Amended in Senate July 2, 2014

Amended in Senate June 16, 2014

Amended in Senate April 3, 2014

Amended in Senate June 18, 2013

Amended in Assembly May 24, 2013

Amended in Assembly April 10, 2013

Amended in Assembly April 1, 2013

California Legislature—2013–14 Regular Session

Assembly Bill No. 1340

Introduced by Assembly Member Achadjian

(Coauthor: Assembly Member Yamada)

(Coauthors: Senators begin insert Anderson, end insert Beall and Wolk)

February 22, 2013

An act to amend Section 1250 of, and to add Section 1265.9 to, the Health and Safety Code, and to amend Sections 4100 and 7200 of, and to add Sections begin delete 4142 end delete begin insert 4142.5 end insert and 4143 to, the Welfare and Institutions Code, relating to mental health.

LEGISLATIVE COUNSEL’S DIGEST

AB 1340, as amended, Achadjian. Enhanced treatment programs.

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 would, commencing July 1, 2015, and subject to available funding, authorize the State Department of State Hospitals to establish and maintain enhanced treatment begin insert pilot end insert programs (ETPs), as defined, for the treatment of patients who are at high risk begin delete for end delete begin insert of end insert most dangerous behavior, as defined, and when treatment is not possible in a standard treatment environment. The bill would require, until January 1, 2018, that an ETP meet the licensing requirements of an acute psychiatric hospital, except as specified. begin delete Commencing January 1, 2018, an ETP that is operated by the State Department of State Hospitals would be required to be licensed by the State Department of Public Health. end delete

The bill would authorize a state hospital psychiatrist or psychologist to refer a patient to an ETP for temporary placement and risk assessment upon a determination that the patient may be at high risk for most dangerous behavior. The bill would require the forensic needs assessment panel (FNAP) to conduct a placement evaluation to determine whether the patient clinically requires ETP placement and ETP treatment can meet the identified needs of the patient. The bill would also require a forensic needs assessment team (FNAT) psychologist to perform an in-depth violence risk assessment and make a treatment plan upon the patient’s admission to an ETP.

The bill would require the FNAP to conduct a treatment placement meeting with specified individuals prior to the expiration of 90 days from the date of placement in the ETP to determine whether the patient may return to a standard treatment environment or the patient clinically requires continued ETP treatment. If the FNAP determines that the patient clinically requires continued ETP treatment, the bill would require the FNAP to certify the patient for further ETP treatment for one year, subject to FNAP reviews every 90 days, as specified. The bill would require the FNAP to conduct another treatment placement meeting prior to the expiration of the one-year certification of ETP placement to determine whether the patient may return to a standard treatment environment or be certified for further ETP treatment for another year.

Because this bill would create a new crime, it imposes a state-mandated local program.

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: yes.

The people of the State of California do enact as follows:

SECTION 1.  

(a) The Legislature finds and declares that the
State Department of State Hospitals delivers inpatient mental health
treatment to over 6,000 patients through more than 10,000
department employees. Their goal is to improve the lives of patients
diagnosed with severe mental health conditions who have been
assigned to their hospitals and units. In the experience of the
department, there can be no effective clinical treatment without
safety for its patients and employees, and no safety without
effective clinical treatment.

(b) It is the intent of the Legislature in enacting this bill to
expand the range of available clinical treatment by establishing
enhanced treatment begin insert pilot end insert programs for those patients determined
to be at begin delete the highest risk for aggression end delete begin insert high risk of most dangerous
behavior end insert against other patients or hospital staff. The goal of these
enhanced treatment begin insert pilot end insert programs is to begin delete deliver end delete begin insert evaluate the
effectiveness of end insert concentrated, evidence-based clinical begin delete therapy, end delete
begin insert therapy end insert and treatment in an environment designed to improve these
patients’ conditions and return them to the general patient
population.

begin insert

(c) The Legislature finds and declares that the purpose of the
establishment of a pilot program creating Enhanced Treatment
Units within the State Department of State Hospitals is to test the
effectiveness of providing improved treatment with a heightened
secure setting to patients with a demonstrated and sustained risk
of aggressive, violent behavior toward other patients and staff.

end insert begin insert

(d) It is the intent of the Legislature that the criteria established
for placement in an Enhanced Treatment Unit within the State
Department of State Hospitals cannot be used to circumvent the
statutory and regulatory criteria for use of seclusion and restrains,
but is instead another level of continuum of care for the patient
receiving treatment in an Enhanced Treatment Unit.

end insert

SEC. 2.  

Section 1250 of the Health and Safety Code is amended
to read:

1250.  

As used in this chapter, “health facility” means any
facility, place, or building that is organized, maintained, and
operated for the diagnosis, care, prevention, and treatment of
human illness, physical or mental, including convalescence and
rehabilitation and including care during and after pregnancy, or
for any one or more of these purposes, for one or more persons,
to which the persons are admitted for a 24-hour stay or longer, and
includes the following types:

(a) “General acute care hospital” means a health facility having
a duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental
Center may, until June 30, 2007, provide surgery and anesthesia
services through a contract or agreement with another acute care
hospital. Notwithstanding the requirements of this subdivision, a
general acute care hospital operated by the Department of
Corrections and Rehabilitation or the Department of Veterans
Affairs may provide surgery and anesthesia services during normal
weekday working hours, and not provide these services during
other hours of the weekday or on weekends or holidays, if the
general acute care hospital otherwise meets the requirements of
this section.

A “general acute care hospital” includes a “rural general acute
care hospital.” However, a “rural general acute care hospital” shall
not be required by the department to provide surgery and anesthesia
services. A “rural general acute care hospital” shall meet either of
the following conditions:

(1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer Grouping
for Efficiency Comparison, dated December 20, 1982.

(2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982,
and has no more than 76 acute care beds and is located in a census
dwelling place of 15,000 or less population according to the 1980
federal census.

(b) “Acute psychiatric hospital” means a health facility having
a duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care for mentally disordered,
incompetent, or other patients referred to in Division 5
(commencing with Section 5000) or Division 6 (commencing with
Section 6000) of the Welfare and Institutions Code, including the
following basic services: medical, nursing, rehabilitative,
pharmacy, and dietary services.

(c) (1) “Skilled nursing facility” means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.

(2) “Skilled nursing facility” includes a “small house skilled
nursing facility (SHSNF),” as defined in Section 1323.5.

(d) “Intermediate care facility” means a health facility that
provides inpatient care to ambulatory or nonambulatory patients
who have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.

(e) “Intermediate care facility/developmentally disabled
habilitative” means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer persons with
developmental disabilities who have intermittent recurring needs
for nursing services, but have been certified by a physician and
surgeon as not requiring availability of continuous skilled nursing
care.

(f) “Special hospital” means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.

(g) “Intermediate care facility/developmentally disabled” means
a facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons with
developmental disabilities whose primary need is for
developmental services and who have a recurring but intermittent
need for skilled nursing services.

(h) “Intermediate care facility/developmentally
disabled-nursing” means a facility with a capacity of 4 to 15 beds
that provides 24-hour personal care, developmental services, and
nursing supervision for persons with developmental disabilities
who have intermittent recurring needs for skilled nursing care but
have been certified by a physician and surgeon as not requiring
continuous skilled nursing care. The facility shall serve medically
fragile persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.

(i) (1) “Congregate living health facility” means a residential
home with a capacity, except as provided in paragraph (4), of no
more than 12 beds, that provides inpatient care, including the
following basic services: medical supervision, 24-hour skilled
nursing and supportive care, pharmacy, dietary, social, recreational,
and at least one type of service specified in paragraph (2). The
primary need of congregate living health facility residents shall
be for availability of skilled nursing care on a recurring,
intermittent, extended, or continuous basis. This care is generally
less intense than that provided in general acute care hospitals but
more intense than that provided in skilled nursing facilities.

(2) Congregate living health facilities shall provide one of the
following services:

(A) Services for persons who are mentally alert, persons with
physical disabilities, who may be ventilator dependent.

(B) Services for persons who have a diagnosis of terminal
illness, a diagnosis of a life-threatening illness, or both. Terminal
illness means the individual has a life expectancy of six months
or less as stated in writing by his or her attending physician and
surgeon. A “life-threatening illness” means the individual has an
illness that can lead to a possibility of a termination of life within
five years or less as stated in writing by his or her attending
physician and surgeon.

(C) Services for persons who are catastrophically and severely
disabled. A person who is catastrophically and severely disabled
means a person whose origin of disability was acquired through
trauma or nondegenerative neurologic illness, for whom it has
been determined that active rehabilitation would be beneficial and
to whom these services are being provided. Services offered by a
congregate living health facility to a person who is catastrophically
disabled shall include, but not be limited to, speech, physical, and
occupational therapy.

(3) A congregate living health facility license shall specify which
of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.

(4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of
59 beds.

(B) A congregate living health facility not operated by a city
and county servicing persons who are terminally ill, persons who
have been diagnosed with a life-threatening illness, or both, that
is located in a county with a population of 500,000 or more persons,
or located in a county of the 16th class pursuant to Section 28020
of the Government Code, may have not more than 25 beds for the
purpose of serving persons who are terminally ill.

(C) A congregate living health facility not operated by a city
and county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more
than 12 beds for the purpose of serving persons who are
catastrophically and severely disabled.

(5) A congregate living health facility shall have a
noninstitutional, homelike environment.

(j) (1) “Correctional treatment center” means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the department, provides inpatient
health services to that portion of the inmate population who do not
require a general acute care level of basic services. This definition
shall not apply to those areas of a law enforcement facility that
houses inmates or wards who may be receiving outpatient services
and are housed separately for reasons of improved access to health
care, security, and protection. The health services provided by a
correctional treatment center shall include, but are not limited to,
all of the following basic services: physician and surgeon,
psychiatrist, psychologist, nursing, pharmacy, and dietary. A
correctional treatment center may provide the following services:
laboratory, radiology, perinatal, and any other services approved
by the department.

(2) Outpatient surgical care with anesthesia may be provided,
if the correctional treatment center meets the same requirements
as a surgical clinic licensed pursuant to Section 1204, with the
exception of the requirement that patients remain less than 24
hours.

(3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.

(4) Physician and surgeon services shall be readily available in
a correctional treatment center on a 24-hour basis.

(5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men’s Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the Department of Corrections and
Rehabilitation from obtaining a correctional treatment center
license at these sites.

(k) “Nursing facility” means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of care
either as a skilled nursing facility in the federal Medicare Program
under Title XVIII of the federal Social Security Act (42 U.S.C.
Sec. 1395 et seq.) or as a nursing facility in the federal Medicaid
Program under Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.), or as both.

(l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, shall not become effective prior to, or if effective, shall
be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.

(m) “Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)” means a homelike
facility with a capacity of four to eight, inclusive, beds that
provides 24-hour personal care, developmental services, and
nursing supervision for persons with developmental disabilities
who have continuous needs for skilled nursing care and have been
certified by a physician and surgeon as warranting continuous
skilled nursing care. The facility shall serve medically fragile
persons who have developmental disabilities or demonstrate
significant developmental delay that may lead to a developmental
disability if not treated. ICF/DD-CN facilities shall be subject to
licensure under this chapter upon adoption of licensing regulations
in accordance with Section 1275.3. A facility providing continuous
skilled nursing services to persons with developmental disabilities
pursuant to Section 14132.20 or 14495.10 of the Welfare and
Institutions Code shall apply for licensure under this subdivision
within 90 days after the regulations become effective, and may
continue to operate pursuant to those sections until its licensure
application is either approved or denied.

(n) “Hospice facility” means a health facility licensed pursuant
to this chapter with a capacity of no more than 24 beds that
provides hospice services. Hospice services include, but are not
limited to, routine care, continuous care, inpatient respite care, and
inpatient hospice care as defined in subdivision (d) of Section
1339.40, and is operated by a provider of hospice services that is
licensed pursuant to Section 1751 and certified as a hospice
pursuant to Part 418 of Title 42 of the Code of Federal Regulations.

(o) (1) “Enhanced treatment program” or “ETP” means a health
facility under the jurisdiction of the State Department of State
Hospitals that provides 24-hour inpatient care for mentally
disordered, incompetent, or other patients who have been
committed to the State Department of State Hospitals and have
been assessed to be at high risk begin delete for end delete begin insert of end insert most dangerous behavior,
as defined in subdivision (k) of Section 4143 of the Welfare and
Institutions Code, and cannot be effectively treated within an acute
psychiatric hospital, a skilled nursing facility, or an intermediate
care facility, including the following basic services: medical,
nursing, rehabilitative, pharmacy, and dietary service.

(2) It is not the intent of the Legislature to have an enhanced
treatment begin insert pilot end insert program supplant health facilities licensed as an
acute psychiatric hospital, a skilled nursing facility, or an
intermediate care facility under this chapter.

(3) Commencing July 1, 2015, and until January 1, 2018, an
enhanced treatment begin insert pilot end insert program shall meet the licensing
requirements applicable to acute psychiatric hospitals under
Chapter 2 (commencing with Section 71001) of Division 5 of the
California Code of Regulations, unless otherwise specified in
Section 1265.9 and any related emergency regulations adopted
pursuant to that section.

begin delete

(4) Commencing January 1, 2018, an ETP shall be subject to
licensure under this chapter as specified in subdivision (a) of
Section 1265.9.

end delete

SEC. 3.  

Section 1265.9 is added to the Health and Safety Code,
to read:

begin delete

1265.9.  

(a) On and after January 1, 2018, an enhanced
treatment program (ETP) that is operated by the State Department
of State Hospitals shall be licensed by the State Department of
Public Health to provide treatment for patients who are at high
risk for most dangerous behavior, as defined by subdivision (k) of
Section 4143 of the Welfare and Institutions Code. Each ETP shall
be part of a continuum of care based on the individual patient’s
treatment needs.

(b)

end delete

begin insert

begin insert 1265.9. end insert   

end insert

begin insert (a) end insert  (1)  begin delete Notwithstanding subdivision (a), commencing end delete
begin insert Commencing end insert July 1, 2015, and until January 1, 2018, the State
Department of State Hospitals may establish and maintain begin delete an ETP
for the treatment of end delete begin insert a pilot Enhanced Treatment Program (ETP)
to test the effectiveness of providing treatment for end insert patients who
are at high risk begin delete for end delete begin insert of end insert most dangerous begin delete behavior, as described in
Section 4142 of the Welfare and Institutions Code, if the ETP
meets the licensing requirements applicable to acute psychiatric
hospitals under Chapter 2 (commencing with Section 71001) of
Division 5 of the California Code of Regulations, unless otherwise
specified in this section or emergency regulations adopted pursuant
to paragraph (2). end delete begin insert behavior. end insert

(2) Prior to January 1, 2018, the State Department of State
Hospitals may adopt emergency regulations in accordance with
the Administrative Procedure Act (Chapter 3.5 (commencing with
Section 11340) of Part 1 of Division 3 of Title 2 of the Government
Code) to implement this section. The adoption of an emergency
regulation under this paragraph is deemed to address an emergency,
for purposes of Sections 11346.1 and 11349.6 of the Government
Code, and the State Department of State Hospitals is hereby
exempted for this purpose from the requirements of subdivision
(b) of Section 11346.1 of the Government Code.

begin delete

(c)

end delete

begin insert (b) end insert  An ETP 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 bathroom in the room.

(5) Each patient room door shall have the capacity to be locked
externally. The door may be locked when clinically indicated and
determined to be the least restrictive environment for provision of
the patient’s care and treatment pursuant to Section 4143 of the
Welfare and Institutions Code, but shall not be considered seclusion
for purposes of Division 1.5 (commencing with Section 1180).

(6) Provide emergency egress for ETP patients.

begin insert

(7) All state licensing and regulations shall be followed when
a patient is experiencing behavior criteria consistent with the need
for seclusion and restraints.

end insert begin insert

(8) Have a full-time independent patient advocate who provides
patients’ rights advocacy services assigned to each ETP.

end insert begin delete

(d)

end delete

begin insert (c) end insert  The ETP shall adopt and implement policies and procedures
consistent with regulations adopted by the State Department of
State Hospitals that provide all of following:

(1)  begin delete Policies and procedures end delete begin insert Criteria and process end insert for admission
into the ETP. begin insert A person shall not be placed into the ETP as a means
of punishment, coercion, convenience, or retaliation. end insert

(2) Clinical assessment and review focused on behavior, history,
begin delete dangerousness, end delete begin insert high risk of most dangerous behavior, end insert and clinical
need for patients to receive treatment in the ETP begin insert as the least
restrictive environment end insert .

(3) A process for identifying begin delete which end delete begin insert the end insert ETP along a continuum
of care begin insert that end insert will best meet the patient’s needs begin insert , including least
restrictive environment end insert .

(4) A process for begin insert development of end insert a treatment plan with regular
clinical review and reevaluation of placement back into a standard
treatment environment begin delete that includes end delete begin insert and end insert discharge and
reintegration planning.

begin delete

(e)

end delete

begin insert (d) end insert  Patients who have been admitted to an ETP shall have the
begin insert same end insert rights guaranteed to patients not in an ETP with the exception
set forth in paragraph (5) of subdivision (c).

begin delete

(f)

end delete

begin insert (e) end insert  (1)  begin delete Commencing January 1, 2018, the department shall
monitor the ETPs, evaluate outcomes, and report on its findings
and recommendations to the Legislature, in compliance with
Section 9795 of the Government Code, every two years. end delete begin insert The
department shall monitor the pilot ETPs, evaluate outcomes, and
report on its findings and recommendations. The information shall
be provided to the fiscal and policy committees of the Legislature
annually, beginning on January 10 of the year in which the first
ETP is opened and services have commenced. The evaluation shall
include, but is not limited to, the following: end insert

begin insert

(A) Comparative summary information regarding the
characteristics of the patients served.

end insert begin insert

(B) Compliance with staffing requirements.

end insert begin insert

(C) Staffing ratios and staff mix.

end insert begin insert

(D) Average monthly occupancy.

end insert begin insert

(E) Average length of stay.

end insert begin insert

(F) The number of residents whose length of stay exceeds 90
days.

end insert begin insert

(G) The number of patients with multiple stays.

end insert begin insert

(H) The number of patients whose discharge was delayed due
to lack of availability of less restrictive treatment environment.

end insert begin insert

(I) Restraint and seclusion use, including the number of incidents
and duration, consistent with paragraph (3) of subdivision (d) of
Section 1180.2.

end insert begin insert

(J) Serious injuries to staff and residents.

end insert begin insert

(K) Serious injuries to staff and residents related to use of
restraint or seclusion.

end insert begin insert

(L) Staff turnover.

end insert begin insert

(M) The number of patients’ rights complaints, including the
subject of the complaint and its resolution.

end insert begin insert

(N) Type and number of training provided for ETP staff.

end insert begin insert

(O) Staffing levels for ETPs.

end insert

(2) The requirement for submitting findings and
recommendations to the Legislature begin delete every two years end delete begin insert annually end insert
under paragraph (1) is inoperative on January 1, 2026.

begin delete

(g)

end delete

begin insert (f) end insert  Notwithstanding paragraph (2) of subdivision begin delete (b), end delete begin insert (a), end insert the
State Department of Public Health and the State Department of
State Hospitals shall jointly develop the regulations governing
ETPs.

SEC. 4.  

Section 4100 of the Welfare and Institutions Code is
amended to read:

4100.  

The department has jurisdiction over the following
begin delete institutions: end delete begin insert hospitals: end insert

(a) Atascadero State Hospital.

(b) Coalinga State Hospital.

(c) Metropolitan State Hospital.

(d) Napa State Hospital.

(e) Patton State Hospital.

(f) Any other State Department of State Hospitals facility subject
to available funding by the Legislature.

begin delete

SEC. 5.  

Section 4142 is added to the Welfare and Institutions
Code, to read:

4142.  

Commencing July 1, 2015, and subject to available
funding, the State Department of State Hospitals may establish
and maintain enhanced treatment programs (ETPs), as defined in
subdivision (o) of Section 1250 of the Health and Safety Code,
for the treatment of patients described in Section 4143.

end delete

begin insert

begin insert SEC. 5. end insert   

end insert

begin insert Section 4142.5 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

begin insert

begin insert 4142.5. end insert   

Commencing July 1, 2015, and subject to available
funding, the State Department of State Hospitals may establish
and maintain enhanced treatment pilot programs (ETPs), as
defined in subdivision (o) of Section 1250 of the Health and Safety
Code, and evaluate the effectiveness of intensive, evidence-based
clinical therapy and treatment of patients described in Section
4143.

end insert

SEC. 6.  

Section 4143 is added to the Welfare and Institutions
Code, to read:

4143.  

(a) A state hospital psychiatrist or psychologist may
refer a patient to an enhanced treatment begin insert pilot end insert program (ETP), as
defined in subdivision (o) of Section 1250 of the Health and Safety
Code, for temporary placement and risk assessment upon
determining that the patient may be at high risk begin delete for end delete begin insert of end insert most
dangerous behavior and when treatment is not possible in a
standard 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, with notice to the patient’s
advocate at the time of the referral.

(b) Within three business days of placement in the ETP, a
dedicated forensic evaluator, who is not on the patient’s treatment
team, shall complete an initial evaluation of the patient that shall
include an interview of the patient’s treatment team, an analysis
of diagnosis, past violence, current level of risk, and the need for
enhanced treatment.

(c) (1) Within seven business days of placement in an ETP 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 initial evaluation. A determination
shall be made as to whether the patient clinically requires ETP
treatment.

(2) (A) The threshold standard for treatment in an ETP is met
if a psychiatrist or psychologist, utilizing standard forensic
methodologies for clinically assessing violence risk, determines
that a patient meets the definition of a patient at high risk begin delete for end delete begin insert of end insert
most dangerous behavior and ETP treatment can meet the identified
needs of the patient begin insert and there is no less restrictive treatment
options end insert .

(B) Factors used to determine a patient’s high risk for most
dangerous behavior 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 the ETP, the FNAP may delay its decision for another
seven business days. The FNAP’s determination of whether the
patient will benefit from continued or longer term ETP placement
and treatment shall be based on the threshold standard for treatment
in an ETP specified in subparagraph (A) of paragraph (2).

(d) (1) The FNAP shall review all material presented at the
FNAP placement evaluation meeting conducted under subdivision
(c), and 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 treatment environment in the hospital.

(2) After the FNAP makes a decision to provide ETP treatment
and if the ETP treatment will be provided at a facility other than
the current hospital, the transfer may take place as soon as
transportation may reasonably be arranged, but no later than 30
days after the decision is made.

(3) The FNAP determination shall be in writing and provided
to the patient and patient’s advocate as soon as possible, but no
later than three business days after the decision is made.

(e) (1) Upon admission to the ETP, a forensic needs assessment
team (FNAT) psychologist who is not on the patient’s treatment
team shall perform an in-depth violence risk assessment and make
a treatment plan for the patient based on the assessment 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 begin insert and response to treatment end insert while
in the ETP.

(2) An ETP patient shall receive treatment from a team
consisting of a psychologist, a psychiatrist, a nurse, a psychiatric
technician, a clinical social worker, a rehabilitation therapist, and
any other staff as begin delete necessary, who end delete begin insert necessary. end insert

begin insert (3) end insert begin insert   end insert begin insert The treatment team end insert shall meet as often as necessary, but no
less than once a week, to assess the patient’s response to treatment
in the ETP.

(f) Prior to the expiration of 90 days from the date of placement
in the ETP and with 72-hour notice provided to the patient and 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 violence risk assessment. The FNAP shall determine
whether the patient may return to a standard treatment environment
or the patient clinically requires continued treatment in the ETP.
If the FNAP determines that the patient clinically requires
continued ETP placement, the patient shall be certified for further
ETP placement for one year. The FNAP determination shall be in
writing and provided to the patient and the patient’s advocate
within 24 hours of the meeting. If the FNAP determines that the
patient is ready to be transferred to a standard treatment
environment, the FNAP shall identify appropriate placement within
a standard treatment environment in a state hospital, and transfer
the patient within 30 days of the determination.

(g) If a patient has been certified for ETP treatment for one year
pursuant to subdivision (f), the FNAP shall review the patient’s
treatment summary every 90 days to determine if the patient no
longer clinically requires treatment in the ETP. This FNAP
determination shall be in writing and provided to the patient and
the patient’s advocate within three business days of the meeting.
If the FNAP determines that the patient no longer clinically requires
treatment in the ETP, the FNAP shall identify appropriate
placement, and transfer the patient within 30 days of the
determination.

(h) Prior to the expiration of the one-year certification of ETP
placement under subdivision (f), and with 72-hour notice provided
to the patient and the patient’s advocate, the FNAP shall convene
a treatment placement meeting with the treatment team, the patient
advocate, the patient, and the FNAT psychologist who performed
the in-depth violence risk assessment. The FNAP shall determine
whether the patient clinically requires continued ETP treatment.
If after consideration, including discussion with the patient’s ETP
team members and review of documents and records, the FNAP
determines that the patient clinically 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 and the patient’s advocate within three
business days of the meeting.

(i) At any point during the ETP placement, if a patient’s
treatment team determines that the patient no longer clinically
requires ETP treatment, a recommendation to transfer the patient
out of the ETP shall be made to the FNAT or FNAP.

(j) The process described in this section may continue until the
patient no longer clinically requires ETP treatment 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 program” or “ETP” means a health
facility as defined in subdivision (o) of Section 1250 of the Health
and Safety Code.

(2) “Forensic needs assessment panel” or “FNAP” means a
panel that consists of a psychiatrist, a psychologist, and the medical
director of the hospital or facility, none of whom are involved in
the patient’s treatment or diagnosis at the time of the hearing or
placement meetings.

(3) “Forensic needs assessment team” or “FNAT” means a panel
of psychologists with expertise in forensic assessment or violence
risk assessment, each of whom are assigned an ETP case or group
of cases.

(4) “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.

(5) “Patient advocate” means the advocate contracted under
Sections 5370.2 and 5510.

(6) “Patient at high risk begin delete for end delete begin insert of end insert most dangerous behavior” means
the individual has a history of physical violence and currently
poses a demonstrated danger of inflicting substantial physical harm
upon others in an inpatient setting, as determined by an
begin insert evidence-based, end insert in-depth violence risk assessment conducted by
the State Department of State Hospitals.

SEC. 7.  

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) Any other State Department of State Hospitals facility subject
to available funding by the Legislature.

SEC. 8.  

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.