BILL ANALYSIS
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Mark Leno, Chair S
2009-2010 Regular Session B
1
2
9
SB 1296 (Correa) 6
As Amended: April 7, 2010
Hearing date: April 20, 2010
Penal Code
SM:dl
PEACE OFFICER TRAINING: PTSD AND TBI
HISTORY
Source: Department of Veterans Affairs
Prior Legislation: SB 1531 (Correa) - Chap. 621, Statutes of
2008
Support: Unknown
Opposition:None known
KEY ISSUES
SHOULD POST BE REQUIRED TO MEET WITH THE DEPARTMENT OF VETERANS
AFFAIRS AND OTHER ORGANIZATIONS, AS SPECIFIED, THAT HAVE
EXPERTISE IN THE AREA OF TRAUMATIC BRAIN INJURY (TBI) AND
POST-TRAUMATIC STRESS DISORDER (PTSD) TO ASSESS THE TRAINING
NEEDED BY SPECIFIED PEACE OFFICERS, ON THE TOPIC OF RETURNING
VETERANS OR OTHER PERSONS SUFFERING FROM TBI OR PTSD?
SHOULD THE COMMISSION, IF IT DETERMINES THAT THERE IS A NEED FOR
TRAINING ON TBI AND PTSD, BE REQUIRED TO CREATE AND MAKE
AVAILABLE ON DVD A COURSE ON HOW TO RECOGNIZE AND INTERACT WITH
(More)
SB 1296 (Correa)
PageB
RETURNING VETERANS OR OTHER PERSONS SUFFERING FROM TBI OR PTSD
DESIGNED FOR, AND MADE AVAILABLE TO, PEACE OFFICERS WHO ARE
FIRST RESPONDERS TO EMERGENCY SITUATIONS, AS SPECIFIED?
(CONTINUED)
SHOULD THE COMMISSION BE REQUIRED TO DEVELOP THE TRAINING COURSE IN
CONSULTATION WITH THE DEPARTMENT OF VETERANS AFFAIRS AND APPROPRIATE
ORGANIZATIONS THAT HAVE EXPERTISE IN THE AREA OF TBI AND PTSD AND TO
MAKE THE COURSE AVAILABLE TO LAW ENFORCEMENT AGENCIES IN CALIFORNIA?
SHOULD THE COMMISSION BE REQUIRED TO DISTRIBUTE, AS NECESSARY, A
TRAINING BULLETIN VIA THE INTERNET TO LAW ENFORCEMENT AGENCIES
PARTICIPATING IN THE COMMISSION'S PROGRAM ON THE TOPIC OF TBI AND
PTSD?
SHOULD THE COMMISSION BE REQUIRED TO REPORT TO THE LEGISLATURE, NO
LATER THAN JUNE 30, 2012, ON THE EXTENT TO WHICH PEACE OFFICERS ARE
RECEIVING ADEQUATE TRAINING IN HOW TO INTERACT WITH PERSONS
SUFFERING FROM TBI OR PTSD?
PURPOSE
The purpose of this bill is to (1) require POST to meet with the
Department of Veterans Affairs and other organizations, as
specified, that have expertise in the area of traumatic brain
injury (TBI) and post-traumatic stress disorder (PTSD) to assess
the training needed by peace officers, who are first responders
in emergency situations, on the topic of returning veterans or
other persons suffering from TBI or PTSD; (2) provide that if
the commission determines that there is an unfulfilled need for
training on TBI and PTSD, require the commission to determine
the appropriate training format, as specified and, upon the next
regularly scheduled review of a training module relating to
persons with disabilities, create and make available on DVD a
course on how to recognize and interact with returning veterans
or other persons suffering from TBI or PTSD designed for, and
made available to, peace officers who are first responders to
(More)
SB 1296 (Correa)
PageC
emergency situations; (3) require the commission to develop the
training course in consultation with the Department of Veterans
Affairs and appropriate organizations that have expertise in the
area of TBI and PTSD and to make the course available to law
enforcement agencies in California; (4) require the commission
to distribute, as necessary, a training bulletin via the
Internet to law enforcement agencies participating in the
commission's program on the topic of TBI and PTSD; and (5)
require the commission to report to the Legislature, no later
than June 30, 2012, on the extent to which peace officers are
receiving adequate training in how to interact with persons
suffering from TBI or PTSD.
Existing law provides that by July 1, 2006, the Commission on
Peace Officer Standards and Training (POST) shall establish and
keep updated a continuing education classroom training course
relating to law enforcement interaction with mentally disabled
persons. The training course shall be developed by the
commission in consultation with appropriate community, local,
and state organizations and agencies that have expertise in the
area of mental illness and developmental disability, and with
appropriate consumer and family advocate groups. In developing
the course, the commission shall also examine existing courses
certified by the commission that relate to mentally disabled
persons. The commission shall make the course available to law
enforcement agencies in California.
The course shall consist of classroom instruction and shall
utilize interactive training methods to ensure that the training
is as realistic as possible. The course shall include, at a
minimum, core instruction in all of the following:
the cause and nature of mental illnesses and
developmental disabilities;
how to identify indicators of mental disability and how
to respond appropriately in a variety of common situations;
conflict resolution and de-escalation techniques for
potentially dangerous situations involving mentally
disabled persons;
(More)
SB 1296 (Correa)
PageD
appropriate language usage when interacting with
mentally disabled persons;
alternatives to lethal force when interacting with
potentially dangerous mentally disabled persons;
community and state resources available to serve
mentally disabled persons and how these resources can be
best utilized by law enforcement to benefit the mentally
disabled community; and
the fact that a crime committed in whole or in part
because of an actual or perceived disability of the victim
is a hate crime, as specified.
(Penal Code 13515.25(a-b).)
Existing law provides that the commission shall submit a report
to the Legislature by October 1, 2004, that shall include all of
the following:
a description of the process by which the course was
established, including a list of the agencies and groups
that were consulted;
information on the number of law enforcement agencies
that utilized, and the number of officers that attended,
the course or other courses certified by the commission
relating to mentally disabled persons from July 1, 2001,
to July 1, 2003, inclusive;
information on the number of law enforcement agencies
that utilized, and the number of officers that attended,
courses certified by the commission relating to mentally
disabled persons from July 1, 2000, to July 1, 2001,
inclusive; and
an analysis of the Police Crisis Intervention Training
(CIT) Program used by the San Francisco and San Jose
Police Departments, to assess the training used in these
programs and compare it with existing courses offered by
the commission in order to evaluate the adequacy of mental
disability training available to local law enforcement
officers.(Penal Code 13515.25(c).)
Existing law states that the Legislature encourages law
(More)
SB 1296 (Correa)
PageE
enforcement agencies to include the course created in this
section, and any other course certified by the commission
relating to mentally disabled persons, as part of their advanced
officer training program. (Penal Code 13515.25(d).)
Existing law states that it is the intent of the Legislature to
reevaluate, on the basis of its review of the report required in
subdivision (c), the extent to which law enforcement officers
are receiving adequate training in how to interact with mentally
disabled persons. (Penal Code 13515.25(e).)
This bill would require POST to meet with the Department of
Veterans Affairs and community, local, or other state
organizations and agencies that have expertise in the area of
traumatic brain injury (TBI) and post-traumatic stress disorder
(PTSD) in order to assess the training needed by peace officers,
who are first responders in emergency situations, on the topic
of returning veterans or other persons suffering from TBI or
PTSD.
This bill would, if the commission determines that there is an
unfulfilled need for training on TBI and PTSD, require the
commission to determine the training format that is both
fiscally responsible and meets the training needs of the
greatest number of officers.
This bill would, if the commission determines that there is an
unfulfilled need for training on TBI and PTSD, require the
commission, upon the next regularly scheduled review of a
training module relating to persons with disabilities, to create
and make available on DVD and may distribute electronically, or
provide by means of another form or method of training, a course
on how to recognize and interact with returning veterans or
other persons suffering from TBI or PTSD. This course shall be
designed for, and made available to, peace officers who are
first responders to emergency situations.
This bill would require the training course to be developed by
the commission in consultation with the Department of Veterans
Affairs and appropriate community, local, or other state
(More)
SB 1296 (Correa)
PageF
organizations and agencies that have expertise in the area of
TBI and PTSD. The commission would be required to make the
course available to law enforcement agencies in California.
This bill would further require the commission to distribute, as
necessary, a training bulletin via the Internet to law
enforcement agencies participating in the commission's program
on the topic of TBI and PTSD.
This bill would require the commission to report to the
Legislature, no later than June 30, 2012, on the extent to which
peace officers are receiving adequate training in how to
interact with persons suffering from TBI or PTSD.
This bill provides that its requirement for submitting a report
is inoperative on June 30, 2016, as specified.
This bill requires that the report is to be submitted as a
printed copy to both the Legislative Counsel and the Secretary
of the Senate, and as an electronic copy to the Chief Clerk of
the Assembly, and made available to the public in compliance
with the Government Code, as specified.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
The severe prison overcrowding problem California has
experienced for the last several years has not been solved. In
December of 2006 plaintiffs in two federal lawsuits against the
Department of Corrections and Rehabilitation sought a
court-ordered limit on the prison population pursuant to the
federal Prison Litigation Reform Act. On January 12, 2010, a
federal three-judge panel issued an order requiring the state to
reduce its inmate population to 137.5 percent of design capacity
-- a reduction of roughly 40,000 inmates -- within two years.
In a prior, related 184-page Opinion and Order dated August 4,
2009, that court stated in part:
"California's correctional system is in a tailspin,"
the state's independent oversight agency has reported.
. . . (Jan. 2007 Little Hoover Commission Report,
(More)
SB 1296 (Correa)
PageG
"Solving California's Corrections Crisis: Time Is
Running Out"). Tough-on-crime politics have increased
the population of California's prisons dramatically
while making necessary reforms impossible. . . . As a
result, the state's prisons have become places "of
extreme peril to the safety of persons" they house, .
. . (Governor Schwarzenegger's Oct. 4, 2006 Prison
Overcrowding State of Emergency Declaration), while
contributing little to the safety of California's
residents, . . . . California "spends more on
corrections than most countries in the world," but the
state "reaps fewer public safety benefits." . . . .
Although California's existing prison system serves
neither the public nor the inmates well, the state has
for years been unable or unwilling to implement the
reforms necessary to reverse its continuing
deterioration. (Some citations omitted.)
. . .
The massive 750% increase in the California prison
population since the mid-1970s is the result of
political decisions made over three decades, including
the shift to inflexible determinate sentencing and the
passage of harsh mandatory minimum and three-strikes
laws, as well as the state's counterproductive parole
system. Unfortunately, as California's prison
population has grown, California's political
decision-makers have failed to provide the resources
and facilities required to meet the additional need
for space and for other necessities of prison
existence. Likewise, although state-appointed experts
have repeatedly provided numerous methods by which the
state could safely reduce its prison population, their
recommendations have been ignored, underfunded, or
postponed indefinitely. The convergence of
tough-on-crime policies and an unwillingness to expend
the necessary funds to support the population growth
has brought California's prisons to the breaking
point. The state of emergency declared by Governor
(More)
SB 1296 (Correa)
PageH
Schwarzenegger almost three years ago continues to
this day, California's prisons remain severely
overcrowded, and inmates in the California prison
system continue to languish without constitutionally
adequate medical and mental health care.<1>
The court stayed implementation of its January 12, 2010 ruling
pending the state's appeal of the decision to the U.S. Supreme
Court. That appeal, and the final outcome of this litigation,
is not anticipated until later this year or 2011.
This bill does not appear to aggravate the prison overcrowding
crisis described above.
COMMENTS
1. Need for This Bill
According to the author:
Traumatic Brain Injury (TBI) and Post Traumatic Stress
Disorder (PTSD) have been identified as the "signature
injuries" and "silent epidemics" affecting an
increasing number of veterans returning from recent
military conflicts. It has been estimated that
300,000 Iraq and Afghanistan war veterans are
afflicted with PTSD. Persons with TBI are often
referred to as the "walking wounded." Their injuries,
mostly unnoticeable at first sight, pose certain
challenges to those who come in contact with them.
TBI and PTSD symptoms can sometimes include behaviors
of anger, hostility, and aggression.
----------------------
<1> Three Judge Court Opinion and Order, Coleman v.
Schwarzenegger, Plata v. Schwarzenegger, in the United States
District Courts for the Eastern District of California and the
Northern District of California United States District Court
composed of three judges pursuant to Section 2284, Title 28
United States Code (August 4, 2009).
(More)
SB 1296 (Correa)
PageI
SB 1296 will provide the necessary tools for peace
officers who are first responders to emergency
situations to recognize and interact with returning
veterans or other persons suffering from TBI and PTSD.
2. What are PTSD and TBI ?
An article in the Journal of Rehabilitation Research &
Development describes PTSD and TBI as follows:
Posttraumatic Stress Disorder
Criteria and Symptoms
As defined in the Diagnostic and Statistical Manual
(DSM)-Fourth Edition-Text Revised (DSM-IV-TR), PTSD is
an anxiety disorder comprising four major criteria:
1. Exposure to or witnessing an event that is
threatening to one's well-being and responding with
intense fear, helplessness, or horror.
2. Symptoms of re-experiencing, such as recurrent and
intrusive memories, nightmares, a sense of reliving
the trauma, or psychological and physiological
distress when reminded of aspects of the trauma.
3. Avoidance of thoughts, feelings, or reminders of
the trauma, and the inability to recall parts of the
trauma, withdrawal, and emotional numbing.
4. Arousal increases, as manifested in sleep
disturbance, irritability, difficulty concentrating,
hypervigilance, or exaggerated startle response.
These symptoms must cause marked impairment in
functioning and persist for at least 1 month after the
trauma. PTSD also has accompanying cognitive effects
that include impaired concentration and decision
making, memory impairment and confusion; behavioral
symptoms of increased relational conflict resulting in
social withdrawal, alienation, reduced relational
intimacy and impaired work and school performance; and
(More)
SB 1296 (Correa)
PageJ
somatic complaints of exhaustion, insomnia, headaches,
startle response, hyperarousal, and cardiovascular,
gastrointestinal, and musculoskeletal
disorders.(Posttraumatic Stress Disorder and
Posttraumatic Stress Disorder-LikeSymptoms and Mild
Traumatic Brain Injury, 895 JRRD Volume 44, Number 7,
2007, Pages 895-920, Journal of Rehabilitation
Research & Development.)
Traumatic Brain Injury
Mechanisms and Criteria
TBI may arise from physical damage by external blunt
or penetrating trauma to the head, skull, dura, or
brain or from acceleration-deceleration movement such
as whiplash or coup-contrecoup, resulting in tearing
or shearing of nerve fibers and bruising or contusion
of the brain against opposite sides of the skull.
Scraping of the brain across the rough bony base of
the skull can cause contusion and can also affect the
olfactory, oculomotor, optic, and acoustic nerves,
leading to anosmia (total loss of the sense of smell,
reduction of taste), double and/or blurred vision, and
dizziness and/or vertigo. These symptoms usually
remit after days and weeks as the damaged axons in
those nerves recover or grow back to reinnervate the
sensory receptors or muscles.
* * * * * * *
Symptoms
With most TBIs, a set of postconcussive symptoms occur
immediately after brain injury and can include
cognitive deficits in memory, attention, and
concentration; physical or somatic complaints of
fatigue, disordered sleep, dizziness, and headache;
and affective complaints of irritability, anxiety, and
depression. In evaluating the symptoms associated with
TBI, clinicians should account for multiple factors
related to the characteristics of the individual
(More)
SB 1296 (Correa)
PageK
injured, severity of the injury, and the time interval
from injury to evaluation that can influence the level
of functional and cognitive performance [14]. Mild
TBI can cause cognitive deficits not only in speed of
information processing, attention, and memory in the
immediate postinjury period but also in motor skills
and new problem-solving and general intellectual
skills [15].
Fortunately, good recovery of postconcussive deficits
can be expected over a time ranging from 4 to 12 weeks
for the majority of patients with mild TBI cases.
However, some patients may recover much more slowly,
with symptoms lingering for several more months [16]
or even years [17]. In terms of the emotional
sequelae of TBI, Rao and Lyketsos state the most
common post-TBI anxiety symptoms include
"free-floating anxiety, fearfulness, intense worry,
generalized uneasiness, social withdrawal,
interpersonal sensitivity and anxiety dreams" [18].
These symptoms are also similar to characteristic PTSD
symptoms and therefore can be a problematic overlap in
considering PTSD incidence rates in those persons with
mild TBI. (Id.)
3. TBI in California
In January 2010, the Senate Office of Research prepared an
"Overview of Traumatic Brain Injury in California," for the
Senate Health Committee. It found:
The Centers for Disease Control estimate 1.4 million
Americans receive Traumatic Brain Injuries annually.
TBI is an injury sustained after birth from an
external force to the brain or any of its parts that
results in psychological, neurological or anatomical
changes in brain functions. Nationwide, the CDC
identifies 5.3 million Americans as having long-term
or lifelong disabilities associated with TBI,
including 350,000 Californians. Approximately 50,000
(More)
SB 1296 (Correa)
PageL
people die annually from TBI. Medical and indirect
costs, such as lost productivity, totaled $60 billion
nationally in 2000.
More than a quarter of the TBI cases result from
falls, another 20 percent are the result of vehicle
accidents and 30 percent are from either assaults or
blows. Additionally, there are two, recent,
high-profile population TBI patients:
4 Athletes, especially football players. Spurred by a
June 2009 study at a brain trauma research center
based at Boston University that showed six of six
ex-NFL football players had extensive TBI from playing
the sport, a controversy has continued to play out
through the fall about whether concussions in sports
lead to lifelong brain trauma.
4 Iraqi and Afghanistan war veterans. The U.S.
Department of Veteran's Affairs, which established a
TBI administration after the Gulf War, noted that
while 14 percent of previous war veterans had TBI,
this war's brain injured veterans is "much higher."
Some providers estimate that 60 percent of injured
vets also have TBI.
Long term symptoms of Traumatic Brain Injury include
memory loss, physical aggression, depression,
difficulty expressing thoughts or understanding
others, seizures, impaired social skills and
inappropriate sexual activity, inability to accept
limitations and heightened risk of Alzheimer's.
In California, funds from traffic and other motor
vehicle fines are diverted into a variety of funds,
including a Traumatic Brain Fund.<2> In FY 2009-2010
the fund total was $1.05 million. This finances seven
Traumatic Brain Injury Services of California centers
----------------------
<2> California Penal Code Section 1464(f)(8)(A) directs 0.66
percent of fees be transferred into the Traumatic Brain Injury
fund.
(More)
SB 1296 (Correa)
PageM
throughout the state, which provide referrals and
written materials to TBI survivors.
With 350,000 TBI survivors, California has the highest
number of any state. Yet, according to a 2004 summary
of state TBI trust funds, California allocates fewer
total dollars to its TBI trust fund than many states,
including Kentucky, Louisiana, New Mexico and
Oklahoma.
***************
(More)
4. Our Responsibility to the Injured
A 2008 RAND Corporation study of the effects of these hidden
types of injuries on service members concluded:
Treating the Invisible Wounds of War
Addressing PTSD, depression, and TBI among those who
deployed to Afghanistan and Iraq is a national
priority. But it is not an easy undertaking. The
prevalence of such wounds is high and may grow as the
conflicts continue. And long-term negative
consequences are associated with these conditions if
they are not treated with evidence-based,
patient-centered, efficient, equitable, and timely
care. The systems of care available to address these
wounds have been improved significantly, but critical
gaps remain.
The nation must ensure that quality care is available
and provided to military veterans now and in the
future. As a group, the veterans returning from
Afghanistan and Iraq are predominantly young, healthy,
and productive members of society. However, about a
third are currently affected by PTSD or depression, or
report exposure to a possible TBI while deployed.
Whether the TBIs will translate into any lasting
impairments is unknown. In the absence of knowing,
these injuries cause great concern for servicemembers
and their families. These veterans need our attention
now to ensure successful adjustment post-deployment
and full recovery.
Meeting the goal of providing care for these service
members will require systemlevel changes, which means
expanding the nation's focus to consider issues not
just within DoD and the VA, from which the majority of
veterans will receive benefits, but also across the
overall U.S. health care system, in which many will
(More)
SB 1296 (Correa)
PageO
seek care through other, employer-sponsored health
plans and in the public sector (e.g., Medicaid).
System-level changes are essential if the nation is to
have the resources it needs to meet its responsibility
not only to recruit, prepare, and sustain a military
force but also to address Service-connected injuries
and disabilities.
ARE PERSONS SUFFERING FROM TBI OR PTSD MORE LIKELY TO HAVE
DIFFICULT ENCOUNTERS WITH LAW ENFORCEMENT?
WOULD IT BE HELPFUL TO LAW ENFORCEMENT AND THE PUBLIC TO BE
FAMILIAR WITH THE SYMPTOMS OF THESE CONDITIONS AND HOW TO
REACT TO THEM?
SHOULD THE POST COMMISSION BE REQUIRED TO DETERMINE, AS
SPECIFIED, IF ADDITIONAL TRAINING FOR PEACE OFFICERS IS
NEEDED IN DEALING WITH PERSONS WITH PTSD OR TBI?
SHOULD THE COMMISSION BE REQUIRED, IF IT DETERMINES THAT
ADDITIONAL TRAINING IS NEEDED, TO DEVELOP AND MAKE
AVAILABLE THAT ADDITIONAL TRAINING, AS SPECIFIED?
**************