BILL ANALYSIS Ó
AB 1340
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CONCURRENCE IN SENATE AMENDMENTS
AB 1340 (Achadjian)
As Amended August 20, 2014
Majority vote
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|ASSEMBLY: |77-0 |(May 30, 2013) |SENATE: |36-0 |(August 21, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Permits the Department of State Hospitals (DSH) to
establish and administer a pilot enhanced treatment program
(ETP), commencing July 1, 2015, until January 1, 2018, for the
purpose of testing the effectiveness of providing treatment for
patients who are at high risk of the most dangerous behavior.
Authorizes ETPs to be licensed under the same requirements as
acute psychiatric hospital licensing requirements, and makes
significant changes to current requirements and procedures
related to the admission of patients and the administration of
care.
The Senate amendments :
1)Establish legislative intent regarding the purpose and need
for additional enhanced treatment units (ETU) and states
findings and declarations accordingly.
2)Permit DSH, commencing July 1, 2015, until January 1, 2018, to
establish and maintain a pilot ETP at each state hospital to
test the effectiveness of providing treatment for patients who
are at high risk of the most dangerous behavior.
3)Permit DSH to adopt emergency regulations, in accordance with
the Administrative Procedure Act (APA), for the administration
of ETPs.
4)Establish ETP requirements, including:
a) Maintaining a staff-to-patient ratio of one to five;
b) Limiting each room to one patient;
c) Requiring that each patient room be allowed visual
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access by staff 24 hours per day;
d) Requiring that each patient room have a toilet and sink
in the room;
e) Requiring that each patient room door have the capacity
to be locked externally;
f) Permitting the door to be locked when clinically
indicated and determined to be the least restrictive
treatment environment for the patient's care and treatment;
g) Providing emergency egress for ETP patients;
h) Requiring that, in the event seclusion or restraints are
used in an ETP, all state licensing and regulations be
followed; and
i) Requiring that a full-time independent patients' rights
advocate who provides patients' rights advocacy services be
assigned to each ETP.
5)Delete the requirement for a new license for an ETP and
instead authorizes ETPs to be licensed under existing hospital
licensing requirements for acute psychiatric hospitals.
6)Exempt the development of regulations by the Department of
Public Health (DPH) from the requirements of the APA.
7)Require DSH to monitor the pilot ETPs, evaluate outcomes, as
specified, and report on its findings and recommendations to
the Legislature.
8)Require ETPs to adopt and implement policies and procedures
necessary to encourage patient improvement, recovery, and a
return to a standard treatment environment, and to create
identifiable facility requirements and bench marks, as
specified.
9)Establish procedures for the evaluation, assessment, and
creation of a treatment plan for each admitted patient, as
specified.
AS PASSED BY THE ASSEMBLY , this bill required, beginning on July
1, 2015, and subject to available funding, each of the five
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state mental hospitals to establish and maintain an ETU for the
placement of aggressive patients and required any case of
assault by a patient, as specified, to be immediately referred
to the local district attorney.
FISCAL EFFECT : According to the Senate Appropriations
Committee, one-time costs likely in the low hundreds of
thousands to develop policies and regulations by DSH, one-time
costs likely in the tens of millions for the construction of new
ETP facilities, significant costs to renovate portions of
current state hospital facilities to create units for the new
ETPs, increased staffing costs of about $2.5 million per year to
comply with the higher staff-to-patient ratio required in the
bill, ongoing costs of $800,000 per year for a contracted
patient advocate for ETPs and minor additional costs for
licensing of ETPs by DPH.
COMMENTS : According to the author, this bill is intended to
provide an alternative mechanism for dealing with violent and
aggressive offenders who threaten the safety of hospital staff
and other patients and disrupt the 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.
The five state hospitals in California currently serve
approximately 6,521 patients. The hospitals' population has
changed dramatically over time, and now approximately 92% of
their population is considered "forensic," meaning patients have
been committed to a hospital by the criminal justice system.
According to 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.
Atascadero State Hospital 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.
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Outcomes data from the ETU pilot show 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.
Coalinga State Hospital 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. DSH reports that although
Coalinga State Hospital 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.
In opposition, California Attorneys for Criminal Justice writes
that this bill would increase costs by interrupting treatment
and any progress a patient is making by mandating referral for
prosecution and requiring extensive and expensive special
housing, treatment, and supervision once the patient is returned
to the hospital.
This bill was substantially amended in the Senate, in which the
subject matter was not heard in Assembly policy committee this
legislative session.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097
FN: 0005137
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