BILL ANALYSIS Ó AB 1340 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 1340 (Achadjian) As Amended August 20, 2014 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |77-0 |(May 30, 2013) |SENATE: |36-0 |(August 21, | | | | | | |2014) | ----------------------------------------------------------------- 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 AB 1340 Page 2 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 AB 1340 Page 3 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. AB 1340 Page 4 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 AB 1340 Page 5