BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair SB 1462 (Leno) - County sheriffs: medical release of prisoners. Amended: April 9, 2012 Policy Vote: Public Safety 5-2 Urgency: No Mandate: No Hearing Date: May 24, 2012 Consultant: Jolie Onodera SUSPENSE FILE. AS PROPOSED TO BE AMENDED. Bill Summary: SB 1462 would authorize a sheriff to release a prisoner from a county jail after conferring with a jail physician if the sheriff determines the prisoner would not reasonably pose a threat to public safety and the prisoner is deemed to have a life expectancy of six months or less. This bill would also authorize the court, at the request of a sheriff, to grant medical probation to any prisoner sentenced to a county jail who is physically incapacitated, as specified, if that incapacitation did not exist at the time of sentencing, or to a prisoner who would require acute long-term inpatient rehabilitation services. Before a prisoner's compassionate release or release to medical probation, the sheriff would be required to secure a placement option for the prisoner, as specified. Fiscal Impact: No state costs. Increased annual costs to provide long-term care services of $1.5 million federal statewide, to the extent 30 prisoners are granted medical probation and determined eligible for Medi-Cal. Estimated costs are based on an average annual cost of $100,000 per individual. Statewide costs could be higher or lower commensurate with the actual number of prisoners granted medical probation and the medical costs specific to each individual. Major annual savings in the millions of dollars to local jails as a result of eliminating costly security and medical costs for these prisoners. In Los Angeles (LA) County alone, annual savings of $7.3 million is estimated for ten individuals identified as potentially eligible for medical probation (based on an average daily security/base medical rate of $2,000 per prisoner). Background: Existing law authorizes a sheriff to release a SB 1462 (Leno) Page 1 prisoner for transfer to a medical facility or residential care facility if the prisoner's physical condition, as determined by a private physician (not under contract with the county or a county employee), renders the prisoner incapable of causing harm to others upon release, the prisoner's condition is not expected to improve to the extent he/she would pose a threat to public safety, and the sheriff determines the prisoner's medical needs would be better served in a medical facility or residence other than a county correctional facility. Existing law includes a form of "compassionate release" for prisoners determined by the Secretary of the CDCR or the Board of Parole Hearings to be either, 1) terminally ill with an incurable condition caused by an illness or disease that would produce death within six months, as determined by a CDCR physician, or, 2) permanently medically incapacitated with a medical condition that renders him or her permanently unable to perform activities of daily living, resulting in 24-hour care, and the incapacitation did not exist at the time of original sentencing. Current law also includes medical parole, if determined by the BPH would not pose a threat to public safety, for any state prisoner other than those sentenced to death, life without parole, or who is otherwise barred by an initiative statute, who the head physician of the institution where the prisoner is located determines is permanently medically incapacitated with a medical condition that renders him or her permanently unable to perform activities of basic daily living resulting in the prisoner requiring 24-hour care, and that incapacitation did not exist at the time of sentencing. Data as of April 2012 from the California Correctional Health Care Services indicates that of 39 cases set for hearing, 35 cases (nearly 90 percent) were approved by the BPH for medical parole. An additional six people received compassionate release prior to their medical parole hearing. Proposed Law: This bill would authorize a sheriff, after conferring with a jail physician, to release from a county correctional facility, a prisoner sentenced to the county jail if the sheriff determines that the prisoner would not reasonably pose a threat to public safety, and the prisoner, upon diagnosis by the examining physician, is deemed to have a life expectancy of six months or less. Prior to a prisoner's compassionate SB 1462 (Leno) Page 2 release, the sheriff would be required to notify the court of his/her intention to release the prisoner, as specified. This bill would further provide that the sheriff, after conferring with the jail physician, may request the court to grant medical probation or to resentence a prisoner to medical probation in lieu of jail time for any prisoner sentenced to the county jail under either of the following circumstances: The prisoner is physically incapacitated with a medical condition that renders the prisoner permanently unable to perform activities of basic daily living, which has resulted in the prisoner requiring 24-hourcare, if that incapacitation did not exist at the time of sentencing. The prisoner would require acute long-term inpatient rehabilitation services. During the time on medical probation, the probation officer or court may, at any time, request a medical examination of the person by a jail physician. If the court determines based on the medical examination that the person's medical condition has improved to the extent that the person no longer qualifies for medical probation, the court may return the person to the custody of the sheriff. Before a prisoner's compassionate release or release on medical probation, the sheriff shall secure a placement option for the prisoner in the community, and in consultation with the county welfare department or another applicable county agency, examine the prisoner's eligibility for Medicaid benefits or other medical coverage that might assist in funding the prisoner's medical treatment while in the community. The bill further states that it may not be construed as authorizing the sheriff to refuse to receive and incarcerate a defendant or sentenced individual who is not in need of immediate medical care or who has a terminal medical condition. Related Legislation: SB 1399 (Leno) Chapter 405/2010 provides that any prisoner determined to be medically incapacitated with a medical condition that renders the prisoner permanently unable to perform activities of basic daily living, and results in the prisoner requiring 24-hour care, and that incapacitation did not exist at the time of sentencing, shall be granted medical parole, if the Board of Parole Hearings determines that the conditions under which the prisoner would be released would not SB 1462 (Leno) Page 3 reasonably pose a threat to public safety. Staff Comments: The fiscal impact of this bill is dependent on several factors that are indeterminable at this time. Because the statute defining eligibility for medical parole is very restrictive and requires both medical documentation and a parole board hearing, there are a relatively small number of eligible prisoners. As the provisions of this bill would authorize the courts to grant medical probation based on a sheriff's determination after discussion with the jail physician, and would not require additional review or a board hearing, the number of medical probationers could potentially be greater. Although an earlier version of the bill would have applied its provisions only to felons sentenced to jail pursuant to 2011 Public Safety Realignment who would have otherwise been sentenced to state prison, the bill as currently proposed would extend the authority for compassionate release and medical probation to any inmate sentenced to county jail, including all felons and misdemeanants. The number of eligible prisoners statewide is unknown at this time. LA County has identified 10 prisoners currently eligible for medical probation under the provisions of this bill. County jails will see substantial savings in the millions of dollars annually due to the elimination of costly security and medical costs associated with these high-cost prisoners. As of April 2012, LA County indicated expenditures of over $900,000 for ten prisoners over a period of less than three months. At an average daily rate of approximately $2,000 for security and basic medical costs, the county would save $7.3 million annually. The bill requires the sheriff to secure a placement option for the prisoners before the prisoner's release on medical probation. To the extent the prisoner is determined eligible for Medi-Cal, increased costs of approximately $100,000 per year per medical probationer would be funded federally 50 percent and 50 percent General Fund. Assuming LA County represents approximately one third of the statewide eligible caseload, 30 prisoners granted medical probation would result in annual costs of $3 million ($1.5 million federal/$1.5 million General Fund). Statewide costs could be higher or lower dependent on the number of prisoners granted medical probation and the medical costs specific to each case. SB 1462 (Leno) Page 4 Recommended Amendments: To address the potential General Fund impact associated with this bill, staff recommends an amendment to specify the local entity currently responsible for payment of the prisoner's medical costs would continue to pay the nonfederal share of Medi-Cal costs associated with each individual's medical treatment. Author's amendments would specify that for any prisoner released pursuant to compassionate release or medical probation that is eligible for Medi-Cal, the county shall continue to pay the non-federal share of the prisoner's Medi-Cal costs.