 
               with law enforcement and testify for the prosecution.  
               Individuals or families who seek shelter or 
               counseling, but who do not wish to report a crime or 
               testify or who fear immigration consequences, may 
               simply choose to not access needed services.  In some 
               communities, family justice centers are the only 
               resources for victims of domestic violence and sexual 
               assault.


               SB 557 should be amended to expressly state that any 
               person seeking services at a family justice center 
               need not participate in the criminal justice system or 
               cooperate with law enforcement.  Provisions should be 
               included to allow persons to file complaints when they 
               are faced with coercive tactics by law enforcement or 
               prosecutors.

               Justice centers have also been free to define victims 
               as excluding those with a criminal conviction, 
               regardless of the circumstances of the case.  In 
               reality many victims of domestic violence and sexual 




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               assault have been previously convicted of crimes.  SB 
               557 should be amended to prohibit family justice 
               centers from denying services to a victim because he 
               or she has a criminal record.  The bill should also be 
               amended to prohibit rap sheets from being run unless 
               the victim has voluntarily contacted law enforcement.  


               CPDA also has concerns about confidentiality.  Victims 
               will fear that information they share with a social 
               service agency will be forwarded to law enforcement 
               and the prosecution.  While SB 557 provides that a 
               victim's consent is not universal and that third 
               parties cannot access such information without the 
               victim's express consent, SB 557 nevertheless grants 
               blanket immunity to all staff of co-located agencies 
               as long as agencies have received some confidentiality 
               training.  The immunity applies regardless of a staff 
               member's motives or coercion.  SB 557 should be 
               amended to remove this immunity.
                                                       
          6.  Double Referral of Bill to Judiciary Committee  

          This bill has also been referred for hearing to the Judiciary 
          Committee.  The Judiciary Committee has not set a date for the 
          hearing.


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