BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1300
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|AUTHOR: |Ridley-Thomas |
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|VERSION: |June 21, 2016 |
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|HEARING DATE: |June 29, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Mental health: involuntary commitment
SUMMARY : Allows an emergency physician or psychiatric professional, who
is not a county-designated professional person, as specified, to
detain a person who is a danger to self or others, or is gravely
disabled, for up to 72 hours for evaluation and treatment, as
specified.
Existing law:
1)Prohibits a facility not designated by a county, as defined,
and licensed professional staff of those facilities or any
physician and surgeon from being civilly or criminally liable
for detaining a person for more than eight hours but less than
24 hours if it is determined, as specified, that the person,
as a result of a mental disorder, is a danger to self or
others, or is "gravely disabled," as defined, or for the
release of a person and the actions of the person after the 24
hours, if certain criteria are met. Defines "gravely disabled"
to include a condition in which a person, as a result of a
mental health disorder, is unable to provide for his or her
basic personal needs for food, clothing, or shelter.
2)Establishes the Lanterman-Petris-Short (LPS) Act and 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, as well as to safeguard a person's rights, provide
prompt evaluation and treatment, and provide services in the
least restrictive setting appropriate to the needs of each
person.
3)Authorizes a peace officer, member of the attending staff of a
facility designated by the county for evaluation and treatment
AB 1300 (Ridley-Thomas) Page 2 of ?
("designated facility"), member of the attending staff of a
designated facility, or other professional person designated
by the county, upon probable cause, to take a person with a
mental disorder who is a danger to self or others, or is
gravely disabled, into custody (a "5150" hold) and place him
or her in a designated facility.
4)Requires facilities, for the purposes of detaining a person
for up to 72-hour treatment and evaluation, to be designated
by a county and approved by the Department of Health Care
Services (DHCS).
5)Requires that a person who is taken into custody for up to
72-hour treatment and evaluation be provided an oral
advisement that informs the person of:
a) The name of the officer or mental health
professional authorizing custody;
b) The fact that the person is not under criminal
arrest but under a mental health examination;
c) Where the evaluation will take place;
d) That he or she may take a few personal items;
and,
e) That he or she may make a phone call or leave
a note to inform family and friends where he or she
has been taken.
6)Requires that a person who is admitted for up to 72 hours for
evaluation and treatment be provided with the following
information in writing:
a) That he or she is being placed in a
psychiatric unit because he or she may hurt him- or
herself, or others, or be gravely disabled;
b) A listing of the facts upon which the above
allegation is based;
c) That he or she will be held for a period of up
to 72 hours, and when that period will begin;
d) That he or she may be held for a longer period
of time; and,
e) His or her right to a lawyer, as specified.
7)Authorizes the county mental health director to develop
procedures for the county's designation and training of
professionals who perform LPS Act functions, including:
AB 1300 (Ridley-Thomas) Page 3 of ?
a) License types, practice disciplines, and
clinical experience of professionals;
b) Initial and ongoing training and testing
requirements for professionals;
c) The application and approval processes for
professionals seeking to be designated by the county,
including the timeframe for initial designation and
procedures for renewal of the designation; and,
d) The county's process for monitoring and
reviewing these professionals to ensure appropriate
compliance with state law, regulations, and county
procedures.
8)Provides immunity to public agencies (which includes public
hospitals) and their employees for the involuntary detention
of persons, including the enforcement and release of
detainment to the extent that the facility or employee acts in
accordance with requirements of the LPS Act in detaining a
person, and enforcing or releasing the detention.
This bill:
1)Allows an "emergency physician" or a "psychiatric
professional," as defined, who is not a county-designated
professional person to take, or cause to be taken, a
person-who is a danger to self or others, or is gravely
disabled-into custody for up to 72 hours for the purpose of
obtaining evaluation and treatment from a professional person,
including members of a mobile crisis team, who is designated
by a county, or to arrange the transfer of the person to a
designated facility for evaluation and treatment.
2)Defines "emergency physician" as a physician and surgeon
during any scheduled period that he or she is on duty to
provide medical screening and treatment of patients in the
emergency department (ED). Defines "psychiatric professional"
as a physician and surgeon licensed by the Medical Board of
California who has completed an approved psychiatric residency
training program and who provides specialty services to EDs of
a hospital that is not a designated facility (non-designated
hospital [NDH]).
3)Requires each designated facility to accept within its
clinical capability and capacity all categories of persons for
whom it is designated, without regard to insurance or
AB 1300 (Ridley-Thomas) Page 4 of ?
financial status. Requires the facility to assist a person who
presents to the facility with a psychiatric emergency medical
condition in obtaining emergency services and care at an
appropriate facility.
4)Allows specified individuals who participate in the
examination, consultation, treatment, placement, referral, or
transport of a detained person, or for whom there may be
probable cause for detainment, to engage in communication of
patient information among each other and with county
behavioral health professionals and staff, including when
examining a person at the scene of an emergency or in
transport to a hospital, and at a designated facility or other
agency, at which the person may be evaluated, treated, placed,
referred, or transported.
5)Requires an application for detention for evaluation and
treatment to be valid in all counties in which there is a
designated facility to which a person who is being detained
may be taken. Requires an application for detention for
evaluation and treatment to be presented to a designated
facility or NDH, as specified, and retained for the period of
time required by the medical records retention policy of the
designated facility or the NDH.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
PRIOR
VOTES :
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|Assembly Floor: |Not relevant |
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|Assembly Appropriations Committee: |Not relevant |
|Assembly Judiciary Committee: |Not relevant |
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|Assembly Health Committee: |Not relevant |
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COMMENTS :
1)Author's statement. According to the author, when the LPS Act
was enacted in 1967, it was envisioned that the evaluation and
treatment of people with mental illnesses would happen in
AB 1300 (Ridley-Thomas) Page 5 of ?
designated facilities. Since its passage, there have been
significant changes that have adversely impacted the mental
health delivery system. As federal and state resources to
support psychiatric facilities have declined, peace officers,
individuals, and families in the middle of a mental health
crisis have turned to EDs for relief. Because the LPS Act did
not contemplate EDs serving as a necessary entry point into
the 5150 process, ED physicians often lack the authority to
place or sustain a 5150 hold. Instead of ignoring a growing
problem, ED physicians have asked to be part of the solution.
By granting ED physicians the authority to place 5150 holds in
a manner similar to peace officers, this bill will improve
public safety and outcomes for individuals during a mental
health crisis. While this bill takes an important step in the
right direction, we still must take significant steps to
improve the LPS Act and increase the capacity of our mental
health delivery system so we can provide better care for
people with mental illnesses.
2)Background. The LPS Act was enacted in the 1960s to develop a
statutory process under which individuals could be
involuntarily held and treated in a county-designated facility
in a manner that safeguarded their constitutional rights. The
LPS Act was intended to balance the goals of maintaining the
constitutional right to personal liberty and choice in mental
health treatment. Since its passage in 1967, the field of
mental health has continued to evolve toward even greater
legal rights for mentally disordered persons. Welfare and
Institutions Code Section 5150 ("5150") of the LPS Act allows
peace officers, staff members of county-designated facilities,
or other county-designated professional persons to take an
individual into custody and place him or her in a facility for
72-hour treatment and evaluation to determine if, due to a
mental disorder, the individual is a danger to self or others,
or is gravely disabled. The LPS Act imposes strict conditions
relating to the detention, assessment and treatment of the
detainee. Provided that specified conditions are met, the
peace officer and the medical director of the facility, as
well as the professional staff responsible for the evaluation
and treatment of the person, are granted immunity from civil
and criminal liability for releasing the detainee at any time
prior to the end of the 72-hour hold or for any actions of the
person released before or after the 72-hour hold.
a) Designated facilities vs. NDHs. Individual counties
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are responsible for determining whether general acute
care hospitals, psychiatric health facilities, acute
psychiatric hospitals, and other licensed facilities
qualify to be designated facilities. DHCS is responsible
for the approval of designated facilities as determined
by the counties. Counties generally have the discretion
to implement how facilities are designated but facilities
are required to uphold proper care of the patient and a
patient's civil rights throughout the process of
detention. As one example, Los Angeles County (LAC) has
strict guidelines that designated facilities must meet.
Every three years, facilities are re-evaluated for
designation. If there are complaints about a designated
facility, the county has the authority to inspect patient
medical records and issue corrective action plans to the
designated facilities. If designated facilities do not
comply, LAC can revoke designation. While the intent of
the LPS Act is for authorized individuals to take a
person who has been placed on a 5150 hold to a designated
facility, if one does not exist, or a person is suffering
another condition that requires immediate emergency
medical services, the person is transported to the
nearest facility, which is often a NDH or other
nondesignated facility, which is any facility
participating in Medicare and is, therefore, required by
federal Emergency Medical Treatment and Labor Act
(EMTALA) laws to provide emergency medical services to
any individual who presents and requires emergency
medical attention.
b) 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 (CMS), 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
AB 1300 (Ridley-Thomas) Page 7 of ?
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, then
an appropriate transfer should be implemented. As an
enforcement mechanism, EMTALA also established a private
right of action.
3)Community-based treatment and inpatient psychiatric beds.
a) Crisis Residential Programs. According to a 2010
report by the California Mental Health Planning Council,
crisis residential programs are a lower-cost,
community-based treatment option in home-like settings
that help reduce ED visits and divert hospitalization and
incarcerations. According to the report, these programs
include peer-run programs such as crisis respites that
offer safer, trauma-informed alternatives to psychiatric
emergency units or other locked facilities. The report
indicates that crisis residential programs reduce
unnecessary stays in psychiatric hospitals, reduce the
number and expense of ED visits, and divert inappropriate
incarcerations while producing the same or superior
outcomes to those of institutionalized care. The report
states that as the cost for inpatient treatment continues
to rise the need to expand an appropriate array of acute
treatment settings becomes more urgent, and state and
county mental health systems should encourage and support
alternatives to costly institutionalization and improve
the continuum of care to better serve individuals
experiencing an acute psychiatric episode.
b) Mobile Crisis Support Teams. Mobile crisis support
teams can be utilized to provide crisis intervention,
family support, and 5150 evaluations. These teams meet
law enforcement in the field and, among other things,
provide diversion into appropriate treatment
arrangements. These teams have been used in several
areas across the state. A mobile crisis team typically
consists of an interdisciplinary team of mental health
professionals (nurses, social workers, psychiatrists,
psychologists, mental health technicians, addiction
specialists, or peer counselors) that respond to
individuals in the community through home visits or
responses to incidents at other locations.
AB 1300 (Ridley-Thomas) Page 8 of ?
c) Crisis Stabilization. "Crisis stabilization (CS)" is
defined in Title 9, California Code of Regulations (CCR),
Division 1, Chapter 11, Section 1810.210 as a service
lasting less than 24 hours, to or on behalf of a
beneficiary for a condition that requires more timely
response than a regularly scheduled visit. Service
activities include, but are not limited to, one or more
of the following: assessment, collateral, and therapy.
Services are required to be provided on-site at a
licensed 24-hour health care facility or hospital-based
outpatient program or a provider site certified by DHCS
or a Mental Health Plan. All beneficiaries receiving CS
are required to receive an assessment of their physical
and mental health. Physicians are required to be on-call
at all times for the provision of CS services that only a
physician can provide. At a minimum, CS staffing
requirements include one registered nurse, psychiatric
technician, or licensed vocational nurse on-site at all
times beneficiaries are present. A ratio of one licensed
mental health or waivered/registered professional on-site
for each four beneficiaries or other patients receiving
CS at any given time is required. The goal of CS is to
stabilize a person and re-integrate him or her back into
the community quickly. According to various reports,
costs for providing care in a crisis stabilization unit
are significantly lower than inpatient hospitalization.
d) Inpatient psychiatric beds. The California Hospital
Association (CHA), a sponsor of this bill, states that
since 1995 the state has lost 43 facilities, either
through the elimination of psychiatric inpatient care, or
complete hospital closure, representing a nearly 24%
drop. CHA states that while there has been an increase in
psychiatric beds over the past several years, as of 2013
data, California has lost nearly 30% of the psychiatric
beds it had in 1995, a drop of almost 2,700 beds, making
the state's psychiatric bed rate one bed for every 5,572
people, compared to a national average of one bed for
every 4,953 people. A County Behavioral Health Directors
Association of California (CBHDAC) Governing Board Policy
Brief from November 2015 cites specific challenges that
contribute to the lack of crisis and inpatient care
capacity, including:
AB 1300 (Ridley-Thomas) Page 9 of ?
i) The federal Medicaid Institution for
Mental Disease exclusion (IMD exclusion), which
prohibits states from receiving federal matching
funds for inpatient services they provide to
adult Medicaid enrollees aged 18-65 years in a
hospital, nursing home, or other inpatient care
setting with more than 16 beds;
ii) Stigma and discrimination, due to
negative attitudes and myths about the
dangerousness of people with mental illness.
Counties and providers often face substantial
community opposition when attempting to construct
or repurpose a facility intended to be used for
individuals in psychiatric crisis or in need of
inpatient care; and,
iii) Divestment in acute psychiatric care
and competing demands on hospitals, as, according
to a report by the California Health Care
Foundation, hospitals have focused more in the
last decade on general acute care services (both
adult and newborn intensive care capacity) over
skilled nursing and acute psychiatric services.
According to the American Hospital Association,
hospitals have been closing psychiatric units
because of low payments from public and private
payers, uncompensated care for uninsured
patients, and a dearth of psychiatrists willing
to work in hospitals.
1)Efforts to bolster the behavioral health services delivery
system.
a) Los Angeles County Department of Mental Health (LAC
DMH) Pilot Project, which is currently being finalized,
is a pilot project whereby the LAC DMH will enter into
memoranda of understanding with NDHs, which through
qualified staff (ED physicians, psychologists, social
workers, and marriage and family therapists) will be
allowed to place 5150 holds, be required to conform to
all applicable LPS designation requirements, and secure
timely transport of persons to designated facilities for
persons detained in EDs, among other requirements. LAC
DMH will provide oversight to the eligible NDHs.
b) SB 364 (Steinberg, Chapter 567, Statues of 2014),
AB 1300 (Ridley-Thomas) Page 10 of ?
made several fundamental and needed changes to the LPS
Act provisions regarding involuntary commitment.
According to CBHDAC, these changes focused on ensuring
clarity and consistency in the 5150 process to enable
people with mental health disorder needs to obtain
assessment, referral, and treatment as appropriate in the
least restrictive setting as possible; broadened the
types of facilities a county can designate for 5150
purposes; and encourages counties to provide training of
personnel authorized to write and release 5150 holds.
Further, it restructured and recast several provisions of
the 5150 process to more clearly articulate the
sequencing of events. A reference to the Children's Civil
Commitment and Mental Health Treatment Act of 1988 was
also added since people detained under 5150 should also
generally apply to children who are detained.
c) SB 82 (Committee on Budget and Fiscal Review,
Chapter 34, Statutes of 2013), made a one-time
appropriation of $500,000 from the General Fund to the
California Health Facilities Financing Authority to
implement grant programs to support the development,
capital, equipment acquisition, and applicable program
startup or expansion costs to increase capacity for
client assistance and services for individuals with
mental health disorders, including services such as
crisis intervention, crisis stabilization, crisis
residential treatment, rehabilitative mental health
services, and mobile crisis support teams, including
personnel and the purchase or lease of equipment, such as
vehicles. According to the CBHDAC policy brief, SB 82 has
so far funded the addition of 796 crisis residential
beds, 149 crisis stabilization beds, and 48 vehicles and
58 staff members for mobile crisis teams. Additionally,
by 2016-17, an estimated 490 triage personnel will be
funded statewide by SB 82 funds.
d) Medicaid Emergency Psychiatric Demonstration
Program, was established in 2010 by Congress to test
whether allowing federal Medicaid matching payments to
freestanding psychiatric hospitals for emergency
psychiatric cases (which are currently subject to the IMD
exclusion) would improve the quality of, and access to,
care and reduce Medicaid program costs. According to
CBHDAC, the demonstration program, which ended December
AB 1300 (Ridley-Thomas) Page 11 of ?
2015, has provided up to $75 million over three years to
enable current IMD-excluded facilities in 11 states,
including California, and the District of Columbia to
receive Medicaid reimbursement for treatment of patients
aged 21 to 64 who require treatment for psychiatric
emergencies. Preliminary data shows that allowing such
reimbursement is reducing utilization and lowering costs.
According to CMS's Web site, a final report to Congress
about this demonstration program is due in September
2016.
e) SB 743 (Committee on Health, Chapter 612, Statutes
of 2009), extended the amount of time, up to 24 hours, a
NDH can detain persons who meet criteria for a 5150
detention and also extended civil and criminal liability
protection to NDHs and specified staff. SB 743 also
protects NDHs from being held liable for the release of a
person, or for the actions of a person after release, as
long as specified criteria is met, including documenting
attempts to transfer a person to an appropriate,
designated facility. Supporters of SB 743 argued at the
time that the bill would provide clarity to and uniform
application of the LPS Act when a person is taken to a
NDH, which have no inpatient psychiatric services or
county-designated staff. Supporters also argued that SB
743 would help ensure that ED physicians would not be
placed in a position to pursue mental health treatment at
a separate facility before they know a patient is
physically stable for transfer.
f) Assisted Outpatient Treatment (AOT) ("Laura's Law"),
enacted pursuant to AB 1421 (Thompson, Chapter 1017,
Statutes of 2002), established a court-ordered AOT
demonstration program aimed at individuals with mental
illness who meet specified criteria but who do not meet
5150 criteria for involuntary commitment to an inpatient,
designated facility. Laura's Law provides counties with
the option to implement intensive programs for
individuals who have difficulty maintaining their mental
health stability in the community and have frequent
hospitalizations and contact with law enforcement related
to untreated or undertreated mental illness. Since
implementation, Nevada County has found that Laura's Law
has resulted in: 46% reduction in hospitalizations, 65%
reduction in incarcerations, 61% reduction in
AB 1300 (Ridley-Thomas) Page 12 of ?
homelessness, 44% reduction in emergency contacts, and
$1.81-$2.52 in savings for every dollar spent as a result
of reducing incarceration, arrest, and hospitalization.
According to DHCS, 15 counties have approved and/or
implemented Laura's Law: Alameda, Contra Costa, El
Dorado, Kern, Los Angeles, Mendocino, Nevada, Orange,
Placer, San Diego, San Francisco, San Luis Obispo, San
Mateo, Ventura, and Yolo.
2)Related legislation. SB 1273 (Moorlach), would allow a county
to use its Mental Health Services Fund moneys for outpatient
crisis stabilization services to individuals who are
voluntarily receiving those services, even when facilities
co-locate services to individuals who are involuntarily
receiving services. SB 1273 is set to be heard in the Assembly
Health Committee on June 28, 2016.
AB 59 (Waldron), would extend the repeal date of Laura's Law
by five years, to January 1, 2022, and delete and recast in
existing law DHCS's reporting requirement, as specified,
regarding the AOT services a county provides. AB 59 is
pending in the Senate Appropriations Committee.
3)Prior legislation. AB 1194 (Eggman, Chapter 570, Statutes of
2015), requires, for purposes of determining whether a person
is a danger to self or others, an individual making that
determination to consider available relevant information about
the historical course of the person's mental disorder if the
individual concludes that the information has a reasonable
bearing on the determination, and that the individual shall
not be limited to consideration of the danger of imminent
harm.
SB 364 (Steinberg, Chapter 567, Statues of 2014).
SB 585 (Steinberg, Chapter 288, Statutes of 2013), clarifies
that Mental Health Services Act funds and various County
Realignment accounts may be used to provide mental health
services under the Assisted Outpatient Treatment Demonstration
Project Act of 2002, or Laura's Law, and allows counties to
opt to implement Laura's Law through the county budget
process.
SB 82 (Committee on Budget and Fiscal Review, Chapter 34,
Statutes of 2013).
AB 1300 (Ridley-Thomas) Page 13 of ?
AB 110 (Blumenfield, Chapter 20, Statutes of 2013), enacts the
2013-14 Budget Act, which includes, among its other
provisions, $206 million ($142 million General Fund one-time)
for a major investment in mental health services, including
additional residential treatment capacity, crisis treatment
teams, and triage personnel.
SB 1381 (Pavley, Chapter 457, Statutes of 2012), deletes in
state law references to "mental retardation" or a "mentally
retarded person" and instead replaces them with "intellectual
disability" or "a person with an intellectual disability."
SB 743 (Committee on Health, Chapter 612, Statutes of 2009).
SB 916 (Yee, Chapter 308, Statutes of 2007), extends to a
licensed acute psychiatric hospital or a licensed general
acute care hospital, that is not a designated facility, civil
and criminal immunity relating to the detention and release of
individuals who are a harm to themselves or others, or are
gravely disabled, and extends from eight to 24 hours the
period of time that patients can be detained in such
hospitals, providing the hospital has not been designated by a
county to conduct psychiatric evaluations under the LPS Act,
and specifies the criteria that must be met for the immunity
to be granted.
AB 1421 (Thompson, Chapter 1017, Statutes of 2002).
AB 1424 (Thomson, Chapter 506, Statutes of 2001), makes
various changes to the LPS Act to: increase the involvement
of family members in commitment hearings for the mentally ill;
require more use of a patient's medical and psychiatric
records in these hearings; and prohibit health plans and
insurers from using the commitment status of a mentally ill
person to determine eligibility for claim reimbursement.
SB 1111 (Costa, Chapter 547, Statutes of 1997), includes
specified clinical psychologists in the list of persons exempt
from civil or criminal liability for detaining a person, or
for the actions of the person following release from a
specified hospital, if certain conditions exist, including
that the detainment must not exceed eight hours. SB 1111 also
requires that specified facility personnel make and document
repeated unsuccessful efforts to find appropriate mental
AB 1300 (Ridley-Thomas) Page 14 of ?
health treatment for the person as an additional condition of
exemption from liability.
SB 2003 (Costa, Chapter 716, Statutes of 1996), prohibits a
general acute care hospital, its licensed professional staff,
or any physician and surgeon providing emergency medical
services at the hospital from being civilly or criminally
liable for detaining a person, or for the actions of the
person following release from the hospital, if certain
conditions exist, including, that the detainment must not
exceed eight hours.
SB 665 (Petris, Chapter 681, Statutes of 1991), establishes
the right, under the LPS Act, to refuse antipsychotic
medication and establishes hearing procedures to determine a
person's capacity to refuse treatment with antipsychotic
medication.
AB 2541 (Bronzan and Mojonnier, Chapter 1286, Statutes of
1985), authorizes county mental health programs to initiate
services to various target populations, requires various
studies and planning activities, and prohibits mental health
personnel from instructing law enforcement personnel to take
individuals detained for mental health evaluations to jail
solely due to the unavailability of a mental health facility
bed.
SB 677 (Lanterman, Petris, and Short, Chapter 1667, Statutes
of 1967), enacts the LPS Act, which governs involuntary civil
commitment for individuals with mental illness, with the
intent to end inappropriate, indefinite, and involuntary
commitment and provide for prompt evaluation and treatment.
4)Support. The California Hospital Association (CHA), the
California Psychiatric Association (CPA), the California
Chapter of the American College of Emergency Physicians
(CalACEP), the San Gabriel Valley Medical Center, and Dignity
Health argue that since the passage of the LPS Act there have
been significant changes in the mental health delivery system
and fragmented application of due process across the state's
58 counties, which adversely impacts a patient's ability to
obtain prompt evaluation and treatment as required by current
law. CHA, CPA, CalACEP, and Dignity state that patients
currently languish in EDs for hours, days, and sometimes weeks
waiting for psychiatric assessment, referral, and treatment,
AB 1300 (Ridley-Thomas) Page 15 of ?
and that this bill makes long overdue improvements to the LPS
Act by removing barriers to treatment and expediting the
ability of ED physicians and psychiatric professionals to
obtain services for patients with mental illness. Silicon
Valley Leadership Group states that standardizing the LPS Act
and easing the transfer of psychiatric patients from EDs to
psychiatric facilities will have an impact that reaches far
beyond mental health providers.
5)Support if amended. Tenet Health writes that its 13 acute care
hospitals, as many hospitals throughout the state, have
experienced a notable growth in the number of 5150 patients
dropped off by law enforcement in their EDs, and Tenet states
it is very important to recognize that these EDs [NDHs] are
not county-designated psychiatric facilities and therefore do
not have the specialized clinical staffing nor facility
designed to appropriately attend to patients in mental health
crisis. Tenet states that in an ideal environment, better
field tools also would be available to ensure that an
involuntary hold is only imposed when it is indisputably
indicated and a patient would be provided appropriate
treatment. Tenet argues that, notwithstanding incremental
improvements that might result from this bill, NDHs and their
EDs would remain ill-equipped to appropriately treat and
manage patients in mental health crisis. Tenet seeks
clarifying amendments to ensure that patient detainment occurs
at facilities with appropriate resources and by individuals
who have proper training.
6)Oppose unless amended. The Union of American Physicians and
Dentists (UAPD)/AFSCME Local 206 argues that this bill
eliminates the need for psychiatrists to evaluate 72-hour/5150
holds and puts the public at risk if a patient with a mental
disorder is incorrectly diagnosed. UAPD argues that this bill
removes a psychiatrist's ability to perform medical duties in
psychiatric holds, which is detrimental for the patient as
they may need prompt assessment of a need for evaluation and
treatment from a physician who specializes in mental health.
UAPD supports the inclusion of psychiatric input in critical
mental health cases. Disability Rights California (DRC) argues
that while they support releasing people from involuntary
holds when they no longer meet the criteria to be held this
bill allows hospital EDs to detain people for longer than 24
hours, and allows the inappropriate exchange of confidential
information with people who do not need it. DRC expresses
AB 1300 (Ridley-Thomas) Page 16 of ?
concern that this bill does not give a county oversight
authority over the 5150 process in NDHS. SEIU California
argues that this bill would bypass important patient rights
and protections put into place by the LPS Act by, in part,
placing no obligation on NDHs to care for a person's mental
health needs while on a detention for up to 72 hours. SEIU
California proposes amendments that require ED physicians and
psychiatrists who wish to place holds to meet minimum
compliance standards to align with the LPS Act, including, but
not limited to: training on laws governing 5150 holds; proper
staffing and provision of appropriate medical and mental
health services; conditions upon which a county could revoke
an nondesignated individual's ability to place holds should
any violations ever occur; that NDHs already have a memorandum
of understanding with a designated facility for transfer of a
person to ensure timely disposition of holds; and require any
detention by an NDH to be reported to a county and the state,
and to require ongoing public reporting that protects patient
confidentiality but allows policymakers to assess trends in
LPS holds over time.
7)Opposition. NAMI California and its various affiliates, the
County Behavioral Health Directors Association of California
(CBHDAC), San Joaquin County, and the Santa Clara County Board
of Supervisors, and others argue that this bill does not
address the real cause of the issue that EDs currently face:
the current lack of mental health crisis services at a time
when the state has lost more than 3,000 psychiatric beds as
hospitals have chosen to reduce capacity within their hospital
systems for those services. The opponents argue that this bill
undermines counties' authority to regulate conditions of the
LPS Act and develop and implement systems of care for
residents. NAMI California states that this bill further
restricts psychiatric care by allowing ED physicians without
specific mental health knowledge or training to place LPS Act
detentions, which would significantly decrease the likelihood
that follow-up care in an appropriate outpatient setting would
be provided to a patient, as well as increase the occurrence
of costly future hospitalizations. NAMI California also states
that it is not clear if patient rights and protections
afforded under the LPS Act would apply when people are
detained in NDHs. CBHDAC argues that its member counties have
worked with state and local partners to build community
behavioral health services by sponsoring legislation and by
helping to enact recently approved legislation that provides
AB 1300 (Ridley-Thomas) Page 17 of ?
added funding for crisis bed capacity. CBHDAC further argues
that this bill makes it easier for hospitals to skirt state
and federal laws that prevent the dumping of patients, and
would result in fewer avenues for emergency psychiatric care
for underserved communities. CBHDAC argues that counties
currently designate a number of ED physicians in NDHs, and the
process for being designated is not onerous. The various NAMI
affiliates argue that this bill fundamentally restructures
California's emergency psychiatric care and is likely to
increase the number of individuals requiring mental health
care who are inappropriately housed in county jails.
8)Policy questions.
a) Is current authority for NDHs insufficient? NDHs
currently have authority to detain people for up to 24
hours when there is probable cause to believe they meet
5150 criteria. This authority was expanded to 24 hours
(from eight hours) in 2009 to help address NDHs' concerns
that they were being left with patients who should have
been taken to designated facilities, with input from
disability rights advocates. If 24 hours is no longer
sufficient to meet the needs of NDHs, the author may wish
to consider other options that could be vetted through a
stakeholder process to ensure that a longer detention
does not infringe upon a person's rights afforded under
the LPS Act.
b) What are the safeguards for patients? Counties have
oversight authority for designated facilities, including
inspecting patient medical records and revoking facility
designation. The author may wish to consider whether
counties should have the same authority over NDHs that
detain people pursuant to the LPS Act to ensure proper
care was provided to patients and that there is available
recourse should a violation of LPS Act provisions ever
occur.
c) Is this bill premature? LAC DMH is currently
finalizing its pilot project to allow NDHs to perform the
functions proposed in this bill, and the LAC DMH draft
memorandum of understanding is more detailed in its
requirements for NDHs. The author may wish to consider if
this bill is premature and whether the LAC DMH pilot
should be allowed to be fully implemented, which could
AB 1300 (Ridley-Thomas) Page 18 of ?
then serve as a guide for implementation statewide.
SUPPORT AND OPPOSITION :
Support: California Chapter of the American College of
Emergency Physicians (cosponsor)
California Hospital Association (cosponsor)
California Psychiatric Association (cosponsor)
San Gabriel Valley Medical Center (cosponsor)
Adventist Health (previous version)
Alliance of Catholic Health Care (previous version)
Association of California Healthcare Districts
(previous version)
Bakersfield Behavioral Healthcare Hospital (previous
version)
Dignity Health
Loma Linda University Health (previous version)
Our Health California (previous version)
Private Essential Access Community Hospitals (previous
version)
Silicon Valley Leadership Group
Oppose: California Association of Social Rehabilitation
Agencies
County Behavioral Health Directors Association of
California
Disability Rights California (unless amended)
NAMI Amador
NAMI Butte County
NAMI California
NAMI Contra Costa County
NAMI Fresno
NAMI Humboldt
NAMI Kern County
NAMI Lassen
NAMI Los Angeles County Council
NAMI Mendocino County
NAMI San Bernardino Area
NAMI San Gabriel Valley
NAMI San Joaquin County
NAMI San Mateo County
NAMI Solano County
NAMI Sonoma County
NAMI South Bay
NAMI Southern Santa Barbara County
NAMI Urban Los Angeles
AB 1300 (Ridley-Thomas) Page 19 of ?
NAMI Ventura County
NAMI Yolo County
San Joaquin County Health Care Services Agency
Santa Clara County Board of Supervisors
SEIU California (unless amended)
Solano County Health & Social Services Department
Union of American Physicians and Dentists/AFSCME Local
206 (unless amended)
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