BILL ANALYSIS Ó
AB 1340
Page 1
Date of Hearing: May 8, 2013
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1340 (Achadjian) - As Amended: April 10, 2013
Policy Committee: Health
Vote: 17-0
Public Safety
6-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires every state hospital to establish and
maintain an enhanced treatment unit (ETU), with increased
security, by July 1, 2015. Specifically, this bill:
1)Requires the hospital to immediately refer to the local
district attorney (DA) any patient who assaults a hospital
employee or another patient, causing injury, illness, or the
potential to cause future illness, rising to the level of a
misdemeanor or felony.
2)Requires the patient to be placed in the ETU until deemed safe
to return to the hospital's regular population if: a) the
patient is found guilty; b) the DA declines prosecution; c)
the patient is incompetent to stand trial; or d) the patient
is found not guilty by reason of insanity.
FISCAL EFFECT
Costs of more than $10 million for the Department of State
Hospitals (DSH) to activate new ETUs based on the model
currently in place at Atascadero State Hospital.
COMMENTS
1)Rationale . 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
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appropriate level of care and treatment needed by other
patients. This bill seeks to help 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.
According to Service Employees International Union (SEIU)
Local 1000, this bill's sponsor, the patient population has
changed since the first state hospital was founded 137 years
ago. Hospital workers are at high risk for workplace
violence. Facilities such as Napa State Hospital were built
in park-like settings to care for mentally ill patients who
were wards of the state; more than 90% of the patients today
have been forensically committed and the staff are working
with the state's most dangerous offenders.
2)Background . According to a 2012 report by the Legislative
Analyst's Office (LAO), "The state's five state
hospitals-Atascadero, Coalinga, Metropolitan, Napa, and
Patton-provide treatment to a combined patient population of
over 5,000. State hospitals treat patients under several
forensic commitment classifications, including Not Guilty by
Reason of Insanity, Incompetent to Stand Trial (IST), SVPs,
and Mentally Disordered Offenders. State hospitals also treat
mentally ill persons referred by the counties under civil
commitments."
3)Pilot Program . In December 2011, the Department of Mental
Health, whose responsibilities have been transferred to DSH,
established an ETU pilot program in Atascadero State Hospital
(ASH). The intent of the pilot program was to treat the
hospital's most aggressive patients. The pilot was
anticipated to include 12 ASH patients, who would receive
focused, longer treatment with more staff attention in an
attempt to lessen aggressive tendencies. There does not yet
appear to be an evaluation report on the ASH pilot.
4)The Use of Seclusion in State Hospitals . A patient in a state
hospital has the right to be free from the use of seclusion
and behavioral restraints of any form imposed as a means of
coercion, discipline, convenience, or retaliation by staff.
According to the DSH Web site, seclusion is defined as the
involuntary confinement of a patient alone in a room or an
area from which the patient is physically prevented from
leaving. Seclusion does not include a time-out wherein a
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patient agrees to remain in an unlocked room or area and
maintains the choice to leave without fear of adverse
consequences or of being placed in seclusion or restraints.
State and federal regulations governing the use of seclusion
in state hospitals provide that seclusion may be used when
other less restrictive interventions have been ineffective.
It is unclear whether a patient's placement in an ETU is
equivalent to seclusion and, if so, whether it is appropriate
to place patients in the ETU without a showing that other less
restrictive interventions have been ineffective and without
following other hospital policies that protect patients from
improper use of seclusion.
5)Concerns and Opposition . Napa County testified in support of
this bill but noted concerns, and make seek amendment to
address the destabilizing effect of jail transfers on the
intensive clinical care of a patient at a state hospital.
Disability Rights California (DRC), writing in opposition,
asserts placement in jail or an ETU will result in little if
any treatment when behaviors are due to a person's disability.
6)Previous legislation . SB 1470 (Leno), Chapter 24, Statutes of
2012, established DSH and changed statutory references to
Department of Mental Health (DMH), which was eliminated under
the Budget Act of 2012, to DSH.
SB 60 (Evans) of 2011 was similar to this measure but as
passed by the Senate was amended to require the DMH to
evaluate any patient in a state hospital committed pursuant to
the Penal Code to determine the security and violence risk of
the patient. SB 60 passed out of the Assembly Health
Committee and was referred to this committee but never heard.
7)SB 130 (Chesbro), Chapter 750, Statutes of 2003, made a number
of changes to state law regarding the use of seclusion and
restraints in a variety of residential facilities, including
psychiatric hospitals, developmental centers, skilled nursing
facilities and foster care group homes.
Analysis Prepared by : Debra Roth / APPR. / (916) 319-2081
AB 1340
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