BILL ANALYSIS
SENATE COMMITTEE ON Public Safety
Senator Bruce McPherson, Chair S
2003-2004 Regular Session B
1
6
4
SB 1644 (Romero) 4
As Amended April 12, 2004
Hearing date: April 20, 2004
Health and Safety and Welfare and Institutions Codes
AA:mc
ELDER ABUSE :
LONG TERM CARE FACILITIES - DEATH OF RESIDENTS
HISTORY
Source: California Senior Legislature; California Advocates for
Nursing Home Reform
Prior Legislation: AB 1836 (Bates) - Ch. 1068, Stats. 2000
Support: California Advocates for Nursing Home Reform; Consumer
Attorneys of California; Area Agency on Aging Advisory
Council for San Luis Obispo and Santa Barbara Counties;
AFSCME, AFL-CIO; Gray Panthers
Opposition:California Association of Health Facilities;
California Association of Homes and Services for the
Aging; California Association for Health Services at
Home
KEY ISSUES
SHOULD LONG-TERM HEALTH CARE FACILITIES BE REQUIRED TO NOTIFY A
(More)
SB 1644 (Romero)
Page 2
HEALTH CARE PROFESSIONAL, AS SPECIFIED, UPON THE SUSPECTED DEATH
OF A LONG-TERM CARE HEALTH FACILITY RESIDENT AND TO REQUIRE THAT
PROFESSIONAL TO DEPOSIT A COPY OF THE DEATH CERTIFICATE WITH THE
CORONER, AS SPECIFIED?
(CONTINUED)
SHOULD MANDATED REPORTERS DEFINED UNDER THE ELDER ABUSE AND
DEPENDENT ADULT CIVIL PROTECTION ACT BE REQUIRED TO REPORT THE DEATH
OF ANY RESIDENT OF A LONG TERM CARE FACILITY TO THE COUNTY MEDICAL
EXAMINER OR CORONER WHEN THEY SUSPECT ABUSE, AS SPECIFIED?
SHOULD THE LAW ADDITIONALLY AUTHORIZE ANY PERSON WHO IS NOT A
MANDATED REPORTER, UNDER SPECIFIED CIRCUMSTANCES, TO REPORT A DEATH
CAUSED BY SUSPECTED ABUSE TO THE COUNTY MEDICAL EXAMINER OR CORONER,
AS SPECIFIED?
PURPOSE
The purpose of this bill is to 1) require long-term health care
facilities to notify a health care professional, as specified,
of a suspected death of a long-term health facility resident,
and to require that professional to deposit a copy of the death
certificate with the county medical examiner or coroner, as
specified; 2) require mandated reporters defined under the Elder
Abuse and Dependent Adult Civil Protection Act to report the
death of any resident of the facility to the county medical
examiner or coroner where abuse is suspected, as specified; and
3) provide that any person who is not a mandated reporter, under
specified circumstances, may report a death caused by suspected
abuse to the medical examiner or coroner, as specified.
Current law imposes specified requirements for collecting
information concerning death certificates, as specified.
(Health and Safety Code 102800.)
(More)
SB 1644 (Romero)
Page 3
Current law requires that each death shall be registered with
the local registrar of births and deaths in the district in
which the death was officially pronounced or the body was found,
within eight calendar days after death and prior to any
disposition of the human remains. (Health and Safety Code
102775.)
This bill would require long-term health care facilities to
notify a health care professional, as specified, of a suspected
death of a long-term health facility resident, and to require
that professional to deposit a copy of the death certificate
with the county medical examiner or coroner, as specified.
This bill would require that a copy of the certificate of death
be provided to the local coroner or medical examiner in these
cases within 15 hours of the death or discovery of the death,
and would impose specified civil penalties for the failure to
comply with these provisions.
This bill would provide that the information required by its
provisions would be a public record, subject to specified
confidentiality provisions for the deceased.
Current law provides generally that persons who have assumed
full or intermittent responsibility for care or custody of an
elder or dependent adult are mandated reporters who are required
to report known or suspected instances of abuse by telephone
immediately or as soon as practicably possible, and by written
report sent within two working days, as specified. (Welfare and
Institutions Code ("WIC") 15630.)
(More)
This bill would provide that a mandated reporter, with the
exception of the State Department of Health Services, who is
required to report an incident that involves a resident in a
long-term health care facility, as defined, who makes a report,
as specified, and the resident who is the subject of the report
dies, shall immediately upon the resident's death, or within 24
hours of learning of the death if the mandated reporter is not
aware of the death when it occurs, report the death and the
incident to the medical examiner or coroner of the county in
which the death occurred. This bill would specify the manner of
communicating the report, and would require the medical examiner
or coroner to whom the report is made to provide acknowledgement
of receipt of the report to the mandated reporter who made the
report.
This bill would apply these provisions "when the mandated
reporter has observed or has knowledge of an incident that
reasonably appears to be, or is told by an elder or dependent
adult that he or she has experienced, behavior, including an act
or omission, that constitutes physical abuse, abandonment,
abduction, isolation, financial abuse, or neglect, or when the
mandated reporter reasonably suspects that abuse, and has made a
report based on that information."
This bill would provide that the information required by its
provisions would be a public record, subject to specified
confidentiality provisions for the deceased.
Current law authorizes persons who are not mandated reporters to
report known or reasonably suspected elder or dependent adult
abuse as specified. (WIC 15631.)
This bill would provide that any person who is not a mandated
reporter who knows, or reasonably suspects, that an elder or a
dependent adult has been the victim of abuse in a long-term
health care facility, as defined, and knows that the victim has
died, may report the abuse and the death to the medical examiner
or coroner of the county in which the death occurred.
(More)
SB 1644 (Romero)
Page 5
This bill would specify the manner of communicating the report,
and would require the medical examiner or coroner to whom the
report is made to provide acknowledgement of receipt of the
report to the person who made the report.
COMMENTS
1. Stated Need for This Bill
The author states:
Currently, there is no single place where deaths
in long-term care facilities are reported in a
timely manner. It is important for the coroner or
the medical examiner to know exactly what is
happening at these facilities. If there were a
pattern developing at a particular facility, the
coroner or medical examiner would have no way of
tracking this information. This measure would
allow the coroner or medical examiner to make
inquiries quickly and perform an autopsy if
necessary.
2. Double Referral from Senate Health and Human Services
Committee
This bill was passed (7-2) by the Senate Committee on Health and
Human Services on March 24, 2004.
3. Background
According to the Senate Committee on Health and Human Services,
there are 1400 nursing homes in California with 110,000 beds.
Approximately 210,000 residents occupy the beds each year.
About 40,000 residents die every year. There is no single
source that tracks the deaths and their causes in long term care
facilities. The Office of Statewide Health Planning and
Development (OSHPD) tracks how many people die each year, but
not the causes of death.
SB 1644 (Romero)
Page 6
4. Opposition
This bill is opposed by the California Association of Health
Facilities. With respect to mandated reporting, which is within
the jurisdiction of this Committee, CAHF argues:
Under the mandated reporting section, the bill
requires a care
custodian to report the death of a resident who
was previously the
subject of suspected abuse. The bill essentially
creates another public
record within the coroner's office which lists
deaths that involve
residents who were previously the subject of a
report of suspected
abuse. Again, it is well-known that more abuse
and neglect of the
elderly occurs in the community. Why not require
every mandated
reporter to report every death of an elder who has
been the subject of a
report to the coroner? SB 1644 will further deter
good professionals
from entering this profession by directing
additional criminal
sanctions for failure to report only to those
mandated reporters who
happen to choose to make a living by providing
nursing or direct care
services to the elderly.
SHOULD CARE PROVIDERS IN LONG TERM CARE FACILITIES HAVE
ADDITIONAL RESPONSIBILITIES AS MANDATED ELDER ABUSE REPORTERS,
AS PROPOSED BY THIS BILL?
Opponents also argue that the public records act provisions of
this bill are unnecessary. They submit that consumers already
have access to virtually any appropriate enforcement or
SB 1644 (Romero)
Page 7
investigative information available on a facility through at
least four separate websites: DHS licensing and survey reports;
California Healthcare Foundation; the Attorney General Operation
Guardian; and the California Advocates for Nursing Home Reform.
Finally, opponents argue that these provisions would turn the
"coroner's office and other oversight or law enforcement
agencies into a clearinghouse for advocates and attorneys
seeking cases against nursing facilities." To illustrate this
concern, opponents have submitted what appears to be an
unsolicited letter from a "nursing home reform advocate" to a
person whose parent died in a long-term care facility. The
writer, who cites the State Department of Vital Statistics,
notes that the person's mother had a "bedsore also known as a
decubitus ulcer." The writer then suggests it "may be possible
to bring a legal action against" the facility, and that there
"are several excellent attorneys handling these cases on a
contingency basis, . . . I know we cannot save your mother, but
in holding these facilities accountable for the horrible care
they are providing, perhaps we can save another person's loved
one."
WOULD THE DISCLOSURES REQUIRED BY THIS BILL THROUGH THE
CORONER'S OFFICE FURTHER INFORM THE PUBLIC WITH RESPECT TO
LONG-TERM CARE FACILITIES?
ARE EXISTING CONSUMER RESOURCES CONCERNING LONG-TERM CARE
FACILITIES ADEQUATE?
OR, WOULD THE DISCLOSURES REQUIRED BY THIS BILL LEAD TO
MISLEADING PERSONS WHOSE FAMILY MEMBERS HAVE DIED IN THESE
FACILITIES?
5. Suggested Amendment
The author and/or the Committee may wish to clarify the language
in the bill's provisions by deleting, at page 4:20-21, the first
phrase and replacing it with, "When a resident in a long term
care health facility, as defined in Section 1418, is either
SB 1644 (Romero)
Page 8
known or suspected to have died, . . ."
This would be a technical, nonsubstantive amendment.
***************