BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 1703


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          Date of Hearing:  March 29, 2016 


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


          AB 1703  
          (Santiago) - As Introduced January 25, 2016


          SUBJECT:  Inmates:  medical treatment.


          SUMMARY:  Expands the definition of immediate medical or  
          hospital care for inmates at county or city jails to include  
          critical specialty medical procedures, such as dialysis, which  
          cannot be furnished, performed, or supplied at a county or city  
          jail.  


          EXISTING LAW:  


          1)Allows a sheriff or jailer to authorize the immediate removal  
            of a prisoner under guard to a hospital, without first  
            obtaining a court order, if a sheriff or jailer believes that  
            the health and welfare of the prisoner will be injuriously  
            affected if the prisoner is not removed to a hospital.


          2)Requires the sheriff or jailer to apply to a judge for a court  
            order authorizing the continued absence of the prisoner from  
            the jail, if the condition of the prisoner prevents their  
            return to the jail within 48 hours from the time of their  
            removal.









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          3)Specifies the cost of such medical services and hospital care  
            and treatment be charged against the county or city, and that  
            the county or city may recover the same cost from the person  
            served, or any person or agency responsible for their care and  
            maintenance.


          4)Allows any prisoner to decline such care or treatment and  
            provide other care and treatment at their own expense.


          FISCAL EFFECT:  None.


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, court orders  
            authorizing removal of an inmate for medical or surgical  
            treatment prolong the process that sheriffs and jailers must  
            undergo to remove an inmate for ongoing specialty treatments.   
            This time consuming process results in backlogs that delay  
            treatment, which usually results in unintended medical  
            emergencies.


          2)BACKGROUND.  


             a)   Public Safety Realignment.  After decades of dramatic  
               prisoner population growth, California's state prisons  
               faced severe overcrowding in the 2000s.  Lawsuits filed in  
               1991 and 2001 alleged inadequate mental health and medical  
               care, and federal courts appointed a special master and a  
               receiver to oversee these functions.  In 2009, a federal  
               three-judge panel ordered the state to reduce the prison  
               population from close to 190% to 137.5% of design capacity,  
               the minimum level believed necessary for the prison system  








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               to provide adequate mental health and medical care.  In  
               2011 the Legislature passed AB 109 (Committee on Budget),  
               Chapter 15, Statutes of 2011, known as public safety  
               realignment.  AB 109 shifted incarceration and supervision  
               responsibility for many lower-level felons from the state  
               prison system to county sheriffs' and probation  
               departments, based on the idea that locals can do a better  
               job.  Realignment changed the profile of county jail  
               populations.  Before realignment, the maximum jail sentence  
               was one year.  Now, the jail time convicted offenders serve  
               is often longer.  According to the Public Policy Institute  
               of California, by early 2014, 1,761 jail inmates were  
               serving sentences of more than five years, up from 1,155 in  
               2013.  Higher inmate populations, especially those serving  
               longer terms, increase demand for medical and mental health  
               beds and program and recreation space.


             b)   Dialysis.  Dialysis is the treatment for end stage  
               kidney disease, which usually occurs when the kidneys have  
               lost about 85 to 90% of their function.  When kidneys fail,  
               dialysis keeps the body in balance by removing waste, salt  
               and extra water to prevent them from building up in the  
               body; keeping a safe level of certain chemicals in the  
               blood, such as potassium, sodium and bicarbonate; and,  
               helping to control blood pressure.  Kidney failure is  
               usually, but not always, permanent.  In chronic or end  
               stage kidney failure, the kidneys do not get better and  
               patients need dialysis for the rest of their life.   
               According to the National Kidney Foundation, dialysis is  
               usually done three times per week for about four hours at a  
               time, and people who stop dialysis may live anywhere from  
               one week to several weeks, depending on the amount of  
               kidney function they have left and their overall medical  
               condition.



               According to medical staff of the Los Angeles County  








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               Sheriff's Department (the sponsor of this bill) at any  
               given time they average six to 12 inmates who require  
               dialysis several times per week.  They must get a court  
               order for each individual every time they take them to a  
               private contract dialysis center.





          3)SUPPORT.  The Los Angeles County Sheriff's Department is the  
            sponsor of this bill and notes that current law allows a  
            sheriff to remove a prisoner under his charge in a county jail  
            or a city jail, if the prisoner is in need of immediate  
            medical or hospital care, provided the health and welfare of  
            the prisoner will be injuriously affected if not transported  
            to a hospital.  The sponsor  states this bill will change the  
            definition of immediate medical or hospital care to include  
            critical specialty medical procedures or treatment such as  
            dialysis, which cannot be furnished, performed, or supplied at  
            such county jail or city jail, ensuring inmates receive timely  
            treatment for their on-going critical medical needs.  


            The American Civil Liberties Union of California states this  
            is an important bill that seeks to ensure that individuals who  
            are detained in jails are able to access critical specialty  
            medical procedures and treatment without adverse delay and  
            without undue burden to the courts.  


            The California State Association of Counties supports this  
            bill, writing that it will expedite the transport process for  
            these inmates by extending the definition of immediate medical  
            care to include critical specialty medical procedures or  
            treatment such as dialysis, which will result in one court  
            order for the medical care of the inmate reducing the burden  
            on the courts and law enforcement for repetitive court orders.









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          4)PREVIOUS LEGISLATION.  AB 2261 (Valadao) of 2012 would have  
            allowed a $5 fee for each inmate initiated medical visit for  
            inmates in city or county jail.  AB 2261 was held in the  
            Senate Public Safety Committee.



          5)DOUBLE REFERRAL.  This bill is double referred; it passed out  
            of the Assembly Public Safety Committee on March 1, 2016 with  
            a vote of 7-0.


          6)POLICY COMMENT.  Existing law allows a sheriff or a jailer to  
            transport a prisoner to a hospital without a court order, when  
            it appears the prisoner is "in need of immediate medical or  
            hospital care, and that the health and welfare of the prisoner  
            will be injuriously affected unless he is forthwith removed to  
            a hospital..."  It could be argued that the need for dialysis  
            should and does qualify as needing immediate medical or  
            hospital care, and a court order should not be necessary.   
            However, some county counsel interpret the law to require a  
            court order to remove a prisoner for treatment unless it is an  
            emergency, hence this bill.


          REGISTERED SUPPORT / OPPOSITION:




          Support



          Los Angeles County Sheriff's Department (sponsor) 
          American Civil Liberties Union of California
          California State Association of Counties
          California State Sheriffs' Association








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          California Peace Officers Association
          Urban Counties of California


          Opposition



          None on file.


          Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097