BILL ANALYSIS Ó 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--- SB 651 | Page 2 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. SB 651 | Page 3 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 SB 651 | Page 4 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 SB 651 | Page 5 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 SB 651 | Page 6 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 SB 651 | Page 7 -- END --