BILL ANALYSIS Ó
AB 1340
Page 1
Date of Hearing: April 16, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1340 (Achadjian) - As Amended: April 10, 2013
SUBJECT : State Hospital Employees Act.
SUMMARY : Requires, beginning on July 1, 2015, each of the five
state mental hospitals (state hospitals) to establish and
maintain an enhanced treatment unit (ETU) for the placement of
aggressive patients and requires any case of assault by a
patient, as specified, to be immediately referred to the local
district attorney (DA). Specifically, this bill :
1)Directs, starting on July 1, 2015, each state hospital to
establish and maintain an ETU as part of its facilities for
the placement of aggressive patients and requires each
hospital administrator to establish procedures to provide an
increased level of security for the ETU.
2)Requires, beginning on July 1, 2015, any case of assault by a
patient of a state hospital that causes injury to or illness
of, or has the potential to cause future illness of, a state
hospital employee or another patient of the state hospital
that rises to the level of a misdemeanor or felony to be
immediately referred to the local DA.
3)Specifies that if, after referral to the local DA, the patient
is found guilty of a misdemeanor or felony assault, the local
DA declines prosecution, the patient is found to be
incompetent to stand trial (IST), or the patient is found not
guilty by reason of insanity (NGI), the patient must be placed
in the ETU of the state hospital until such time as the
individual is deemed safe to return to the regular population
of the hospital.
EXISTING LAW :
1)Establishes the Department of State Hospitals (DSH) as the
lead agency charged with overseeing and managing the state's
system of five state hospitals: Atascadero; Coalinga;
Metropolitan; Napa; and, Patton.
4)Provides for the involuntary commitment of mentally ill
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persons to a state hospital pursuant to various provisions of
the Welfare & Institutions Code for civil commitments and the
Penal Code, such as the patient is deemed IST or, NGI; or the
patient is a mentally disordered offender.
5)Requires DSH, prior to admission of a patient committed as IST
or NGI to Metropolitan or Napa, to evaluate each patient for
risk.
6)Designates Napa and Metropolitan to only treat low-to-moderate
risk patients and requires high-risk patients to only be
treated at Atascadero or Patton, a correctional facility, or
other secure facility.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to provide an alternative mechanism to dealing with
the type of violent and aggressive offenders who threaten the
safety of hospital staff and other patients and disrupt the
state's efforts to provide the appropriate level of care and
treatment needed by other patients. The author states that
this bill will help to protect state hospital staff and
patients and decrease the level of violence in these
facilities by requiring these offenders to be removed from the
general population to receive enhanced treatment.
2)BACKGROUND . According to background information from the
Assembly Budget Committee, DSH has the singular focus of
providing improved oversight, safety, and accountability of
the state's mental hospitals and prison-based psychiatric
facilities. The state hospitals' population has changed
dramatically over time, and now, unlike many years ago,
approximately 92% of the hospitals' population is considered
"forensic," in that patients have been committed to a hospital
by the criminal justice system.
Atascadero is an all-male, maximum security, forensic facility
that treats persons appointed by the court for criminal
violations. Coalinga treats forensically committed and
sexually violent predators. Metropolitan serves individuals
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placed for treatment pursuant to the civil commitments under
the Welfare & Institutions Code, as well as court Penal Code
commitments. Napa is a low- to moderate-security level state
hospital. Patton cares for judicially committed, mentally
disordered individuals. There are approximately 6,521
patients currently in the state hospital system.
3)INCIDENCES OF VIOLENCE . As the patient population at state
psychiatric hospitals has changed from a civilly committed
population to a 92% forensic population, incidents of violent
and aggressive behavior have increased. The well-publicized
death of Donna Gross, a psychiatric technician at Napa, in
October 2010 focused attention on the increased number of
assaults on state hospital staff and patients. According to
background data obtained from DSH, there were a total of 4,283
incidents involving patient-on-patient aggression and 3,050
aggressive acts against staff system-wide in 2012.
The Division of Occupational Safety and Health, known as
Cal/OSHA, within the Department of Industrial Relations, has
had significant and ongoing involvement with DSH as a result
of insufficient protections for staff. According to a Los
Angeles Times article from March 2, 2012, Cal/OSHA has issued
nearly $100,000 in fines against Patton and Atascadero,
alleging that they have failed to protect staff and have
deficient alarm systems. These citations are similar to
citations levied in 2011 against Napa and Metropolitan.
Cal/OSHA found an average of 20 patient-caused staff injuries
per month at Patton from 2006 through 2011 and eight per month
at Atascadero from 2007 through 2011, including severe head
trauma, fractures, contusions, lacerations, and bites.
According to DSH, they have been working closely with Cal/OSHA
to resolve the issues and take all necessary corrective
measures to protect staff at all of the state hospital
facilities.
4)CURRENT ETU PILOT . DSH indicates that Atascadero is currently
implementing a pilot ETU to address violence due to mental
illness that does not respond to standard treatment. The goal
of the ETU is to decrease psychiatric symptoms of some of the
most violent patients, in order to enable DSH to
simultaneously assist the patients in their recovery, thereby
increasing the safety of the facility. Patients must meet
certain criteria, based on the patient's mental illness and
psychiatric symptoms, before being admitted to the ETU. DSH
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reviews patient referrals to determine if patients meet the
following entrance criteria:
a) the patient engages in pathology-driven behaviors;
b) the patient engages in recurrent aggressive behaviors
that have been unresponsive to mainstream therapeutic
interventions; or,
c) the patient commits a serious assaultive act that
results in serious injury.
Outcomes data from the ETU pilot shows there have been 16
patients discharged since the unit opened in December 2011.
When patient aggression is compared 90 days before ETU
admission to 90 days post-discharge, 10 of 16 patients, or
71%, demonstrated a reduction in acts of physical violence;
one patient was equally as aggressive before and after
treatment in the ETU; and, three patients were neither
aggressive before admission, or at follow-up. DSH reports
there is no follow-up data available for three other patients
who were charged with new offenses and returned to the
Department of Corrections and Rehabilitation.
DSH indicates that it currently does not have plans for
additional ETUs at the other four facilities. However, DSH
notes that Coalinga operates a Specialized Services Unit
(SSU), which treats individuals committed under the Penal Code
who have severe and chronic aggressive behaviors. The
therapeutic goal of the SSU is to encourage compliance with
treatment and medication in order to decrease aggressive and
socially undesirable behaviors. Entrance criteria for
patients placed in the SSU are limited to those individuals
who meet two of the following criteria:
a) Significant acts of pathology-driven aggression;
b) Substantial substance abuse incidents;
c) Previously failed interventions; or,
d) Behavioral issues which pose a risk to safety and
security.
DSH reports that although Coalinga is actively tracking
outcomes since the SSU opened in September 2011, the data is
not readily available. DSH also indicates that a patient's
average stay in the SSU is six to nine months.
5)SUPPORT . The sponsors of this bill, the California
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Association of Psychiatric Technicians, the Service Employees
International Union Local 1000, and the Union of American
Physicians and Dentists, representing state hospital labor
groups, state that the ETUs required by this bill would
provide additional individualized care and treatment to
patients with histories of highly assaultive behavior until
they are deemed safe to return to general state hospital
units. The sponsors note in support that currently the only
way to separate these aggressive patients from the general
population is to seek prosecution for their assaults through
local DAs who are often loath to prosecute individuals who are
already in forensic state facilities. The California
Correctional Supervisors Organization adds in support that
this bill will reduce a large percentage of employee injuries
sustained at state hospitals and make for a safer working
environment.
6)OPPOSITION . California Attorneys for Criminal Justice objects
to this bill and contends that it would increase costs by
interrupting treatment and any progress a patient is making by
mandating referral for prosecution and require extensive and
expensive special housing, treatment, and supervision once the
patient is returned to the hospital.
7)PRIOR LEGISLATION .
a) AB 2399 (Allen), Chapter 751, Statutes of 2012, requires
each of the five state hospitals to update its injury and
illness prevention plan (IIPP) at least once a year,
establish an IIPP committee to provide recommendations for
updates to the plan, and develop an incident reporting
procedure for assaults on employees.
b) SB 60 (Evans) of 2011 would have required the former
Department of Mental Health (now DSH) to conduct a security
and violence risk assessment, as specified, of each patient
upon admission to a state hospital. SB 60 was held in the
Assembly Appropriations Committee.
c) SB 391 (Solis), Chapter 294, Statutes of 1997, provides
for patient risk assessments for inmates committed to Napa
or Metropolitan for certain Penal Code violations and
requires patients subject to assessments who are determined
to be a high security risk to be treated in the most secure
state hospital facilities.
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8)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to
the Assembly Committee on Public Safety.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Psychiatric Technicians (sponsor)
Service Employees International Union Local 1000 (sponsor)
Union of American Physicians and Dentists (sponsor)
California Correctional Supervisors Organization
Opposition
California Attorneys for Criminal Justice
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097