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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