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: |     |(May 30, 2013)  |SENATE: |36-0 |(August 21, 2014)    |
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                  (vote not relevant)


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        |COMMITTEE VOTE:  |16-0 |(August 26, 2014)   |RECOMMENDATION: |concur    |
        |(Health)         |     |                    |                |          |
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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)  
        at each state hospital, for the duration of five calendar years,  
        for testing the effectiveness of 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.  

         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 the Department of Public Health.

         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  








                                                                AB 1340
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        violence in these facilities by requiring these offenders to be  
        removed from the general population to receive enhanced treatment.

        DSH oversees a total of five state hospitals for the care,  
        treatment, and education of severely mentally ill individuals.   
        Those hospitals are the Metropolitan State Hospital, Atascadero  
        State Hospital, Napa State Hospital, Patton State Hospital, and  
        Coalinga State Hospital.  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  
        enhanced treatment unit (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.  Unlike the pilot ETPs authorized by this  
        bill, the Atascadero State Hospital Pilot does not permit ETU's to  
        have locked doors. 

        SB 852 (Leno), Chapter 25, Statutes of 2014, appropriated $2.1  
        million in funds available for encumbrance and expenditure until  
        June 30, 2016, and are authorized for the development of  
        preliminary plans and working drawings to implement enhanced  
        treatment units at state hospitals.  DSH cannot proceed with the  
        construction phase of this project until legislation is enacted  
        authorizing the use of ETUs.

        According to the sponsor of the bill, California Association of  
        Psychiatric Technicians, this urgently needed 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 Service Employees International Union, Local 1000, writes in  
        support that this bill provides an added protection for patients  
        and staff in an environment where 1% of the population commits 40%  








                                                                AB 1340
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        of the violent acts.  They further state that their members are on  
        the ground and risk their lives every day to do this work that is  
        so vital to the state and the patients they serve.

        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.

         
        Analysis Prepared by  :    Paula Villescaz / HEALTH / (916) 319-2097


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