BILL ANALYSIS Ó AB 1703 Page 1 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. AB 1703 Page 2 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 AB 1703 Page 3 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 AB 1703 Page 4 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. AB 1703 Page 5 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 AB 1703 Page 6 California Peace Officers Association Urban Counties of California Opposition None on file. Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097