BILL NUMBER: AB 1340 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 18, 2013
AMENDED IN ASSEMBLY MAY 24, 2013
AMENDED IN ASSEMBLY APRIL 10, 2013
AMENDED IN ASSEMBLY APRIL 1, 2013
INTRODUCED BY Assembly Member Achadjian
FEBRUARY 22, 2013
An act to amend Sections 1180.1 and 1180.2 of, and to add
Section 1255.9 to, the Health and Safety Code, and to amend Sections
4100 and 7200 of, and to add Sections 4142 and
4142, 4143 to , and 4144
to, the Welfare and Institutions Code, relating to mental
health.
LEGISLATIVE COUNSEL'S DIGEST
AB 1340, as amended, Achadjian. State Hospital Employees Act.
Existing law establishes state hospitals for the care, treatment,
and education of mentally disordered persons. These hospitals are
under the jurisdiction of the State Department of State Hospitals,
which is authorized by existing law to adopt regulations regarding
the conduct and management of these facilities. Existing law requires
each state hospital to develop an incident reporting procedure that
can be used to, at a minimum, develop reports of patient assaults on
employees and assist the hospital in identifying risks of patient
assaults on employees. Existing law provides for the licensure
and regulation of health facilities, including acute psychiatric
hospitals, by the State Department of Public Health. A violation of
these provisions is a crime.
This bill, as of July 1, 2015, bill would
establish an Enhanced Treatment Facility and specified programs
within the State Department of State Hospitals, and subject to
available funding, would require each state hospital to establish and
maintain an enhanced treatment unit (ETU) as part of its
facilities and facilities. The bill would
authorize an acute psychiatric hospital under the jurisdiction of the
department to be licensed to offer an ETU that meets specified
requirements, including that each room be limited to one
patient, and would authorize the department to adopt and implement
policies and procedures, as specified. Because the bill would create
a new crime, it imposes a state-mandated local program.
The bill would also require any case of assault by a
patient of a state hospital, as specified, to be immediately referred
to the local district attorney, and if, after the referral, the
patient is found guilty of a misdemeanor or a felony assault, the
local district attorney declines to prosecute, or the patient is
found incompetent to stand trial or not guilty by reason of insanity,
the bill would require the patient to be placed in the
enhanced treatment unit ETU of the hospital
until the patient is deemed safe to return to the regular population
of the hospital.
The bill would authorize a state hospital psychiatrist or
psychologist to refer a patient to an ETU for temporary placement and
risk assessment upon determining that the patient may pose a
substantial risk of inpatient aggression. The bill would require a
forensic needs assessment panel (FNAP) to conduct a placement
evaluation to determine whether the patient meets the threshold
standard for treatment in an enhanced treatment program (ETP). The
bill would require, if the FNAP determines that the ETU placement is
appropriate, that the FNAP certify the patient for 90 days of ETP
placement and provide the determination in writing to the patient and
the patient's advocate. The bill would also require a forensic needs
assessment team (FNAT) psychologist to perform an in-depth clinical
assessment and make a treatment plan upon the patient's admission to
an ETP. The bill would require the FNAP to meet with specified
individuals to determine whether the patient may stay in the ETP
placement or return to a standard security treatment setting and
provide the determination in writing to the patient's advocate. If
the FNAP determines the patient is no longer appropriate for ETP
placement, the FNAP may refer the patient to the 7-day step down
unit, as defined, or a standard security setting in a department
hospital.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. This act may be known and cited as the State Hospital
Employees Act.
SEC. 2. Section 1180.1 of the Health
and Safety Code is amended to read:
1180.1. For purposes of this division, the following definitions
apply:
(a) "Behavioral restraint" means "mechanical restraint" or
"physical restraint" as defined in this section, used as an
intervention when a person presents an immediate danger to self or to
others. It does not include restraints used for medical purposes,
including, but not limited to, securing an intravenous needle or
immobilizing a person for a surgical procedure, or postural
restraints, or devices used to prevent injury or to improve a person'
s mobility and independent functioning rather than to restrict
movement.
(b) "Containment" means a brief physical restraint of a person for
the purpose of effectively gaining quick control of a person who is
aggressive or agitated or who is a danger to self or others.
"Containment" does not include admission into an enhanced treatment
unit or enhanced treatment facility,
as defined in subdivision (k) of Section 4144 of the Welfare and
Institutions Code.
(c) "Mechanical restraint" means the use of a mechanical device,
material, or equipment attached or adjacent to the person's body that
he or she cannot easily remove and that restricts the freedom of
movement of all or part of a person's body or restricts normal access
to the person's body, and that is used as a behavioral restraint.
(d) "Physical restraint" means the use of a manual hold to
restrict freedom of movement of all or part of a person's body, or to
restrict normal access to the person's body, and that is used as a
behavioral restraint. "Physical restraint" is staff-to-person
physical contact in which the person unwillingly participates.
"Physical restraint" does not include briefly holding a person
without undue force in order to calm or comfort, or physical contact
intended to gently assist a person in performing tasks or to guide or
assist a person from one area to another.
(e) "Seclusion" means the involuntary confinement of a person
alone in a room or an area from which the person is physically
prevented from leaving. "Seclusion" does not include a "timeout," as
defined in regulations relating to facilities operated by the State
Department of Developmental Services.
Services, nor does "seclusion" include admission into an
enhanced treatment unit or enhanced treatment
facility, as defined in subdivision (k) of Section 414
4 of the Welfare and Institutions Code.
(f) "Secretary" means the Secretary of California Health and Human
Services.
(g) "Serious injury" means significant impairment of the physical
condition as determined by qualified medical personnel, and includes,
but is not limited to, burns, lacerations, bone fractures,
substantial hematoma, or injuries to internal organs.
SEC. 3. Section 1180.2 of the Health and
Safety Code is amended to read:
1180.2. (a) This section shall apply to the state hospitals
, the enhanced treatment units, and the enhanced treatment facility
operated by the State Department of State Hospitals , as
listed in Section 7200 of the Welfare and Institutions Code,
and facilities operated by the State Department of Developmental
Services that utilize seclusion or behavioral restraints.
(b) The State Department of State Hospitals and the State
Department of Developmental Services shall develop technical
assistance and training programs to support the efforts of facilities
described in subdivision (a) to reduce or eliminate the use of
seclusion and behavioral restraints in those facilities.
(c) Technical assistance and training programs should be designed
with the input of stakeholders, including clients and direct care
staff, and should be based on best practices that lead to the
avoidance of the use of seclusion and behavioral restraints,
including, but not limited to, all of the following:
(1) Conducting an intake assessment that is consistent with
facility policies and that includes issues specific to the use of
seclusion and behavioral restraints as specified in Section 1180.4.
(2) Utilizing strategies to engage clients collaboratively in
assessment, avoidance, and management of crisis situations in order
to prevent incidents of the use of seclusion and behavioral
restraints.
(3) Recognizing and responding appropriately to underlying reasons
for escalating behavior.
(4) Utilizing conflict resolution, effective communication,
deescalation, and client-centered problem solving strategies that
diffuse and safely resolve emerging crisis situations.
(5) Individual treatment planning that identifies risk factors,
positive early intervention strategies, and strategies to minimize
time spent in seclusion or behavioral restraints. Individual
treatment planning should include input from the person affected.
(6) While minimizing the duration of time spent in seclusion or
behavioral restraints, using strategies to mitigate the emotional and
physical discomfort and ensure the safety of the person involved in
seclusion or behavioral restraints, including input from the person
about what would alleviate his or her distress.
(7) Training in conducting an effective debriefing meeting as
specified in Section 1180.5, including the appropriate persons to
involve, the voluntary participation of the person who has been in
seclusion or behavioral restraints, and strategic interventions to
engage affected persons in the process. The training should include
strategies that result in maximum participation and comfort for the
involved parties to identify factors that lead to the use of
seclusion and behavioral restraints and factors that would reduce the
likelihood of future incidents.
(d) (1) The State Department of State Hospitals and the State
Department of Developmental Services shall take steps to establish a
system of mandatory, consistent, timely, and publicly accessible data
collection regarding the use of seclusion and behavioral restraints
in facilities described in this section. It is the intent of the
Legislature that data be compiled in a manner that allows for
standard statistical comparison.
(2) The State Department of State Hospitals and the State
Department of Developmental Services shall develop a mechanism for
making this information publicly available on the Internet.
(3) Data collected pursuant to this section shall include all of
the following:
(A) The number of deaths that occur while persons are in seclusion
or behavioral restraints, or where it is reasonable to assume that a
death was proximately related to the use of seclusion or behavioral
restraints.
(B) The number of serious injuries sustained by persons while in
seclusion or subject to behavioral restraints.
(C) The number of serious injuries sustained by staff that occur
during the use of seclusion or behavioral restraints.
(D) The number of incidents of seclusion.
(E) The number of incidents of use of behavioral restraints.
(F) The duration of time spent per incident in seclusion.
(G) The duration of time spent per incident subject to behavioral
restraints.
(H) The number of times an involuntary emergency medication is
used to control behavior, as defined by the State Department of State
Hospitals.
(e) A facility described in subdivision (a) shall report each
death or serious injury of a person occurring during, or related to,
the use of seclusion or behavioral restraints. This report shall be
made to the agency designated in subdivision (i) of Section 4900 of
the Welfare and Institutions Code no later than the close of the
business day following the death or injury. The report shall include
the encrypted identifier of the person involved, and the name, street
address, and telephone number of the facility.
SEC. 4. Section 1255.9 is added to the
Health and Safety Code , to read:
1255.9. (a) On and after January 1, 2018, an acute psychiatric
hospital that is operated by the State Department of State Hospitals
may be licensed by the State Department of Public Health to offer, as
a special service, an enhanced treatment unit (ETU) to provide
treatment to the most violent patients.
(b) An ETU shall meet all of the following requirements:
(1) Maintain a staff-to-patient ratio of one-to-five.
(2) Limit each room to one patient.
(3) Each patient room shall allow visual access by staff 24 hours
per day.
(4) Each patient room shall have a private bathroom in the room.
(c) Each patient room may have the capacity to lock the door
externally.
(d) An acute psychiatric hospital that has an approved ETU on its
license shall adopt and implement policies and procedures that
provide for all of the following:
(1) A definition of patients considered to be "most violent."
(2) A process for a clinical assessment and review focused on
behavior, history, dangerousness, and clinical need for patients who
have been designated to receive treatment in an ETU.
(3) A process for a risk for violence assessment that meets the
criteria for treatment in an ETU.
(4) A process for a continuum of care with an ETU appropriate for
each patient's need.
(5) A process for a phased treatment plan with regular clinical
review and reevaluation of placement back into an appropriate unit
for less violent patients that includes discharge planning designed
to achieve a quick and safe transition out of an ETU.
(6) A process for continual oversight and enhanced treatment
focused on the individual physical and psychiatric care and
assessment of a patient.
(7) Emergency egress of ETU patients and staff.
(e) Regulations defining an ETU that is operated by the State
Department of State Hospitals that are in effect prior to January 1,
2014, shall be inoperative until January 1, 2018. Regulations adopted
on and after January 1, 2014, shall not become effective until
January 1, 2018, and until that time, the enhanced treatment units
and facility are exempt from any licensing requirements.
SEC. 5. Section 4100 of the Welfare and
Institutions Code is amended to read:
4100. The department has jurisdiction over the following
programs and institutions:
(a) Atascadero State Hospital.
(b) Coalinga State Hospital.
(c) Metropolitan State Hospital.
(d) Napa State Hospital.
(e) Patton State Hospital.
(f) State Department of State Hospitals Enhanced Treatment
Facility, subject to funding be made available in the annual Budget
Act.
(g) Vacaville Psychiatric Program of the State Department of State
Hospitals.
(h) Salinas Valley Psychiatric Program of the State Department of
State Hospitals.
(i) Stockton Psychiatric Program of the State Department of State
Hospitals.
SEC. 2. SEC. 6. Section 4142 is
added to the Welfare and Institutions Code, to read:
4142. Commencing July 1, 2015, and subject to available funding,
each state hospital shall establish and maintain an enhanced
treatment unit as part of its facilities for the placement of
patients described in Section 4143. Sections
4143 and 4144. The hospital administrator of each state
hospital shall establish procedures to provide an increased level of
security for the enhanced treatment unit.
SEC. 3. SEC. 7. Section 4143 is
added to the Welfare and Institutions Code, to read:
4143. (a) Subject to available funding, any case of assault by a
patient of a state hospital that causes injury to or illness of, or
has the potential to cause future illness of, a state hospital
employee or another patient of the state hospital rising to the level
of a misdemeanor or felony shall be immediately referred to the
local district attorney.
(b) If, after referral to the local district attorney, the patient
is found guilty of misdemeanor or felony assault, the local district
attorney declines prosecution, the patient is found to be
incompetent to stand trial, or the patient is found not guilty by
reason of insanity, the patient shall be placed in the enhanced
treatment unit of the state hospital pursuant to Section 4144,
until the patient is deemed safe to return to the regular
population of the hospital.
(c) This section shall become operative on July 1, 2015.
SEC. 8. Section 4144 is added to the
Welfare and Institutions Code , to read:
4144. (a) A state hospital psychiatrist or psychologist may refer
a patient to an enhanced treatment unit (ETU) for temporary
placement and risk assessment upon determining that the patient may
pose a substantial risk of inpatient aggression and the patient's
care and treatment may not be possible in a standard security
treatment environment. The referral may occur at any time after the
patient has been admitted to a hospital or program under the
jurisdiction of the department.
(b) Within three business days of placement in an ETU, a dedicated
forensic evaluator, who is not on the patient's treatment team,
shall complete a full clinical evaluation of the patient that shall
include an analysis of diagnosis, past violence, and any instances of
an offense, and a valid and reliable violence risk assessment.
(c) (1) Within seven business days of placement in an ETU and with
72-hour notice to the patient and patient's advocate, the forensic
needs assessment panel (FNAP) shall conduct a placement evaluation
meeting with the referring psychiatrist or psychologist, the patient
and patient's advocate, and the dedicated forensic evaluator who
performed the full clinical evaluation. A determination shall be made
as to whether the patient meets the threshold standard for treatment
in an enhanced treatment program (ETP).
(2) (A) The threshold standard for treatment in an ETP may be met
if a doctor, utilizing standard forensic methodologies for clinically
assessing violence risk, determines that a patient poses a
substantial risk of inpatient aggression and the patient's care and
treatment cannot be provided in his or her present environment.
(B) Factors used to determine a patient's substantial risk of
inpatient aggression may include, but are not limited to, an analysis
of past violence, delineation of static and dynamic violence risk
factors, and utilization of valid and reliable violence risk
assessment testing.
(3) If a patient has shown improvement during his or her placement
in an ETU, the FNAP may delay its decision for another seven
business days. The FNAP's determination of whether the patient is
appropriate for continued or longer term ETU placement and treatment
shall be based on the threshold standard for treatment in an ETP as
specified in paragraph (1).
(d) (1) After consideration of discussion and reviewed materials,
the FNAP shall either certify the patient for 90 days of treatment in
an ETP or direct that the patient be returned to a standard security
treatment environment in the hospital.
(2) After the FNAP makes a decision to provide an ETP on a longer
term basis and if the ETP will be provided at a hospital other than
the referring hospital, such as an enhanced treatment facility (ETF),
the transfer may take place as soon as transportation may be
reasonably arranged.
(3) The FNAP determination shall be in writing and provided to the
patient and patient's advocate as soon as possible, but if the ETP
will be provided at a state hospital other than the referring
hospital, then no later than prior to transfer. The determination
shall also be included in a quarterly report to the State Department
of Health Care Services.
(e) (1) Upon admission to an ETP, a forensic needs assessment team
(FNAT) psychologist who is not on the patient's treatment team shall
perform an in-depth clinical assessment and make a treatment plan
for the patient within 14 business days of placement in the ETP.
Formal treatment plan reviews shall occur on a monthly basis, which
shall include a full report on the patient's behavior while in the
ETP.
(2) An ETP patient shall receive treatment from a team of
psychologists, a psychiatrist, a nurse, and a psychiatric technician,
who shall meet as often as necessary, but no less than on a weekly
basis, to assess the patient's need for continued placement in an
ETP.
(f) Prior to the expiration of 90 days from the date of placement
in an ETP and with 72-hour notice provided to the patient's advocate,
the FNAP shall convene a treatment placement meeting with a
psychologist from the treatment team, a patient advocate, the
patient, and the FNAT psychologist who performed the in-depth
clinical assessment. The FNAP shall determine whether the patient may
return to a standard security treatment environment or whether the
patient is appropriate for continued ETP placement. If after
consideration of the discussion and documentation, the FNAP
determines that the patient requires continued ETP placement, the
patient shall be certified for further treatment. The FNAP
determination shall be in writing and provided to the patient's
advocate within 24 hours of the meeting. The report shall also be
included in a quarterly report to State Department of Health Care
Services.
(g) The FNAP shall review the patient's treatment summary every 90
days after the first FNAP meeting and determine if the patient
requires continued ETP placement. If the FNAP determines that the
patient is no longer appropriate for ETP placement, the FNAP may
refer the patient to the seven-day step down unit or to a standard
security treatment environment in a state hospital. The FNAP report
shall also be included in a quarterly report to State Department of
Health Case Services.
(h) If a patient continues to remain in an ETP placement, prior to
the expiration of one year from the date of certification to an ETP
and with 72-hour notice provided to the patient's advocate, the FNAP
shall convene a treatment placement meeting with a psychologist from
the treatment team, a patient advocate, the patient, and the FNAT
psychologist who performed the in-depth clinical assessment. The FNAP
shall determine whether the patient may return to a standard
security treatment environment or whether the patient is appropriate
for continued ETP placement. If after consideration of the discussion
and documentation, the FNAP determines that the patient requires
continued ETP placement, the patient shall be certified for further
treatment for an additional year. The FNAP determination shall be in
writing and provided to the patient's advocate within 24 hours of the
meeting. The report shall also be included in a quarterly report to
State Department of Health Care Services.
(i) At any point during an ETP placement, if a patient's treatment
team determines that the patient no longer requires treatment at the
ETU or ETF, a recommendation to transfer the patient out of the ETU
or ETF shall be made to the FNAT and FNAP. After a determination that
an ETP placement is no longer necessary, the patient shall be
transferred to a step down unit for seven business days for
transitioning and evaluation of the patient's stability at the step
down unit. After completing the seven-day step down placement, the
FNAT shall meet to recommend either continued evaluation at the step
down unit, a return to ETP placement, or a transfer to a standard
security treatment environment in a state hospital. If the FNAT
recommends that the patient be transferred to a standard security
treatment environment, the department shall identify a state hospital
and appropriate placement, and transfer the patient within 30
business days of the recommendation.
(j) The process described in this section may continue until the
patient is no longer appropriate for ETP placement or until the
patient is discharged from the state hospital.
(k) As used in this section, the following terms have the
following meanings:
(1) "Enhanced treatment environment" means an enhanced treatment
unit, an enhanced treatment facility, or a step down unit.
(2) "Enhanced treatment facility" or "ETF" means a state hospital
that is part of the enhanced treatment program designed and dedicated
to house and treat patients who have been assessed to pose a
substantial risk of inpatient aggression which cannot be contained in
a standard treatment program.
(3) "Enhanced treatment program" or "ETP" means supplemental
treatment provided in an acute psychiatric hospital or facility under
the jurisdiction of the department for patients who have been
assessed to pose a substantial risk of inpatient aggression which
cannot be contained in a standard treatment program.
(4) "Enhanced treatment unit" or "ETU" means a unit in a hospital
under the jurisdiction of the department that is part of the enhanced
treatment program designed to house, treat, and evaluate patients
who have been assessed to pose a substantial risk of inpatient
aggression which cannot be contained in a standard treatment program.
(5) "Forensic needs assessment panel" or "FNAP" means a panel that
consists of the placement hospital medical director, the referring
hospital medical director if the patient will be transferred, and the
ETF hospital medical director or their designee, who all evaluate
the placement of a patient into an ETP, and conduct ETP placement
evaluation meetings.
(6) "Forensic needs assessment team" or "FNAT" means a panel of
psychologists with expertise in forensic assessment and/or violence
risk assessment, each of whom are assigned an ETP case, or group of
cases, to conduct an in-depth violence risk assessment, ensure the
treatment plan encompasses the elements delineated by that
assessment, and follow the patient through placement in the ETP.
(7) "In-depth violence risk assessment" means the utilization of
standard forensic methodologies for clinically assessing the risk of
a patient posing a substantial risk of inpatient aggression.
(8) "Standard security treatment environment" means a state
hospital or facility, or a portion of a state hospital or facility,
that is not part of an enhanced treatment environment.
(9) "Step down unit" means a unit in an enhanced treatment unit or
enhanced treatment facility that is part of the enhanced treatment
program designed to help assess a patient's readiness to return to a
standard security treatment environment.
SEC. 9. Section 7200 of the Welfare and
Institutions Code is amended to read:
7200. There are in the state the following state hospitals for
the care, treatment, and education of the mentally disordered:
(a) Metropolitan State Hospital near the City of Norwalk, Los
Angeles County.
(b) Atascadero State Hospital near the City of Atascadero, San
Luis Obispo County.
(c) Napa State Hospital near the City of Napa, Napa County.
(d) Patton State Hospital near the City of San Bernardino, San
Bernardino County.
(e) Coalinga State Hospital near the City of Coalinga, Fresno
County.
(f) State Department of State Hospitals Enhanced Treatment
Facility at a location to be determined by the State Department of
State Hospitals and subject to available funding.
SEC. 10. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.