BILL ANALYSIS Ó
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Loni Hancock, Chair S
2013-2014 Regular Session B
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8
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SB 580 (Leno)
As Amended April 17, 2013
Hearing date: April 23, 2013
Government Code
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TRAUMA RECOVERY CENTERS
HISTORY
Source: Californians for Safety and Justice
Prior Legislation: SB 733 (Leno) - Vetoed
AB 50 (Leno) - Ch. 884, Stats. 2006
AB 1768 (Committee on Public Safety) - Vetoed
Support: California Hospital Conference; California Catholic
Conference; Youth Law Center; Los Angeles Regional
Reentry Partnership; California Protective Parents
Association; California Crime Victims for Alternatives
to the Death Penalty; Youth Law Center; California
Hospital Association; American College of Emergency
Physicians - California Chapter; City and County of San
Francisco; Taxpayers for Improving Public Safety;
County of San Bernardino; City of San Leandro Police
Department
Opposition:California District Attorneys Association; Crime
Victims Action Alliance
KEY ISSUE
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SHOULD THE CALIFORNIA VICTIMS COMPENSATION PROGRAM BE AUTHORIZED
TO GIVE GRANTS TO TRAUMA RECOVERY CENTERS THAT PROVIDE
COMPREHENSIVE, COORDINATED SERVICES FOR PERSONS RECOVERING FROM
TRAUMA CAUSED BY VIOLENT CRIME?
PURPOSE
The purposes of this bill are to 1) authorize the California
Victims Compensation and Government Claims Board, upon
appropriation by the Legislature, to evaluate applications and
award grants totaling up to $2 million to multi-disciplinary
trauma recovery centers (TRC); 2) provide that a TRC receiving a
grant shall meet specified criteria and provide services that
include mental health, clinical case management, community-based
outreach and coordination of care by psychiatrists,
psychologists and social workers; 3) allow grants for a maximum
of three years and require unused grant money to revert to the
Restitution Fund; 4) allow a grant only if the fund's reserves
are at least 25% of expenditures; 5) set a preference for
centers that treat underserved victims, as specified; 6) require
a TRC to comply with laws concerning federal matching funds; and
7) state legislative declarations and findings regarding the
importance of providing comprehensive and coordinated treatment
and services to victims of crime, as specified.
Existing law creates the Victims of Crime Program, administered
by the California Victim Compensation and Government Claims
Board (board), to reimburse victims of crime for the pecuniary
losses they suffer as a direct result of criminal acts.
Indemnification is made from the Restitution Fund, which is
continuously appropriated to the board for these purposes.
(Gov. Code §§ 13950-13968.)
Existing law authorizes reimbursement to a victim for "[t]he
medical or medical related expenses incurred by the victim?."
(Gov. Code § 13957, subd. (a)(1).)
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Existing law provides that the total award to or on behalf of
each victim or derivative victim may not exceed $35,000, except
that this amount may be increased to $70,000 if federal funds
for that increase are available. (Gov. Code § 13957, subd.
(b).)
Existing law provides that board shall enter into an interagency
agreement with the University of California, San Francisco to
establish a recovery center for victims of crime at the San
Francisco General Hospital for comprehensive and integrated
services to victims of crime, subject to conditions set by the
board. The University Regents must approve the agreement and
the section shall only be implemented to the extent that funding
is appropriated for that purpose. (Gov. Code § 13974.5.)
This bill would authorize board to administer a program to
evaluate applications and award grants to trauma recovery
centers ("TRCs") that total no more than $2 million. A
qualifying TRC would be required to meet the following criteria:
The TRC shall demonstrate that it serves the community
by, among other endeavors, making presentations and
providing training on the identification and effects of
violent crime to the following:
o law enforcement;
o community based agencies; and
o health care providers.
The TRC shall meet any related criteria required by the
board.
TRC services and resources shall include, but not be limited to,
the following:
§ a multidisciplinary staff of clinicians;
§ mental health services;
§ case management;
§ assertive community outreach;
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§ coordination of care among medical and mental health
care providers, law enforcement and social services;
§ services to families and loved ones of homicide victims;
and
§ services to juveniles who have come into contact with
the juvenile dependency court or came within the terms of
Welfare and Institutions Code Section 601.
This bill provides that each center that receives a grant shall
do the following:
Report to the board annually about how funds were spent,
the number of clients served, units of service, staff
productivity, outcomes, and patient flow through evaluation
and treatment.
Comply with federal statutes and rules for federal
reimbursement for services provided by the center.
This bill would codify legislative declarations and findings
concerning the importance of treatment and services for victims
of crime, as specified.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
For the last several years, severe overcrowding in California's
prisons has been the focus of evolving and expensive litigation
relating to conditions of confinement. On May 23, 2011, the
United States Supreme Court ordered California to reduce its
prison population to 137.5 percent of design capacity within two
years from the date of its ruling, subject to the right of the
state to seek modifications in appropriate circumstances.
Beginning in early 2007, Senate leadership initiated a policy to
hold legislative proposals which could further aggravate the
prison overcrowding crisis through new or expanded felony
prosecutions. Under the resulting policy known as "ROCA" (which
stands for "Receivership/ Overcrowding Crisis Aggravation"), the
Committee held measures which created a new felony, expanded the
scope or penalty of an existing felony, or otherwise increased
the application of a felony in a manner which could exacerbate
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the prison overcrowding crisis. Under these principles, ROCA
was applied as a content-neutral, provisional measure necessary
to ensure that the Legislature did not erode progress towards
reducing prison overcrowding by passing legislation which would
increase the prison population. ROCA necessitated many hard and
difficult decisions for the Committee.
In January of 2013, just over a year after the enactment of the
historic Public Safety Realignment Act of 2011, the State of
California filed court documents seeking to vacate or modify the
federal court order issued by the Three-Judge Court three years
earlier to reduce the state's prison population to 137.5 percent
of design capacity. The State submitted in part that the, ". .
. population in the State's 33 prisons has been reduced by over
24,000 inmates since October 2011 when public safety realignment
went into effect, by more than 36,000 inmates compared to the
2008 population . . . , and by nearly 42,000 inmates since 2006
. . . ." Plaintiffs, who opposed the state's motion, argue in
part that, "California prisons, which currently average 150% of
capacity, and reach as high as 185% of capacity at one prison,
continue to deliver health care that is constitutionally
deficient." In an order dated January 29, 2013, the federal
court granted the state a six-month extension to achieve the
137.5 % prisoner population cap by December 31st of this year.
In an order dated April 11, 2013, the Three-Judge Court denied
the state's motions, and ordered the state of California to
"immediately take all steps necessary to comply with this
Court's . . . Order . . . requiring defendants to reduce overall
prison population to 137.5% design capacity by December 31,
2013."
The ongoing litigation indicates that prison capacity and
related issues concerning conditions of confinement remain
unresolved. However, in light of the real gains in reducing the
prison population that have been made, although even greater
reductions are required by the court, the Committee will review
each ROCA bill with more flexible consideration. The following
questions will inform this consideration:
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whether a measure erodes realignment;
whether a measure addresses a crime which is directly
dangerous to the physical safety of others for which there
is no other reasonably appropriate sanction;
whether a bill corrects a constitutional infirmity or
legislative drafting error;
whether a measure proposes penalties which are
proportionate, and cannot be achieved through any other
reasonably appropriate remedy; and
whether a bill addresses a major area of public safety
or criminal activity for which there is no other
reasonable, appropriate remedy.
COMMENTS
1. Need for This Bill
According to the author:
As with any serious health issue -- cancer, stroke,
bodily injury -- early treatment is critical for a
good outcome. Unfortunately, a report by the State
Auditor confirmed that the state's current system of
victim services fails to meet the critical needs of
victims. Instead of rapid intervention, victims must
1) find out on their own that the State offers
compensation for certain health and support services
and then obtain those services, 2) victims must then
navigate a highly bureaucratic paperwork process which
requires them to produce as many as twelve documents
for verifying agencies including police reports, tax
returns, etc. before 3) beginning a waiting period -
lasting up to 3 months or more - to find out whether
their application for compensation from the VCGCB has
been accepted.
Our Broken System - Victim Compensation Program Facts
from the CA State Auditor:
Over a four year period the VCGCB decreased the
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amount of payments distributed to victims by 50%, from
$123.9 million to $61.6 million.
Despite a significant decline in payments, program
costs have increased - LAO estimates that
administrative spending accounted for $39 million, or
about 31% of annual funding for 2006-07.
1 in 3 victims failed to receive their claim
payments within 30 days, and nearly 30% of those paid
and examined by the Auditor took longer than 90 days
to be processed.
Many victims are completely unaware of the
existence of services due to the VCGCB's consistently
poor community outreach (Report of the CA State
Auditor, December, 2008).
What Is The TRC Model?
The TRC treatment model was developed in 2001 to
address the multiple barriers to access within the
state's current victim service system. The TRC model
utilizes a comprehensive, flexible approach that
integrates three modes of service - assertive
outreach, clinical case management, and
evidence-informed trauma-focused therapies. The TRC
model meets the special needs of crime victims
immediately following trauma by utilizing a
multidisciplinary staff to provide direct mental
health services and health treatment while
coordinating services with law enforcement and other
social service agencies all under one roof.
Improved Victim Outcomes under the TRC Model
Increased return to employment by 56%.
Increased participation with law enforcement by
69%.
Increased cooperation with District Attorneys by
44%.
Provided more victim services at a lower rate -
$66.81 per unit of service for the TRC as compared to
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$101.84 for VCGCB providers.<1>
SB 580 takes an important step toward ensuring that
more victims receive comprehensive, expert treatment
as soon as possible by establishing a grant program
which will allow the TRC model of streamlined,
clinically cost effective rapid intervention to
partner with the state's current model of document
review and reimbursement.
2. Comprehensive Community Response to Crime
It has become increasingly recognized that crime, particularly
violent crime, causes harm to entire communities. (The Culture
of Control, Garland, Univ. of Chicago Press, 2001, pp. 11-12.)
The harm caused by violent crime may be especially pronounced in
poor communities where residents have few financial resources
and limited access to medical care and counseling. A victim who
loses a job because he or she is too traumatized to work may be
the sole support for more than one generation of relatives.
Younger relatives of such victims may stop attending school and
become delinquent. Untreated victims may seek retribution,
especially those who live in areas where the police are not
trusted. Retribution will lead to more victims. Untreated
victims often turn to drugs and alcohol, which further damages
the victim and his or her community.
Gang research has established that gang crimes can best, or
perhaps only, be stopped where the whole community becomes
involved. Increased suppression of gangs through police action
-when not combined with comprehensive community action -
actually increases gang crime. (Klein and Maxson, Street Gang
Patterns and Policies, Oxford Univ. Press, 2006.) The broken
windows strategy in New York City was based on a theory that
where communities are dysfunctional in everyday services and
conditions, greater ills will result. Recent Dutch research has
shown that the presence of graffiti and trash in a neighborhood
promotes crime. (Graffiti Study Bolsters Broken Window Theory,
LA Times, November 21, 2008.)
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<1> Data is from UCSF - San Francisco General Hospital
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Another recent study concluded that homicides can be assessed as
an infectious disease.<2> The study found that homicides could
be tracked and perhaps prevented through the same
epidemiological methods and models used to study and prevent the
spread of disease.
The research described above suggests that treating victims of
crime within a community context may do much more to heal
communities and reduce crime than any programs or strategies
that focus on offenders. In addition to treating individual
victims, the TRC model seeks to address the harm caused to
families and the community from violent crime.
IN ADDITION TO PROVIDING COMPREHENSIVE CARE FOR INDIVIDUAL
VICTIMS OF VIOLENT CRIME, COULD THE TRAUMA RECOVERY MODEL HELP
LIMIT HARM TO COMMUNITIES CAUSED OR EXACERBATED BY VIOLENT
CRIME?
3. A Developing Standard of Care for Trauma Victims
Programs such as the TRC in San Francisco, the Center for
Nonviolence and Social Justice at Drexel University in
Philadelphia and other programs have shown the effectiveness of
comprehensive and integrated care for trauma victims. Victims
of violent crime have been recognized as particularly likely to
suffer from Post Traumatic Stress Disorder, a syndrome or
combination of symptoms and maladies that occur from the
experience or exposure to severe trauma. The abstract<3> of an
article in the Journal of Trauma and Acute Care Surgery noted as
far back as 1998:
The study of both short-term and long-term outcomes
after major trauma has become an increasingly
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<2>
http://www.npr.org/2012/12/06/166600403/can-murder-be-tracked-lik
e-an-infectious-disease
<3>
http://journals.lww.com/jtrauma/Abstract/1998/08000/Multiple_Carp
al_Bone_Fractures_in_an.18.aspx
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important focus of injury research because of the
improved survival rates attributable to the evolution
of sophisticated trauma care systems. The Trauma
Recovery Project (TRP) is a large prospective
epidemiologic study designed to examine multiple
outcomes after major trauma in adults aged 18 years
and older, including quality of life, functional
outcome, and psychologic sequelae such as depression
and posttraumatic stress disorder (PTSD).
Research on the effects of trauma and standardized treatments
have continued to develop in recent years. The Centers for
Disease Control and Kaiser Permanente in San Diego is conducting
a very large, comprehensive and long-term study on the
relationship between adverse childhood experiences (ACE) and
negative health outcomes later in life. The study began in 1995
with more than 17,000 participants who will be assessed over
their lifetimes.
The Centers for Disease Control and Prevention states the
following on its website:
The ACE Study findings suggest that certain
experiences are major risk factors for the leading
causes of illness and death as well as poor quality of
life in the United States. Progress in preventing and
recovering from the nation's worst health and social
problems is likely to benefit from understanding that
many of these problems arise as a consequence of
adverse childhood experiences.<4>
The American Psychological Association website includes an
article or note on managing traumatic stress. The article noted
that reactions to traumatic stress often vary. However, the
article recommended strategies for coping with traumatic stress
that apply to many victims.
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<4> http://www.cdc.gov/ace/
These include taking time to recover, communicating experiences,
finding support services and groups - especially with trained
professionals and creating positive experiences.<5>
The United States Senate is considering a bill to reauthorize
and extend the National Child Traumatic Stress Initiative
(NCTSI<6>). The NCTSI concerns children and families exposed to
a wide range of traumatic experiences including physical and
sexual abuse; domestic, school, and community violence; natural
disasters, terrorism, or military family challenges; severe
bereavement and loss; and life-threatening injury and illness.
4. Audit of the Victims of Crime Program
The December 2008 California State Auditor Report on the Victim
Compensation Program
The report included the following highlights:
From fiscal years 2001-02 through 2004-05, program
compensation payments decreased from $123.9 million to $61.6
million-a 50 percent decline.
Despite the significant decline in payments, the costs to
support the program have increased.
These costs make up a significant portion of the Restitution
Fund disbursements-ranging from 26 percent to 42 percent
annually.
The program did not always process applications and bills as
promptly or efficiently as it could have. We noted staff
took longer than 180 days to process applications in two
instances out of 49, and longer than 90 days to pay bills for
23 of 77 paid bills we examined.
The program's numerous problems with the transition to a new
application and bill processing system led to a reported
increase in complaints regarding delays in processing
applications and bills.
Some payments in CaRES appeared to be erroneous. Although
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<5> http://www.apa.org/helpcenter/recovering-disasters.aspx
<6> http://www.nctsn.org/about-us/history-of-the-nctsn
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board staff provided explanations for the payments when we
brought the matter to their attention, the fact that they
were unaware of these items indicates an absence of controls
that would prevent erroneous payments.
The board lacks the necessary system documentation for
CaRES.
There are no benchmarks, performance measures, or formal
written procedures for workload management.
Despite the board's efforts to increase awareness of the
program, several victim witness assistance centers do not
think the public is generally aware of program services.
Further, the board has not established a comprehensive
outreach plan.
Victim Compensation and Government Claims Board Response to the
Audit
In a response letter to the audit report by the California State
Auditor, the board stated:
The audit finds, and we agree, the [board] can make
improvements in processing time for applications and
payments, developing specific verification procedures,
and maintaining documentation.
The [board] concurs with the recommendation to develop
written procedures and time frames for the appeals
process. A new procedure manual, as discussed below,
will include this subject.
The board's ability to process applications and pay
bills in a timely manner is dependent upon the timely
submittal of key information from verifying entities.
To improve [receipt of] such information, the [board]
plans to develop a new procedure manual, [with]
specific direction to staff for processing
applications and bills in CaRES. The manual will
include specific time frames for follow up with
non-responsive verifying entities. ? [T]he [board]
has [told] ? service providers the importance of
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prompt submittal of requested information to the board
so that [payments can be timely processed].
Similarly, we are reaching out to law enforcement
during our numerous law enforcement outreach seminars.
(Victim Compensation and Government Claims Board: It
Has Begun Improving the Victim Compensation Program,
but More Remains to Be Done. California State Auditor
Report 2008-113 at 70, 71 (December 2008).)
5. Victims of Crime Fund - Current Balance Issues
Disagreements about the condition of the Victims of Crime Fund
are common. Some of the confusion or disagreement about the
fund can be traced to the fact that the cash balance in the fund
does not reflect the payments the board has approved but not
made, and payments and expense that the board anticipates it
will need to pay over the months ahead.
The Legislative Analyst (LAO) has noted in an e-mail to
interested parties in 2012 "that there is a significant
difference between the fund balance reported in the budget
($28.4 million at the end of 10-11, $19.3 million projected for
the end of 11-12) and the cash balance reported by the
Controller ($62.2 million as of 3/8/12). This was apparently
due, at least in part, to an accounting error by DGS<7>, [with]
whom the Board contracts with for accounting services. DGS has
reviewed everything and has accounted for most if not all of the
discrepancy."
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<7> Department of General Services.