BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1296|
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THIRD READING
Bill No: SB 1296
Author: Correa (D)
Amended: 4/7/10
Vote: 21
SENATE PUBLIC SAFETY COMMITTEE : 7-0, 4/20/10
AYES: Leno, Cogdill, Cedillo, Hancock, Huff, Steinberg,
Wright
SENATE APPROPRIATIONS COMMITTEE : 10-0, 5/27/10
AYES: Kehoe, Alquist, Corbett, Denham, Leno, Price,
Walters, Wolk, Wyland, Yee
NO VOTE RECORDED: Cox
SUBJECT : Peace officer training: traumatic brain
injury: post-
Traumatic stress disorder
SOURCE : Department of Veterans Affairs
DIGEST : This bill: (1) requires the Commission on Peace
Officer Standards and Training (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) provides that if the commission determines
that there is an unfulfilled need for training on TBI and
CONTINUED
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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 emergency situations; (3) requires 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) requires 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)
requires 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.
ANALYSIS : Existing law provides that POST establish and
keep updated various training programs to maintain the
level of competence of various law enforcement officers.
This bill requires 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 TBI and 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, if the commission determines that there is an
unfulfilled need for training on TBI and PTSD, requires 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, if the commission determines that there is an
unfulfilled need for training on TBI and PTSD, requires 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
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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 requires the training course to be developed by
the commission in consultation with the Department of
Veterans Affairs and appropriate community, local, or other
state 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 further requires 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 requires 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.
Background
What are TBI and PTSD ?
An article in the Journal of Rehabilitation Research &
Development describes TBI and PTSD as follows:
Posttraumatic Stress Disorder: Criteria and Symptoms
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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 one 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 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
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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 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.)
TBI in California
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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
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:
1. 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.
2. 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
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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. In FY 2009-2010 the
fund total was $1.05 million. This finances seven
Traumatic Brain Injury Services of California centers
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.
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.
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Meeting the goal of providing care for these service
members will require system level 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 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
POST training development $88-150$88-150 likely minor
General
SUPPORT : (Verified 5/27/10)
Department of Veterans Affairs (source)
American Legion
AMVETS
California Brain Injury Association
Vietnam Veterans of America
ARGUMENTS IN SUPPORT : According to the author's office:
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
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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.
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.
RJG:nl 5/28/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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