BILL ANALYSIS
AB 2222
Page 1
Date of Hearing: April 20, 2010
Counsel: Meghan Masera
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
AB 2222 (Galgiani) - As Amended: April 6, 2010
SUMMARY : Authorizes the Department of Corrections and
Rehabilitation (CDCR) to install telemedicine fixtures and
broadband infrastructure in new or existing buildings.
Specifically, this bill :
1)States legislative intent to allow the CDCR to continue to
reduce prison health care delivery costs by maximizing the
benefits that come with the use of telemedicine.
2)Allows the CDCR to install telemedicine fixtures and broadband
infrastructure in new or existing buildings as authorized by
the Public Safety and Offender Rehabilitation Services Act of
2007 in order to reduce prison health care delivery costs.
EXISTING LAW :
1)Creates Phase I of the Public Safety and Offender
Rehabilitation Services Act of 2007 that allows the CDCR to
design, construct, or renovate housing units, support
buildings, and programming space in order to add up to 12,000
beds at facilities under its jurisdiction. CDCR shall
complete site assessments at facilities at which it intends to
construct or renovate additional housing units, support
buildings, and programming space. [Government Code Section
15819.40(a).]
2)Authorizes the CDCR to design, construct, and establish new
buildings at facilities under the jurisdiction of CDCR to
provide medical, dental, and mental health treatment or
housing for up to 6,000 inmates. [Government Code Section
15819.40(c).]
3)Creates Phase II of the Public Safety and Offender
Rehabilitation Services Act of 2007 that authorizes the CDCR
to complete site assessments at facilities where it intends to
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construct or renovate additional housing units, support
buildings, and programming space in order to add up to 4,000
beds at facilities under its jurisdiction. After completing
these site assessments, CDCR shall define the scope and costs
of each project. Any new beds constructed shall be supported
by rehabilitative programming for inmates, including, but not
limited to, education, vocational programs, substance abuse
treatment programs, employment programs, and prerelease
planning. CDCR is authorized to design, construct, or
renovate housing units, support buildings, and programming
space in order to add up to 4,000 beds at facilities under its
jurisdiction. [Government Code Section 15819.40(a).]
4)Authorizes the CDCR to design and construct new, or renovate
existing, buildings at facilities under the jurisdiction of
the department to provide medical, dental, and mental health
treatment or housing for up to 2,000 inmates. [Government
Code Section 15819.40(c).]
FISCAL EFFECT : Unknown
COMMENTS :
1)Author's Statement : According to the author, "In an effort to
improve performance and reduce the costs associated with
prison healthcare, efforts are underway to expand the use of
telemedicine technology within CDCR.
"The expansion of telemedicine technology in the state's prison
system prior to 2010 has been funded through the Consolidated
Information Technology Infrastructure Project, awarded in
2007, to improve the performance and cost-effectiveness of
infrastructure in prison health care. $191 million was
awarded to CDCR to, among other things, expand the CDCR data
communications network, increase network bandwidth, and
address electrical power needs for the new infrastructure.
"According to California's Federal Prison Receiver, Clark Kelso,
federal funds are available for future broadband projects.
The author suggests potential funding could be pursued through
the Office of the State Chief Information Officer (OCIO) which
is working to secure ARRA stimulus funding for broadband
projects. The author notes that in a January 2010 report, the
'California Information Technology Strategic Plan,' Joe
Camicia, Chief of Staff , OCIO, states that the agency is
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'working with the California Public Utilities Commission, the
California Emerging Technology Fund and local government
representatives to share information, discuss projects and
provide what guidance we can to ensure that California
receives our fair share of ARRA stimulus dollars. We do know
that there are two sources of funding - $4.7 billion from the
National Telecommunications and Information Administration
(NTIA) and $2.5 billion from the Rural Service Utility. There
will also be $350 million available for broadband mapping.'
"While potential federal funding sources exist, and should be
pursued, they are not guaranteed.
"In the event that additional funding is necessary to expand
telemedicine fixtures and broadband infrastructure, and the
state exhausts its resources to pursue necessary federal
funding, or finds it necessary to provide a state match for
federal funding, it is important to provide CDCR with a state
source from which to seek funding.
"Existing law, the Public Safety and Offender Rehabilitation
Services Act of 2007, authorizes CDCR, in two phases, to
design, construct, or renovate prison facilities to provide
medical, dental, and mental health treatment or housing for
inmates.
"This bill clarifies that construction, and renovation of prison
health facilities may include installation of telemedicine
fixtures and broadband infrastructure to make medical, mental
health, or dental building improvements, to reduce prison
healthcare delivery costs.
"The scope and costs of projects authorized by the Public Safety
and Offender Rehabilitation Services Act of 2007 are subject
to approval and administrative oversight by the State Public
Works Board. Therefore, as proposed by this bill, projects
for telemedicine fixtures and broadband infrastructure would
also be subject to approval and administrative oversight by
the State Public Works Board, ensuring prudent expenditure of
the State's valuable tax dollars while reducing costs for
prison health care delivery."
2)Background : According to information provided by the author,
"The 'CDCR, Legislative Analysts Office Report,' presented to
the Senate Budget Subcommittee No. 4 on State Administration,
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March 19, 2009, state spending on corrections 'has increased
by approximately $8 billion, or 340%, between 1989-90 and
2009-10, an average annual increase of about 8%.' The average
cost to incarcerate an inmate was approximately $49,000 in
2008-09, an average annual increase of about 5 percent each
year over the last 20 years. Of this $49,000 per year, an
average of $11,607 is spent on inmate health care: medical
care, psychiatric services, pharmaceuticals, and dental care.
"According to a February 3, 2010 State Senate Committee on
Budget and Fiscal Review hearing document, 'under the
Receiver, inmate medical costs have increased from about $883
million in 2005-06, to $1.8 billion in 2009-10.' The Governor
proposed a reduction of $811 million in the budget for inmate
medical care. The Administration did not offer a specific
plan for how these savings would be achieved, but it was
stated that options might include reduced reliance on outside
health care providers, and expanded use of telemedicine.
"While potential federal funding sources exist, and should be
pursued for telemedicine fixtures and broadband
infrastructure, they are not guaranteed. Therefore, it is
necessary to identify an existing funding source which can be
utilized to achieve cost savings in prison health care
delivery, without adding an additional burden to the General
Fund. Furthermore, it is necessary to ensure oversight and
accountability of any expenditures related to the delivery of
prison health care. The scope and costs of projects
authorized by the Public Safety and Offender Rehabilitation
Services Act of 2007 are subject to approval and
administrative oversight by the State Public Works Board.
Therefore, as proposed by this bill, projects for telemedicine
fixtures and broadband infrastructure would also be subject to
approval and administrative oversight by the State Public
Works Board."
3)California Prison Health Care Services Recommendations :
According to the California Prison Health Care Services'
(CPHCS) "Cost Containment Report" (April 2010), "Telemedicine
leads to cost avoidance in the areas of contract medical and
medical custody transportation costs. Telemedicine avoids
$580 in custody costs for a one inmate transportation and
about $290 in custody costs for the more traditional two
inmate transportation. The true benefits of telemedicine are
public safety from keeping the inmate in the institution, cost
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avoidance to medical custody transportation costs by not
transporting the inmate and cost avoidance to contract medical
through increased access to care allowing for preventative
care.
"Telemedicine has been implemented in the area of specialty
services which drives the most custody medical
transportations. The medical custody transportations have
been operating at capacity in order to meet demand and
alleviate the backlog of appointments. Until transportations
level off and backlog is greatly reduced or eliminated; the
true cost avoidance of telemedicine is hard to generate and
based on 'assumptions'. As telemedicine visits continue to
increase and RFS' decrease a more accurate picture of cost
avoidance can be generated based on actual expenditures and
not assumptions. Additionally, CPHCS is expanding
telemedicine for specialty services, and is in the process of
making telemedicine the default for specialty service
referrals whenever medically appropriate. A Phase I expansion
of services has been completed at six institutions, and a
Phase II expansion has been launched at an additional six.
These expansions are a collaboration of efforts by Information
Technology, Human Resources, Medical, Nursing, Custody, Allied
Health, Mental Health, and the Office of Telemedicine Services
(OTS).
"CPHCS is also launching a pilot to increase primary care
coverage via Telemedicine to institutions where recruitment of
primary care physicians has traditionally been unsuccessful.
In addition, the pilot will address primary care coverage to
institutions that are experiencing periodic backlog issues.
"Another area of expansion is in Mental Health telepsychiatry;
where plans are currently being explored to address Mental
Health services at remote institutions. Expansion focus will
address providing coverage to institutions where recruitment
has traditionally been unsuccessful.
"Lastly, an additional possible area of expansion is in the area
of after hours and weekend treatment triage areas (TTAs) at
institutions. Physicians would provide urgent care assessment
and triage via telemedicine during hours when TTAs are not
staffed with physicians.
"Overall, Telemedicine increases access to care; which is a
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major component of the Receivers' Turnaround Plan of Action.
Increased access to care allows for preventative care and
decreases catastrophic outcomes of care that are very
expensive. Avoiding catastrophic care episodes is another
cost avoidance that is hard to quantify. Telemedicine also
decreases expenditures by increasing the provider pool of
specialty care doctors. More doctors are comfortable using
telemedicine visits with patient inmates and are not
logistically restricted to an institution's location.
Telemedicine expects the provider pool to continue to grow and
the specialty doctors with the lowest rates used before more
expensive doctors. As telemedicine begins to expand and
become more utilized CPHCS expects to see contract medical
expenditures decrease in the upcoming budget years."
4)AB 900 and Prison Health Care Reform : In an effort to reform
the system and reduce prison overcrowding, the Legislature
passed AB 900 (Solorio), Chapter 7, Statutes of 2007. The two
main goals of AB 900 were to ease the state's massive prison
overcrowding problem and to overhaul inmate rehabilitation
programs. AB 900 authorized a total of $7.7 billion in lease
revenue bonds to build 53,000 new prison, reentry and local
jail beds. The money is to be distributed in two phases.
[Regents of the University of California on behalf of Boalt
Journal of Criminal Law, An Update on the California Prison
Crisis and Other Developments in State Corrections Policy
(2009) 14 Berkeley J. Crim. L. 143, 144.]
"Phase I provides $3.6 billion in bonds to create 12,000
so-called infill beds, which are beds on the grounds of
existing state prisons that will replace "bad beds" - the
temporary housing in gymnasiums, dayrooms, classrooms and
hallways of the prison. This includes 6000 new reentry beds
for inmates who have less than a year of their sentence
remaining, and 6000 new medical beds to improve prison health
care. (14 Berkeley J. Crim. L. 143, 144.)
"In Phase II, Assembly Bill 900 provides an additional $2.5
billion in lease revenue bonds for up to 16,000 new infill,
medical and reentry beds. However, this Phase II funding is
contingent on CDCR meeting certain rehabilitation and
construction goals during Phase I. There are thirteen
benchmarks that must be met in order to trigger Phase II
funding. Among the most significant are the requirements that
4000 new beds be under construction, 2000 of the original
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reentry beds be under construction or have an identified site,
and that half of the substance abuse treatment beds be in
operation with continued treatment available upon release from
prison. During Phase I, the Department also must implement a
new inmate assessment tool at its reception centers and have
it operational for six months. There is no specific date by
which these benchmarks must be completed in order to activate
Phase II funding. (14 Berkeley J. Crim. L. 143, 144-45.)
"Another key component of Assembly Bill 900 is the $1.2 billion
allotted to create 13,000 new beds in the local county jails.
However, in order for counties to receive funding for new
jails in Phase I, they must agree to provide sites for reentry
facilities. These state-run "mini-prisons," which house up to
500 inmates each, would provide more intensive rehabilitation
programming for inmates who will soon be released on parole.
Aside from the major prison expansion plans, Assembly Bill 900
also authorizes CDCR to transfer inmates to out-of-state
facilities over the next four years." (14 Berkeley J. Crim.
L. 143, 145.)
Implementation of AB 900 has been significantly delayed.
However, according to the CDCR's Annual Report, Corrections:
Moving Forward (2009), as of July 2009, CDCR had transferred
nearly 8,000 inmates out-of-state to ease overcrowding and
meet the goal set in AB 900. In addition, "CDCR reduced the
total number of non-traditional or 'bad beds' by 8,900 beds
since reaching an all time high of 19,618 inmates in these
beds in August 2007. The August 2009 non-traditional bed
count was at 10,568, the lowest level since the 1990s."
[California Department of Corrections and Rehabilitation,
Corrections: Moving Forward (2009) p. IV.]
5)NuPhysicia Assessment : In March 2010, NuPhysicia, a company
that has evolved from the telemedicine programs of The
University of Texas Medical Branch, released its assessment of
the California correctional health care system, "Assessment
and Evaluation: California's Opportunities for Improved
Inmate Health Care Quality and Cost Controls." In this
assessment, NuPhysicia stated, "[CDCR's] current program plans
for telemedicine are inadequate and do not emphasize this
important tool strong enough into the care methods at the
local units. Units are left to 'choose' whether to use the
telemedicine 'offering.' Telemedicine must be integrated into
the default care escalations from primary care, be used more
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frequently in mental health, and used more broadly in
specialty care initial assessments and chronic care follow
ups. Equipment procurement and installation must be
accelerated, and changeover from the defunct and expensive
ISDN communications protocol to the effective and inexpensive
IP protocol must be immediate." [NuPhysicia, Assessment and
Evaluation: California's Opportunities for Improved Inmate
Health Care Quality and Cost Controls (March 2010) p. 6.]
NuPhysicia recommends a fast-tracked implementation of
telemedicine systems in California's prison health care system
because it feels telemedicine will bring immediate quality
improvements and cost reductions. (Id. at p. 6.)
6)Related Legislation : AB 2668 (Galgiani) requires the CDCR
Secretary to install telemedicine fixtures and broadband
infrastructure in the CDCR Medical Facility. AB 2668 will be
heard by this Committee on Public Safety today.
7)Prior Legislation :
a) AB 900 (Solorio) Chapter 7, Statutes of 2007, authorized
the CDCR to design, construct, or renovate prison housing
units, prison support buildings, and programming space in
order to add new beds, to acquire land, design, construct,
and renovate reentry program facilities, and to construct
and establish new buildings at facilities under the
jurisdiction of the department to provide medical, dental,
and mental health treatment or housing for inmates.
b) SB 81 (Committee on Budget and Fiscal Review) Chapter
175, Statutes of 2007, specified additional items to be
included in the master plan relative to the construction
and renovation projects authorized by AB 900.
REGISTERED SUPPORT / OPPOSITION :
Support
Crime Victims United of California
Opposition
None
AB 2222
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Analysis Prepared by : Meghan Masera / PUB. S. / (916)
319-3744