BILL ANALYSIS Ó
SB 319
Page 1
SENATE THIRD READING
SB
319 (Beall)
As Amended August 28, 2015
Majority vote
SENATE VOTE: 40-0
------------------------------------------------------------------
|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Human Services |7-0 |Chu, Mayes, Calderon, | |
| | |Lopez, Maienschein, | |
| | |Mark Stone, Thurmond | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |19-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chávez, Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
SB 319
Page 2
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bloom, Bonta, | |
| | |Calderon, Chang, | |
| | |Nazarian, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Holden, | |
| | |Jones, Quirk, Rendon, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
------------------------------------------------------------------
SUMMARY: Includes the monitoring and oversight of psychotropic
medications among the duties of foster care public health nurses,
and ensures these nurses' access to relevant medical information.
Specifically, this bill:
1)Authorizes a provider of health care to disclose medical
information to a foster care public health nurse, as defined,
for the purpose of coordinating health care services and medical
treatment for a minor who has either been taken into temporary
custody, had a petition filed with the court, or been adjudged a
dependent child or ward of the juvenile court, as specified.
2)Specifies that medical information regarding a minor, as
defined, disclosed by a provider of health care to authorized
entities includes, but is not limited to, information related to
screenings, assessments, and laboratory tests necessary to
monitor the administration of psychotropic medications.
3)Requires that a foster care health nurse have access to a
child's medical, dental, and mental health care information in
order to allow that nurse to fulfill his or her duties, as
specified, and in a manner that is consistent with all relevant
privacy requirements.
SB 319
Page 3
4)Includes among the duties of public health nurses the monitoring
and oversight of psychotropic medications.
5)Requires a foster care public health nurse to, among other
things at the request of and under the direction of a nonminor
dependent, assist the nonminor dependent in making informed
decisions about his or her health care by, at a minimum,
providing educational materials.
EXISTING LAW:
1)Requires the Department of Social Services (DSS) to establish
and maintain a public health nursing program in the child
welfare services system, as specified, whereby counties are
required to use the services of foster care public health nurse.
Further states that the purpose of this program is to identify,
respond to, and enhance the physical, mental, dental, and
developmental well-being of children in the child welfare
system. (Welfare and Institutions Code (WIC) Section 16501.3)
2)Requires foster care public health nurses to work with the
appropriate child welfare services workers to coordinate health
care services, as specified. Further outlines the duties of
foster care public health nurses. (WIC Section 16501.3)
3)Limits the services a foster care public health nurse can
provide to those reimbursable under Title XIX of the federal
Social Security Act, which provides enhanced matching funds
(75%) for services pertaining to health-related case management,
but not for direct health care services. (WIC Section 16501.3
and 42 United States Code Section 1396 et seq.)
SB 319
Page 4
4)Establishes conditions under which confidential information and
records regarding a minor who has been taken into temporary
custody or adjudged a dependent child or ward of the court may
be shared with specified entities for purposes of coordinating
health care services and medical treatment. (WIC Section
5328.04)
5)Defines "psychotropic medication" or "psychotropic drugs" as
those medications administered for the purpose of affecting the
central nervous system to treat psychiatric disorders or
illnesses. Further states that these medications include, but
are not limtied to, anxiolytic agents, antidepressants, mood
stabilizers, antipsychotic medications, anti-Parkinson agents,
hypnotics, medications for dementia, and psychostimulants. (WIC
Section 369.5 (d))
FISCAL EFFECT: According to the Assembly Appropriations
Committee, this bill may result in the following costs:
1)Unknown, but likely significant, ongoing costs to DCHS for
foster care public health nurses to monitor and oversee
psychotropic medications.
2)Ongoing non-reimbursable costs of approximately $6 million
($4.85 million General Fund (GF)) to DSS for social workers to
work with foster care public health nurses to coordinate health
care services. (Proposition 30 exempts the State from mandate
reimbursement for realigned programs, however, legislation that
has an overall effect of increasing the costs already borne by a
local agency for realigned programs, including child welfare
services, apply to local agencies only to the extent that the
State provides annual funding for the cost increase.)
SB 319
Page 5
3)One time costs of $45,000 ($22,000 GF) and ongoing costs of
$7,000 ($3,500 GF) to DHCS to develop curriculum and train
public health nurses.
COMMENTS:
Foster care public health nurses: AB 1111 (Chesbro), Chapter 147,
Statutes of 1999, required DSS to establish a program of public
health nursing within the child welfare services program. This
program - the Health Care Program for Children in Foster Care - is
located in county child welfare agencies and probation departments
and serves to assist in meeting the medical, dental, mental
health, and developmental needs of foster youth.
Foster care public health nurses work with child welfare
caseworkers and probation officers to promote access to
comprehensive health services. Federal funding requirements
stipulate that the services provided by foster care public health
nurses must be limited to health-related case management and not
involve the provision of direct health care services. Under the
supervision of supervising public health nurses, foster care
public health nurses consult and collaborate with social workers
and probation officers to provide services such as: medical and
health care case planning; expediting referrals for medical,
dental, mental health and developmental services; and helping to
develop and maintain each child's Health and Education Passport,
which provides a summary of all obtainable health and education
information for foster youth that travels with each youth
throughout out-of-home placement. According to the County Welfare
Directors Association of California, there are approximately 250
foster care public health nurses working throughout the state.
SB 319
Page 6
Psychotropic medications and foster youth: Psychotropic
medications include drugs prescribed to manage psychiatric and
mental health disorders or issues including depression,
obsessive-compulsive disorder, attention deficit hyperactivity
disorder, bipolar disorder, schizophrenia, and others.
There continues to be significant concern over the use of
psychotropic medications for children, due to a vast array of side
effects (which can include aggressive behavior, hostility,
seizures, significant weight gain, and more) and due to the fact
that the long-term effects for children using these drugs are
largely unknown. Research has repeatedly indicated that children
and youth in foster care face higher levels of inappropriate or
excessive medication use, and that those foster youth placed in
group home settings are particularly vulnerable to
over-prescription and misuse of psychotropic medications. Data
shared by the author's office indicate that, in Fiscal Year
2013-14, almost 15% of all foster youth in California ages zero to
20 years old were prescribed at least one psychotropic medication;
looking specifically at all foster youth ages 12 through 20, this
rate was almost 25% and for youth placed in group homes, it was
50%.
Need for this bill: According to the author, "Nearly one in four
children in foster care and 56% of children in group homes are
receiving psychotropic drugs, often without adequate oversight.
It is currently unclear if foster youth are being given these
potent drugs as part of a therapeutic regimen or whether these
medications are being used solely to control a youth's behavior.
Without adequate oversight, these powerful drugs can cause
irreversible damage, and many youth experience long-term side
effects, including diabetes, tics, weight gain, and drowsiness.
This bill is grounded in the expertise we've developed working
with medical experts in the State's Quality Improvement Project,
the federally mandated process for developing protocols and
procedures to govern the use of these medications on foster
children. The bill utilizes Public Health nurses; one of the
SB 319
Page 7
great resources of our child welfare system, to oversee the
medical monitoring of psychotropic drugs to increase oversight and
reduce the number of children prescribed these powerful drugs."
Analysis Prepared by:
Daphne Hunt / HUM. S. / (916) 319-2089 FN:
0001709