BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 1340 (Achadjian) - Enhanced treatment programs.
Amended: July 2, 2014 Policy Vote: Health 8-0, PS 7-0
Urgency: No Mandate: Yes
Hearing Date: August 14, 2014
Consultant: Brendan McCarthy
SUSPENSE FILE. AS AMENDED.
Bill Summary: AB 1340 would authorize the creation of enhanced
treatment programs within the state hospital system, to provide
enhanced treatment to patients with histories of violent
behavior.
Fiscal Impact (as approved on August 14, 2014):
One-time costs likely in the low hundreds of thousands to
develop policies and regulations by the Department of State
Hospitals (General Fund).
One-time costs likely in the tens of millions for the
construction of new enhanced treatment program facilities
(General Fund). The Department intends to renovate existing
units of state hospitals to create units for the new
enhanced treatment programs, rather than to construct new
buildings. Most state hospital facilities are very old and
do not meet current building standards. The costs to
significantly renovate portions of state hospital facilities
are likely to be significant.
Increased staffing costs of about $2.5 million per year to
comply with the higher staff-to-patient ratio required in
the bill (General Fund). Under current law and practice,
state hospitals have a nursing staff-to-patient ratio of
one-to-six on acute units (with a lower ratio during the
night shift). This bill requires a staff-to-patient ratio of
one-to-five at all times. Based on the Department's plan to
create four enhanced treatment programs with either eight or
twelve patients and the need for 24-hour per day coverage,
staff estimates that the Department will need about 16
additional nursing positions at a cost of about $2.5 million
per year.
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Ongoing costs of $800,000 per year for a contracted patient
advocate for each enhanced treatment program (General Fund).
Minor additional costs for licensing of enhanced treatment
programs by the Department of Public Health (Licensing and
Certification Fund).
Background: The Department of State Hospitals manages five state
hospitals: Atascadero, Coalinga, Metropolitan, Napa, and Patton.
Over time, the patient population of the state hospital system
has shifted to almost entirely comprise "forensic" patients who
have a history of violent behavior and/or criminal behavior.
Forensic patients committed to state hospitals include
individuals found incompetent to stand trial, not guilty by
reason of insanity, mentally disordered offenders, and sexually
violent predators.
As the patient population has shifted to a more forensic
population, incidents of violence against state hospital staff
and other patients have increased significantly. According to
the Department, in 2013 there were 2,586 patient-on-staff
assaults and 3,344 patient-on-patient assaults. Because the
state hospital system was not initially designed as a system to
accommodate mostly forensic population, the state hospital
system often lacks the physical infrastructure to handle violent
patients.
Since December 2011, the Department has operated a pilot
enhanced treatment unit at Atascadero State Hospital. That pilot
unit does not allow for locked doors, but is otherwise the model
for the proposal in this bill. A review by the Department
indicates that the pilot program is likely effective at reducing
violence.
In the recently adopted Budget Act, the Department was
appropriated $2 million for planning for the development of
facilities to accommodate enhanced treatment programs
(conditional on the enactment of authorizing legislation).
Proposed Law: AB 1340 would authorize the creation of an
enhanced treatment program within the state hospital system, to
provide enhanced treatment to patients with histories of violent
behavior.
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Specific provision of the bill would:
Require the enhanced treatment pilot program to meet the
licensing requirements for acute psychiatric hospitals,
unless otherwise specified;
Authorize the Department of State Hospitals to create a
pilot enhanced treatment program, from July 1, 2015 to
January 1, 2018;
Authorize the Department to adopt emergency regulations to
implement the bill;
Specify criteria for the enhanced treatment program,
including staff-to-patient ratios and requirements for the
patient rooms;
Authorize patient room doors to be locked by staff when
clinically indicated;
Require the adoption of policies and procedures for
admission criteria, clinical assessment of patients, and
other issues;
Require ongoing evaluation of the program and reporting to
the Legislature;
Specify the process for referral to an enhanced treatment
program and periodic reviews of the appropriateness of the
placement.
Related Legislation:
AB 2399 (Allen, Statutes of 2012) requires state hospitals
to update their injury and illness prevention plans once per
year and to develop a reporting system for assaults on
employees.
SB 60 (Evans, 2011) would have required a security and
violence assessment of each patient upon admission to a
state hospital. That bill was held on the Assembly
Appropriations Committee's Suspense File.
Staff Comments: The only costs to local agencies that may be
incurred under the bill relate to crimes and infractions. Under
the California Constitution, such costs are not reimbursable by
the state.
Author's amendments: The amendments make a number of changes to
the policies and processes required by the bill. Amongst other
changes, the amendments would: delete the requirement for a
separate license for an enhanced treatment program and authorize
them to be provided under an existing hospital license; exempt
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the development of regulations by the Department of Public
Health from the requirements of the Administrative Procedure
Act; delete the requirement that the Department of Public Health
monitor outcomes and require the Department of State Hospitals
to do so; make a number of changes to the requirements and
procedures relating to admission and treatment plans for
patients in an enhanced treatment program.