BILL ANALYSIS �
SB 913
Page 1
Date of Hearing: July 5, 2011
Counsel: Stella Choe
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
Tom Ammiano, Chair
SB 913 (Pavley) - As Amended: June 27, 2011
SUMMARY : Provides that a probation officer may authorize
medical care for a minor who is taken into temporary custody
under specified circumstances. Specifically, this bill :
1)Permits a probation officer to authorize a medical exam that
complies with regulations promulgated by the Corrections
Standards Authority (CSA) for a minor who has been taken into
temporary custody, as specified.
2)States that if the minor is retained in custody by the
probation officer, and prior to the detention hearing, the
probation officer may authorize medical or dental treatment or
care based on the written recommendation of the examining
physician and considered necessary for the health of the
minor.
3)Requires the probation officer to make a reasonable effort to
notify and to obtain the consent of the parent, guardian, or
person standing in loco parentis for the minor, and, if the
parent, guardian, or person standing in loco parentis objects,
the treatment or care shall be given only upon order of the
court in the exercise of its discretion.
4)Mandates the probation officer to document the efforts made to
notify and obtain parental consent and enter this information
into the case file for the minor.
5)Adds to existing provisions of law that defines "emergency
situation" to also include known conditions or illnesses that,
during any period of secure detention of the minor by the
probation officer, require immediate laboratory testing,
medication, or treatment to prevent and imminent and severe or
life-threatening risk to the health of the minor.
6)States that nothing in this bill shall be construed to
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interfere with a minor's right to authorize or refuse medical,
surgical, dental, or other care when the minor's consent for
care is sufficient or specifically required pursuant to
existing law, or to interfere with a minor's right to refuse,
verbally or in writing, nonemergency medical and mental health
care.
EXISTING LAW :
1)Allows a peace officer to take a minor into temporary custody
without a warrant when such officer has reasonable cause for
believing that the minor has violated a law or an order of the
juvenile court or has escaped from any commitment ordered by
the juvenile court. A peace officer may take into temporary
custody a minor who is found in any street or public place
suffering from any sickness or injury which requires care,
medical treatment, hospitalization, or other remedial care.
�Welfare & Institutions Code (WIC) Section 625.]
2)Requires that the probation officer notify the parent,
guardian, or person standing in loco parentis of the minor, if
any, of the care found to be needed before the care is
provided, and if the parent, guardian, or person standing in
loco parentis objects, the care shall be given only upon order
of the court in the exercise of its discretion. �WIC Section
739(a).]
3)Authorizes the court to make an order for the performance of
the necessary care, as specified, if there is no parent or
other person capable or willing to authorize treatment. �WIC
Section 739(b).]
4)Provides that whenever it appears that a minor requires
immediate emergency medical, surgical, or other remedial care
in an emergency situation, that care may be provided by a
licensed physician and surgeon or, if the minor needs dental
care in an emergency situation, by a licensed dentist, without
a court order and upon authorization of a probation officer.
If the minor needs foot or ankle care within the scope of
practice of podiatric medicine, as defined in existing
provisions of law, a probation officer may authorize the care
to be provided by a podiatrist after obtaining the advice and
concurrence of a physician and surgeon. The probation officer
shall make reasonable efforts to obtain the consent of, or to
notify, the parent, guardian, or person standing in loco
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parentis prior to authorizing emergency medical, surgical,
dental, or other remedial care. Defines "emergency
situation," for the purposes of this subdivision to mean that
a minor requires immediate treatment for the alleviation of
severe pain or an immediate diagnosis and treatment of an
unforeseeable medical, surgical, dental, or other remedial
condition or contagious disease which if not immediately
diagnosed and treated, would lead to serious disability or
death. �WIC Section 739(d).]
5)States that these provisions of law shall not be construed as
limiting the right of a parent, guardian, or person standing
in loco parentis, who has not been deprived of the custody or
control of the minor by order of the court, in providing any
medical, surgical, dental, or other remedial treatment
recognized or permitted under the laws of California. �WIC
Section 739(f).]
6)States that a minor may consent to medical care related to the
prevention or treatment of pregnancy, as specified. (Family
Code Section 6925.)
7)Allows a minor who is 15 years of age or older to consent to
medical care and dental care provided that the minor is living
separate and apart from the minor's parents or guardian,
whether with or without the consent of a parent or guardian
and regardless of the duration of the separate residence, and
the minor is managing his or her own financial affairs,
regardless of the source of the minor's income. States that
the parents or guardian are not liable for medical care or
dental care provided pursuant to this section. (Family Code
Section 6922.)
8)States that a minor who is 12 years of age or older and who
may have come into contact with an infectious, contagious, or
communicable disease may consent to medical care related to
the diagnosis or treatment of the disease, if the disease or
condition is one that is required by law or regulation adopted
pursuant to law to be reported to the local health officer, or
is a related sexually transmitted disease, as may be
determined by the State Director of Health Services. States
that the parents or guardian are not liable for medical care
or dental care provided pursuant to this section. (Family
Code Section 6926.)
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FISCAL EFFECT : Unknown
COMMENTS :
1)Author's Statement : According to the author, "SB 913 would
provide probation officers, under the advisement of the
medical staff, with the legal authority to consent to, and
provide medical care, under specified circumstances, to
juvenile offenders, but only in cases when the parent or legal
guardian cannot be found.
"Minors in juvenile detention facilities receive an array of
services to address their special needs. They also are
required to attend classes to maintain school enrollment. As
a former middle school teacher, I know firsthand the
importance of children receiving medical exams, including
immunizations, to identify health issues that could impact
their learning ability. Further, it is critical that these
children receive prompt high quality medical care so their
condition does not become more acute, which could then require
the minor to be transported to the emergency room for
treatment."
2)Background : According to the background provided by the
author, "Under existing law, a probation officer is only
authorized to consent to emergency medical treatment for
minors detained in juvenile facilities if the parent or legal
guardian cannot be found. State regulation Juvenile Title 15
requires detained minors to have a health assessment within 96
hours of being taken into custody, which include holidays and
weekends. The required health evaluation includes, at a
minimum, 1) a health and mental health history; 2) a physical
examination, including laboratory and diagnostic testing; and
3) the necessary immunizations based on current public health
guidelines. There are times when the parent or legal guardian
cannot be found, and therefore, the medical staff at the
detention facilities cannot complete the medical examination
without parental consent. The regulations require that,
absent parental consent, the probation officer must seek an
order from the court. It takes approximately 72 hours to get
to court, and the County is often out of compliance because
the medical exam is not completed within the required 96-hour
timeframe.
"Current law requires the consent of the parent or legal
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guardian for many of these medical procedures, including
drawing blood or administering immunizations or other
medications.
"Current law also authorizes the probation officer to consent to
medical treatment once a minor is adjudicated and becomes a
ward of the court; however, the adjudication process is often
protracted.
"Minors detained in juvenile facilities often have undetected
health and mental health problems. Physicians at the juvenile
facilities are unable to determine the condition of the
juvenile detainee without a complete physical examination. To
further complicate matters, if the probation department is
forced to seek a court order for medical treatment, a separate
order must be sought for each examination or medical
procedure. This creates an unnecessary and costly burden for
both the court and the facility, but more importantly, it puts
the minor's health at risk, as well as the other juvenile
detainees and staff at the detention facility. Finally, if
care is delayed because consent could not be obtained, the
child's medical condition could worsen, which could put them
in the ER, thus aggravating already overcrowded ERs and
increasing the cost of medical care."
3)Juvenile Title 15 Regulations : The CSA has the responsibility
to develop and maintain standards governing the operation of
local juvenile detention facilities. The standards pertaining
to programs, procedures, health care, nutrition and sanitation
are found in Title 15 of the California Code of Regulations
(CCR). According to the Title 15 Regulations, juvenile
facilities are required to complete the mandatory health
appraisal/medical examination within 96 hours of admission
into the facility. (15 CCR Section 1432.) According to the
Guidelines for the Title 15 Regulations, the time frame is not
modified due to weekends, holidays, or other factors. Also,
the health appraisal/medical examination must be conducted in
privacy, limited only by significant security considerations,
and at minimum, must include a health history, physical
examination, laboratory and diagnostic testing, and
immunizations. With regard to the immunizations, the facility
is given two weeks after the health appraisal/medical exam to
verify necessary immunizations and establish a plan to update
immunizations in order to avoid over-immunizations. A dental
screen is also an essential part of the health appraisal.
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Dental services may be provided either on-site or in community
based offices, and should focus on acute conditions in order
to avert adverse effects on the minor's health. �Juvenile
Title 15 Guidelines (July 2007) pgs. 105-107.]
4)A Minor's Consent to Medical Treatment : According to Juvenile
Title 15 Regulations, all examinations, treatments, and
procedures requiring verbal or written informed consent in the
community also require that consent for confined minors.
Thus, if parental consent normally would be required outside
the facility, parental consent is also required inside the
juvenile facility; and if a minor's consent is necessary to
provide a particular service outside the juvenile facility, a
minor's consent is necessary inside. Existing law allows
minors to consent for their own medical treatment when it
involves certain types of care, such as drug abuse treatment
or pregnancy related services. (See Family Code Sections 6925
and 6929.) Additionally, a minor may consent for their own
medical treatment if they meet certain status conditions, such
as being emancipated or living separate and apart from the
minor's parents and guardian and managing his or her own
financial affairs. (See Family Code Sections 6922 and 7050.)
The Guidelines for the Title 15 Regulations specifies that a
health appraisal/medical exam requires consent. According to
the Guidelines, "It is recommended that any consequences
resulting from a refusal be based on specific rationale. For
instance, a minor with a chronic cough who refuses
tuberculosis screening may be isolated from others, whereas
isolation of an apparently healthy individual may be more
difficult to justify. Disciplinary procedures should not be
instituted as the result of refusal of health screening."
�Juvenile Title 15 Guidelines (July 2007) pg. 107.]
If a minor or parent refuses treatment, "The physician or
dentist shall explain the consequences of the refusal to the
ward or a parent or guardian if the ward is under 18 and
record the refusal in the medical record, including a
statement of the possible consequences if the medical,
surgical mental and/or dental treatment is not administered."
(15 CCR Section 4734.) Medical treatment authorization may be
sought from the court. "The court may authorize health care
services if a licensed physician, surgeon, or dentist
recommends treatment; due notice is given to the minor's
parent or guardian; and the juvenile court finds that no
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parent, guardian, or person standing in loco parentis is
willing and able to provide consent." �WIC Section 739(b).]
5)Argument in Support : According to the California State
Association of Counties , "Current juvenile Title 15
Regulations, promulgated by the Corrections Standards
Authority, require county probation departments to provide a
routine medical exam to juveniles within the first 96 hours of
their detainment. Current law allows probation officers to
authorize medical treatment for a juvenile only in cases of
emergency or after a probation officer has received consent
form the court if a parent has not, or refuses to, provide
consent. For a variety of reasons, probation officers may
have difficulty reaching a juvenile's parent or guardian to
get consent for treatment. Seeking consent through the court
can be a lengthy process, taking longer than 96 hours to
navigate. These situations mean that a probation department
often cannot comply with regulations despite its best efforts
and through no fault of its own.
"SB 913 provides a sound framework whereby a probation officer
may provide consent for routine exams and any needed follow-up
as long as the probation officer has made reasonable efforts
to contact the juvenile's parent(s) and/or guardian. Further,
it would enable probation departments to comply with existing
regulations and ensure the health and safety of the youth in
its facilities and its staff by preventing the spread of
viruses and disease."
REGISTERED SUPPORT / OPPOSITION :
Support
Los Angeles County Board of Supervisors (Sponsor)
California Probation, Parole, and Correctional Association
California State Association of Counties
Chief Probation Officers of California
County of Los Angeles Probation Department
Los Angeles County Sheriff's Department
Sacramento County Board of Supervisors
Opposition
None
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Analysis Prepared by : Stella Choe / PUB. S. / (916) 319-3744