BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 1693 (Hagman) - Persons incompetent to stand trial: pilot
program.
Amended: August 6, 2012 Policy Vote: Public Safety 4-1
Urgency: No Mandate: Yes
Hearing Date: August 16, 2012
Consultant: Jolie Onodera
SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
Bill Summary: AB 1693 would authorize the Department of State
Hospitals (DSH) to expand a restoration of competency pilot
program in San Bernardino County to Los Angeles County and Kern
County, and to any other county that voluntarily chooses to
participate in the pilot program. This bill would provide that
if DSH expands the pilot program, as specified, Los Angeles and
Kern County shall cooperate with DSH as necessary to establish
the competency restoration programs in those counties.
Fiscal Impact:
One-time costs in the low hundreds of thousands of
dollars for start-up costs for Los Angeles and Kern
Counties, to be offset by future cost savings of $2.9
million (General Fund) to the DSH based on a restoration of
competency rate of 47.5 percent, a daily hospital rate of
$569 per IST, and an average SH length of stay of six
months.
Additional local startup costs for counties that
voluntarily choose to participate, to be offset by
additional future state and local cost savings.
Unknown impact on DSH and county operations with regard
to less prescriptive provisions enacted under Chapter
24/2012, the mental health budget trailer bill.
Background: Existing law provides that a person cannot be tried
or adjudged to punishment while that person is mentally
incompetent. Under existing law, a defendant is incompetent to
stand trial (IST) where, as a result of mental disorder or
developmental disability, the defendant is unable to understand
the nature of the criminal proceedings or to assist counsel in
the conduct of a defense in a rational manner.
AB 1693 (Hagman)
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Typically, individuals deemed by the court to be mentally IST
have waited in county jails pending transfer to a state hospital
for evaluation and treatment to be restored to competency.
However, the lack of physical space at state hospitals to house
ISTs coupled with difficulty in staffing key personnel at state
hospitals resulted in an extensive backlog of IST commitments in
county jails and extended wait times for ISTs pending transfer
to a state hospital.
Pursuant to the Budget Act of 2007, the Department of Mental
Health (now DSH) received an appropriation from the Legislature
in the amount of $4.3 million to begin pilot programs to examine
alternative approaches to addressing the IST waitlist. After
several years, a pilot program was initiated in San Bernardino
County to treat ISTs in the county jail instead of at a state
hospital. In its January 2012 report, An Alternative Approach:
Treating the Incompetent to Stand Trial, the Legislative
Analyst's Office (LAO) examined the San Bernardino County pilot
and noted that the nine-month results were promising with regard
to the ability of the program to reduce the IST waitlist. The
LAO noted, "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." In its recommendations to the Legislature, the LAO
indicated to further reduce the IST waitlist, expansion of the
pilot into counties with historically long waitlists should be
considered, and specifically noted the counties of Los Angeles,
Kern, and San Diego as prime candidates.
AB 1470 (Committee on Budget) Chapter 24/2012, the recently
enacted budget trailer bill on mental health, includes a number
of provisions concerning treatment of IST defendants in county
jail treatment facilities and authorizes a county mental health
program director to determine whether an IST defendant should be
treated in jail:
The community program director or designee shall evaluate
the appropriate placement for the defendant between a state
hospital or a local county jail treatment facility based
upon guidelines provided by the State Department of State
Hospitals. If a local county jail treatment facility is
selected, the State Department of State Hospitals shall
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provide treatment at the county jail treatment facility and
reimburse the county jail treatment facility for the
reasonable costs of the bed during the treatment. The
six-month limitation in Section 1369.1 shall not apply to
individuals deemed incompetent to stand trial who are being
treated to restore competency within a county jail treatment
facility pursuant to this section.
Proposed Law: This bill would authorize the DSH to expand the
pilot program originally authorized pursuant to the Budget Act
of 2007 to establish competency restoration programs in Los
Angeles County and Kern County, and any other county that
voluntarily chooses to participate in the pilot program, to
provide appropriate treatment in county jails to individuals
found IST and who have not been committed to a state hospital.
This bill:
Provides that if the DSH expands the pilot program, Los
Angeles County and Kern County must cooperate with the
department as necessary to establish the competency
programs in those counties.
Specifies the competency restoration programs must
include, but are limited to, the following elements:
o Objective competency assessment upon
admission.
o Individualized treatment programs.
o Multimodal, experiential competency
educational experiences.
o An educational component addressing the
criminal justice e system, including but not limited
to various charges and their severity, sentencing,
pleas, roles of courtroom personnel, the adversarial
nature of the trial process, and evaluating evidence.
o Additional educational components for
individuals with specific knowledge deficits.
o Periodic reassessment of competency.
o Medication treatment.
o Capacity and involuntary treatment assessment.
Requires admissions criteria for competency restoration
programs to be coordinated through the DSH, with initial
priority given to ISTs most likely to be restored to
competency in the selected treatment environment.
States the Legislative finding and declaration that a
special law is necessary and that a general law cannot be
made applicable because of the historically long waiting
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lists of ISTs in Los Angeles County and Kern County, which
expose the state and counties to potential future court
involvement from delays in the treatment of ISTs held in
county jail longer than recommended by the courts.
Related Legislation: AB 1470 (Committee on Budget) Chapter
24/2012, the budget trailer bill on mental health, includes a
number of provisions concerning treatment of IST defendants in
jail treatment facilities and authorizes a county mental health
program director to determine whether an IST defendant should be
treated in jail.
Staff Comments: If the DSH were to expand the pilot to establish
competency restoration programs in the prescribed counties of
Los Angeles and Kern Counties, by requiring the counties to
participate in the pilot program, any local costs would likely
be state-reimbursable. Based on the start-up costs for San
Bernardino County of $300,000 for 20 beds, start-up state costs
for Los Angeles and Kern County could be in the range of
$900,000 (General Fund) for approximately 60 beds.
Future cost savings to the DSH based on an average daily DSH
patient cost of $569 and an average length of stay of six months
could be in the range of $2.9 million (General Fund), based on a
restoration of competency rate of 47.5 percent (48 of 101 ISTs
served in San Bernardino). Additionally, local savings to county
jails based on an average annual savings of $6,700 per IST
participating in the program would be $400,000. The timing of
cost savings to offset the start-up costs of the program would
be dependent upon the start date of the programs. Should the
programs be implemented in early 2013, startup costs incurred in
2012-13 would likely not be recouped in cost savings to the DSH
until the subsequent fiscal year (2013-14).
The impact of the provisions of this bill on the recently
enacted budget trailer bill on mental health is unclear but
could potentially create confusion for implementing counties by
having conflicting competency restoration program requirements
in two different sections of code. This measure prescribes
specific elements to be included in restoration of competence
(ROC) programs under the Welfare and Institutions Code. In
comparison, the IST provisions of AB 1470 are included in the
Penal Code and allow ROC programs to be based on accepted
standards of mental health practice, which could change over
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time.
Proposed Author Amendments: Require the DSH to expand the pilot
program to Los Angeles County and Kern County, if the counties
voluntarily choose to participate in the pilot program.