BILL ANALYSIS �
AB 1693
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Date of Hearing: March 28, 2012
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1693 (Hagman) - As Amended: March 26, 2012
Policy Committee: Public
SafetyVote: 6-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill authorizes the Department of Mental Health (DMH) to
expand an existing pilot program designed to restore competence
for defendants found incompetent to stand trial (IST) while a
defendant is in county jail awaiting a state hospital placement.
The pilot would be expanded from San Bernardino to L.A. and Kern
Counties, as well as any county that chooses to participate.
Specifically, this bill:
1)States jail competency restoration programs shall include:
a) competency assessment upon admission and periodic
reassessment;
b) individualized treatment programs;
c) education regarding the criminal justice system;
d) education for individuals with special problems;
e) medication treatment.
2)Requires admissions criteria for competency restoration
programs to be coordinated through DMH, prioritizing ISTs most
likely to be restored to competency.
FISCAL EFFECT
Precise costs and savings are unknown at this point, but based
on the San Bernardino pilot program, startup costs for the two
counties specified in the bill would be in the range of $1
million (GF), offset within about one year by GF savings in the
range of $4 million and local savings in the range of $700,000
assuming a similar rate of success. In addition, to the extent
the program succeeds, more state hospital beds will be
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available.
In the San Bernardino pilot, the county used about $300,000 from
a $4.3 million DMH budget appropriation for local IST pilot
programs to fund a 20-bed program in which a private contractor
(Liberty Healthcare Corporation) provided psychiatric treatment
and stabilization services. The state paid the contractor $278
per day, compared with the cost of about $500 for a state
hospital bed. The contractor also covered most of the county's
daily jail costs. In addition, according to DMH, the average
length-of-stay for IST defendants in the San Bernardino program
was 55 days, compared to 196 days in a state hospital.
Extrapolating from a review of the first nine months of pilot by
the Legislative Analyst's Office (LAO), San Bernardino saved
about $260,000 and the state about $1.6 million.
COMMENTS
1)Rationale . The author cites a January 2012 report by the LAO,
Treating the Incompetent to Stand Trial, which recommends
expansion of the San Bernardino pilot program.
According to the LAO, "Specifically, we find the pilot program
provides less incentive for potential malingerers, has greater
flexibility to hold down costs, and is able to restore ISTs to
competency in a shorter amount of time than the state
hospitals. Additionally, the number of referrals from courts
into IST treatment has decreased, possibly because treatment
in a county jail is less appealing to defendants who may use a
claim of incompetency as a defense strategy to keep out of
prison.
"We find expansion of the pilot not only has the potential to
reduce the waitlist, but also to significantly decrease costs
to the public sector. ?
"If the Legislature wishes to reduce the waitlist, we
recommend that it do so first by expanding the pilot into
counties with historically long waitlists. Those counties
would be the ones that ordinarily send their IST commitments
to Patton and Atascadero state hospitals. Our analysis
indicates that such an approach would result in significant
savings for the state and counties in the costs of providing
services to IST commitments. Furthermore, it would reduce
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state and county exposure to potential future court
involvement from delays in the treatment of ISTs held in
county jail longer than recommended by the courts. "
2)Proposed author's amendments delete San Diego County from the
proposed pilot expansion.
3)Competing budget trailer bill proposal. DMH recently released
draft language for a statewide proposal similar to this bill.
DMH preliminary estimates are net savings of $3 million in
2012-13. At the time of this analysis, DMH was unable to
provide fiscal details for their expenditure or savings
projections. The author is working with DMH and other parties
to unify the proposals.
4)Significant waiting list for state hospital beds for ISTs in
county jails.
Criminal defendants must be mentally competent to assist in
their defense. When the court determines a defendant is IST,
the defendant is ordered to undergo competency restoration
treatment; violent felons generally at a state mental
hospital, misdemeanants and non-violent felons in a local
mental health facility or other community setting. In recent
years the number of ISTs awaiting a state hospital bed at a
given time for treatment to restore competency has ranged from
160 to 300.
Statute requires that state hospitals report to the court on
the status and likelihood of competency restoration within 90
days of commitment.
A 2010 case, Freddy Mille v. Los Angeles, ruled IST
commitments must be transferred to a state hospital within a
reasonable amount of time. Subsequent to Mille, courts have
recommended jail to state hospital transfers occur within 35
days. Given a shortage of state hospital beds and staffing,
however, ISTs spend, on average, about 70 days in county
jails. The LAO estimates it would cost about $20 million per
year to eliminate the waitlist by increasing state hospital
beds and staff.
(There are about 6,500 state hospital beds, with about 5,000
patients. In terms of bed priority, the 1,160 IST patients
follow sexually violent predators (900), mentally disordered
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offenders (1,220), and persons found not guilty by reason of
insanity (1,230).)
5)Support . According to the San Bernardino County Sheriff's
Department, "This pilot program in San Bernardino County has
dramatically improved patient outcome as there is no delay in
treatment. Additionally the long wait list in the past
represented continued expense for the county while the inmate
awaited transfer. Since Restoration of Competency (ROC)
continues treatment during any wait time, the cost of
incarceration is reimbursed. ROC has proven to lower the
number of ISTs for San Bernardino County Sheriff's Department
that are treated or waiting Patton State Hospital (PSH)
admission, thereby benefitting regional demand and competition
for state hospital bed space."
According to the California State Sheriffs' Association, "The
CSSA supports the expansion of this pilot program where many
IST's were successfully restored to competency, eliminating
the need to transfer them to a state hospital, providing
further savings to the state."
Analysis Prepared by : Geoff Long / APPR. / (916) 319-2081