BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Leland Y. Yee, Chair
BILL NO: AB 602
A
AUTHOR: Yamada
B
VERSION: May 24, 2013
HEARING DATE: June 25, 2013
6
FISCAL: Yes
0
2
CONSULTANT: Mareva Brown
SUBJECT
Mentally and developmentally disabled persons: reporting
abuse: peace officer training
SUMMARY
This bill requires the Commission on Peace Officer
Standards and Training (POST) to establish a course for law
enforcement officers about how to interact with individuals
living within state mental hospitals or developmental
centers. Additionally, the bill requires local law
enforcement to coordinate with state investigators at these
facilities on investigations of alleged abuse. It requires
that mandated reporters notify both local law enforcement
and state facility investigators of suspected patient abuse
or neglect in specified cases, and requires state
investigators to report suspected abuse to local law
enforcement agencies within two hours.
ABSTRACT
Existing law:
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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1) Requires that every peace officer in California
complete an introductory course of training developed
by POST, and pass an associated exam. (PEN 832)
2) Requires every police officer or deputy sheriff who
is assigned field or investigative duties to complete
an elder and dependent adult abuse training course
certified by POST, as specified. (PEN 13515 (a))
3) Requires POST to establish and update a continuing
education classroom training course related to law
enforcement interaction with mentally disabled
persons. Further, requires that the training course
shall be developed by POST in consultation with
appropriate community, local, and state organizations
and agencies that have expertise in the area of mental
illness and developmental disabilities, and with
appropriate consumer and family advocate groups. In
developing the course, the commission shall also
examine existing courses certified by the commission
that relate to mentally disabled persons. The
commission shall make the course available to law
enforcement agencies in California. (PEN 13515.25(a))
4) Requires POST to create and make available on DVD a
course on how to recognize and interact with persons
with autism spectrum disorders (ASD), in consultation
with the Department of Developmental Services (DDS).
This course shall be designed for, and made available
to, peace officers who are first responders to
emergency situations. (PEN 13515.35)
5) Establishes in state law that a mandated reporter
is any person who has assumed full or intermittent
responsibility for the care or custody of an elder or
dependent adult, whether or not he or she receives
compensation, including administrators, supervisors,
and any licensed staff of a public or private facility
that provides care or services for elder or dependent
adults, or any elder or dependent adult care
custodian, health practitioner, clergy member, or
employee of a county adult protective services agency,
or a local law enforcement agency. (WIC 15630 (a))
6) Defines a "dependent adult" as any person aged 18
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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to 64 years living in California with physical or
mental limitations that restrict his or her ability to
carry out normal activities or to protect his or her
rights including persons who have physical or
developmental disabilities, or whose physical or
mental abilities have diminished because of age.
Additionally, defines a dependent adult as any person
aged 18 to 64 who is admitted to a 24-hour health
facility, as defined. (WIC 15610.23)
7) Requires any mandated reporter who, in his or her
professional capacity or scope of employment has
observed or knows of an incident of physical abuse,
abandonment, abduction, isolation, financial abuse, or
neglect, or is told by an elder or dependent adult
that he or she has experienced such behavior, or who
reasonably suspects abuse, to report by telephone or
through a confidential Internet reporting tool,
immediately or as soon as possible. (WIC 15630
(b)(1))
8) Requires that if suspected or alleged abuse occurs
in a state mental health hospital or a state
developmental center, the mandated reporter may report
to the designated investigator of the State Department
of State Hospitals (DSH) or to the Office of
Protective Services (OPS) at DDS, or to a local law
enforcement agency. (WIC 15630 (b)(1)(E))
9) Requires a developmental center to immediately
report all resident deaths and serious injuries of
unknown origin to the appropriate local law
enforcement agency. This reporting requirement does
not substitute for the reporting requirement of a
mandated reporter. (WIC 4427.5.)
This bill:
1) Requires POST to establish and keep updated a
continuing education classroom training course
relating to law enforcement interaction with mentally
disabled and developmentally disabled persons living
within a state mental hospital or state developmental
center.
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2) Requires that the training course be developed by
POST in consultation with appropriate community,
local, and state organizations and agencies that have
expertise in the area of mental illness and
developmental disabilities, and with appropriate
consumer and family advocate groups. In developing the
course, the commission shall also examine existing
courses certified by the commission that relate to
mentally disabled and developmentally disabled
persons.
3) Requires POST to make the course available to all
law enforcement agencies in California, and
establishes that the course be a required part of an
officer training program for personnel serving in law
enforcement agencies with jurisdiction over state
mental hospitals and state developmental centers.
4) Provides that the POST course may consist of
video-based or classroom instruction.
5) Requires that the course shall include, at a
minimum, core instruction in all of the following:
a. The prevalence, cause, and nature of
mental illnesses and developmental disabilities.
b. The unique characteristics, barriers, and
challenges of individuals who may be a victim of
abuse or exploitation living within a state
mental hospital or state developmental center.
c. How to accommodate, interview, and
converse with individuals who may require
assistive devices in order to express themselves.
d. Capacity and consent of individuals with
cognitive and intellectual barriers.
e. Conflict resolution and de-escalation
techniques for potentially dangerous situations
involving mentally disabled or developmentally
disabled persons.
f. Appropriate language usage when
interacting with mentally disabled or
developmentally disabled persons.
g. Community and state resources and
advocacy support and services available to serve
mentally disabled or developmentally disabled
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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persons, and how these resources can be best
utilized by law enforcement to benefit the
mentally disabled or developmentally disabled
community.
h. The fact that a crime committed in whole
or in part because of an actual or perceived
disability of the victim is a hate crime
punishable under Title 11.6 (commencing with
Section 422.55) of Part 1.
i. Information on the state mental hospital
system and the state developmental center system.
j. Techniques in conducting forensic
investigations within institutional settings
where jurisdiction may be shared.
aa. Examples of abuse and exploitation
perpetrated by caregivers, staff, contractors, or
administrators of state mental hospitals and
state developmental centers, and how to conduct
investigations in instances where a perpetrator
may also be a caregiver or provider of
therapeutic or other services.
6) Adds to existing requirements to report suspected
or alleged abuse, the requirement to report suspected
or alleged neglect in a state mental hospital or
developmental center.
7) Specifies that a report be made "immediately but
not later than within two hours of the mandated
reporter observing, obtaining knowledge of or
suspecting abuse" to designated investigators of DSH
or DDS and also to the local law enforcement agency if
any of the following incidents is alleged:
a. A death.
b. A sexual assault as defined in Section
15610.63, which defines nine specified crimes by
penal code including rape, sexual battery and
other crimes.
c. An assault with a deadly weapon, as
described in Section 245 of the Penal Code, by a
nonresident of the state mental hospital or state
developmental center.
d. An assault with force likely to produce
great bodily injury, as described in Section 245
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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of the Penal Code.
e. An injury to the genitals when the cause
of the injury is undetermined.
f. A broken bone, when the cause of the
break is undetermined.
8) Requires that all other reports of suspected or
alleged abuse or neglect that occurred in a state
mental hospital or a state developmental center shall
be made to designated investigators of DSH or DDS, or
to the local law enforcement agency.
9) Requires that when a local law enforcement agency
receives an initial report of suspected or alleged
abuse or neglect in a state mental hospital or a state
developmental center, as specified, the local law
enforcement agency shall coordinate efforts with the
designated investigators at DSH and provide the most
immediate and appropriate response warranted to
investigate the mandated report.
10) Permits the designated investigators of DSH and
local law enforcement agencies to collaborate to
develop protocols to implement the coordinated
investigative efforts.
11) Requires mandated reporters within the DSH or DDS
to immediately "but no later than within two hours of
the mandated reporter observing, obtaining knowledge
of or suspecting abuse" report that abuse to OPS or
the local law enforcement agency.
FISCAL IMPACT
An Assembly Appropriations committee analysis estimated
implementation of this bill would cost approximately
$100,000 in special fund costs for POST to create and offer
a course for law enforcement regarding interaction with
people living in a state hospital or developmental center.
Additionally, the committee projected minor costs (likely
less than $25,000 GF) to state hospitals and developmental
centers to provide additional training to peace officers,
as well as minor state-reimbursable local costs (likely
less than $50,000), to provide additional mandated training
to peace officers, in most cases within existing training
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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courses. The analysis also noted that there may be minor,
if any, reimbursable local agency costs for specified
coordination with state hospitals and developmental
centers, which in most cases is current practice.
BACKGROUND AND DISCUSSION
Purpose of the bill
The author writes that AB 602 was inspired by SB 1522
(Leno) Chapter 666, Statutes of 2012, which specified a
list of crimes that must be reported by DDS investigators
to outside law enforcement agencies with jurisdiction over
the facilities.
This bill extends the requirements of SB 1522 by adding
neglect to the list of suspected crimes that must be
reported to outside law enforcement, by requiring all
mandated reporters at the facilities to report directly to
outside law enforcement as well as to investigators at DSH
or DDS, and by shortening the time frame by which mandated
reporters must report from "immediately" to "immediately,
but no later than within two hours of the mandated reporter
observing, obtaining knowledge of, or suspecting abuse."
The author mirrors language in AB 40 (Yamada) Chapter 659,
Statues of 2012, which required that mandated reporters of
elder or dependent adult abuse to report suspected physical
abuse in a long term care facility to both local law
enforcement and the Long-Term Care Ombudsman. Both that
bill and this bill provide for a two-hour window to report
abuse in long-term health care facilities directly to law
enforcement.
The author writes that she is "proposing extending the same
protocol to other facilities which may support the needs
of, and provide services to, long-term care recipients."
Developmental Centers and State Hospitals
DDS operates California's four state-owned and operated
developmental centers, which care for approximately 1,535
people with developmental disabilities. These facilities
lie on large campuses with various residential units that
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were built, in many cases, more than a century ago to house
individuals who were unable to remain at home. Each
developmental center has a mix of units that are licensed
as skilled nursing facilities, general acute care hospitals
or intermediate care facilities. Housing within the units
is based on specific resident needs. In addition, the state
operates a smaller, state-owned community facility, Canyon
Springs, in Riverside County.
The developmental centers are part of a system of care
overseen by DDS. DDS is responsible for coordinating care
and providing services for individuals in developmental
centers, as well as for approximately 260,000 people with
developmental disabilities who receive services and
supports to live in their communities. A developmental
disability is defined as a severe and chronic disability
that is attributable to a mental or physical impairment
that begins before age 18. These disabilities include
cerebral palsy, autism, epilepsy and other similar
conditions.
DSH operates five state hospitals and three psychiatric
programs statewide, providing in-patient mental health
treatment services to 6,560 patients in FY 2013-14. Two
facilities are located in southern California (Metropolitan
State Hospital in Los Angeles County and Patton State
Hospital in San Bernardino County), one facility near the
central coast (Atascadero State Hospital) and one in
northern California (Napa State Hospital). A fifth
facility, Coalinga State Hospital in the central valley,
opened its doors in September 2005. Additionally, in July
2013, the department will open a new 1,722-bed facility in
Stockton as a joint project with the California Department
of Corrections and Rehabilitation, and the California
Correctional Health Care Services. The new facility is
designed to provide medical and mental health care for
patient-inmates. Of that total, 514 beds in 17 treatment
units will be designated for mentally ill patients
including 432 in intermediate care and 82 in acute care
units.
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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In 2012, the Governor divided the state Department of
Mental Health, moving community mental health services to
the Department of Health Care Services and creating a new
and separate Department of State Hospitals to oversee the
state-run mental health hospitals, which primarily house
forensic patients.
Abuse and neglect in DSH and DDS facilities
A number of news articles and federal compliance actions in
recent years underscore problems of abuse at the state
hospitals and developmental centers.
In 2011 and 2012, the Los Angeles Times, National Public
Radio and other media outlets reported on violence in the
state mental hospitals prompted by a variety of incidents
include the strangulation of a nurse at Napa State Hospital
by a patient.
A federal Civil Rights of Institutionalized Persons Act
(CRIPA) investigation and correction plan already had been
underway at the state hospitals since 2006 because of
reports of patient abuse and neglect. The Los Angeles
Times, in a series of reports, wrote that, while federal
oversight of the four state hospitals cost hundreds of
millions of dollars and was intended to make patients safer
and improve their care, instead violence shot up overall,
patients on average were confined longer and treatment
suffered. The articles, in part, resulted in the reversal
of those policies and in November 2012, a federal judge
released most of the state hospitals from CRIPA oversight,
however she noted that several patient deaths, including
that of a 6-foot-4, 300 pound patient at Napa State
Hospital who died in 2012 after being handcuffed and placed
face down on the ground, were still troubling.
In 2012, the Center for Investigative Reporting published a
series of stories detailing abuses at Sonoma Developmental
Center and ineffective investigative practices by the
developmental centers' police force, OPS. According to the
articles, which cite Department of Public Health data,
there were 327 patient abuse cases since 2006. The series
detailed a number of specific incidents at various
developmental centers including the 2005 death of a
quadriplegic cerebral palsy patient at the Sonoma
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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Developmental Center, after he swallowed 4-inch swabs that
shredded his esophagus. A doctor and a pathologist
concluded it was highly unlikely that the patient could
have placed the swabs in his own mouth.
The adequacy of OPS investigations at developmental centers
was the subject of a Senate Human Services Committee
hearing in March 2012. Included in that hearing was a
discussion of the memorandums of understanding that exist
between developmental centers and their local law
enforcement agencies, which were intended to strengthen the
link between outside investigators and OPS in cases of
serious crimes.
The passage of two bills followed the newspaper articles
and hearing: SB 1051 (Liu) Chapter 660, Statutes of 2012
mandated job requirements for the chief of police at OPS,
required that the job be appointed by the Secretary of the
Health and Human Services Agency, and required DDS and DSH
to report specified crimes to the state's designated
protection and advocacy agency. SB 1522 (Leno) Chapter 666,
Statutes of 2012 expanded the list of crimes that must be
reported to outside law enforcement agencies.
Law enforcement response to crimes against disabled people
In the wake of troubling incidents at DSH and DDS, some
have proposed removing law enforcement officers entirely
from these institutions and instead relying solely on local
law enforcement to perform investigations. However,
advocates have been reluctant to consider that in part
because of long-standing concerns about the completeness of
investigations by local law enforcement officers in
agencies statewide.
In 2003, Disability Rights California and other
collaborators released a report, "Abuse and Neglect of
Adults with Developmental Disabilities: A Public Health
Priority for the State of California," raising concerns
about the lack of training for officers in local police and
sheriff's departments and about poor arrest and prosecution
rates in cases where individuals with developmental
disabilities are victims of crimes.
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The report noted that high rates of victimization were
present throughout the developmental disabilities
population, regardless whether they lived in institutions
or community settings. The report found that individuals
with developmental disabilities were four to 10 times more
likely to be victimized than others, were at higher risk of
re-victimization, and were most likely to be abused by
someone they know and were more seriously abused and for
longer periods of time than other individuals. It cited
some studies that estimate close to 80 percent of women
with developmental disabilities have been sexually
assaulted at some point in their lives.<1>
It also found that reports of abuse against people with
developmental disabilities were significantly
under-reported and that, when reported, they were far less
likely to be prosecuted:
Research findings document excessively low rates
of prosecution and conviction of crimes against
people with disabilities. One study found that
65% of sexual assault cases reported to police
were not prosecuted when the victim had a
disability (Sobsey & Varnhaggen, 1991). A more
recent survey in Boston found that only 5% of
serious crimes against people with disabilities
were prosecuted compared to 70% for similar
crimes against people without disabilities
(Boston Globe, 2001). A study of sexual assaults
of people with intellectual disabilities in
Britain found that police investigated only 21
percent of cases reported and only 9 percent were
referred by police for prosecution. Just two
cases (less than 1 percent) proceeded to court
with only one resulting in conviction. (Brown &
Stein, 1997).
-------------------------
<1>
http://www.scdd.ca.gov/res/docs/pdf/Publications/Abuse_and_N
eglect_WhitePaper.pdf
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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One of the report's eight recommendations was to increase
training to responders who work with individuals with
developmental disabilities.
Prior legislation
SB 1051 (Liu) Chapter 660, Statutes of 2012, required DSH
and DSS to report suspected abuse to the designated
protection and advocacy agency.
SB 1522 (Leno) Chapter 666, Statutes of 2012, required a
state developmental center to report to local law
enforcement all deaths, sexual assaults, assaults with a
deadly weapon or force likely to produce great bodily
injury, and other specified incidents.
AB 40 (Yamada) Chapter 659, Statutes of 2012, required
mandated reporters of elder or dependent adult abuse to
report suspected or known instances of physical abuse,
occurring in a long-term care facility, to both the
Long-Term Care Ombudsman and local law enforcement.
COMMENTS
This bill creates a new reporting requirement for mandated
reporters in developmental centers and state hospitals
intended to mirror changes made last year in AB 40, by
requiring that reporting be done, in some cases,
"immediately and no later than within two hours." AB 40,
which reflected new federal requirements in the Elder
Justice Act, dictated the actions of mandated reporters in
long-term care facilities, but specifically excluded
reporters in state hospitals and developmental centers.
AB 40 further divided mandated reports into two courses of
action, if the incident involved physical abuse: Those
resulting serious bodily injury, as defined, must be
reported to law enforcement by phone "immediately and no
later than within two hours," and a written report made to
licensing entities and the ombudsman within two hours. For
incidents resulting in lesser than serious bodily injury,
mandated reporters in long-term care facilities must make a
telephone report to the local law enforcement agency within
24 hours and a written report to licensing and the
ombudsman within the same 24-hour window. In cases where
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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the victim has dementia, and the injury is not serious, the
mandated reporter has the option to report to either law
enforcement or the ombudsman. (WIC 15630 (b)(1)(A)
Additional requirements apply if the abuse is non-physical.
Current law requires mandated reporters in Developmental
Centers and state hospitals to report either to designated
investigators within those state institutions or to outside
law enforcement. Mandated reporters within DDS are
additionally required to "immediately" report suspected
abuse to OPS or to local law enforcement. (WIC
15630(b)(1)(E))
Further, mandated reporters of elder or dependent adult
abuse who are not in developmental centers, state hospitals
or long-term care facilities, as defined, are required to
report suspected abuse or neglect to law enforcement
investigators "immediately or as soon as practicably
possible." (WIC 15630 (b)(1))
Staff notes that while this bill attempts to strengthen
reporting requirements for mandated reporters within the
state institutions, it creates yet another layer of
reporting requirements that differs from other similar
reporters and illustrates the need for broader reporting
reform.
PRIOR VOTES
Senate Public Safety committee 6 - 0
Assembly Floor 76 - 0
Assembly Appropriations 17 - 0
Assembly Public Safety 7 - 0
POSITIONS
Support: Alameda County Developmental
Disabilities Planning and Advisory
Council
Area Board 4, State Council on Developmental
Disabilities
California Association of Psychiatric
Technicians
STAFF ANALYSIS OF ASSEMBLY BILL 602 (Yamada)
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California Coalition Against Sexual Assault
(CALCASA)
California Council of Community Mental Health Agencies
Contra Costa Health Services
East Bay Developmental Disabilities
Legislative Coalition
Mental Health America of California
National Association of Social Workers -
California Chapter
State Council on Developmental Disabilities
The Arc and United Cerebral Palsy in
California
Oppose: None received
-- END --