BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 743|
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UNFINISHED BUSINESS
Bill No: SB 743
Author: Senate Health Committee
Amended: 6/1/09
Vote: 21
SENATE HEALTH COMMITTEE : 11-0, 4/1/09
AYES: Alquist, Strickland, Aanestad, Cedillo, Cox,
DeSaulnier, Leno, Maldonado, Negrete McLeod, Pavley, Wolk
SENATE JUDICIARY COMMITTEE : 5-0, 4/21/09
AYES: Corbett, Harman, Florez, Leno, Walters
SENATE FLOOR : 37-0, 4/23/09
AYES: Aanestad, Alquist, Ashburn, Benoit, Calderon,
Cedillo, Cogdill, Corbett, Correa, Cox, Denham,
DeSaulnier, Dutton, Florez, Hancock, Hollingsworth, Huff,
Kehoe, Leno, Liu, Lowenthal, Maldonado, Negrete McLeod,
Oropeza, Padilla, Pavley, Romero, Runner, Simitian,
Steinberg, Strickland, Walters, Wiggins, Wolk, Wright,
Wyland, Yee
NO VOTE RECORDED: Ducheny, Harman, Vacancy
ASSEMBLY FLOOR : 77-0, 6/30/09 - See last page for vote
SUBJECT : Health facilities: psychiatric patient release
SOURCE : Author
DIGEST : This bill clarifies the immunities from civil
and criminal liability that are granted to specified
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hospitals and their staff related to the detention of
persons who cannot be safely released from the hospital
because they are a danger to themselves, to others, or are
gravely disabled, as defined.
Assembly Amendments clarify that telephone calls or other
contacts will commence at the earliest possible time when
the treating physician and surgeon have determined the time
at which the person will be medically stable for transfer.
ANALYSIS :
Existing Federal Law
The Emergency Medical Treatment and Active Labor Act
(EMTALA) governs when and how a patient may be refused
treatment or transferred form one hospital to another when
he or she is in an unstable medical condition. Under
EMTALA, a psychiatric patient is considered stable for
discharge if the patient is no longer considered a threat
to him/herself or others. Stabilization does not require
resolution of an emergency psychiatric condition; rather a
patient must be sufficiently evaluated and treated to the
point that the discharging professional reasonably believes
that the patient is unlikely to harm him/herself or others.
Existing federal law provides that psychiatric emergencies
include, but are not limited to, depression with feelings
of suicidal hopelessness, delusions, severe insomnia,
helplessness, history of recent suicidal attempts or
suicidal ideation, recent assault, self-mutilation, or
destructive behavior, and psychotic behavior.
Existing State Law
The Lanterman-Petris-Short (LPS) Act governs the
involuntary detention of persons who exhibit behavior that
makes them a danger to themselves or to others who are so
gravely disabled that they cannot take care of themselves.
The LPS Act allows a peace officer or a member of the
attending staff or members of a mobile crisis team or other
professional designated by the county to take that person
into custody and place him or her in a county-designated
facility (hospital facilities with inpatient psychiatric
services) for up to 72 hours for treatment and psychiatric
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evaluation. Further, the LPS Act imposes strict rules on
the detention, assessment and treatment of the detained
person. Provided all the rules are adhered to, the peace
officer and the medical director of the facility, as well
as the professional staff responsible for the evaluation
and treatment of the person, are granted immunity from
civil and criminal liability for detaining the person,
releasing the detained person at any time prior to the end
of the 72-hour hold, or for any actions of that person
released before or after the 72-hour hold.
Existing law also grants civil and criminal immunity to
non-county designated hospitals (hospitals with no
inpatient psychiatric services) related to the detention
and release of individuals who are a harm to themselves or
others, or are gravely disabled and meet certain criteria.
Such individuals may be detained for up to 24 hours,
generally, to allow time to arrange for the placement of an
individual in a 72-hour hold for further treatment and
evaluation. Specified conditions must be met for the
immunity to be granted.
Current law lists certain conditions under which a hospital
may detain an individual beyond eight hours, one of which
is that a transfer has not been delayed for appropriate
mental health evaluation or treatment.
This bill clarifies that the immunity from civil and
criminal liability that is granted to the specified
hospitals and staff for the detention of any person that
cannot be safely released from the hospital because they
are a danger to themselves, or others, or are gravely
disabled, as defined, applies whether or not they qualify
for a 72-hour evaluation.
This bill clarifies that telephone calls or other contacts
will commence at the earliest possible time when the
treating physician and surgeon has determined the time at
which the person will be medically stable for transfer.
This bill clarifies that these immunities also apply for
the actions after release of a person who was detained up
to 24 hours and who meets specified criteria.
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This bill clarifies the conditions under which a hospital
may detain a patient beyond eight hours to include when a
transfer for any time of evaluation or treatment (mental
health or physical health) is delayed.
This bill also makes other related technical changes.
Background
The LPS Act was enacted to protect patients in the mental
health care system as well as the surrounding community.
The California Hospital Association states that at the time
the LPS Act was enacted, no one anticipated patients would
need to be detained in hospitals without psychiatric
inpatient beds, because there was an adequate supply of
psychiatric beds in most communities. SB 916 (Yee),
Chapter 308, Statutes of 2007, changed the law to allow
hospitals to detain individuals who are a danger to
themselves or others, or are gravely disabled up to 24
hours. These changes were needed to give hospitals time to
assess a patient's physical and mental health needs and to
secure psychiatric treatment, when necessary. After
enactment of the law, technical issues were identified,
which this bill seeks to address, primarily that
individuals may be brought into hospitals by family members
or friends and do not come in detained under Section 5150,
therefore, this clause that was put into law by SB 916
would be deleted.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 6/26/09)
California Hospital Association
California Psychiatric Association
Civil Justice Association of California
ARGUMENTS IN SUPPORT : The California Hospital
Association states that this bill will provide clarity and
uniform application of the law regarding individuals who
are a danger to themselves or others or are gravely
disabled and present themselves at hospitals that have no
inpatient psychiatric services. The California Psychiatric
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Association contends that this bill offers small, simple
changes in policy that will be valuable to the patients
that will increase access to services.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, De La Torre, De Leon,
DeVore, Duvall, Emmerson, Eng, Evans, Feuer, Fletcher,
Fong, Fuentes, Fuller, Furutani, Gaines, Galgiani,
Garrick, Gilmore, Hagman, Hall, Harkey, Hayashi,
Hernandez, Hill, Huber, Huffman, Jeffries, Jones, Knight,
Krekorian, Lieu, Logue, Bonnie Lowenthal, Ma, Mendoza,
Miller, Monning, Nava, Nestande, Niello, Nielsen, John A.
Perez, V. Manuel Perez, Portantino, Ruskin, Salas,
Saldana, Silva, Skinner, Smyth, Solorio, Audra
Strickland, Swanson, Torlakson, Torres, Torrico, Tran,
Yamada, Bass
NO VOTE RECORDED: Davis, Villines, Vacancy
CTW:cm 9/16/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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