BILL ANALYSIS Ó
AB 1300
Page 1
ASSEMBLY THIRD READING
AB
1300 (Ridley-Thomas)
As Amended January 25, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Burke, Chávez, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Judiciary |10-0 |Mark Stone, Wagner, | |
| | |Alejo, Chau, Chiu, | |
| | |Gallagher, Cristina | |
| | |Garcia, Holden, | |
| | |Maienschein, | |
| | |O'Donnell | |
| | | | |
|----------------+-----+----------------------+--------------------|
AB 1300
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|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Holden, | |
| | |Jones, Quirk, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires, when a person has been involuntarily
detained and taken to an emergency department of a
non-designated hospital, that the non-designated hospital notify
the county in which the non-designated hospital is located of
the person's detention, as specified. Establishes definitions
for non-designated hospitals and emergency departments of
non-designated hospitals.
EXISTING LAW:
1)Declares the intent of the Legislature to end the
inappropriate, indefinite, and involuntary commitment of
persons with mental health disorders, developmental
disabilities, and chronic alcoholism, and to eliminate legal
disabilities.
2)Defines "Emergency" to mean a situation in which action to
impose treatment over the person's objection is immediately
necessary for the preservation of life or the prevention of
serious bodily harm to the patient or others, and it is
impracticable to first gain consent.
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3)Defines "Designated facility" or "facility designated by the
county for evaluation and treatment" means a facility that is
licensed or certified as a mental health treatment facility or
a hospital, as defined by Department of Public Health
regulations, and may include, but is not limited to, a
licensed psychiatric hospital, a licensed psychiatric health
facility, and a certified crisis stabilization unit.
4)Provides for the involuntary commitment and treatment of
individuals with specified mental disorders and for the
protection of committed individuals, with the declared goal of
ending inappropriate, indefinite, and involuntary commitment
of mentally disordered persons, developmentally disabled
persons, and persons impaired by chronic alcoholism.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, negligible state fiscal effect.
COMMENTS: According to the author, the Lanterman-Petris-Short
Act (LPS Act) governs the involuntary detention of individuals
for psychiatric treatment in California. In the 48 years since
its passage, there have been significant changes in the mental
health delivery system, adversely impacting a patient's ability
to obtain prompt evaluation and treatment as required by current
law. In addition, the fragmented and inconsistent application
of the LPS Act by California's 58 counties has led to an
increasing and often inappropriate dependence on hospital
emergency departments to care for this population, without the
necessary resources. The author states that this has resulted
in individuals with mental illness languishing for hours, days,
and sometimes weeks, awaiting psychiatric assessment and
treatment.
The author states that no one should face involuntary detention
for up to 72 hours without a timely assessment and evaluation of
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whether he or she meets the criteria for a behavioral health
hold. The author concludes that this bill will ensure the
safety of the public-at-large and hospital personnel by removing
obstacles to the delivery of critical mental health services to
those who need them, while also protecting the interests of
individuals and their families.
The LPS Act, enacted in the 1960s, was intended to balance the
goals of maintaining the constitutional right to personal
liberty and choice in mental health treatment, with the goal of
safety when an individual may be a danger to oneself or others
or is gravely disabled. At the time of its enactment, the LPS
Act was considered progressive because it afforded the mentally
disordered more legal rights than most other states. Since its
passage in 1967, the law in the field of mental health has
continued to evolve toward greater legal rights for mentally
disordered persons. Welfare and Institutions Code Section 5150
of the LPS Act allows peace officers, staff-members of
county-designated evaluation facilities, or other
county-designated professional persons, to take an individual
into custody and place him in a facility for 72-hour treatment
and evaluation if they believe that, due to a mental disorder,
the individual is a danger to himself, herself, or others, or is
gravely disabled - i.e., unable to provide for basic personal
needs for food, clothing, or shelter due to a mental disability.
1)Designated vs. Non Designated Facilities. Individual counties
are responsible for determining whether general acute care
hospitals, psychiatric health facilities, acute psychiatric
hospitals and other licensed facilities qualify to be
designated facilities. The Department of Health Care Services
is responsible for the approval of designated facilities as
determined by the counties. According to the California
Hospital Association, 25 of 58 counties have no inpatient
psychiatric services or beds available to serve their
populations. While peace officers and other authorized
individuals are required to take an individual first to a
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designated facility, if one does not exist individuals are
transported to a non-designated facility, which is also any
facility participating in Medicare that is therefore required
by federal Emergency Medical Treatment and Labor Act (EMTALA)
laws to provide medical services to any individual who shows
up requiring medical attention.
2)EMTALA. Sometimes referred to as the "Patient Anti-Dumping
Law," EMTALA was passed to address the problem of hospitals
refusing to treat indigent, uninsured, or Medicaid patients,
or "dumping" these patients by transferring them to county
hospitals or other charity hospitals. According to the
federal Centers for Medicare and Medicaid Services, in 1986,
Congress enacted EMTALA to ensure public access to emergency
services regardless of ability to pay. Section 1867 of the
Social Security Act imposes specific obligations on
Medicare-participating hospitals that offer emergency services
to provide a medical screening examination when a request is
made for examination or treatment for an emergency medical
condition, including active labor, regardless of an
individual's ability to pay. Hospitals are then required to
provide stabilizing treatment for patients with an emergency
medical condition. If a hospital is unable to stabilize a
patient within its capability, or if the patient requests, an
appropriate transfer should be implemented. As an enforcement
mechanism, EMTALA also established a private right of action.
The California Hospital Association writes in support of a
previous version of this bill that it would modernize the
involuntary hold law, most commonly known as a "5150" to more
closely conform to the evolving community health care delivery
system, while ensuring consistent civil liberty protections
for all individuals subject to detention as a result of an
involuntary psychiatric hold.
The County Behavioral Health Directors Association of
California writes with concerns to a previous version of the
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bill, stating that they worked collaboratively with Senate Pro
Tem Darrell Steinberg and Disability Rights of California to
pass SB 364 (Steinberg), Chapter 567, Statues of 2014, which
made several fundamental and needed changes to the LPS Act
provisions regarding involuntary commitment.
The California Professional Firefighters (CPF) state in
opposition to a previous version of the bill that it would
require emergency ambulance service providers, including fire
departments, and pre-hospital emergency medical care
personnel, including firefighter-emergency medical technicians
and paramedics, to transport involuntarily-detained
individuals to designated and non-designated facilities at the
direction of law enforcement. CPF further states that by
empowering individual peace officers in this regard,
particularly if an officer is untrained or unfamiliar with a
jurisdiction's local emergency medical services agency
policies and procedures, CPF is concerned that patient care
could be negatively impacted and the availability of emergency
medical service resources could be strained throughout the
system.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0002580
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