BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 955|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: SB 955
Author: Beall (D), et al.
Amended: 4/26/16
Vote: 21
SEANATE HEALTH COMMITTEE: 7-2, 3/30/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
SENATE PUBLIC SAFETY COMMITTEE: 5-2, 4/19/16
AYES: Hancock, Glazer, Leno, Liu, Monning
NOES: Anderson, Stone
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SUBJECT: State hospital commitment: compassionate release
SOURCE: Union of American Physicians and Dentists
DIGEST: This bill requires the Director of the Department of
State Hospitals to release a patient, as specified, from
confinement, parole, or outpatient status if specified criteria
are met for being terminally ill or permanently medically
incapacitated and the conditions under which the patient would
be released do not pose a threat to public safety.
ANALYSIS:
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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 the Department of State Hospitals
(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
release of state prisoners who are terminally ill or
permanently medically incapacitated, to DSH patients who have
been committed as a mentally disordered offender (MDO), were
found not guilty by reason of insanity (NGI), or were found
incompetent to stand trial (IST) or be adjudicated to
punishment. Gives the court 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.
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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.
5) Requires the hearing to be held before the same court that
originally committed the patient, if possible. If the patient
is an MDO on parole and was committed for treatment by BPH,
the matter shall be heard by the court that committed the
patient to the state prison for the underlying conviction, if
possible.
6) Requires the court to order the DSH medical director to send
copies of all medical records reviewed in developing the
recommendation to all of the following parties:
a) The district attorney of the county from which the
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patient was committed.
b) In the case of an MDO on parole, the district attorney
of the county from which the patient was committed to the
state prison.
c) The public defender of the county from which the
patient was committed, or the patient's private attorney,
if available.
d) In the case of an MDO on parole, the public defender
of the county from which the patient was committed to the
state prison, if one is available, or the patient's
private attorney, if applicable.
e) If the patient is an MDO on parole, the BPH.
f) If the patient is on mandatory supervision or
postrelease community supervision and has been found
incompetent to be adjudged to punishment, the county
entity designated to supervise him or her.
7) 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.
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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.
8) Prohibits a patient from being released unless the discharge
plan verifies placement for the patient upon release.
9) 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.
10)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.
11)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.
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
family. However, other DSH patients, such as those who are NGI
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or IST, 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. This
bill creates 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. This bill 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 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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:Yes Local: No
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According to the Senate Appropriations Committee:
DSH new process: One-time costs potentially in excess of
$150,000 (General Fund) to the DSH to develop internal
policies, training, and regulations for the new process.
Ongoing administrative costs potentially in excess of $200,000
(General Fund) annually to evaluate patients for eligibility,
respond to patient and family requests for consideration of
release, and other activities related to patient release.
BPH: Negligible impact to receive notification and records of
MDO releases from the DSH.
Courts: Potentially significant increase in state costs
(General Fund*) for additional hearings for consideration of
potential dismissal of commitment from DSH.
Medi-Cal: Potential increase in Medi-Cal eligibility (Federal
Funds/General Fund) for treatment services to the extent a
patient is released who was previously ineligible for federal
reimbursement for services while in custody. Medi-Cal
generally provides 50 percent federal reimbursement for such
costs.
DSH commitment releases: While the number of DSH patients
potentially eligible to be released is unknown, to the extent
even five DSH commitments are released will result in
potential future cost savings (General Fund) to DSH for
custody, treatment, and services likely in the low millions of
dollars (General Fund) annually, given these patients likely
require the most intensive medical care.
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* Trial Court Trust Fund
SUPPORT: (Verified5/27/16)
Union of American Physicians and Dentists (source)
American Civil Liberties Union of California
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
Legal Services for Prisoners with Children
National Association of Social Workers, California Chapter
OPPOSITION: (Verified5/27/16)
California State Sheriffs' Association
ARGUMENTS IN SUPPORT: Supporters argue that keeping terminally
ill or permanently medically incapacitated patients in state
hospitals prevents health care workers from providing 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.
ARGUMENTS IN OPPOSITION: The California State Sheriffs'
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Association (CSSA) argues that people who are committed to the
state hospital from the criminal justice system are dangerous
and in need of significant treatment. CSSA states that the
desire to see such a person enjoy a compassionate release
because he or she is near the end of life or meets a definition
regarding his or her medical condition should not trump the
reason the person was committed for treatment. CSSA argues that
mechanisms exist to release patients who no longer need care and
that this bill goes beyond that notion.
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
5/28/16 16:45:57
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