BILL ANALYSIS                                                                                                                                                                                                    �






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       AB 2190
          AUTHOR:        Maienschein
          AMENDED:       May 23, 2014
          HEARING DATE:  June 18, 2014
          CONSULTANT:    Diaz

           SUBJECT  :  Criminal defendants: gravely disabled persons.
           
          SUMMARY  :  Allows a court to place a person found to be  
          incompetent to stand trial or not guilty by reason of insanity  
          on outpatient status within a mental health treatment facility,  
          as specified. Requires a conservatorship investigator to submit  
          a copy of his or her report, upon prior written request of the  
          defendant or the defendant's attorney, to specified entities in  
          a criminal case.

          Existing law:
          1.Prohibits any person charged with and found incompetent to  
            stand trial (IST) on a charge or conviction or found not  
            guilty by reason of insanity (NGI) of the following felonies  
            from being released on outpatient status unless the person has  
            been confined in a state hospital or other treatment facility  
            for 180 days or more:

                  a.        Murder;
                  b.        Mayhem;
                  c.        Aggravated mayhem;
                  d.        Kidnapping, kidnapping for ransom, or  
                    kidnapping during the commission of a carjacking and  
                    the victim suffered the  intentional infliction of  
                    great bodily harm (GBH);
                  e.        Robbery or carjacking with a deadly or  
                    dangerous weapon and the victim suffers GBH;
                  f.        Arson that causes GBH or causes an inhabited  
                    structure or property to burn;
                  g.        Rape accomplished by means of force by giving  
                    the victim an intoxicating, anesthetic substance or  
                    controlled substance, or retaliation has been  
                    threatened against the victim, as specified;
                  h.        Rape of a spouse accomplished by means of  
                    force or threat of retaliation;
                  i.        Burglary in the first degree;
                  j.        Assault with intent to commit mayhem, rape,  
                                                         Continued---



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                    sodomy, oral copulation rape in concert with another,  
                    lascivious acts upon a child, or penetration of  
                    genitals or anus with a foreign object that result in  
                    GBH to the victim;
                  aa.       Lewd and lascivious acts;
                  bb.       Carrying or placing an explosive or  
                    destructive devise on a passenger vessel, aircraft,  
                    car, or other vehicle;
                  cc.       Possession of an explosive or destructive  
                    devise in public places such as a theatre, hall,  
                    college, church, hotel, other public building, or in,  
                    on, or near specified public transportation;
                  dd.       Wrongful possession of an explosive or  
                    destructive devise with intent to injure or  
                    intimidate; or,
                  ee.       Any felony involving death, GBH, or an act  
                    that poses a serious threat of bodily injury to  
                    another person. 

          2.Allows any person subject to the provision above to be placed  
            on outpatient status if all of the following conditions are  
            satisfied:

                  a.        The director of the state hospital or other  
                    treatment facility to which the person has been  
                    committed advises the committing court and the  
                    prosecutor that the defendant would no longer be a  
                    danger to the health and safety of others, including  
                    himself or herself, while under supervision and  
                    treatment in the community and will benefit from that  
                    status;
                  b.        The community program director advises the  
                    court that the defendant will benefit from that status  
                    and identifies an appropriate program of supervision  
                    and treatment; and, 
                  c.        The prosecutor provides notice of the hearing  
                    date and pending release to the victim (or his or her  
                    next of kin) where a request for the notice has been  
                    filed with the court, and after a hearing in court,  
                    the court specifically approves the recommendation and  
                    plan for outpatient status, as specified.  

          3.Authorizes a court to grant outpatient status, prior to actual  
            confinement in a state hospital or other treatment facility,  
            to any person charged with and found IST on the charge or  
            conviction of any misdemeanor or any non-specified felony or  




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            found NGI of any misdemeanor. Allows any person subject to  
            this provision to be placed on outpatient status if all of the  
            following conditions are satisfied:

                  a.        In the case of a person who is an inpatient,  
                    the director of the state hospital or other treatment  
                    facility to which the person has been committed  
                    advises the court that the defendant will not be a  
                    danger to the health and safety of others while on  
                    outpatient status and will benefit from such  
                    outpatient status;
                  b.        In all cases, the community program director  
                    or a designee advises the court that the defendant  
                    will not be a danger to the health and safety of  
                    others while on outpatient status, will benefit from  
                    such status, and identifies an appropriate program of  
                    supervision and treatment; and,
                  c.        After actual notice to the prosecutor and  
                    defense attorney, and after a hearing in court, the  
                    court specifically approves the recommendation and  
                    plan for outpatient status. 

          4.Permits any person alleged, as a result of mental disorder, to  
            be a danger to him- or herself or others; or, to be gravely  
            disabled to be given an evaluation of his condition under a  
            superior court order, as specified. Requires that the  
            evaluation be carried out with the utmost consideration for  
            the privacy and dignity of the person for whom a court-ordered  
            evaluation is requested.  

          5.Permits a conservator of the person, of the estate, or of the  
            person and the estate to be appointed for any person who is  
            gravely disabled as a result of mental disorder or impairment  
            by chronic alcoholism.  

          6.Requires the officer providing conservatorship investigation  
            to investigate all available alternatives to conservatorship  
            and to recommend conservatorship to the court only if no  
            suitable alternatives are available and to set forth all  
            alternatives available if he or she recommends against  
            conservatorship. Requires the officer, prior to the hearing,  
            to render to the court a comprehensive written report that  
            contains all relevant aspects of the person's medical;  
            psychological; financial; family; vocational; and, social  
            condition; information obtained from the person's family  




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            members, close friends, social worker, or principal therapist;  
            and all available information concerning the person's real and  
            personal property. Requires the facilities providing intensive  
            treatment or comprehensive evaluation to disclose any records  
            or information that may facilitate the investigation.  

          7.Requires a copy of the officer's report to be transmitted to  
            the individual who originally recommended conservatorship, to  
            the person or agency, if any, recommended to serve as  
            conservator, and to the person recommended for  
            conservatorship. Allows the court that is determining  
            conservatorship to receive the report in evidence and to read  
            and consider its contents in rendering its judgment.  
          
          This bill:
          1.Allows outpatient status to a person, who under existing law  
            is required to be confined in a state hospital or other  
            treatment facility for 180 days or more for the commission of  
            specified felonies, if the court finds a suitable placement,  
            including an outpatient placement program, that would provide  
            the person with more appropriate mental health treatment and  
            the court finds that the placement would not pose a danger to  
            the health or safety of others, including the victim and his  
            or her family.

          2.Requires the officer providing a conservatorship  
            investigation, when a court with jurisdiction over a person in  
            a criminal case orders an evaluation of the person's mental  
            condition, as specified, to serve a copy of the report to the  
            defendant or his or her attorney. Requires, upon prior written  
            request of the defendant or his or her attorney, the officer  
            providing the conservatorship investigation to submit a copy  
            of the report to the court hearing the criminal case, the  
            district attorney, and the county probation department.  
            Requires the conservatorship investigation report, and the  
            information contained in it, to be kept confidential and not  
            further disclosed to anyone without the prior written consent  
            of the defendant.

          3.Requires the court to place all copies of the report in a  
            sealed file after disposition of the criminal case. Permits  
            the defendant and defendant's attorney to retain their copies.  
            Permits, if the defendant is placed on probation status, the  
            probation department to retain a copy for the purpose of  
            supervision until probation is terminated, at which time the  
            department is required to return its copy to the court for  




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            placement in the sealed file.

          4.Makes findings and declarations relative to a conservatee's  
            confidentiality rights. Makes other technical, clarifying  
            changes.

           FISCAL EFFECT  :   According to the Assembly Appropriations  
          Committee:

          1.Potential increase in state trial court costs to the extent  
            additional hearings are required to determine outpatient  
            placement for patients made eligible by this bill. If, for  
            example, however, an additional five percent of the IST or NGI  
            population in state hospitals receives a two-and-a-half-hour  
            outpatient placement hearing as a result of this bill, the  
            General Fund costs would be in the range of $165,000. 

          2.No significant state hospital costs/savings as result of  
            authorizing outpatient placements for IST or NGI defendants  
            who have not served 180 days in a state hospital or other  
            treatment facility. To the extent this authorization makes  
            more IST or NGI beds available, these beds will be filled  
            immediately from the existing waiting list of patients in  
            county jail until a bed becomes available. 

           PRIOR VOTES  :  
          Assembly Public Safety:6- 0
          Assembly Appropriations:17- 0
          Assembly Floor:     78- 0
           
          COMMENTS  :  
           1.Author's statement.  According to the author, by permitting  
            courts to place certain mentally disordered offenders in  
            outpatient settings, the bill both permits courts to make  
            placements that are most appropriate for an individual  
            defendant and results in cost savings. Also by permitting  
            defendants to authorize release of conservatorship reports to  
            criminal courts, the bill increases the options available to  
            criminal courts when handling cases involving mentally  
            disordered offenders, and improves coordination between  
            conservatorship courts and the criminal courts.

          2.Background. In an April 2011 report, "Recommendations for  
            Changing the Paradigm for Persons with Mental Illness in the  
            Criminal Justice System," the Task Force for Criminal Justice  




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            Collaboration on Mental Health Issues stated that courts, in  
            collaboration with state hospitals and local mental health  
            treatment facilities, should create and employ methods that  
            prevent prolonged delays in case processing and ensure timely  
            access to restoration programs for defendants found  
            incompetent to stand trial. The Task Force recommended that  
            state hospitals and mental health outpatient programs be  
            adequately funded to ensure effective and timely restoration  
            of competency; increase community placement options through  
            the Forensic Conditional Release Program and other  
            community-based programs for IST defendants charged with  
            nonviolent offenses; and modify existing law to provide courts  
            hearing competency matters more alternative procedural and  
            disposition tools, including the jurisdiction to conditionally  
            release a defendant found IST to the community, where  
            appropriate, rather than in a custodial or hospital setting,  
            to receive mental health treatment with supervision until  
            competency is restored. The Task Force also recognized that  
            some criminal defendants with mental illness may be conserved  
            or may be involved in conservatorship proceedings at the same  
            time that their criminal case is being processed. Because  
            these cases are currently heard by different judicial officers  
            on different calendars, judicial officers hearing either the  
            civil or criminal case often do not have all applicable  
            information, which can result in conflicting orders and other  
            complications for the defendant.  

          3.Confidentiality of mental health records. According to the  
            Disability Rights California Web site, all information about  
            mental health services that one receives, whether received  
            voluntarily or involuntarily, is confidential and cannot be  
            released without authorization. However, there are situations  
            when records can be released without authorization. In some  
            cases, limited information must be released to law enforcement  
            when a person is an involuntary patient or under a Penal Code  
            commitment in a facility and being moved, is under criminal  
            investigation, or escapes from a state hospital. Information  
            about a person's mental health care can also be released if  
            one is an involuntary patient and gravely disabled and the  
            person disappears from a facility or is transferred between  
            state hospitals. Generally, in order for mental health records  
            to be shared, a form must be signed by the person (or a  
            person's conservator) each time the information is shared, and  
            it must contain specific information to be shared, the name of  
            the agency or individual with whom information is shared, the  
            name of the agency or person authorized to release the  




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            information and the purpose, and a valid expiration date.  
            Statements must also be provided informing a person about his  
            or her right to revoke authorization to share information, as  
            well as a person's right to a copy of the authorization. A  
            person has the right to receive copies of the form, which must  
            be placed in the person's medical record.
               
          4.Double referral. This bill has been double referred. Should it  
            pass out of this committee, it will be referred to the Senate  
            Public Safety Committee.

          5.Related legislation. AB 2186 (Lowenthal) seeks to change the  
            process of the involuntary administration of antipsychotic  
            mediation of individuals who are found to be incompetent to  
            stand trial. This bill was heard in the Senate Public Safety  
            Committee on June 10, 2014, and passed with a vote of 6-0. 

            AB 2625 (Achadjian), would require the return to court, as  
            specified, of a defendant who was confined to a state hospital  
            for treatment to regain competency if the treating facility  
            reports that there is no substantial likelihood that the  
            defendant will regain competence in the foreseeable future.  
            This bill was heard in the Senate Public Safety Committee on  
            June 10, 2014, and passed with a vote of 6-0.
            
          6.Support. The sponsor and supporters argue that this bill  
            permits courts to make placements that are most appropriate  
            for individual defendants, which can result in cost savings  
            while still protecting the public. They further argue that  
            providing care to people in the criminal justice system with a  
            serious mental illness is essential to stopping the cycle of  
            crime and that access to appropriate care should be a  
            priority.

           SUPPORT AND OPPOSITION  :
          Support:  Judicial Council of California (sponsor)
                    Californians for Safety and Justice
                    Legal Services for Prisoners with Children
                    National Association of Social Workers, California  
                    Chapter

          Oppose:   None received.







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