BILL ANALYSIS                                                                                                                                                                                                    Ó



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          SENATE THIRD READING
          SB 651 (Pavley and Leno)
          As Amended  August 6, 2013
          Majority vote 

           SENATE VOTE  :37-0  
           
           HUMAN SERVICES      7-0         HEALTH              19-0        
           
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          |Ayes:|Stone, Maienschein,       |Ayes:|Pan, Logue, Ammiano,      |
          |     |Ammiano,                  |     |Atkins, Bonilla, Bonta,   |
          |     |Ian Calderon, Garcia,     |     |Chesbro, Gomez, Roger     |
          |     |Grove, Hall               |     |Hernández, Lowenthal,     |
          |     |                          |     |Maienschein, Mansoor,     |
          |     |                          |     |Mitchell, Nazarian,       |
          |     |                          |     |Nestande, V. Manuel       |
          |     |                          |     |Pérez, Wagner,            |
          |     |                          |     |Wieckowski, Wilk          |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
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          APPROPRIATIONS      17-0                                        
           
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          |Ayes:|Gatto, Harkey, Bigelow,   |     |                          |
          |     |Bocanegra, Bradford, Ian  |     |                          |
          |     |Calderon, Campos,         |     |                          |
          |     |Donnelly, Eggman, Gomez,  |     |                          |
          |     |Hall, Holden, Linder,     |     |                          |
          |     |Pan, Quirk, Wagner, Weber |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
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           SUMMARY  :  Establishes requirements for sexual assault  
          examinations of residents in state hospitals and developmental  
          centers, and establishes new penalties for failure of  
          developmental centers to report specified incidents.   
          Specifically,  this bill  :

          1)Authorizes the Department of Public Health to assess a civil  
            penalty against the licensee of a general acute care hospital  
            or an acute psychiatric hospital that is part of a  
            developmental center of up to $100 for each day the licensee  








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            fails to report an incident involving major injury or death of  
            a resident, as specified, to law enforcement.

          2)Deems a developmental center's failure to report certain  
            incidents involving major injury or death of a resident in a  
            distinct part long-term health care facility, as defined, a  
            class B violation, as specified.

          3)Requires designated investigators of state hospitals to  
            request a sexual assault forensic medical examination at an  
            appropriate facility off the grounds of the state hospital for  
            a resident who is a victim or reasonably suspected to be a  
            victim of sexual assault, as specified, and requires the  
            person performing the examination to obtain consent and notify  
            the local law enforcement agency that has jurisdiction over  
            the state hospital.

          4)Authorizes the sexual assault forensic medical examination to  
            be performed at a state hospital by an independent sexual  
            assault forensic examiner if the state hospital is deemed  
            safer for the resident being examined than other facilities  
            and the state hospital is equipped with more adequate forensic  
            examination and evidence collection capacity than the  
            otherwise designated community examination facility, as  
            specified.

          5)Requires designated investigators of developmental centers to  
            request a sexual assault forensic medical examination at an  
            appropriate facility off the grounds of the developmental  
            center for a resident who is a victim or reasonably suspected  
            to be a victim of sexual assault, as specified, and requires  
            the person performing the examination to obtain consent and  
            notify the local law enforcement agency that has jurisdiction  
            over the developmental center.

          6)Authorizes the sexual assault forensic medical examination to  
            be performed at a developmental center by an independent  
            sexual assault forensic examiner if the developmental center  
            is deemed safer for the resident being examined than other  
            facilities and the developmental center is equipped with more  
            adequate forensic examination and evidence collection capacity  
            than the otherwise designated community examination facility,  
            as specified.









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           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee, costs associated with this legislation should be  
          minor and absorbable within existing Department of Developmental  
          Services (DDS) and Department of State Hospitals (DSH)  
          resources.

           COMMENTS  :  This bill seeks to ensure that timely and appropriate  
          sexual assault examinations are performed by trained examiners  
          for victims and suspected victims of sexual assaults in  
          California's developmental centers and state hospitals.   
          Additionally, this bill imposes penalties for a developmental  
          center's failure to report specified crimes, including sexual  
          assault, to law enforcement.  Penalties were not included in  
          prior legislation that created the reporting requirement.

          Developmental services  :  The Lanterman Act guides the provision  
          of services and supports for Californians with developmental  
          disabilities.  Each individual under the Lanterman Act,  
          typically referred to as a "consumer," is legally entitled to  
          treatment and habilitation services and supports in the least  
          restrictive environment.  Lanterman Act services are designed to  
          enable all consumers to live more independent and productive  
          lives in the community.  The term "developmental disability"  
          means a disability that originates before an individual attains  
          18 years of age, is expected to continue indefinitely, and  
          constitutes a substantial disability for that individual.  It  
          includes intellectual disabilities, cerebral palsy, epilepsy,  
          and autism spectrum disorders (ASD).  Other developmental  
          disabilities are those disabling conditions similar to an  
          intellectual disability that require care and management similar  
          to that required by individuals with intellectual disabilities.

          DDS contracts with 21 regional centers, which are private  
          nonprofit entities, to carry out many of the state's  
          responsibilities under the Lanterman Act.  The regional center  
          caseload is comprised of nearly 260,000 consumers who receive  
          services such as residential placements, supported living  
          services, respite care, transportation, day treatment programs,  
          work support programs, and various social and therapeutic  
          activities.

           Developmental centers (DCs)  :  Over 1,400 regional center  
          consumers reside at one of California's four developmental  
          centers (Lanterman, Porterville, Sonoma, and Fairview) and one  








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          state-operated, specialized community facility (Canyon Springs).  
           These facilities provide 24-hour habilitation and medical and  
          social treatment services.  While some residents in these  
          facilities were voluntarily placed there by relatives and  
          conservators due to acute medical needs and other special needs  
          that make it unsafe for them to live in the community, some  
          residents have experienced involuntary placements due to court  
          orders (e.g., forensic placements at Porterville DC).

           State hospitals  :  There are eight facilities in California under  
          the jurisdiction of the Department of State Hospitals (DSH);  
          five state hospitals and three psychiatric treatment facilities,  
          one of which (Stockton) received its first patients in July of  
          this year.  The cumulative in-patient population of the eight  
          facilities is expected to be 6,560 in the 2013-14 fiscal year,  
          according to DSH budget estimates.  Unlike developmental  
          centers, where residents' primary diagnoses are developmental  
          disabilities, most patients in state hospitals are diagnosed  
          with serious mental illnesses.  Many of them have been  
          involuntarily committed because they have been deemed to be  
          harmful to themselves or others, or because they have committed  
          crimes due wholly or in part to their mental illness.  The  
          projected top two commitment types in state hospitals during the  
          2013-14 fiscal year, accounting for over 40% of the population,  
          will be mentally disordered offenders (e.g., patients with  
          severe mental disorders that are not in remission, which led to  
          the commission of their crimes) and patients who, when  
          prosecuted, pled not guilty by reason of insanity.

           Facility police services  :  The Office of Protective Services  
          (OPS) at developmental centers and the Department of Police  
          Services at state hospitals consist of on-site police officers  
          and investigators charged with preserving the peace, enforcing  
          laws and regulations, and maintaining and protecting facility  
          residents and their rights.  The investigators and officers  
          within OPS are charged with duties within the facilities similar  
          to those of peace officers in the community, including  
          responding to allegations of sexual assault.  However, incidents  
          brought to light in 2012 show that OPS investigators in the  
          state's developmental centers were not handling reports of  
          sexual assault appropriately for a number of years.  According  
          to numerous reports from the state's protection and advocacy  
          organization, Disability Rights California, developmental center  
          residents accused facility caretakers of rape and molestation 36  








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          times from 2009 to 2012, but none of those residents were sent  
          out for an independent examination by a trained medical  
          professional, nor were they even examined using a sexual assault  
          response team (SART) exam, also known as a "rape kit," which is  
          standard law enforcement practice in the community.  Since these  
          reports of abuse, two pieces of legislation, SB 1051 (Liu and  
          Emmerson), Chapter 660, and SB 1522 (Leno), Chapter 666, were  
          both signed into law in 2012, resulting in more stringent  
          requirements for police officers and other staff within  
          developmental centers and state hospitals to report certain  
          incidents to law enforcement, including sexual assault  
          allegations.  As a result, developmental centers and state  
          hospitals have had to tighten their processes with respect to  
          responding to and reporting allegations of sexual assault, which  
          has led to more cases being referred out of facilities for  
          appropriate exams, and more reports being made to Disability  
          Rights California, as required by law.

           Sexual assault forensic medical exams  :  Under current law,  
          counties are required to have a medical professional trained in  
          sexual assault examinations present or on call, at all times, in  
          a designated county hospital.  Counties with fewer than 100,000  
          residents are authorized to partner with the trained exam team  
          in a nearby county to meet this requirement.  Statute defines a  
          medical evidentiary examination as the process of evaluating,  
          collecting, preserving and documenting evidence, interpreting  
          findings, and documenting examination results.  The health care  
          professionals qualified to perform medical evidentiary  
          examinations, pursuant to Penal Code Section 13823.5(e), are  
          physicians and surgeons or nurses working in conjunction with a  
          physician and surgeon.  Forensic medical examiners are trained  
          by the California Clinical Forensic Medical Training Center and  
          follow specific protocols with respect to performing the exams.   


          While the examination can include the collection of physical  
          evidence, an observation and evaluation through an interview of  
          the victim is also essential.  The interview might include  
          communication through the use of anatomical dolls or drawings,  
          or other means that allow victims to provide information if they  
          are unable to talk about their assault.  Examiner training in  
          specialized methods of collecting evidence can be especially  
          important for residents of state hospitals or developmental  
          centers that may have difficulty communicating verbally, either  








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          due to their condition or emotional state.  Additionally, a  
          thorough examination that does not simply rely on what a  
          resident can verbally say about their assault is essential in  
          cases in which residents are unable to provide testimony in  
          court.

           Facility citations  :  Class AA, A and B citations are issued to  
          long-term health care facilities when it is found that patient  
          or resident rights or facility protocols have been violated,  
          leading to imminent danger, physical or emotional harm, or death  
          of a patient or resident.  Class B citations for skilled nursing  
          and intermediate care facilities, which carry the lowest penalty  
          amount of $100 to $2,000, are issued when it is determined that  
          a long-term care patient's or resident's rights have been  
          violated in a manner that will likely cause significant  
          humiliation, indignity, anxiety or other emotional trauma to the  
          patient or resident (Health and Safety Code (HSC) Section 1424).

           Need for the bill  :  This bill sets forth a standard, objective  
          process for developmental centers and state hospitals to follow  
          with respect to sexual assault examinations of their residents  
          in order to facilitate a higher degree of accuracy, better  
          outcomes for sexual assault victims, and increased  
          accountability within the facilities.  As proposed, this bill  
          will still allow developmental center and state hospital  
          investigators to base their referrals to outside sexual assault  
          examiners on information they have gathered that indicates that  
          a resident is a victim or is reasonably suspected to be a victim  
          of sexual assault.  However, by requiring that the interviewing  
          and examining duties only be carried out by qualified, trained  
          forensic medical examiners, the bill may help reduce bias in  
          evidence collection and documentation, and can mitigate the  
          potential to lose or degrade evidence.  The processes  
          established in this bill may shed more light on sexual abuse  
          occurring in these facilities in a way that allows for better  
          follow-up care and treatment for victims, in addition to steps  
          the facilities can take to prevent future occurrences.  
           

          Analysis Prepared by  :    Myesha Jackson / HUM. S. / (916)  
          319-2089 


                                                                FN: 0001813








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