BILL ANALYSIS Ó AB 1340 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 1340 (Achadjian) As Amended August 20, 2014 Majority vote ---------------------------------------------------------------------- |ASSEMBLY: | |(May 30, 2013) |SENATE: |36-0 |(August 21, 2014) | ---------------------------------------------------------------------- (vote not relevant) ------------------------------------------------------------------------ |COMMITTEE VOTE: |16-0 |(August 26, 2014) |RECOMMENDATION: |concur | |(Health) | | | | | ------------------------------------------------------------------------ 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 Page 2 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 Page 3 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 FN: 0005486