BILL ANALYSIS �
AB 2374
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 2374 (Mansoor)
As Amended August 22, 2014
Majority vote
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|ASSEMBLY: |73-0 |(May 23, 2014) |SENATE: |36-0 |(August 27, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Requires deaths at licensed residential treatment
facilities to be reported to the Department of Health Care
Services (DHCS) in a timely manner. Requires private
organizations that register or certify substance abuse
counsellors to verify that an applicant has not had another
registration or certification revoked.
The Senate amendments require telephonic reports of resident
deaths to be filed with DHCS within one working day of the event
and written reports to be filed within seven days of the event.
Specify that if a counselor's registration or certification has
been previously revoked, the certifying organization must deny
the request and send the counselor a written notice of denial.
Requires the notice to specify the counselor's right to appeal
the denial. Authorizes DHCS to conduct periodic reviews of
certifying organizations to determine compliance with the
provisions of this bill, and to take actions for noncompliance,
including revocation of an organization's certification.
Requires DHCS to adopt regulations specified by this bill by
December 31, 2017.
FISCAL EFFECT : According to the Senate Appropriations
Committee, one-time costs of up to $250,000 to revise
regulations and verify that certifying organizations comply with
the requirements of this bill and minor ongoing costs to
periodically review policies and performance of certifying
organizations.
COMMENTS : According to the author, this bill is intended to
ensure that a resident's death is promptly reported by an
alcoholism and drug abuse recovery or treatment (ADART) facility
and addressed by DHCS in a timely manner. The author
acknowledges that DHCS recently took over the responsibilities
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previously held by the Department of Alcohol and Drug Programs
(DADP) but states that there have been rising concerns that
current regulations and enforcement remain inadequate. Finally,
the author states this bill will implement the recommended
reforms in a 2012 report by the California Senate Office of
Oversight and Outcomes (SOOO) as to improve the quality of care
provided in ADART residential facilities and ensure that proper
oversight is established.
The state's residential ADART facilities are authorized to
provide nonmedical services to individuals recovering from
alcohol and drug addiction. ADART programs must be licensed by
DHCS, with licensing criteria that are focused on health and
safety rather than treatment program content. DHCS conducts
site visits every two years to check for compliance with
regulations, including: staff tuberculosis tests; health
questionnaires for residents; staff First Aid and
cardiopulmonary resuscitation training; and, adequate food for
residents.
Licensing of ADART programs was shifted from the Department of
Social Services (DSS) to DADP in the 1980s because ADART
programs required less intensive services than other facilities
licensed by DSS. At the time, the dominant model of treatment
for substance abuse recovery was the social model, a
peer-oriented program based on the 12th step in the Alcoholics
Anonymous process: reaching out to help other alcoholics as a
way of sustaining sobriety. The social model is essentially
nonmedical; accordingly, the ADART programs were defined in
statute as programs that provide nonmedical services.
In 2013, DADP was eliminated and responsibility for ADART
programs was shifted from DADP to DHCS. DHCS administers the
ADART programs under the same statutory and regulatory standards
previously administered by DADP.
SOOO issued two investigative reports relating to oversight of
ADART facilities and staff by the DADP, responsible for ADART
oversight at that time, as summarized below.
Oversight of Drug and Alcohol Facilities. The September 2012
SOOO report, Rogue Rehabs: State Failed to Police Drug and
Alcohol Homes, with Deadly Results, identified two serious
problems in DADP oversight of ADART programs: first, a pattern,
over the past decade, of DADP failing to identify potentially
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dangerous problems and, when it did, neglecting to follow up and
assure that the problems were corrected; and, second, evidence
of the widespread provision of medical treatment by ADART
programs, in direct violation of state law.
SOOO cited several incidents where DADP's enforcement and
investigation activities following resident deaths at ADART
facilities were inconsistent. At one facility where four
patient deaths occurred over a span of two and a half years,
DADP was slow to respond: one death was only investigated a year
and a half after the fact, upon DADP learning of another death
in the same facility. By the time DADP suspended the facility's
license, the home had already been closed due to foreclosure.
At other facilities, patients who were too sick to receive care
at an ADART facility died after being admitted with the
expectation that they would receive medical care. According to
the 2012 report, DADP indicated it was being more aggressive in
halting practices that could lead to injury or death, and DADP
was revoking and suspending licenses more frequently. DADP
implemented new policies intended to focus limited resources on
cases that pose the greatest risk to the public. The 2012
report recommends that DADP's improved death investigation
policy be used as a template for statutory death investigation
requirements, if the policy is found to be effective.
The second major problem identified by the September 2012 report
is that DADP interprets its mission as overseeing non-medical
care in residential homes, yet the industry routinely offers
services that include medications and care by doctors and other
medical professionals. Though many programs continue to adhere
to the "social model," much of the industry has abandoned that
model in favor of a "comfortable" model that provides medicine
to help with detoxification. The 2012 report notes that
California is unusual among populous states in prohibiting
medical care in residential treatment programs, and recommends
that the Legislature consider legislation to allow medical care
in residential treatment facilities, given that many experts
believe that medical care is an integral part of successful
treatment. However, the 2012 report adds that it would not be
enough to simply lift the ban; the state may have to strengthen
other laws and regulations to make sure that medical care in the
facilities would be safe and effective.
Oversight of alcohol and other drug (AOD) Counselors. In May
2013, SOOO released a second report, Suspect Treatment: State's
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lack of scrutiny allows unscreened sex offenders and unethical
counselors to treat addicts. SOOO reported that about 36,000
registered or certified AOD counselors work in 2,534 private and
publicly funded AOD programs. The 2013 report concluded that
California's system of AOD counselor oversight allows residents
to be treated by registered sex offenders and other serious
felons, counselors facing current drug and alcohol charges, and
those whose certification already was revoked for misconduct.
SOOO also concluded that AOD counselors can easily flout
existing education and training requirements. The 2013 report
pointed out California is one of only two states (and
Pennsylvania) among the 15 largest states making no attempt to
review counselor criminal backgrounds and that AOD counselors
are the only health-related profession in California not subject
to such background checks. In the absence of the certifying
organizations not being required to check with other state
health licensing boards in California, SOOO found instances
where doctors, nurses, and certified nurse assistants had been
banned from their fields before becoming AOD counselors.
The 2013 report also pointed out that for three decades, the
state and AOD treatment industry have been unable to agree on a
framework to give the state authority to credential counselors
but concluded that California's public-private hybrid system
precludes criminal background checks and leaves gaps that can be
exploited by counselors who move between seven private
organizations that register and certify them. While the 2013
report acknowledged that many counselors draw from their own
struggles with AOD addiction to excel at jobs with not much pay,
others come to the profession with serious criminal backgrounds
that raise questions about their fitness to treat clients, who
are often at the most vulnerable time of their lives.
Among other things, the 2013 report recommends that the
Legislature reconsider past efforts to give the state authority
to license/certify AOD counselors and conduct background checks.
Alternatively, SOOO offers that the state could authorize the
accrediting organizations to conduct the background checks and
set guidelines for circumstances and convictions that would
preclude certain individuals from working as counselors. The
2013 report also recommends that DHCS or the accrediting
organizations check applicants against the National Practitioner
Data Bank, and require certifying organizations to check with
the other counterpart organizations at the time of registration,
not just at the point of certification, because certification
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may occur five to seven years later, or longer if the person
moves between certifying organizations and re-registers starting
the five-year clock over.
California Association of Addiction Recovery Resources (CAARR)
writes in support of this bill, as it was amended to make
clarifying changes to the incident reporting section, including
deleting reporting of communicable diseases and limiting the
types of injuries and fires that must be reported. CAARR also
recommends that the author consider expanding counselor
registration/certification to include counselors in outpatient
settings. California Narcotic Officers Association supports
this bill because it will provide for greater oversight of ADART
facilities.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097
FN:
0005459