BILL ANALYSIS                                                                                                                                                                                                    






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       SB 651
          AUTHOR:        Pavley and Leno
          AMENDED:       April 22, 2013
          HEARING DATE:  May 1, 2013
          CONSULTANT:    Robinson-Taylor

           SUBJECT  :  Developmental centers and state hospitals.
           
          SUMMARY  :  Requires designated investigators of state  
          developmental centers and state hospitals to authorize a sexual  
          assault forensic medical examination for any resident who is a  
          victim or suspected victim of sexual assault, as defined.   
          Requires the medical examination to be performed at an  
          appropriate facility off the grounds of the state developmental  
          center or state hospital in accordance with specified  
          provisions.

          Existing law:
             1.   Establishes the Department of Developmental Services  
               (DDS) and identifies the state's developmental centers as  
               being within its jurisdiction. 

             2.   Establishes the Department of State Hospitals (DSH) and  
               identifies the state hospitals for the mentally disordered  
               as being within its jurisdiction. 

             3.   Establishes an investigative force within each state  
               developmental center and state hospital for the purpose of  
               enforcing the rules and regulations of the facility,  
               preserving peace and order on the premises thereof, and  
               protecting and preserving the property of the state. 

             4.   Requires a state developmental center to immediately  
               report specified incidents involving a resident to the  
               local law enforcement agency having jurisdiction over the  
               city or county where the developmental center is located. 

             5.   Establishes that the Department of Public Health, which  
               licenses and regulates health facilities, including  
               long-term care facilities, as specified. 

             6.   Establishes a series of fines and penalties to be levied  
               against skilled nursing facilities and intermediate care  
                                                         Continued---



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               facilities for each citation, as specified. 

             7.   Requires the California Emergency Management Agency,  
               with the assistance of an advisory committee, to establish  
               a protocol for the examination and treatment of victims of  
               sexual assault and attempted sexual assault, including  
               child molestation, and the collection and preservation of  
               evidence therefrom. 

             8.   Requires that each county designate at least one general  
               acute care hospital to perform examinations on victims of  
               sexual assault, including child molestation.

             9.   Requires that each county with a population of more than  
               100,000 arrange for professional personnel trained in the  
               examination of victims of sexual assault, including child  
               molestation, to be present or on call either in the county  
               hospital which provides emergency medical services or in  
               any general acute care hospital which has contracted with  
               the county to provide emergency medical services.   
               Requires, in a county with a population of 1,000,000  
               residents or more, the presence of these professional  
               personnel to be arranged in at least one general acute care  
               hospital for each 1,000,000 persons in the county. 

          This bill:
          1.Requires that designated investigators at state developmental  
            centers and state hospitals authorize a sexual assault  
            forensic medical examination for any resident who is a victim  
            or suspected victim of sexual assault, as specified.  Requires  
            the forensic medical examination to be performed at an  
            appropriate facility off the grounds of a state hospital.

          2.Requires that the law enforcement agency having jurisdiction  
            over the city or county in which the state developmental  
            center or state hospital is located be notified, in accordance  
            with existing law, by the person performing the sexual assault  
            forensic medical examination.

          3.Establishes that failure of a state developmental center to  
            report specified criminal incidents to local law enforcement  
            is a class B violation and subject up to a $2,000 penalty.

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal  
          committee.





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           COMMENTS  :  
           1.Author's statement.  SB 651 is designed to address the lack of  
            forensic evidence collection for sexual assault victims and  
            suspected sexual assault victims in state developmental  
            centers and state hospitals.  The author argues that these  
            residents are vulnerable to sexual assault, but few, if any  
            receive timely forensic medical examinations by trained  
            independent sexual assault examiners.  If there is any  
            follow-up, victims are interviewed and examined by untrained  
            staff physicians and internal facility investigators.  The  
            author maintains that these individuals lack the expertise and  
            equipment necessary to conduct examinations and collect  
            physical evidence.  Medical evidence is crucial in cases  
            involving individuals with disabilities who may lack the  
            ability to give testimony in court.

          The author asserts that forensic medical examinations by trained  
            sexual assault nurse examiners are the best way to collect  
            physical evidence of a sexual assault.  These examiners have  
            specialized training and expertise in recognizing the subtle  
            signs of sexual assault and interviewing sexual assault  
            victims.  Such examinations often involve specialized  
            equipment (e.g. scopes with the capacity to take photographs  
            and procedures to ensure an unbroken chain of evidence).  For  
            victims with cognitive intellectual disabilities, anatomical  
            dolls and drawings may be utilized.  These resources and  
            expertise are not available at state facilities.  SB 651 will  
            assist victims of sex crimes in these institutions to receive  
            timely and objective forensic medical examinations.

          2.State Developmental Centers.  DDS currently operates four  
            state developmental centers which care for approximately 1,800  
            people with developmental disabilities (Fairview in Orange  
            County, Lanterman in Los Angeles County, Porterville in Tulare  
            County, and Sonoma in Sonoma County).  Each developmental  
            center has a mix of units that are licensed as skilled nursing  
            facilities, general acute care hospitals or intermediate care  
            facilities.  Housing within the units is based on specific  
            resident needs.  Additionally, the state operates a smaller,  
            state-leased community facility, Canyon Springs, in Riverside  
            County.  Admission to state developmental centers requires a  
            court order and is based on a formal determination that the  
            developmental center is the most appropriate residential  
            setting available to ensure the individual's health and  
            safety.  Referrals for admission are made through the 21  




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            developmental regional centers located throughout the state.  

          A developmental disability is defined as a severe and chronic  
            disability that is attributable to a mental or physical  
            impairment that begins before age 18.  These disabilities  
            include intellectual disabilities, cerebral palsy, autism,  
            epilepsy and other similar conditions.  
          
          3.State Hospitals.  DSH oversees the operation of the following  
            five state hospitals that provide inpatient psychiatric care  
            to more than 5,000 individuals committed to the hospitals  
            civilly or in connection with criminal proceedings:   
            Atascadero State Hospital located in the Central Coast;   
            Coalinga State Hospital, located in the city of Coalinga;   
            Metropolitan State Hospital, located in the City of Norwalk;   
            Napa State Hospital, located in the City of Napa; and, Patton  
            State Hospital, located in San Bernardino County.

            Also under DSH and subject to the requirements of this bill  
            are three Department of Corrections and Rehabilitation medical  
            facilities that have mental health units which include:  
            Salinas Valley Psychiatric Program; Vacaville Psychiatric  
            Program; and, Stockton Psychiatric Program.

          4.Sexual assault investigative concerns.  In February 2012, a  
            series of reports by California Watch (an independent,  
            non-profit online investigative reporting center) outlined  
            questionable practices in several major crime investigations  
            at various state developmental centers.  The series questioned  
            the training qualifications of developmental center  
            investigators and cited cases in which charts were altered and  
            also pointed to poor police work as a reason for a lack of  
            prosecutions in major cases.  

          An investigation requested in March 2012 by DDS and undertaken  
            by Disability Rights of California (DRC), the sponsor of this  
            bill, found 36 cases of alleged molestation of residents at  
            California's developmental centers by caretakers during the  
            last three years, but on-site police charged to protect  
            residents did not complete even basic forensic evidence  
            collections.  The Office of Protective Services, the police  
            force at California's five developmental centers, failed to  
            order a single rape exam during this period.  In response to  
            increasing concerns about DDS' failure to protect residents  
            from various forms of abuse, DDS announced on March 13, 2013,  
            that they will institute new protection for residents of the  




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            state's developmental centers.  These measures and protocols  
            include actions recommended by DRC.

          5.Sexual assault forensic exams.  For the general population,  
            California law requires that a sexual assault victim be  
            examined by a forensic medical examiner who is required to  
            document findings, including the collection of evidence, by  
            using a series of standard state forensic medical report  
            forms.  Examiners also are trained to adhere to specific  
            protocols.  State law also requires each county to designate  
            at least one general acute hospital to perform examinations  
            for sexual assault victims.  Counties with populations of  
            100,000 residents or more are required to have a medical  
            professional trained in sexual assault examinations present or  
            on call at all times in the designated county emergency  
            medical services hospital.  Counties with fewer than 100,000  
            residents may contract or partner with a Sexual Assault  
            Forensic Exam team in a nearby county.
            
          6.Double referral. This bill was heard in the Senate Human  
            Services Committee on April 9, 2013, and passed with a 6-0  
            vote.

          7.Related legislation.  AB 602 (Yamada) requires the Commission  
            on Peace Officer Standards and Training to update its training  
            to include information on handling persons who are  
            developmentally or intellectually disabled.   Requires peace  
            officers who deal with these populations to take this  
            training.  This bill is currently in the Assembly  
            Appropriations Committee.
               
          8.Prior legislation.  SB 1522 (Leno), Chapter 578, Statutes of  
            2012, requires state developmental centers to immediately  
            report serious incidents of abuse or criminal conduct to law  
            enforcement and requires the state developmental center to  
            submit a written report of the incident to the local law  
            enforcement agency within two working days of any telephone  
            report to that agency.

          SB 1051 (Liu),Chapter 660, Statutes of 2012, requires DSH and  
            state developmental centers to report suspected abuse to the  
            designated protection and advocacy agency.

          AB 430 (Cardenas), Chapter 171, Statutes of 2001, mandates that  
            each developmental center immediately report all resident  




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            deaths and serious injuries of unknown origin to the  
            appropriate law enforcement agency that may, at its  
            discretion, conduct an independent investigation. 
            
          9.Support.  DRC writes in support that people with developmental  
            and psychiatric disabilities are at much greater risk for  
            sexual assault than their non-disabled peers, and are often  
            repeatedly victimized.  According to DRC, conservative  
            estimates are 80 percent of women and nearly 40 percent of men  
            with developmental disabilities will be sexually assaulted at  
            least once in their lifetime.  Of these, DRC asserts, 50  
            percent will be assaulted 10 or more times.  People who have  
            psychiatric disabilities are 23 times more likely to be raped  
            than those who do not and, additionally, the risk of sexual  
            assault is two to four times higher in institutions than in  
            the community, according to DRC.  DRC maintains that this bill  
            will increase the collection of forensic evidence and victim  
            statements to support criminal prosecution of sexual assaults  
            in facilities that serve people with disabilities.

          The California Coalition Against Sexual Assault (CALCASA) writes  
            that, unlike sexual assault victims in the community, few, if  
            any, sexual assault victims who reside in state developmental  
            centers and state hospitals are sent for outside medical  
            forensic examinations.  Instead, CALCASA maintains, they are  
            examined by doctors and nurses on duty at state developmental  
            centers and state hospitals.  These clinicians lack the  
            specialized training and equipment to conduct proper  
            examinations and collect evidence.
          
           SUPPORT AND OPPOSITION  :
          Support:  Disability Rights California (sponsor)
                    California Alliance for Retired Americans
                    California Association of Psychiatric Technicians
                    California Coalition Against Sexual Assault (CALCASA)
                    California District Attorneys Association
                    California Statewide Law Enforcement Association
                    East Bay Developmental Disabilities Legislative  
                    Coalition
                    The ARC/United Cerebral Palsy
                    The Alliance - Supporting People with Intellectual and  
                    Developmental Disabilities

          Oppose:   None Received






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