BILL ANALYSIS                                                                                                                                                                                                    �



                                                                      



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          |SENATE RULES COMMITTEE            |                  AB 1062|
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                                 THIRD READING


          Bill No:  AB 1062
          Author:   Dickinson (D)
          Amended:  8/24/12 in Senate
          Vote:     21

           
          PRIOR VOTES NOT RELEVANT

          �See note in Digest]


           SUBJECT  :    Public social services

           SOURCE  :     Author


           DIGEST  :    This bill changes the evidentiary standard of 
          proof for elder and dependent abuse or neglect cases from 
          clear and convincing to preponderance of the evidence.

           Senate Floor Amendments  of 8/24/12 delete the prior version 
          of the bill relating to arbitration, and instead change the 
          evidentiary standard of proof for elder and dependent abuse 
          or neglect cases from clear and convincing to preponderance 
          of the evidence.

          �NOTE: The August 24, 2012 amendments are contained in SB 
                 558 (Simitian), which passed the Senate (21-14) on 
                 June 1, 2012.  The bill is held under submission in 
                 the Assembly Appropriations Committee.]

           ANALYSIS  :    

                                                           CONTINUED





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          Existing law:

          1. Provides for the award of attorney's fees and costs to, 
             and the recovery of damages by, a plaintiff, when it is 
             proven by clear and convincing evidence that a defendant 
             is liable for physical abuse or neglect of an elder or 
             dependent adult and the defendant has also been guilty 
             of recklessness, oppression, fraud, or malice in the 
             commission of the abuse.

          2. Authorizes a plaintiff to recover damages for the sake 
             of example and by way of punishing the defendant in 
             addition to the actual damages. 

          3. Provides that an employer is not liable for punitive 
             damages based on the acts of an employee unless certain 
             conditions are satisfied. 

          4. Requires that these conditions regarding the imposition 
             of punitive damages on an employer based upon the acts 
             of an employee be satisfied before any damages or 
             attorney's fees permitted due to liability for physical 
             abuse or neglect of an elder or dependent adult are 
             authorized to be imposed against an employer.

          In 2002, the U.S. General Accounting Office (GAO) prepared 
          a report on nursing home resident abuse.  This report was 
          presented to the U.S. Senate Special Committee on Aging.  
          The GAO found that 30 percent of the 17,000 nursing homes 
          in the United States were cited for deficiencies involving 
          actual harm to the nursing home residents or for placing 
          the residents at risk of death or serious injury.  (Nursing 
          Homes: More Can Be Done to Protect Residents from Abuse, 
          GAO-02-312, Mar 1, 2002, 
          http://www.gao.gov/new.items/d02312.pdf as of Apr 2, 2011.) 
           This report stated that "relatively few prosecutions 
          result from allegations of physical and sexual abuse of 
          nursing home residents because allegations of abuse were 
          not always referred to local law enforcement or MFCUs 
          �Medicaid Fraud Control Units].  When referrals were made 
          it was often days or weeks after the incident occurred, 
          compromising the integrity of what limited evidence might 
          have still been available.  Second, a lack of witnesses to 
          instances of abuse made prosecutions difficult and 







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          convictions unlikely."  

          This bill changes the evidentiary standard of proof for 
          elder and dependent abuse or neglect cases from clear and 
          convincing to preponderance of the evidence.  This bill 
          also clarifies that punitive damages may not be imposed 
          against an employer unless the requirements for other civil 
          case exemplary damages against employers are satisfied; 
          this requirement would not apply to the recovery of 
          compensatory damages or attorney's fees and costs.  The 
          bill also clarifies that the bill is not intended to affect 
          the standard of proof for punitive damages, as specified.  

          The August 24, 2012 amendments are the same as the 
          provisions contained in SB 558 (Simitian), which was heard 
          in and approved by the Senate Judiciary Committee.  SB 558 
          is held in the Assembly Appropriations Committee.

          SB 558 support was as follows:

            California Advocates for Nursing Home Reform (co-source)
            California Alliance for Retired Americans (co-source)
            Congress of California Seniors (co-source)
            Consumer Attorneys of California (co-source)
            California Council of the Alzheimer's Association
            California Disability Community Action Network
            California Long-Term Care Ombudsman Association
            California Nurses Association
            County Welfare Directors Association
            Disability Rights California
            Gray Panthers Sacramento
            Older Women's League of California
            Peace Officers Research Association of California
            State Public Affairs Committee of the Junior Leagues Palo 
            Alto
               Mid Peninsula

          SB 558 opposition was as follows:

            Aging Services of California
            Beta Healthcare Group
            California Association of Health Facilities
            California Association of Professional Liability Insurers
            California Chamber of Commerce







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            Civil Justice Association of California
            Horizon West Auburn Ridge
            Lakeport Skilled Nursing Center
            Sanders, Collins & Rehaste, LLP

          According to the author of SB 558, it is estimated that 
          over 132,000 elders in California are abused every year.  
          However, for every abuse reported, research has found that 
          at least five others go unreported, making the actual 
          number of abused people much higher than the reported rate. 
           Studies show that neglect and abuse of nursing home 
          residents have reached epidemic proportions.  A report by 
          the Centers for Medicare and Medicaid Services found that 
          at least 91 percent of homes have been cited for health and 
          safety deficiencies.  Yet many residents who suffer neglect 
          and abuse find it virtually impossible to seek justice in 
          court.  �A] �h]igher evidentiary standard makes winning 
          cases of elder abuse very difficult.

          Consumer Attorneys of California (CAOC), a supporter of SB 
          558, writes that:

             Teresa Rodriguez, injured at birth, was a resident at 
             a Res-Care facility in San Mateo County.  As a 
             developmentally disabled adult, she was non verbal, 
             but could perform small functions like brushing her 
             hair with assistance and watching TV.  A new 
             employee, with no training, left Teresa in a scalding 
             shower, alone, in water that was over 130 degrees for 
             over twenty minutes.  Teresa suffered second and 
             third degree burns over her thighs, genitals, stomach 
             and lower back.  Even worse, after the employee 
             returned to get her, the employee hid what happened 
             and put Teresa in bed, covered in sheets, and later, 
             after another employee discovered her condition, the 
             employees still failed to call 911 for more than 3  
             hours after the injury.  Teresa spent the rest of her 
             life in sub-acute care, with breathing and feeding 
             tubes, and lost any ability of life control, 
             including the small milestones of care for herself.

             The defendant facility claimed that an elder abuse 
             claim under EADACPA could not proceed because there 
             was not enough clear and convincing proof, i.e., that 







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             because of the lack of witnesses and because Teresa 
             could not "tell" what happened, clear and convincing 
             evidence did not exist. . . . The case finally 
             settled before trial, but sadly Teresa died a short 
             time thereafter.

          The California Association of Health Facilities, in 
          opposition to AB 1062, states:

            EADACPA Is Already Working - When EADACPA was amended to 
            include enhanced remedies, the stated legislative intent 
            was to "enable interested persons to engage attorneys to 
            take up the cause of abused elderly persons and dependent 
            adults."  The 1991 legislation focused on two specific 
            legal reforms to meet the broad objective of increased 
            access to legal counsel:  (1) allow legal counsel to 
            obtain awards of reasonable attorneys' fees; and (2) 
            allow plaintiffs awards of non-economic damages in 
            "survival" claims for victims that die prior to judgment 
            in the action.  While it was clear that EADACPA would 
            trigger more litigation, the increase in the frequency 
            and severity of resulting litigation against LTC 
            providers has far exceeded expectations.

            According to a June 2010 actuarial analysis of nursing 
            facility litigation costs by AON Corporation, the cost 
            per occupied bed in California is $2,150, compared to the 
            national average of $1,340.  California also leads the 
            nation in the number of claims brought against nursing 
            home operators at an annual rate of 11 claims per 1,000 
            beds per year, or roughly 1.1 claims per facility per 
            year.  The size of the average award has tripled from 
            $65,000 in the early 1990's to $195,000 in 2009.  
            California SNF providers are paying approximately $240 
            million per year in litigation related expenses.

            There is no shortage of attorneys willing to take these 
            cases and nothing to suggest that consumers have problems 
            gaining access to counsel for this purpose.  In many 
            parts of the state, the local county bar associations 
            have added an elder abuse section and the Continuing 
            Education of the Bar (CEB) has developed an extensive 
            practice guide for attorneys who litigate these cases.








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            California is already unique in allowing an evidentiary 
            standard for enhanced remedies for elder abuse claims.  
            By lowering the standard, SB 558 would only promote 
            additional attorney exploitation of EADACPA remedies."  
           
           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  No   
          Local:  No

          According to the Assembly Appropriations Committee analysis 
          on SB 558, the principal state impact of the bill will be 
          General Fund/federal fund cost pressure, potentially in the 
          hundreds of thousands to millions of dollars, on Medi-Cal 
          payments to skilled nursing facilities (SNFs) resulting 
          from increases, linked to increased litigation, in 
          professional liability insurance (PLI) costs for these 
          facilities. 

           SUPPORT  :   (Verified  8/28/12)

          --- 
           OPPOSITION  :    (Verified  8/28/12)

          California Association of Health Facilities


          RJG:m  8/29/12   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

                                ****  END  ****