BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 2397 (Allen) - State hospitals: staff-to-patient ratios.
Amended: July 5, 2012 Policy Vote: Health 7-1
Urgency: No Mandate: No
Hearing Date: August 6, 2012
Consultant: Jolie Onodera
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 2397 would require the Department of State
Hospitals (DSH) to reimburse an independent entity to conduct a
review and analysis of staffing ratios to determine the
appropriate levels for effective patient treatment. This bill
would require a report to the Legislature by August 1, 2013,
regarding the entity's findings, as specified.
Fiscal Impact:
One-time costs potentially in excess of $300,000
(General Fund) for an independent review and analysis of
staffing ratios.
Potentially significant future cost pressure to the
extent report findings recommend revisions to existing
state hospital staffing ratios.
Background: The recently enacted Budget Act of 2012 eliminated
the Department of Mental Health (DMH) and created the new DSH to
continue administration of the five state hospitals and two
psychiatric programs located within state prison facilities,
with the operation of the remaining community mental health
programs being shifted to various departments.
Changes in policies and patient demographics over the past
decade have necessitated adjustments to staffing, the mental
health care delivery model, and other aspects of state hospital
operations. The forensic population now comprises approximately
92 percent of the DSH statewide hospital system caseload.
Pursuant to the provisions of the 2008-09 Budget Act, the Office
of Statewide Audits and Evaluations (OSAE) conducted an audit of
the DMH budget estimation process. The OSAE audit concluded that
the staffing model did not adequately reflect hospital workload,
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funding was insufficient for annual operating expenditures, and
state hospitals were not efficiently using their staff. More
recently, the Legislative Analyst's Office (LAO) noted in its
March 2012 analysis of oversight at state hospitals that many of
the problems identified by the OSAE audit in 2008-09 have not
been addressed and were still issues when DMH conducted a
self-audit in 2011. The LAO recommended the OSAE conduct an
audit of the DSH beginning in January 2013 with an analysis of a
detailed review of the needed personnel by hospital.
Proposed Law: This bill would require, to the extent permitted
by the California Constitution and specified provisions of law
governing the use of personal services contracts, the DSH to
reimburse an independent entity for the purposes of conducting a
review and analysis of staffing ratios to determine appropriate
levels for effective patient treatment. Specifically, this bill:
Requires the DSH to provide information to this entity
as necessary for it to complete its analysis and provide
recommendations.
States the intent of the Legislature that the DSH
request the independent entity to complete this analysis by
June 1, 2013.
Requires a report to be submitted to the Legislature by
August 1, 2013, regarding the entity's findings to ensure
state hospitals are making progress and to enable the
Legislature to consider further action that may be
necessary during the subsequent legislative year.
Sunsets the provisions of the bill on January 1, 2015.
Related Legislation: AB 1464 (Blumenfield) Chapter 21/2012, the
Budget Act of 2012, among other things, eliminated the
Department of Mental Health (DMH) and created the DSH, shifting
the remaining community mental health programs to various
departments.
AB 1470 (Committee on Budget) Chapter 24/2012, the mental health
budget trailer bill includes legislative intent language stating
the following: "It is the intent of the Legislature that any
changes in staffing ratios at the state's mental hospitals
address adequate staff and patient safety standards, and that
staffing ratios may vary based on patient acuity."
Staff Comments: The cost of contracting with an independent
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entity to review and analyze the DSH existing staffing ratios is
estimated at $300,000 to $800,000 (General Fund) based on
previously contracted audits. Staff notes it is unclear at this
time whether the audit requirement would be duplicative of, or
supplementary to, the OSAE audit required in the recently
enacted Budget Act of 2012.
Pursuant to AB 1464 (Budget Act of 2012), the DSH is required to
reimburse the OSAE to review its prior audit report of the DMH
and determine which of its recommendations related to state
hospitals have not been implemented by the DMH or DSH, and the
status of implementation. The OSAE is also required to assist
the DSH to determine the priorities of outstanding audit
findings based on fiscal and programmatic risk and cost
efficiency.
Prior to contracting with the OSAE, the DSH must further define
the scope of the audit in consultation with the Legislature. AB
1464 states the Legislature's intent for the DSH to notify the
OSAE to proceed with the analysis during the fall of 2012 and
requires the OSAE report to be submitted to the Legislature by
April 1, 2013, to ensure hospitals are making progress and to
enable the Legislature to consider what further actions may need
to be taken for the subsequent fiscal year.
As the scope of the required OSAE audit may be further defined
in consultation with the Legislature prior to contracting with
the OSAE, the scope of the OSAE audit may already include, or
may or may not potentially be revised to include, a review and
analysis of staffing ratios to determine the appropriate levels
for effective patient treatment.
Staff notes that submittal of the independent analysis and
recommendations to the Legislature by August 1, 2013, as
required under the provisions of this measure, would be
presented only four months after the required OSAE audit report
due on April 1, 2013.