BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 955
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|AUTHOR: |Beall |
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|VERSION: |March 28, 2016 |
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|HEARING DATE: |March 30, 2016 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : State hospital commitment: compassionate release
SUMMARY : Requires the Director of the Department of State Hospitals
(DSH) to release a patient from confinement, parole, or
outpatient status if a physician employed by DSH makes a
determination, and the court agrees, that the patient meets the
same criteria of being terminally ill or permanently medically
incapacitated that currently permits the compassionate release
of state prisoners.
Existing law:
1)Requires a court to commit a person to a state hospital,
public or private treatment facility, or place him or her on
outpatient status if he or she is found to be not guilty by
reason of insanity.
2)Requires the Director of DSH to notify the Board of Parole
Hearings (BPH) within the Department of Corrections and
Rehabilitation (CDCR), and requires DSH to discontinue
treating a parolee, if a prisoner's severe mental health
disorder is put into remission during the parole period and
can be kept in remission.
3)Authorizes the release of a prisoner from state prison, known
as "compassionate release," if the court finds that the
prisoner is terminally ill with an incurable condition caused
by an illness or disease that would result in death within six
months or is permanently medically incapacitated, as
determined by a physician employed by CDCR, and the prisoner's
release does not pose a threat to public safety.
This bill:
1)Extends compassionate release, which currently permits the
SB 955 (Beall) Page 2 of ?
release of state prisoners who are terminally ill or
permanently medically incapacitated, to DSH patients. Gives
the court sole discretion to dismiss a DSH patient's
commitment for compassionate release when specified criteria
are met.
2)Requires a physician employed by DSH to notify the DSH medical
director and the patient advocate when a prognosis is made of
a patient being eligible for compassionate release. Requires
the medical director to notify the DSH Director if he or she
concurs with the prognosis. Requires the DSH Director or a
designee to notify the patient of the discharge procedures and
to obtain the patient's consent for discharge. Requires the
DSH Director or designee to arrange for a patient to designate
a family member, other outside agent, an emergency contact, or
the patient advocate to be notified of the patient's medical
condition, prognosis, and release procedures, and to provide
those individuals with updated information throughout the
release process.
3)Allows a patient or his or her family member or designee to
contact the DSH medical director or director of the state
hospital where the patient is located, or the DSH Director, to
request consideration for a recommendation from the DSH
Director to the court that the patient's commitment be
dismissed for compassionate release.
4)Requires the court to hold a noticed hearing within 10 days of
receiving a recommendation to consider whether a patient's
commitment should be dismissed and the patient released.
Requires a recommendation to the court to include at least the
following: one medical evaluation, a discharge plan, a
post-release plan for the relocation and treatment of the
patient, and the findings by the court that the patient's
release does not pose a threat to public safety. Requires the
hearing to be held before the same court that originally
committed the patient, if possible.
5)Requires the court to order the DSH medical director to send
copies of all medical records reviewed in developing the
recommendation to the district attorney of the county from
which the patient was committed and to the public defender of
the county from which the patient was committed, or the
patient's private attorney, if available.
SB 955 (Beall) Page 3 of ?
6)Requires the DSH Director to release a patient from
confinement, parole, or outpatient status if a physician
employed by DSH makes a determination, and the court agrees,
that the patient meets the following criteria:
a) The patient is terminally ill with an
incurable condition caused by an illness or disease
that would likely produce death within six months; or
b) The patient is permanently medically
incapacitated and requires 24-hour total care, and the
medical director responsible for the patient's care
and the DSH Director both certify that the patient is
incapable of receiving mental health treatment.
c) The release conditions in a) or b) above under
which the patient would be released or receive
treatment do not pose a threat to public safety.
7)Requires DSH to release a patient, if the court, pursuant to
4) above, approves the recommendation for dismissal and
release, within 72 hours of receipt of the court's order
unless a longer time period is requested by the director and
approved by the court.
8)Requires the DSH Director or a designee to ensure that upon
release the patient or the patient's representative has the
following in his or her possession: a discharge plan,
discharge medical summary, medical records, identification,
all necessary medications, and any property belonging to the
patient. Requires any additional records to be sent to the
patient's forwarding address after discharge.
9)Provides that these provisions do not preclude a patient who
is granted compassionate release from being committed to a
state hospital under the same commitment or another
commitment.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, current law
provides for a compassionate release program for state prison
inmates. The program allows inmates who have six months left
to live, including those receiving treatment at a state
hospital, to be discharged to spend their remaining time with
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family. However, other DSH patients, such as those who are Not
Guilty by Reason of Insanity or Incompetent to Stand Trial,
are not eligible for such compassionate release. This creates
a situation in which a patient can be in a coma and unable to
receive treatment but cannot be released to a more palliative
care setting closer to their loved ones. These patients also
keep state hospital beds from being used to treat patients
that could benefit from treatment. Additionally, patients
released from DSH facilities are eligible for federal matching
funds for their treatment. SB 955 would create a compassionate
release program for all DSH patients regardless of commitment
reason. Patients would be required to meet specific criteria,
and petitions for compassionate release would be
court-approved. SB 955 will provide a humane, less restrictive
environment for terminally ill and medically incapacitated
patients and free up much-needed state hospital beds for
patients who are currently waiting for placement and could
benefit from treatment.
2)DSH. DSH oversees five state hospitals (Atascadero, Coalinga,
Metropolitan [in Los Angeles County], Napa, and Patton) and
three psychiatric programs located in state prisons. Through
an interagency agreement with the CDCR, DSH also treats
inmates at prisons in Vacaville, Salinas Valley, and Stockton.
According to DSH's Web site, as of 2015, DSH serves nearly
7,000 patients who are mandated for treatment by either a
criminal or civil court judge. These patients are sent to DSH
through the criminal court system and have committed or have
been accused of committing crimes linked to their mental
illness. (According to a 2015 Legislative Analyst's Office
[LAO] budget report, 92% of current DSH patients are forensic
commitments.) In addition to forensic commitments, DSH treats
patients who have been classified by a judge or jury as
sexually violent predators. They are committed to DSH for
treatment until a judge deems they are no longer a threat to
the community. The remainder of the DSH's population has been
committed in civil court for being a danger to themselves or
others. These patients are commonly referred to as
Lanterman-Petris-Short (LPS) commitments. DSH also works with
city and county government on a variety of public safety
issues. Several county mental health departments purchase beds
at state hospitals for LPS patients.
According to the LAO report, DSH's population has increased
over recent years, with a growth rate of about 14% since
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Fiscal Year 2010-11. Even though the state provided additional
resources to DSH, and the department was able to add nearly
250 additional beds, DSH still had a patient waitlist of
nearly 550 individuals as of January 2015. According to the
LAO, having such a long waitlist for placement in a DSH
facility delays access to care, and poses other legal issues.
The federal Substance Abuse and Mental Health Services
Administration's Web site states that adults who had a mental
illness in the past year have higher rates of certain physical
illnesses than those not experiencing mental illness,
including increased rates of high blood pressure, asthma,
diabetes, heart disease, and stroke. The National Institute of
Health's Web site states that the lifespan of people with
severe mental illness is shorter compared to the general
population. This excess mortality is mainly due to physical
illness as a result of individual lifestyle choices, side
effects of psychotropic medications, and disparities in health
care access, utilization, and provision, which contribute to
poor physical health outcomes.
3)Concerns over the aging and infirm. A May 2015 article
published on The Marshall Project's Web site states that the
costs of holding elderly and infirm inmates, who often have
multiple health problems, is extraordinarily high and getting
higher, and prison officials don't or can't adequately care
for them. The article cites interviews with inmates who state
they have had heart attacks, surgeries, rely on multiple daily
medications, and have a number of chronic diseases, some of
which require high-cost medications. The Office of the
Inspector General argues that prisons are not only caring for
an expensive population but also one that will more than
likely not commit more crimes if they were to be released,
given their medical conditions. Also cited in the article are
cases in which inmates can no longer perform daily activities
on their own; are unable to navigate prison quarters; and are
forced to leave wheelchairs outside of their small cells.
4)Double referral. Should this bill pass out of this Committee,
it will be referred to the Committee on Public Safety.
5)Related legislation. SB 6 (Galgiani), would exempt from
medical parole eligibility and compassionate release
eligibility a prisoner who was convicted of the first degree
murder of a peace officer or a person who had been a peace
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officer, as provided. SB 6 is pending in the Assembly.
6)Prior legislation. SB 1462 (Leno, Chapter 837, Statutes of
2012), authorized a sheriff to release a prisoner from a
county jail after conferring with a jail physician if the
sheriff determines the prisoner would not reasonably pose a
threat to public safety and the prisoner is deemed to have a
life expectancy of six months or less. Authorized the court,
at the request of a sheriff, to grant medical probation to any
prisoner sentenced to a county jail who is physically
incapacitated, as specified, if that incapacitation did not
exist at the time of sentencing, or to a prisoner who requires
acute long-term inpatient rehabilitation services. Before a
prisoner's compassionate release or release to medical
probation, the sheriff is required to secure a placement
option for the prisoner, as specified.
SB 1399 (Leno, Chapter 405, Statutes of 2010), provided that
any prisoner determined to be medically incapacitated with a
medical condition that renders the prisoner permanently unable
to perform activities of basic daily living, and results in
the prisoner requiring 24-hour care, and that incapacitation
did not exist at the time of sentencing, is granted medical
parole, if BPH determines that the conditions under which the
prisoner would be released would not reasonably pose a threat
to public safety.
AB 1539 (Krekorian, Chapter 740, Statutes of 2007), extended
the criteria for compassionate release to a state prisoner if
he or she is permanently medically incapacitated and the
release is deemed not to threaten public safety.
AB 29 (Villaraigosa, Chapter 751, Statutes of 1997),
established a procedure, known as "compassionate release,"
whereby the Director of Corrections (now CDCR) or the Board of
Prison Terms (now BPH), or both, could recommend to the court
that a prisoner's sentence be recalled, and the court may
recall the sentence if the court finds that the prisoner is
terminally ill and the conditions under which the prisoner
would be released or receive treatment do not pose a threat to
public safety.
7)Support. Supporters argue that keeping terminally ill or
permanently medically incapacitated patients in state
hospitals prevents health care workers from providing
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assistance to patients who could benefit from treatment.
Supporters state that patients that meet the criteria for
compassionate release do not pose a threat to public safety,
can no longer benefit from mental health treatment, and should
live out the rest of their lives in a less restrictive
environment. Disability Rights California states that
compassionate release allows a person to live out their final
days in the community, and provisions in this bill, such as
patient consent and an adequate discharge plan, are critical.
8)Technical amendments. One of the provisions of this bill
delineates what is required to be submitted to the court as
part of the compassionate release process. However, the way
this provision is drafted suggests that the court's own
findings must be submitted to the court, when the court has
yet to make a finding. The author may wish to accept the
following amendments to clarify that it is the physician's and
medical director's determination that is required as part of
the recommendation to the court:
In SEC. 3, Section 4146:
(c) A recommendation for dismissal submitted to the court
shall include at least one medical evaluation, a discharge
plan, a postrelease plan for the relocation and treatment of
the patient, and the findings listed in physician's and
medical director's determination that the patient meets the
criteria set forth in (A) or (C) of paragraph (5) of
subdivision (a). The court shall order the medical director to
send copies of all medical records reviewed in developing the
recommendation to both of the following parties:
SUPPORT AND OPPOSITION :
Support: Union of American Physicians and Dentists (sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
American Federation of State, County and Municipal
Employees, Local 2620
California Association of Psychiatric Technicians
California Psychiatric Association
Disability Rights California
National Association of Social Workers, California
Chapter
Oppose: None received
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