BILL ANALYSIS                                                                                                                                                                                                    �







                      SENATE COMMITTEE ON PUBLIC SAFETY
                            Senator Loni Hancock, Chair              A
                             2013-2014 Regular Session               B

                                                                     2
                                                                     1
                                                                     9
          AB 2190 (Maienschein)                                      0
          As Amended May 23, 2014
          Hearing date:  June 24, 2014
          Penal Code
          JM:mc

                           FORENSIC MENTAL HEALTH PATIENTS:

                                   OUTPATIENT CARE  


                                       HISTORY

          Source:   Judicial Council 

          Prior Legislation: None directly on point

          Support:  Californians for Safety and Justice; Legal Services  
                    for Prisoners with Children; National Association of  
                    Social Workers, California Chapter

          Opposition:None known

          Assembly Floor Vote:  Ayes 78 - Noes 0



                                      KEY ISSUES
           
          SHOULD COURTS BE ALLOWED TO PLACE MENTALLY DISORDERED OFFENDERS  
          CHARGED WITH SPECIFIED SERIOUS CRIMES INTO OUTPATIENT TREATMENT  
          IF THE PLACEMENT WOULD NOT THREATEN PUBLIC SAFETY?





                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 2


                                                                (CONTINUED)



          SHOULD A COPY OF AN EVALUATION OF A PERSON'S MENTAL STATE MADE FOR A  
          CONSERVATORSHIP INVESTIGATION IN CONNECTION WITH A CRIMINAL ACTION  
          BE PROVIDED TO THE PERSON AND HIS OR HER ATTORNEY?

          UPON THE REQUEST OF A CRIMINAL DEFENDANT, SHOULD A CONSERVATORSHIP  
          INVESTIGATION REPORT CONCERNING THE DEFENDANT BE PROVIDED TO THE  
          COURT, THE PROSECUTOR AND THE PROBATION DEPARTMENT, BUT OTHERWISE  
          KEPT CONFIDENTIAL?



                                       PURPOSE

          The purpose of this bill is to 1) allow a court to place a  
          mentally disordered criminal defendant charged with specified  
          serious crimes into an outpatient program if the program can  
          provide effective treatment and the public would not be  
          endangered; 2) require that a conservatorship investigation  
          report concerning a criminal defendant be provided to the  
          defendant and his or her attorney; and 3) authorize the  
          defendant to provide the report to the court, the prosecutor and  
          the probation department in order to assist the parties in  
          making appropriate and beneficial decisions about the  
          defendant's care and treatment.

           Existing law  prohibits any person charged with and found  
          incompetent on a charge of, convicted of, or found 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 at least 180 days:

                 Murder;
                 Mayhem;
                 Aggravated mayhem;
                 Kidnapping, kidnapping for ransom, or kidnapping during  
               the commission of a carjacking and the victim suffered the  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 3


               intentional infliction of great bodily injury (GBI);
                 Robbery or carjacking with a deadly or dangerous weapon  
               and the victim suffers GBI;
                 Arson that causes GBI or causes an inhabited structure  
               or property to burn.  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;
                 Rape of a spouse accomplished by means of force or  
               threat of retaliation;
                 Burglary of a residence;
                 Assault with intent to commit mayhem, rape, sodomy, oral  
                copulation rape in concert with another, lascivious acts  
               upon a child, or penetration of genitals or anus with a  
               foreign object which result in GBI to the victim;
                 Lewd and lascivious acts;
                 Carrying or placing an explosive or destructive devise  
               on a passenger vessel, aircraft, car, or other vehicle;
                 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;
                 Wrongful possession of an explosive or destructive  
               devise with intent to injure or intimidate; or,
                 Any felony involving death, GBI, or an act which poses a  
               serious threat of bodily injury to another person.  (Pen.  
               Code, � 1601, subd. (a).)

           Existing law  allows any person subject to the provision above to  
          be placed on outpatient status if all of the following  
          conditions are satisfied:

                 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;
                 The community program director advises the court that  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 4


               the defendant will benefit from that status and identifies  
               an appropriate program of supervision and treatment; and, 

           Existing law  requires the prosecutor to provide notice of the  
          hearing date and pending release to the committing-offense  
          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.  (Pen. Code, � 1603.)

           Existing law  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  
          incompetent on a charge of, or convicted of, any misdemeanor or  
          any non-specified felony or found NGI of any misdemeanor.  (Pen.  
          Code, � 1601, subd. (b).)

           Existing law  allows any person subject to provision above to be  
          placed on outpatient status if all of the following conditions  
          are satisfied:

                 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;
                 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,
                 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.  (Pen. Code, � 1602, subd. (a).)

           Existing law provides that any person alleged, as a result of  
          mental disorder, to be a danger to himself or others or to be  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 5


          gravely disabled may 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.  (Welf. & Inst. Code, � 5200.)

           Existing law  provides that a conservator of the person, of the  
          estate, or of the person and the estate may be appointed for any  
          person who is gravely disabled as a result of mental disorder or  
          impairment by chronic alcoholism.  (Welf. & Inst. Code, � 5350.)

           Existing law  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 this 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  
          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.  (Welf. &  
          Inst. Code, � 5354.)

           Existing law  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.  (Welf. &  
          Inst. Code, � 5354.)

           This bill  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  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 6


          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.
            
           This bill  requires the officer providing a conservatorship  
          investigation in a case where a criminal 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

           This bill  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. The conservatorship  
          investigation report shall be kept confidential and not  
          disclosed without the prior written consent of the defendant.

           This bill  requires the court to place all copies of the report  
          in a sealed file after disposition of the criminal case.  The  
          defendant and defendant's attorney may retain their copies.   
          Permits 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 placement in the sealed file.

           This bill  makes findings and declarations relative to a  
          conservatee's confidentiality rights. 

                    RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION

          For the last several years, severe overcrowding in California's  
          prisons has been the focus of evolving and expensive litigation  
          relating to conditions of confinement.  On May 23, 2011, the  
          United States Supreme Court ordered California to reduce its  
          prison population to 137.5 percent of design capacity within two  
          years from the date of its ruling, subject to the right of the  
          state to seek modifications in appropriate circumstances.   




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 7



          Beginning in early 2007, Senate leadership initiated a policy to  
          hold legislative proposals which could further aggravate the  
          prison overcrowding crisis through new or expanded felony  
          prosecutions.  Under the resulting policy, known as "ROCA"  
          (which stands for "Receivership/ Overcrowding Crisis  
          Aggravation"), the Committee held measures that created a new  
          felony, expanded the scope or penalty of an existing felony, or  
          otherwise increased the application of a felony in a manner  
          which could exacerbate the prison overcrowding crisis.  Under  
          these principles, ROCA was applied as a content-neutral,  
          provisional measure necessary to ensure that the Legislature did  
          not erode progress towards reducing prison overcrowding by  
          passing legislation, which would increase the prison population.  
            

          In January of 2013, just over a year after the enactment of the  
          historic Public Safety Realignment Act of 2011, the State of  
          California filed court documents seeking to vacate or modify the  
          federal court order requiring the state to reduce its prison  
          population to 137.5 percent of design capacity.  The State  
          submitted that the, ". . .  population in the State's 33 prisons  
          has been reduced by over 24,000 inmates since October 2011 when  
          public safety realignment went into effect, by more than 36,000  
          inmates compared to the 2008 population . . . , and by nearly  
          42,000 inmates since 2006 . . . ."  Plaintiffs opposed the  
          state's motion, arguing that, "California prisons, which  
          currently average 150% of capacity, and reach as high as 185% of  
          capacity at one prison, continue to deliver health care that is  
          constitutionally deficient."  In an order dated January 29,  
          2013, the federal court granted the state a six-month extension  
          to achieve the 137.5 % inmate population cap by December 31,  
          2013.  

          The Three-Judge Court then ordered, on April 11, 2013, the state  
          of California to "immediately take all steps necessary to comply  
          with this Court's . . . Order . . . requiring defendants to  
          reduce overall prison population to 137.5% design capacity by  
          December 31, 2013."  On September 16, 2013, the State asked the  
          Court to extend that deadline to December 31, 2016.  In  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 8


          response, the Court extended the deadline first to January 27,  
          2014 and then February 24, 2014, and ordered the parties to  
          enter into a meet-and-confer process to "explore how defendants  
          can comply with this Court's June 20, 2013 Order, including  
          means and dates by which such compliance can be expedited or  
          accomplished and how this Court can ensure a durable solution to  
          the prison crowding problem."

          The parties were not able to reach an agreement during the  
          meet-and-confer process.  As a result, the Court ordered  
          briefing on the State's requested extension and, on February 10,  
          2014, issued an order extending the deadline to reduce the  
          in-state adult institution population to 137.5% design capacity  
          to February 28, 2016.  The order requires the state to meet the  
          following interim and final population reduction benchmarks:

                 143% of design bed capacity by June 30, 2014;
                 141.5% of design bed capacity by February 28, 2015; and
                 137.5% of design bed capacity by February 28, 2016. 

          If a benchmark is missed the Compliance Officer (a position  
          created by the February 10, 2016 order) can order the release of  
          inmates to bring the State into compliance with that benchmark.   


          In a status report to the Court dated May 15, 2014, the state  
          reported that as of May 14, 2014, 116,428 inmates were housed in  
          the State's 34 adult institutions, which amounts to 140.8% of  
          design bed capacity, and 8,650 inmates were housed in  
          out-of-state facilities.   

          The ongoing prison overcrowding litigation indicates that prison  
          capacity and related issues concerning conditions of confinement  
          remain unresolved.  While real gains in reducing the prison  
          population have been made, even greater reductions may be  
          required to meet the orders of the federal court.  Therefore,  
          the Committee's consideration of ROCA bills -bills that may  
          impact the prison population - will be informed by the following  
          questions:





                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 9


                 Whether a measure erodes realignment and impacts the  
               prison population;
                 Whether a measure addresses a crime which is directly  
               dangerous to the physical safety of others for which there  
               is no other reasonably appropriate sanction; 
                 Whether a bill corrects a constitutional infirmity or  
               legislative drafting error; 
                 Whether a measure proposes penalties which are  
               proportionate, and cannot be achieved through any other  
               reasonably appropriate remedy; and,
                 Whether a bill addresses a major area of public safety  
               or criminal activity for which there is no other  
               reasonable, appropriate remedy.

                                      COMMENTS

          1.  Need for this Bill  
          
          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 -Mentally Ill Persons in the Criminal Justice  
            System  
          
          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 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  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 10


          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.  

























                                                                     (More)











          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 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.  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.  AB  
          2186 bill was heard in this 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  




                                                                     (More)






                                                      AB 2190 (Maienschein)
                                                                     Page 12


          defendant will regain competence in the foreseeable future.  AB  
                                                    2625 bill was heard in the Senate Public Safety Committee on  
          June 10, 2014, and passed with a vote of 6-0.
          
          5.    Recent Budget Actions and State Hospital Related  
          Legislation  

          DSH now almost exclusively treats forensic patients - those  
          committed from the criminal justice system.  Most DSH facilities  
          were not designed to house and treat that volume or proportion  
          of patients.  There have been growing concerns about the great  
          increase in assaults against staff and other patients by  
          particularly dangerous patients.  AB 1340 (Achadjian) - set for  
          hearing in this Committee with this bill - would establish  
          "enhanced treatment programs" (ETP) for dangerous inmates.  The  
          ETP proposal is controversial because it includes placing  
          patients in single rooms that can be locked from outside.  

          AB 1468 (Committee on Budget), the public safety trailer bill  
          that passed on June 15, 2014, contains a number of provisions  
          concerning safety in state hospitals, including the development  
          of training protocols, policies and procedures for peace  
          officers in state hospitals, and a requirement that the Health  
          and Human Services Agency develop recommendations to improve the  
          quality and stability of law enforcement and investigative  
          functions in state hospitals, as specified.  

          This bill appears to be part of a process to reduce the  
          population in DSH facilities by treating forensic patients who  
          pose the least danger to others in local facilities and  
          outpatient programs.  It appears that treatment of mentally ill  
          offenders should be done in a comprehensive manner in order to  
          avoid the cycling of these persons through the system.  Robust  
          local treatment programs would be essential to a successful  
          treatment system.  


                                   ***************













                                                      AB 2190 (Maienschein)
                                                                     Page 13