BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 453| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 453 Author: Pan (D) Amended: 7/8/15 Vote: 21 SENATE PUBLIC SAFETY COMMITTEE: 7-0, 4/21/15 AYES: Hancock, Anderson, Leno, Liu, McGuire, Monning, Stone SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 SENATE FLOOR: 36-0, 5/18/15 AYES: Allen, Anderson, Bates, Beall, Block, Cannella, De León, Fuller, Gaines, Galgiani, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach, Morrell, Nguyen, Nielsen, Pan, Roth, Runner, Stone, Vidak, Wieckowski, Wolk NO VOTE RECORDED: Berryhill, Hall, Pavley ASSEMBLY FLOOR: 79-0, 8/20/15 (Consent) - See last page for vote SUBJECT: Prisons: involuntary medication SOURCE: Union of American Physicians and Dentists DIGEST: This bill 1) provides that where the treating psychiatrist of a person who is incompetent to stand trial concludes, based on the need to maintain the doctor-patient relationship or prevent harm that another psychiatrist should be designated to seek an order for involuntary medication, the facility director may make such a designation; 2) requires the treating psychiatrist to brief the designated psychiatrist about the case; and 3) requires the designated prescribing SB 453 Page 2 psychiatrist to examine the person as to whom the involuntary medication order is sought. Assembly Amendments make technical changes to ensure that the provisions of the bill apply to the correct statutory provisions. ANALYSIS: Existing law: 1)States that a person cannot be tried or adjudged to punishment while he or she is mentally incompetent (IST - incompetent to stand trial). A defendant is IST where he or she has a mental disorder or developmental disability that renders him or her unable to understand the nature of the criminal proceedings or assist counsel in his or her defense. (Pen. Code § 1367, subd. (a).) 2)States that if the court has a doubt as to whether or not a defendant is IST, the matter then proceeds as follows: The court shall appoint a psychiatrist or psychologist to examine the defendant. If the defendant objects to an IST finding, the court shall appoint two psychiatrists or psychologists. The examining expert or experts shall evaluate the defendant's mental disorder, ability to understand the proceedings or assist counsel in his or her a defense, and opine whether medications are medically appropriate and likely to restore the defendant to competency. (Pen. Code § 1369.) 1)States that prior to committing an IST defendant for treatment, the court shall determine whether the defendant SB 453 Page 3 consents to the administration of antipsychotic medications. (Pen. Code § 1370, subd. (a)(2)(B).) If the defendant consents, the commitment order shall confirm that medication may be given to the defendant. If the defendant does not consent to the administration of medication, the court shall hear and determine whether any of the following is true: o Serious harm to the physical or mental health of the patient will result. o The defendant is a danger to others. o The defendant has been charged with a serious crime; involuntary administration of anti-psychotic medication is likely to render the defendant competent; the medication is unlikely to interfere with the defendant's defense and less intrusive treatments are ineffective. (Pen. Code § 1370, subd. (a)(2)(B)(ii)(I)-(III).); or, o If any of these grounds are true, the court shall authorize the treatment facility to involuntarily administer anti-psychotic medication to the defendant when and as prescribed by the defendant's treating psychiatrist. (Pen. Code § 1370, subd. (a)(2)(B)(iii).) 1)Provides that where an IST in treatment withdraws consent for administration of medication, or if involuntary medication was not ordered upon commitment, and the treating psychiatrist believes that grounds for involuntary medication exist, the following shall occur: The treating psychiatrist may issue a certificate for administration of medication for up to 21 days, until a hearing before a court can be held. The IST defendant shall have the right to a medication review hearing before an administrative law judge (ALJ) within 72 hours.If the ALJ agrees that grounds for SB 453 Page 4 involuntary administration of medication exist, the involuntary medication may continue until a court hearing on the issue can be held. If the ALJ finds that grounds for involuntary administration of medication have not been established, medication may not be involuntarily administered until a court decides the issue. (Pen. Code § 1370, subd. (a)(2)(C)-(D).) 1)Provides that if the ALJ upholds the certification by the treating psychiatrist for involuntary medication of the defendant for 21 days, the psychiatrist shall file with the court a copy of the certification and a petition for an order authorizing involuntary medications: The court shall provide notice to the prosecutor and counsel for the defendant of the pending hearing. The court shall hold the hearing within 18 days of the certification and determine if a formal order for involuntary medication should be made. The court shall issue a decision within three calendar days, but within the 21-day certification period. (Pen. Code § 1370, subd. (a)(2)(D).) 1)Provides that an order for involuntary medication shall remain valid at any facility housing the defendant for purposes of return to competency and resumption of criminal proceedings, if the medication is prescribed by the defendant's treating psychiatrist. 2)Provides that if an ALJ upholds the 21-day certification that antipsychotic medication has become medically necessary, the court may extend the certification and continue the hearing for no more than 14 days, upon a showing of good cause or the stipulation of the parties. (Pen. Code § 1370, subd. (a)(2)(D).) SB 453 Page 5 3)Requires the court to review the order to administer involuntary medication at the time of the review of the initial competency report by the treating facility and at review of the six-month progress reports. (Pen. Code § 1370, subd. (a)(2)(B).) 4)Allows the district attorney, county counsel, or representative of any facility where a defendant found incompetent to stand trial is committed, within 60 days before the expiration of the one-year involuntary medication order, to petition the committing court for a renewal of the order, subject to specified conditions and requirements. (Pen. Code § 1370, subd. (a)(7)(B).) This bill: 1)Provides that the treating psychiatrist of an IST patient may request the facility director to "designate another psychiatrist to act" in his or her place for the purposes of determining if an order for involuntary administration of antipsychotic medication should be sought. The request shall be based on the need to do one of the following: Maintain doctor-patient rapport; or Prevent harm; 1)Requires the treating psychiatrist to "brief the acting psychiatrist on the relevant facts of the case." 2)Requires the designated prescribing psychiatrist to examine the patient for whom an involuntary medication order is sought. BackgroundDefendants who are incompetent to stand trial are often committed to the Department of State Hospitals (DSH) subject to court order that they be involuntarily medicated with SB 453 Page 6 antipsychotic medication. The grounds for involuntary medication include that the defendant is gravely disabled - unable to care for oneself - or a danger to self or others. Where a defendant withdraws consent for medication, or where treating clinicians believe that the defendant needs medication, the treating clinician will seek an involuntary medication order. DSH has reported that defendants who do not want to be medicated can become upset and distrustful of a clinician who seeks a medication order. This can lead to breakdown of the patient-psychotherapist relationship and angry reactions by the defendant. DSH clinicians have reported being assaulted after testifying in medication hearings. This bill authorizes the facility medical director to designate another psychiatrist to seek the involuntary medication order, stabilizing or improving the relationship between the defendant and the clinician and likely maintaining a more calm hospital environment. The treating clinician must brief the designated psychiatrist. As amended in the Senate Public Safety Committee, this bill requires the designated psychiatrist to examine the defendant. Requiring the prescribing psychiatrist to examine the IST defendant will reduce the chances that inappropriate medication will be prescribed to him or her. This should result in better health for the IST defendant and timely returns to competency. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Assembly Appropriations Committee, there are minor absorbable costs. SUPPORT: (Verified 8/21/15) Union of American Physicians and Dentists (source) American Federation of State, County and Municipal Employees SB 453 Page 7 OPPOSITION: (Verified8/21/15) Legal Services for Prisoners with Children ASSEMBLY FLOOR: 79-0, 8/20/15 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Chu Prepared by:Jerome McGuire / PUB. S. / 8/21/15 14:07:38 **** END ****