BILL ANALYSIS
AB 1785
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1785 (Galgiani) - As Amended: April 5, 2010
SUBJECT : Corrections: telemedicine systems.
SUMMARY : Requires the California Department of Corrections and
Rehabilitation (CDCR) to maintain a statewide telemedicine
services program, requires an operational telemedicine program
at each institution, and expands existing telemedicine services
and encounters. Specifically, this bill :
1)States the intent of the Legislature to require CDCR to
implement and maintain telemedicine in state prisons, and
makes specified legislative findings and declarations
regarding the benefits of telemedicine to reduce costs and
improve quality and delivery of health care in prisons.
2)Requires CDCR to do all of the following:
a) Maintain a statewide telemedicine services program, and
require each institution to maintain a program as well;
b) Expand services and encounters currently delivered by
telemedicine in CDCR prisons, and require each prison to
use telemedicine for medical consultations when authorized
by utilization management; and,
c) Expand the use of existing external telemedicine sources
and establish and maintain an information technology
support infrastructure to enable timely tracking and
reporting of telemedicine services.
EXISTING LAW :
1)Establishes the Telemedicine Development Act for purposes of
overcoming significant barriers to access to health services
in medically underserved rural and urban areas and defines
telemedicine as the practice of health care delivery,
diagnosis, consultation, treatment, transfer of medical data,
and education using interactive, video, or data
communications.
AB 1785
Page 2
2)Defines, in the Medical Practice Act, telemedicine as the
practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using
interactive audio, video or data communications.
3)Allows the use of telemedicine in the Medi-Cal Program, when
those services would be otherwise covered by the program when
appropriate, and when the contact between the health care
provider and the patient is real time or near real time.
4)Defines, for the purposes of Medi-Cal, "teleophthalmology and
teledermatology by store and forward" as transmission of
medical information to be reviewed at a later time and at a
distant site by a physician who is trained in ophthalmology,
optometry, or dermatology, where the physician at the distant
site reviews the medical information without the patient being
present in real time and allows these telemedicine services to
be reimbursed under the Medi-Cal Program. Existing law
provides a sunset date of January 1, 2013 for these
provisions.
5)States the intent of the Legislature that CDCR operate in the
most cost-effective and efficient manner when purchasing
health care services for inmates.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THE BILL . According to the author, this bill,
which is sponsored by the federal Receiver, will ensure that
the progress made in expanding telemedicine in California's
prisons will continue. The author states that expanding
telemedicine services will further benefit the state by
avoiding medical guarding and transportation costs associated
with transporting inmates off-site to receive medical
services, and reducing staff physician and psychiatric
vacancies in remote locations.
2)BACKGROUND . The California HealthCare Foundation defines
telemedicine as the use of telecommunications and information
technologies to provide health care services remotely.
Equipment such as exam cameras, monitors, and electronic
stethoscopes allow physicians to treat patients without
AB 1785
Page 3
meeting them face-to-face. Telemedicine is most commonly used
by psychiatrists and specialists such as dermatologists and
orthopedists to conduct initial and follow-up consultations.
It is particularly beneficial for patients who live in rural
areas throughout the state.
CDCR currently provides health care to approximately 167,000
inmates in the form of primary care and specialty services,
which are generally provided by CDCR staff or contract staff,
and medical specialty care, which is provided in prisons by
health care staff during regularly scheduled clinics. Inmates
who need other medical specialty care are transported to
outside facilities, which requires transportation and staffing
costs to escort the patients. Recently, inmates have received
medical and mental health treatment through telemedicine.
3)TELEMEDICINE IN CALIFORNIA PRISONS . According to its
"Analysis of the 2006-07 Budget Bill" the Legislative
Analysts' Office (LAO) states that California's telemedicine
program began in 1997, with a pilot program for mental health
inmates (typically inmates with schizophrenia and bipolar
disorder) at Pelican Bay State Prison. The pilot program
improved inmates' access to mental health care and CDCR later
decided to expand the program to other prisons. Correctional
facilities have found telemedicine to be particularly
beneficial for the delivery of medicine, as it enhances public
safety and reduces costs by allowing inmates to receive
treatment inside prison rather than being transported to
off-site medical facilities. Additionally, telemedicine
enables correctional systems to expand provider networks and
lower contract costs with physicians. CDCR's telemedicine
program is currently administered by the Office of
Telemedicine Services, which is a unit of the Division of
Correctional Health Care Services. According to CDCR,
telemedicine saves roughly $850 in transportation and medical
guarding costs for each outside medical visit that is avoided
because of the technology.
In its analysis, the LAO found that CDCR is not maximizing the
benefits of telemedicine. Based on CDCR's own assessments,
increased use of telemedicine could further reduce the number
of outside medical visits by as much as 20,000 per year, which
would save up to $17 million annually in transportation and
guarding costs. The LAO found that telemedicine was
underutilized because CDCR does not require prison health care
staff to utilize telemedicine and it only offers a limited
AB 1785
Page 4
number of medical specialties. In order to improve the
utilization of telemedicine, the LAO recommended requiring
prisons to use the telemedicine program for all medical
consultations that are appropriate for telemedicine, and that
CDCR establish guidelines concerning the conditions under
which telemedicine should be used.
4)FEDERAL RECEIVER FOR CDCR . In February 2006, the U.S.
District Court for Northern California appointed a Receiver to
control the delivery of medical services for prisoners in
California. The receivership is the result of a class action
law suit in 2001, Plata v. Schwarzenegger (N.D. Cal. Oct. 3,
2005) No. C01-1351 THE, that found the medical care in
California's 33 adult prisons violates the Eighth Amendment of
the U.S. Constitution, which forbids cruel and unusual
punishment. The court found that on average an inmate died
needlessly every six to seven days due to inadequate medical
care. The Receiver is charged with taking over the operations
of the state's prison medical care system and bringing it up
to constitutional levels.
One of the Receiver's stated goals is to expand and improve
telemedicine capabilities. In its most recent tri-annual
progress report, dated January 2010, the Receiver notes that
telemedicine staffing and governance continues to improve.
The Receiver has hired two new additional staff to schedule
specialty services and is recruiting for a Health Program
Manager and is expanding telemedicine services to six
institutions (North Kern State Prison, Kern Valley State
Prison, Richard J. Donovan Correctional Facility, Centinela
State Prison, California State Prison at Corcoran, and
Substance Abuse Treatment Facility). Currently, the Receiver
is in the process of collecting statistics to measure progress
in increasing telemedicine encounters while reducing off-site
specialty services encounters. The Receiver anticipates
completing the six-institution initiative and a phased rollout
of increased telemedicine services statewide by the next
reporting period.
5)ARGUMENTS IN SUPPORT . The federal Receiver, who is sponsoring
this bill, states that this bill will result in significant
cost avoidance and savings, improve public safety, and improve
medical care for inmate-patients. SEIU Local 1000 states that
telemedicine is already in use at Salinas Valley State Prison
and the Central California Women's Facility where Radiology
AB 1785
Page 5
Technicians report great success with the consultation system
available through telemedicine.
6)CONCERNS WITH LEGISLATION . The Union of American Physicians
and Dentists (UAPD), AFL-CIO expressed concerns about the
scope of the legislation and its implications for civil
service primary care physicians. UAPD states that this bill
is silent on the issue of how telemedicine will interface with
existing medical and healthcare personnel working at
correctional institutions. In a recent report, the LAO
recommended the expansion and use of telemedicine for
specialty care and psychiatry. As a result, UAPD would like
to make clear in the bill that telemedicine will only be
expanded where medically appropriate.
7)RELATED LEGISLATION .
a) AB 1817 (Arambula), which is sponsored by the federal
Receiver, would require CDCR to maintain a statewide
utilization management program, ensure that each adult
prison employ the same program, and annually report to the
Legislature, as specified. AB 1817 is set to be heard in
the Assembly Committee on Health on April 20, 2010.
b) AB 2747 (Lowenthal), which is sponsored by the federal
Receiver, would require CDCR to maintain and operate a
comprehensive pharmacy services program for those
facilities under its jurisdiction, that incorporates a
statewide pharmacy administration system, as specified. AB
2747 is set to be heard in the Assembly Committee on Health
on April 20, 2010.
8)PREVIOUS LEGISLATION .
a) AB 1289 (Galgiani) of 2009 would require CDCR to
establish guidelines and performance targets for the prison
telemedicine program and to require prisons to use
telemedicine for all medical consultations that are
appropriate for telemedicine. AB 1289 died on the Assembly
Appropriations Committee Suspense File.
b) AB 175 (Galgiani) Chapter 175, Statutes of 2009,
expands, for the purposes of Medi-Cal reimbursement, until
AB 1785
Page 6
January 1, 2013, the definition of "teleophthalmology and
teledermatology by store and forward" to include services
of a licensed optometrist.
9)POLICY CONCERNS . This bill requires that CDCR expand services
and encounters without defining clear goals and requiring
legislative oversight. The author should establish clear
goals and anticipated dates for completing each stated goal,
and require CDCR to report its progress to the Legislature.
Additionally, the author should clarify that CDCR should only
use telemedicine when it is medically appropriate and never at
the risk of the patient's health and safety.
REGISTERED SUPPORT / OPPOSITION :
Support
California Prison Health Care Services (sponsor)
California State Sheriffs' Association
Crime Victims United of California
Association for Los Angeles Deputy Sheriffs
Riverside Sheriffs' Association
Service Employees International Union, Local 1000
Opposition
None on file.
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097