Amended in Senate August 20, 2014

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

begin delete

(Coauthor: Assembly Member Yamada)

end delete begin insert

(Coauthors: Assembly Members Perea and Yamada)

end insert

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

February 22, 2013

An act begin delete to amend Section 1250 of, and end delete to add begin insert and repeal end insert Section 1265.9 begin delete to, end delete begin insert of, end insert the Health and Safety Code, and to amend Sections 4100 and 7200 of, and to add Sections begin delete 4142.5 and 4143 end delete begin insert 4143, 4144, and 4145 end insert 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 begin insert pilot end insert enhanced treatment begin delete pilot end delete programs (ETPs), as defined, for the treatment of patients who are at high risk of most dangerous behavior, as defined, and when begin insert safe end insert treatment is not possible in a standard treatment environment. The bill would begin delete require, until January 1, 2018, that an ETP meet the licensing requirements of an acute psychiatric hospital, except as specified. end delete begin insert authorize the State Department of Public Health to approve, on or after July 1, 2015, an ETP, which meets specified requirements and regulations, as a supplemental service for an acute psychiatric hospital that submits a completed application and is operated by the State Department of State Hospitals. end insert

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 begin insert at least end insert 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. begin insert The bill would also require, if the FNAP determines that the patient requires continued ETP placement, that the patient’s case be referred to a forensic psychiatrist or psychologist outside of the State Department of State Hospitals for independent review, that a hearing be conducted, and notice given, as specified. end insert

begin insert

The bill would require the State Department of State Hospitals to monitor the ETPs, evaluate outcomes, and report its findings and recommendations to the Legislature.

end insert

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
begin insert pilot end insert enhanced treatment begin delete pilot end delete programs begin insert (ETP) end insert for those patients
determined to be at high risk of most dangerous behavior against
other patients or hospital staff. The goal of these begin delete enhanced
treatment pilot programs end delete begin insert pilot ETPs end insert is to evaluate the effectiveness
of concentrated, evidence-based clinical therapy and treatment in
an environment designed to improve these patients’ conditions
and return them to the general patient population.

(c) The Legislature finds and declares that the purpose of the
establishment of begin delete a pilot program creating Enhanced Treatment
Units end delete begin insert the pilot ETPs end insert 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.

(d) It is the intent of the Legislature that the criteria established
for placement in an begin delete Enhanced Treatment Unit end delete begin insert ETP end insert within the State
Department of State Hospitals cannot be used to circumvent the
statutory and regulatory criteria for use of seclusion and begin delete restrains, end delete
begin insert restraints, as defined by Section 1180.1 of the Health and Safety
Code, end insert but is instead another level of continuum of care for the
patient receiving treatment in an begin delete Enhanced Treatment Unit. end delete begin insert ETP. end insert

begin delete

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 of 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 pilot 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 pilot 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.

end delete

begin delete SEC. 3. end delete
begin insert SEC. 2. end insert   

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

begin delete

1265.9.  

(a) (1) Commencing July 1, 2015, and until January
1, 2018, the State Department of State Hospitals may establish and
maintain a pilot Enhanced Treatment Program (ETP) to test the
effectiveness of providing treatment for patients who are at high
risk of most dangerous behavior.

(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.

end delete

begin insert

begin insert 1265.9. end insert   

end insert begin insert

(a) On and after July 1, 2015, any acute psychiatric
hospital that submits a completed application and is operated by
the State Department of State Hospitals may be approved by the
State Department of Public Health to offer, as a supplemental
service, an Enhanced Treatment Program (ETP) that meets the
requirements of this section, Section 4144 of the Welfare and
Institutions Code, and applicable regulations.

end insert begin insert

(b) This section shall remain in effect for each pilot ETP until
January 1 of the fifth calendar year after each pilot ETP site has
admitted its first patient, and is repealed as of January 1 of the
fifth calendar year after each pilot ETP site has admitted its first
patient, unless a later enacted statute extending the program is
enacted prior to those dates. The State Department of State
Hospitals shall post a declaration on its Internet Web site when
the condition for repealing this section is met stating that this
section is repealed.

end insert begin insert

(c) (1) Prior to the admission of the first patient into the last
pilot ETP, the State Department of Public Health 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 Public Health is hereby
exempted for this purpose from the requirements of subdivision
(b) of Section 11346.1 of the Government Code.

end insert begin insert

(2) As an alternative to paragraph (1) and notwithstanding the
rulemaking provisions of Administrative Procedures Act (Chapter
3.5 (commencing with Section 11340) of Part 1 of Division 3 of
Title 2 of the Government Code), the director of the State
Department of Public Health may implement this section, in whole
or in part, by means of an all facility letter or other similar
instruction.

end insert begin delete

(b)

end delete

begin insert (d) 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 begin delete bathroom end delete begin insert toilet and sink end insert 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 begin insert treatment end insert environment for
begin delete provision of end delete the patient’s care and treatment pursuant to Section
begin delete 4143 end delete begin insert 4144 end insert of the Welfare and Institutions Code, but shall not be
considered seclusion begin insert , as defined by subdivision (e) of Section
1180.1, end insert for purposes of Division 1.5 (commencing with Section
1180).

(6) Provide emergency egress for ETP patients.

(7)  begin delete All end delete begin insert In the event seclusion or restraints, as defined by Section
1180.1, are used in an ETP, all end insert state licensing and regulations
shall be begin delete followed when a patient is experiencing behavior criteria
consistent with the need for seclusion and restraints. end delete begin insert followed. end insert

(8)  begin delete Have a end delete begin insert A end insert full-time independent begin delete patient end delete begin insert patients’ rights end insert
advocate who provides patients’ rights advocacy services begin insert shall be end insert
assigned to each ETP.

begin delete

(c)

end delete

begin insert (e) end insert  The begin delete ETP end delete begin insert ETPs end insert shall adopt and implement policies and
procedures begin delete consistent with regulations adopted by the State
Department of State Hospitals that provide all of following: end delete
begin insert necessary to encourage patient improvement, recovery, and a
return to a standard treatment environment, and to create
identifiable facility requirements and bench marks. The policies
and procedures shall also provide all of the following: end insert

(1) Criteria and process for admission into begin delete the ETP. A person
shall not be placed into the ETP as a means of punishment,
coercion, convenience, or retaliation. end delete begin insert an ETP pursuant to Section
4144 of the Welfare and Institutions Code. end insert

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

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

(4) A process for begin delete development of end delete begin insert creating and implementing end insert a
treatment plan with regular clinical review and reevaluation of
placement back into a standard treatment environment and
discharge and reintegration planning begin insert as specified in subdivision
(e) of Section 4144 of the Welfare and Institutions Code end insert .

begin delete

(d)

end delete

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

begin delete

(e) (1) 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:

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

(B) Compliance with staffing requirements.

(C) Staffing ratios and staff mix.

(D) Average monthly occupancy.

(E) Average length of stay.

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

(G) The number of patients with multiple stays.

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

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

(J) Serious injuries to staff and residents.

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

(L) Staff turnover.

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

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

(O) Staffing levels for ETPs.

(2) The requirement for submitting findings and
recommendations to the Legislature annually under paragraph (1)
is inoperative on January 1, 2026.

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

end delete begin insert

(g) For purposes of paragraph (1) of subdivision (d), “staff”
means licensed nurses and psychiatric technicians providing direct
patient care.

end insert

begin delete SEC. 4. end delete
begin insert SEC. 3. end insert   

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

4100.  

The department has jurisdiction over the following
hospitals:

(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. end delete
begin insert SEC. 4. end insert   

Section begin delete 4142.5 end delete begin insert 4143 end insert is added to the Welfare and
Institutions Code, to read:

begin delete 4142.5. end delete
begin insert 4143. end insert   

Commencing July 1, 2015, and subject to available
funding, the State Department of State Hospitals may establish
and maintain begin insert pilot end insert enhanced treatment begin delete pilot end delete programs (ETPs), as
defined in begin delete subdivision (o) of end delete Section begin delete 1250 end delete begin insert 1265.9 end insert of the Health
and Safety Code, and evaluate the effectiveness of intensive,
evidence-based clinical therapy and treatment of patients described
in Section begin delete 4143. end delete begin insert 4144. end insert

begin delete SEC. 6. end delete
begin insert SEC. 5. end insert   

Section begin delete 4143 end delete begin insert 4144 end insert is added to the Welfare and
Institutions Code, to read:

begin delete 4143. end delete
begin insert 4144. end insert   

(a) A state hospital psychiatrist or psychologist may
refer a patient to begin delete an end delete begin insert a pilot end insert enhanced treatment begin delete pilot end delete program
(ETP), as defined in begin delete subdivision (o) of end delete Section begin delete 1250 end delete begin insert 1265.9 end insert of the
Health and Safety Code, for temporary placement and risk
assessment upon determining that the patient may be at high risk
of most dangerous behavior and when begin insert safe end insert treatment is not possible
in a standard treatment environment. The referral may occur begin delete 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. end delete begin insert after admission
to the State Department of State Hospitals, and after sufficient and
documented evaluation of violence risk of the patient, with notice
to the patients’ rights advocate at the time of the referral. A patient
shall not be placed into an ETP as a means of punishment,
coercion, convenience, or retaliation. end insert

(b) Within three business days of placement in begin delete the end delete begin insert an end insert 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 begin delete patient’s end delete begin insert patients’ rights end insert
advocate, the forensic needs assessment panel (FNAP) shall
conduct a placement evaluation meeting with the referring
psychiatrist or psychologist, the patient and begin delete patient’s end delete begin insert patients’
rights end insert 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 of most
dangerous behavior and ETP treatment begin delete can meet end delete begin insert meets end insert the
identified needs of the patient and begin delete there is no less restrictive end delete begin insert safe end insert
treatment begin delete options. end delete begin insert is not possible in a standard treatment
environment. end insert

(B) Factors used to determine a patient’s high risk begin delete for end delete begin insert of end insert 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 begin delete the end delete begin insert an end insert ETP, the FNAP may delay its begin insert certification end insert
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 begin delete the end delete 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 begin delete patient’s end delete begin insert patients’ rights end insert advocate as soon as
possible, but no later than three business days after the decision is
made.

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

begin insert

(A) Be in writing and developed in collaboration with the
patient, when possible. The initial treatment plan shall be
developed as soon as possible, but no later than 72 hours following
the patient’s admission. The comprehensive treatment plan shall
be developed following a complete violence risk assessment.

end insert begin insert

(B) Be based on a comprehensive assessment of the patient’s
physical, mental, emotional, and social needs, and focused on
mitigation of violence risk factors.

end insert begin insert

(C) Be reviewed and updated no less than every 10 days.

end insert begin insert

(2) The individual treatment plan shall include, but is not limited
to, all of the following:

end insert begin insert

(A) A statement of the patient’s physical and mental condition,
including all mental health and medical diagnoses.

end insert begin insert

(B) Prescribed medication, dosage, and frequency of
administration.

end insert begin insert

(C) Specific goals of treatment with intervention and actions
that identify steps toward reduction of violence risk and observable,
measurable objectives.

end insert begin insert

(D) Identification of methods to be utilized, the frequency for
conducting each treatment method, and the person, or persons, or
discipline, or disciplines, responsible for each treatment method.

end insert begin insert

(E) Documentation of the success or failure in achieving stated
objectives.

end insert begin insert

(F) Evaluation of the factors contributing to the patient’s
progress or lack of progress toward reduction of violence risk and
a statement of the multidisciplinary treatment decision for followup
action.

end insert begin insert

(G) An activity plan.

end insert begin insert

(H) A plan for other services needed by the patient, such as care
for medical and physical ailments, which are not provided by the
multidisciplinary treatment team.

end insert begin insert

(I) Discharge criteria and goals for an aftercare plan in a
standard treatment environment and a plan for post-ETP discharge
follow up.

end insert begin delete

(2)

end delete

begin insert (3) end insert  An ETP patient shall receive treatment from a
begin insert multidisciplinary end insert team consisting of a psychologist, a psychiatrist,
a nurse, a psychiatric technician, a clinical social worker, a
rehabilitation therapist, and any other begin delete staff as necessary. end delete begin insert necessary
staff who shall meet as often as necessary, but no less than once
a week, to assess the patient’s response to treatment. end insert

begin delete

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

end delete begin insert

(4) The staff shall observe and note any changes in the patient’s
condition and the treatment plan shall be modified in response to
the observed changes.

end insert begin insert

(5) Social work services shall be organized, directed, and
supervised by a licensed clinical social worker.

end insert begin insert

(6) (A) Mental health treatment programs shall provide and
conduct organized therapeutic social, recreational, and vocational
activities in accordance with the interests, abilities, and needs of
the patients, including the opportunity for exercise.

end insert begin insert

(B) Mental health rehabilitation therapy services shall be
designed by and provided under the direction of a licensed mental
health professional, a recreational therapist, or an occupational
therapist.

end insert begin insert

(7) An aftercare plan for a standard treatment environment
shall be developed.

end insert begin insert

(A) A written aftercare plan shall describe those services that
should be provided to a patient following discharge, transfer, or
release from an ETP for the purpose of enabling the patient to
maintain stabilization or achieve an optimum level of functioning.

end insert begin insert

(B) Prior to or at the time of discharge, transfer, or release
from an ETP, each patient shall be evaluated concerning the
patient‘s need for aftercare services. This evaluation shall consider
the patient’s potential housing, probable need for continued
treatment and social services, and need for continued medical and
mental health care.

end insert begin insert

(C) Aftercare plans shall include, but shall not be limited to,
arrangements for medication administration and follow-up care.

end insert begin insert

(D) A member of the multidisciplinary treatment team designated
by the clinical director shall be responsible for ensuring that the
aftercare plan has been completed and documented in the patient‘s
health record.

end insert begin insert

(E) The patient shall receive a copy of the aftercare plan when
referred to a standard treatment environment.

end insert

(f) Prior to the expiration of 90 days from the date of placement
in begin delete the end delete begin insert an end insert ETP and with 72-hour notice provided to the patient and
the begin delete patient’s end delete begin insert patients’ rights end insert advocate, the FNAP shall convene a
treatment placement meeting with a psychologist from the
treatment team, a begin delete patient end delete begin insert patients’ rights end insert 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 begin insert whether end insert the patient
clinically requires continued treatment in begin delete the end delete begin insert an end insert 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 begin delete patient’s end delete begin insert patients’ rights end insert 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 begin insert at least end insert 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 begin delete patient’s end delete begin insert patients’ rights end insert 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 begin delete patient’s end delete begin insert patients’ rights end insert advocate, the FNAP
shall convene a treatment placement meeting with the treatment
team, the begin delete patient end delete begin insert patients’ rights end insert 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. begin delete 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. end delete The
FNAP determination shall be in writing and provided to the patient
and the begin delete patient’s end delete begin insert patients’ rights end insert advocate within begin delete three business
days end delete begin insert 24 hours end insert of the meeting.

begin insert

(i) If after the treatment placement meeting described in
subdivision (h), and after discussion with the patient, the patients’
rights advocate, patient’s ETP team members, and review of
documents and records, the FNAP determines that the patient
clinically requires continued ETP placement, the patient’s case
shall be referred outside of the State Department of State Hospitals
to a forensic psychiatrist or psychologist for an independent
medical review for the purpose of assessing the patient’s overall
treatment plan and the need for ongoing ETP treatment. Notice
of the referral shall be provided to the patient and the patients’
rights advocate within 24 hours of the FNAP meeting as part of
the FNAP determination. The notice shall include instructions for
the patient to submit information to the forensic psychiatrist or
psychologist conducting the independent medical review.

end insert begin insert

(1) The forensic psychiatrist or psychologist conducting the
independent medical review shall be provided with the patient’s
medical and psychiatric documents and records, along with any
additional information submitted by the patient, within five business
days from the date of the FNAP’s determination that the patient
requires continued ETP placement.

end insert begin insert

(2) After reviewing the patient’s medical and psychiatric
documents and records, along with any additional information
submitted by the patient, but no later than 14 days after the receipt
of the patient’s medical and psychiatric documents and records,
the forensic psychiatrist or psychologist conducting the
independent medical review shall provide the State Department
of State Hospitals, the patient, and the patients’ rights advocate
with a written notice of the date and time for a hearing. At least
one FNAP member is required to attend the hearing. The notice
shall be provided at least 72 hours in advance of the hearing, shall
include a statement that at least one FNAP member is required to
attend the hearing, and advise the patient of his or her right to a
hearing or to waive his or her right to a hearing. The notice shall
also include a statement that the patient may have assistance of a
patients’ rights advocate or staff member at the hearing.
Seventy-two-hour notice shall also be provided to any individuals
whose presence is requested by the forensic psychiatrist or
psychologist conducting the independent medical review in order
to help assess the patient’s overall treatment plan and the need
for ongoing ETP treatment.

end insert begin insert

(3) If the patient waives his or her right to a hearing, the forensic
psychiatrist or psychologist conducting the independent medical
review shall make recommendations to the FNAP on whether or
not the patient should be certified for ongoing ETP treatment.

end insert begin insert

(4) If the patient does not waive the right to a hearing, both of
the following shall be provided:

end insert begin insert

(A) If the patient elects to have the assistance of a patients’
rights advocate or a staff person, including the patients’ rights
advocate, the requested person shall provide assistance relating
to the hearing, whether or not the patient is present at the hearing,
unless the forensic psychiatrist or psychologist conducting the
hearing finds good cause why the requested person should not
participate. Good cause includes a reasonable concern for the
safety of a staff member requested to be present at the hearing.

end insert begin insert

(B) An opportunity for the patient to present information,
statements, or arguments, either orally or in writing, to show either
that the information relied on for the FNAP’s determination for
ongoing treatment is erroneous, or any other relevant information.

end insert begin insert

(5) The conclusion reached by the forensic psychiatrist or
psychologist who conducts the independent medical review shall
be in writing and provided to the State Department of State
Hospitals, the patient, and the patients’ rights advocate within
three business days of the conclusion of the hearing.

end insert begin insert

(6) If the forensic psychiatrist or psychologist who conducts the
independent medical review concludes that the patient requires
ongoing ETP treatment, the patient shall be certified for further
treatment for an additional year.

end insert begin insert

(7) If the forensic psychiatrist or psychologist who conducts the
independent medical review determines that the patient no longer
requires ongoing ETP treatment, the FNAP shall identify
appropriate placement and transfer the patient within 30 days of
determination.

end insert begin delete

(i)

end delete

begin insert (j) end insert  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.

begin delete

(j)

end delete

begin insert (k) end insert  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 begin delete state hospital. end delete begin insert State Department of
State Hospitals. end insert

begin delete

(k)

end delete

begin insert ( end insert begin insert l end insert begin insert ) end insert  As used in this section, the following terms have the
following meanings:

(1) “Enhanced treatment program” or “ETP” means a begin delete health
facility as defined in subdivision (o) of Section 1250 end delete begin insert supplemental
treatment unit as defined in Section 1265.9 end insert 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)  begin delete “Patient end delete begin insert “Patients’ rights end insert advocate” means the advocate
contracted under Sections 5370.2 and 5510.

(6) “Patient at high risk of 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 evidence-based,
in-depth violence risk assessment conducted by the State
Department of State Hospitals.

begin insert

(m) The State Department of State Hospitals may adopt
emergency regulations in accordance with the Administrative
Procedures Act (Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code) to
implement the treatment components of 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.

end insert

begin insert

begin insert SEC. 6. end insert   

end insert

begin insert Section 4145 is added to the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

begin insert

begin insert 4145. end insert   

(a) The State Department of State Hospitals shall
monitor the pilot enhanced treatment programs (ETP), evaluate
outcomes, and report on its findings and recommendations. This
report shall be provided to the fiscal and policy committees of the
Legislature annually, beginning on January 10 of the first year
after which the first ETP is opened and services have commenced,
and shall be in compliance with Section 9795 of the Government
Code. The evaluation shall include, but is not limited to, all of the
following:

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

(2) Compliance with staffing requirements.

(3) Staff classification to patient ratio.

(4) Average monthly occupancy.

(5) Average length of stay.

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

(7) The number of patients with multiple stays.

(8) The number of patients whose discharge was delayed due
to lack of available beds in a standard treatment environment.

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

(10) Serious injuries to staff and residents.

(11) Serious injuries to staff and residents related to the use of
seclusion and restraints as defined under Section 1180 of the
Health and Safety Code.

(12) Staff turnover.

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

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

(15) Staffing levels for ETPs.

(b) The State Department of State Hospitals’ reporting
requirements under Section 4023 of the Welfare and Institutions
Code, shall apply to the ETPs.

end insert

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.