BILL ANALYSIS Ó
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 955|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
UNFINISHED BUSINESS
Bill No: SB 955
Author: Beall (D), et al.
Amended: 8/1/16
Vote: 21
SENATE 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: 5-2, 5/27/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NOES: Bates, Nielsen
SENATE FLOOR: 24-13, 5/31/16
AYES: Allen, Beall, Block, De León, Glazer, Hall, Hancock,
Hernandez, Hertzberg, Hill, Hueso, Lara, Leno, Liu, McGuire,
Mendoza, Mitchell, Monning, Moorlach, Pan, Pavley, Roth,
Wieckowski, Wolk
NOES: Anderson, Bates, Berryhill, Cannella, Fuller, Gaines,
Galgiani, Huff, Leyva, Morrell, Nielsen, Stone, Vidak
NO VOTE RECORDED: Jackson, Nguyen, Runner
ASSEMBLY FLOOR: 50-24, 8/22/16 - See last page for vote
SUBJECT: State hospital commitment: compassionate release
SOURCE: Union of American Physicians and Dentists
DIGEST: This bill requires the Director of the Department of
SB 955
Page 2
State Hospitals (DSH) 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.
Assembly Amendments (1) specify medical conditions that make a
patient permanently medically incapacitated, including, but not
limited to, coma, persistent vegetative state, brain death,
ventilator dependency, or loss of control of muscular or
neurological function; (2) require DSH to promulgate
regulations, as specified, to establish a process for
reinstating a patient's suspended commitment order, as
specified; and (3) make other clarifying and technical changes.
ANALYSIS:
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.
SB 955
Page 3
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 adjudged to
punishment. Gives the court the discretion to suspend the
commitment for compassionate release when specified criteria
are met.
2) Requires a physician employed by DSH to notify the 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 medical director or
the medical director's designee to notify the patient of the
discharge procedures and to obtain the patient's consent for
discharge. Requires the medical director or medical
director's 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.
SB 955
Page 4
3) Allows a patient or his or her family member or designee to
contact the medical director or the executive director of the
state hospital where the patient is located, or the DSH
Director, to request consideration for a recommendation from
the medical director or the medical director's designee to
the court that the patient's commitment be suspended 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 suspended and the patient released.
Requires a recommendation for compassionate release 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, the physician's and
medical director's determination that the patient meets
compassionate release criteria, 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 judge that
originally committed the patient, if possible. Requires, if
the patient is an MDO on parole and was committed for
treatment by BPH, the matter to 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 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
patient was committed.
b) If the patient is an MDO on parole, the district
attorney of the county from which the patient was
committed to the state prison.
SB 955
Page 5
c) The public defender of the county from which the
patient was committed, or the patient's private attorney,
if available.
d) If the patient is 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 a patient's commitment to be suspended and the
patient released if the court approves a determination for
compassionate release made by a physician employed by DSH,
and the court agrees, and 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
with a medical condition that renders him or her
permanently unable to perform activities of basic daily
living and results in the patient requiring 24-hour total
care, including, but not limited to, coma, persistent
vegetative state, brain death, ventilator-dependency, or
loss of control of muscular or neurological function, the
incapacitation did not exist at the time of the original
SB 955
Page 6
commitment, and the medical director responsible for the
patient's care and the Director of DSH 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.
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 compassionate
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 executive director of the state hospital 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)Prohibits a patient whose commitment has been suspended for
compassionate release from being considered to be under the
custody of, or the responsibility of, DSH.
12)Allows a patient's suspended commitment to be reinstated by
the court pursuant to a finding by DSH that the patient's
SB 955
Page 7
condition has changed such that he or she poses a threat to
public safety or no longer meets the criteria for
compassionate release.
13)Requires DSH, in consultation with relevant stakeholders, as
specified, to promulgate regulations to establish a process
for petitioning the court for reinstatement of a suspended
commitment order, as specified.
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
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
SB 955
Page 8
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
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
SB 955
Page 9
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.:YesLocal: No
According to the Assembly Appropriations Committee, this bill is
likely to result in an overall General Fund (GF) cost savings as
described below:
1)DSH and CDCR would likely incur minor and absorbable one-time
costs to promulgate regulations as well as minor and
absorbable ongoing costs to evaluate patients for eligibility
and perform other activities related to patient release. DSH
anticipates 20-30 patients a year may be eligible for this
program. Although patients may be released under this bill,
it is not likely to result in fewer commitments, given a
waiting list for beds. To the extent persons released under
this bill have significantly higher health care costs than an
average patient, significant ongoing reductions in health care
costs, potentially in the low millions are possible. Those
SB 955
Page 10
persons eligible for release include those close to the end of
life or permanently medically incapacitated, who tend to have
high health care costs. For context, the Department of Health
Care Services reports the top 1% of highest-utilizing Medi-Cal
enrollees have costs of over $100,000 per year.
2)Potential cost pressure to the Medi-Cal program for enrollment
of persons released under the program. Persons released may
also be eligible for Medicare due to age or disability, which
is paid by the federal government and would cover a
significant portion of hospital and medical costs. If persons
released pursuant to this bill are childless adults under age
65, the Medi-Cal costs would be largely paid for through
federal funds. To the extent individuals require skilled
nursing services, Medi-Cal would likely be the primary payer
(GF/federal).
SUPPORT: (Verified8/17/16)
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: (Verified 8/17/16)
California State Sheriffs' Association
ARGUMENTS IN SUPPORT: Supporters argue that keeping terminally
SB 955
Page 11
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'
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.
ASSEMBLY FLOOR: 50-24, 8/22/16
AYES: Alejo, Arambula, Atkins, Baker, Bloom, Bonilla, Bonta,
Brown, Burke, Calderon, Campos, Chau, Chávez, Chiu, Chu,
Cooley, Daly, Dodd, Eggman, Frazier, Cristina Garcia, Eduardo
Garcia, Gipson, Gomez, Gonzalez, Gordon, Gray, Roger
Hernández, Holden, Jones-Sawyer, Lackey, Levine, Lopez, Low,
McCarty, Medina, Mullin, Nazarian, O'Donnell, Quirk,
Ridley-Thomas, Salas, Santiago, Mark Stone, Thurmond, Ting,
Weber, Williams, Wood, Rendon
NOES: Travis Allen, Bigelow, Brough, Chang, Dahle, Beth
Gaines, Gallagher, Gatto, Grove, Hadley, Harper, Irwin, Jones,
Kim, Linder, Maienschein, Mathis, Mayes, Obernolte, Patterson,
Steinorth, Wagner, Waldron, Wilk
NO VOTE RECORDED: Achadjian, Cooper, Dababneh, Melendez,
Olsen, Rodriguez
SB 955
Page 12
Prepared by:Reyes Diaz / HEALTH / (916) 651-4111
8/29/16 10:34:30
**** END ****