BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                  SB 1399|
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                                 THIRD READING


          Bill No:  SB 1399
          Author:   Leno (D)
          Amended:  5/20/10
          Vote:     21

           
           SENATE PUBLIC SAFETY COMMITTEE  :  5-2, 4/20/10
          AYES:  Leno, Cedillo, Hancock, Steinberg, Wright
          NOES:  Cogdill, Huff

           SENATE APPROPRIATIONS COMMITTEE  :  7-1, 5/17/10
          AYES:  Kehoe, Cox, Alquist, Corbett, Leno, Wolk, Yee
          NOES:  Denham
          NO VOTE RECORDED:  Price, Walters, Wyland


           SUBJECT  :    Medical Parole

           SOURCE  :     Federal Prison Health Care Receiver


           DIGEST  :    This bill establishes a medical parole program  
          for certain state prison inmates, as specified.  This bill  
          requires the Department of Corrections and Rehabilitation  
          to:  1) Enter into memoranda of understanding with the  
          Social Security Administration and the State Department of  
          Health Care Services to facilitate prerelease agreements to  
          help inmates initiate benefits claims; 2) pay the state  
          share of Medi-Cal costs for inmates that have been granted  
          medical parole; 3) reimburse providers for the medical  
          treatment and long-term care costs of inmates granted  
          medical parole who have not retained medical insurance, at  
          a rate no lower than the Medi-Cal rate until a parolee  
                                                           CONTINUED





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          retains alternate health care coverage; and 4) reimburse  
          counties for costs associated with providing an inmate  
          granted medical parole with a public guardian.  This bill  
          specifies a medical evaluation process, and requirements  
          for the Board of Parole Hearings.

           ANALYSIS  :    Existing law provides that if the Secretary of  
          the Department of Corrections and Rehabilitation (CDCR) or  
          the Board of Parole Hearings (BPH) or both determine that a  
          prisoner is either: 

          1.Terminally ill with an incurable condition caused by an  
            illness or disease that would produce death within six  
            months, as determined by a physician employed by CDCR; or  


          2.The prisoner is permanently medically incapacitated with  
            a medical condition that renders him or her permanently  
            unable to perform activities of basic daily living, and  
            results in the prisoner requiring 24-hour total care,  
            including, but not limited to, coma, persistent  
            vegetative state, brain death, ventilator-dependency,  
            loss of control of muscular or neurological function, and  
            that incapacitation did not exist at the time of the  
            original sentencing;

          3.And that the conditions under which the prisoner would be  
            released or receive treatment do not pose a threat to  
            public safety, 

          The secretary or BPH may recommend to the court that the  
          prisoner's sentence be recalled and that the court shall  
          have the discretion to resentence or recall if the court  
          finds that the facts described above exist.  (Penal Code  
          section 1170(e)(1) and (e)(2).)

          Existing law provides that BPH shall make findings, as  
          specified, before making a recommendation for resentencing  
          or recall to the court.  This subdivision does not apply to  
          a prisoner sentenced to death or a term of life without the  
          possibility of parole.  (Penal Code section (e)(2).  

          Existing law provides that within 10 days of receipt of a  
          positive recommendation by the secretary or BPH, the court  







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          shall hold a hearing to consider whether the prisoner's  
          sentence should be recalled.  (Penal Code section (e)(3).)

          Existing law provides that any physician employed by CDCR  
          who determines that a prisoner has six months or less to  
          live shall notify the chief medical officer of the  
          prognosis.  If the chief medical officer concurs with the  
          prognosis, he or she shall notify the warden.  Within 48  
          hours of receiving notification, the warden or the warden's  
          representative shall notify the prisoner of the recall and  
          resentencing procedures, and shall arrange for the prisoner  
          to designate a family member or other outside agent to be  
          notified as to the prisoner's medical condition and  
          prognosis, and as to the recall and resentencing  
          procedures.  If the inmate is deemed mentally unfit, the  
          warden or the warden's representative shall contact the  
          inmate's emergency contact and provide the information  
          described above, as specified.  (Penal Code section  
          (e)(4).)

          Existing law provides that the warden or the warden's  
          representative shall provide the prisoner and his or her  
          family member, agent, or emergency contact, updated  
          information throughout the recall and resentencing process  
          with regard to the prisoner's medical condition and the  
          status of the prisoner's recall and resentencing  
          proceedings.  (Penal Code section (e)(5).)

          Existing law provides that the prisoner or his or her  
          family member or designee may independently request  
          consideration for recall and resentencing by contacting the  
          chief medical officer at the prison or the secretary.  Upon  
          receipt of the request, the chief medical officer and the  
          warden or the warden's representative shall follow the  
          procedures described above.  If the secretary determines  
          that the prisoner satisfies the criteria for sentencing  
          recall described above, the secretary or BPH may recommend  
          to the court that the prisoner's sentence be recalled.  The  
          secretary shall submit a recommendation for release within  
          30 days in the case of inmates sentenced to determinate  
          terms and, in the case of inmates sentenced to  
          indeterminate terms, the secretary shall make a  
          recommendation to BPH with respect to the inmates who have  
          applied under this section.  BPH shall consider this  







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          information and make an independent judgment of eligibility  
          and make findings related thereto before rejecting the  
          request or making a recommendation to the court.  This  
          action shall be taken at the next lawfully noticed board  
          meeting.  (Penal Code section (e)(6).)

          Existing law provides that any recommendation for recall  
          submitted to the court by the secretary or BPH shall  
          include one or more medical evaluations, a postrelease  
          plan, and findings pursuant to paragraph (2).  (Penal Code  
          section (e)(7).)

          Existing law provides that, if possible, the matter shall  
          be heard before the same judge of the court who sentenced  
          the prisoner.

          Existing law provides that if the court grants the recall  
          and resentencing application, the prisoner shall be  
          released by CDCR within 48 hours of receipt of the court's  
          order, unless a longer time period is agreed to by the  
          inmate.  At the time of release, the warden or the warden's  
          representative shall ensure that the prisoner has each of  
          the following in his or her possession: a discharge medical  
          summary, full medical records, state identification, parole  
          medications, and all property belonging to the prisoner.   
          After discharge, any additional records shall be sent to  
          the prisoner's forwarding address.  (Penal Code section  
          (e)(9).) 

          Existing law provides that the secretary shall issue a  
          directive to medical and correctional staff employed by  
          CDCR that details the guidelines and procedures for  
          initiating a recall and resentencing procedure.  The  
          directive shall clearly state that any prisoner who is  
          given a prognosis of six months or less to live is eligible  
          for recall and resentencing consideration, and that recall  
          and resentencing procedures shall be initiated upon that  
          prognosis.  (Penal Code section (e)(10).)

          This bill requires CDCR to complete all of the following  
          tasks associated with inmates granted medical parole  
          pursuant to Section 3041 or 3550:

          1.CDCR shall enter into memoranda of understanding with the  







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            Social Security Administration and the State Department  
            of Health Care Services to facilitate prerelease  
            agreements to help inmates initiate benefits claims.

          2.CDCR shall pay the state share of Medi-Cal costs for  
            inmates that have been granted medical parole.

          3.CDCR shall reimburse providers for the medical treatment  
            and long-term care costs of inmates granted medical  
            parole who have not retained medical insurance, at a rate  
            no lower than the Medi-Cal rate until the point that a  
            parolee retains alternate health care coverage.

          4.CDCR shall reimburse counties for the costs associated  
            with providing an inmate granted medical parole with a  
            public guardian.

          This bill provides that, except as specified below, a  
          prisoner who the chief medical officer at the institution  
          where the prisoner is located, determines the prisoner  
          suffers from a significant and permanent condition,  
          disease, or syndrome resulting in the prisoner being  
          physically or cognitively debilitated or incapacitated  
          shall be granted medical parole if BPH determines that the  
          conditions under which the prisoner would be released would  
          not reasonably pose a threat to public safety.

          This bill provides that this "medical parole" shall not  
          apply to:

          1.Any prisoner sentenced to death,
          2.Any prisoner sentenced to life in prison without  
            possibility of parole or 
          3.Any inmate who is serving a sentence for which medical  
            parole is prohibited by any initiative statute. 

          This bill provides that medical parole placements and  
          revocations shall be made in accordance with the Victim's  
          Bill of Rights Act of 2008:  Marsy's Law.

          This bill provides that when a physician employed by CDCR  
          who is the primary care provider for an inmate identifies  
          an inmate that he or she believes meets the criteria for  
          medical parole, as specified, the primary care physician  







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          shall recommend to the chief medical officer of the  
          institution where the prisoner is located that the prisoner  
          be referred to BPH for consideration for medical parole.   
          Within 30 days of receiving that recommendation, if the  
          chief medical officer concurs in the recommendation of the  
          primary care physician he or she shall, refer the matter to  
          BPH, and if the chief medical officer does not concur in  
          the recommendation, he or she shall provide the primary  
          care physician with a written explanation of the reasons  
          for denying the referral.

          This bill provides that the prisoner or his or her family  
          member or designee may independently request consideration  
          for medical parole by contacting the chief medical officer  
          at the prison or the secretary.  Within 30 days of  
          receiving the request, the chief medical officer shall, in  
          consultation with the prisoner's primary care physician,  
          make a determination whether the prisoner meets the  
          criteria for medical parole as specified, and, if the chief  
          medical officer determines that the prisoner does satisfy  
          the specified criteria he or she shall refer the matter to  
          BPH.  If the chief medical officer does not concur in the  
          recommendation, he or she shall provide the prisoner or his  
          or her family member or designee with a written explanation  
          of the reasons for denying the application.

          This bill provides that upon receiving a recommendation  
          from a chief medical officer of CDCR for a prisoner to be  
          granted medical parole, BPH, as specified, shall make an  
          independent judgment regarding whether the conditions under  
          which the inmate would be released pose a reasonable threat  
          to public safety, and make findings related thereto.  

          This bill provides that the Division of Adult Parole  
          Operations shall have the authority to impose any  
          reasonable conditions on prisoners subject to medical  
          parole supervision, including, but not limited to, the  
          requirement that the parolee submit to electronic  
          monitoring.  As a further condition of medical parole the  
          parolee may be required to submit to an examination by a  
          physician for the purpose of diagnosing their current  
          medical condition.  In the event such an examination takes  
          place, a report of the examination and diagnosis shall be  
          submitted to BPH by the examining physician.  If BPH  







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          determines that the person's medical condition has  
          substantially improved and that the person poses a threat  
          to public safety, BPH may revoke the parole and return the  
          person to the custody of CDCR.

          This bill provides that a prisoner placed on medical parole  
          supervision prior to the earliest possible parole date that  
          the prisoner would otherwise have been released to parole  
          under, shall remain on medical parole, until that earliest  
          possible parole date, at which time the parolee shall  
          commence serving the normal period of parole that they  
          would otherwise have been subject to.

          This bill requires CDCR, at the time a prisoner is placed  
          on medical parole, to ensure that the prisoner has applied  
          for any federal entitlement programs for which the prisoner  
          is eligible, and has in his or her possession a discharge  
          medical summary, full medical records, parole medications,  
          and all property belonging to the prisoner that was under  
          the control of CDCR.  Any additional records shall be sent  
          to the prisoner's forwarding address after release to  
          health care-related parole supervision.

           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  
          MOUs           minor & absorbable, one-time workload      
          General
          Administration                               minor &  
          absorbable BPH costs                                      
          General
                                potentially substantial prison cost
                                reduction
          Federal waiver      potentially significant DHCS workload    
             General

           SUPPORT  :   (Verified  5/19/10)








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          Federal Prison Health Care Receiver (source) 
          California Catholic Conference
          Crestwood Behavioral Health, Inc.
          Life Support Alliance
          Service International Employee's Union, Local 1000

           OPPOSITION  :    (Verified  5/19/10)

          Taxpayers for Improving Public Safety
          California Hospital Association

           ARGUMENTS IN SUPPORT  :    According to the author's office:

               Does it make sense for the state to pay for two  
               correctional officers to guard an inmate  
               24-hours-a-day as the inmate lies comatose or in a  
               permanent vegetative state in a hospital bed?  Does it  
               make sense for CDCR to become a long-term care  
               facility for inmates with, for example, end-stage  
               Alzheimer's disease, whose dementia is so severe they  
               no longer understand that they are in prison?   
               California is paying tens of millions of dollars every  
               year to incarcerate these very high-cost inmates.   
               These offenders were sent to prison to protect society  
               and to punish them for their crimes.  Because of their  
               medical condition, however, they are no longer a  
               threat and the ones being punished are the taxpayers.   


               California is not alone in facing this problem.   
               Across the country 36 states have implemented some  
               form of medical release to relieve them of the  
               crushing financial burden of keeping inmates in prison  
               whose medical condition has rendered their  
               incarceration no longer necessary.  In 1997,  
               California first authorized the Secretary of CDCR or  
               the Parole Board to recommend to the sentencing judge  
               that an inmate's sentence be recalled due to terminal  
               illness.  Ten years later that authority was extended  
               to cover cases of medical incapacitation.  However,  
               last year only two such releases were approved and we  
               continue to incarcerate inmates who could, by any  
               rational standard, be released without posing a threat  
               to the public.  







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               SB 1399 addresses some of the issues that have been  
               identified as problematic in the current law.  Rather  
               than requiring a sentence recall it creates an  
               alternative procedure that permits these inmates to be  
               placed on parole supervision under conditions  
               determined by the parole board, and allows the parole  
               to be revoked if for any reason the parolee's  
               condition changes and creates a danger to the public.

               This medical parole will place public safety paramount  
               and stop needlessly punishing the taxpayers.  

           ARGUMENTS IN OPPOSITION  :    The California Hospital  
          Association (CHA) state that "Patients receiving medical  
          care in any setting, including acute-care hospitals and  
          post-acute settings such as long-term acute-care hospitals,  
          skilled-nursing facilities and home health care must be  
          under the care of a physician. While incarcerated, the  
          patient is under the care of a department physician,  
          regardless of where they reside. In order to be released  
          and to receive treatment at a medical facility, a community  
          physician who will agree to assume care of the  
          patient/parolee must be identified. CHA recommends that the  
          bill be amended to require that a receiving facility and  
          community physician be identified and agree to accept the  
          patient before medical parole is granted.

          "The bill currently requires that the warden ensure that a  
          prisoner has applied for any federal entitlement programs  
          for which they are eligible at the time they are placed on  
          medical parole supervision. CHA requests that the bill be  
          amended to require a pre-release application process, and  
          the establishment of benefits as a condition for release to  
          medical parole. Such a process would increase the  
          likelihood of success of the medical parole program."  
           

          RJG:nl  5/20/10   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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