BILL ANALYSIS
SB 1534
Page 1
Date of Hearing: June 27, 2000
ASSEMBLY COMMITTEE ON HEALTH
Martin Gallegos, Chair
SB 1534 (Perata) - As Amended: June 22, 2000
SENATE VOTE : 24-15
SUMMARY : Specifies the duties and responsibilities of patients'
rights advocates and clarifies the rights of mental health
clients. Specifically, this bill , among other things:
1)Specifies that people with psychiatric disabilities residing
in specified community care facilities have the same legal and
civil rights guaranteed patients hospitalized in mental health
treatment facilities, including access to the services of a
patients' rights advocate.
2)Adds mental health clients to the list of persons who can
bring an enforcement action for rights violations, and
specifies that the aggrieved person need not prove actual
damages to bring such an action.
3)Specifies that the duties of county patients' rights advocates
(PRAs) include: a) providing representation in certification
review hearings, capacity hearings, and hearings pertaining to
the commitment of minors to public hospitals, unless such
representation is already provided; b) providing assistance to
minors in clinical review proceedings; c) assisting recipients
of public mental health services with grievances; and d)
providing outreach to recipients of mental health services to
ensure that they are aware of their rights.
4)Specifies that PRAs have access to mental health clients in
community care facilities. Requires this access to be
provided as necessary and reasonable, and if feasible, during
normal hours of operation, for routine monitoring. If a PRA
conducting monitoring wishes to interview a patient or
resident, the advocate must contact a representative of the
facility and the treating provider before conducting the
interview.
5)Permits a PRA to inspect and copy confidential client
information and records, without specific authorization by the
client or guardian, in the course of investigating a complaint
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if the client is deceased, is absent, is unable to authorize
the release of information due to his or her physical or
mental condition, or in accordance with routine monitoring
duties. Prohibits a PRA from having access to records over a
client's objections.
6)Clarifies the authority of PRAs to refer complaints to any
appropriate state or local government agency, and requires any
licensing agency that responds to a complaint referred by an
advocate to prepare an annual report to the Legislature, as
specified.
7)Requires a county mental health director to be responsible for
responding to complaints about any PRA.
8)Prohibits retaliation against advocates for the performance of
their duties and prohibits discrimination and retaliation
against a resident of a community care facility who initiates
or participates in a complaint.
EXISTING LAW :
1)Establishes rights of patients in mental health treatment
facilities, including the right to receive the services of a
patient advocate.
2)Requires each local mental health director to appoint or
contract for one or more county patients' rights advocates.
Requires the duties of these advocates to include, but not be
limited to the following: a) investigating complaints from or
concerning recipients of mental health services residing in
licensed health or community care facilities regarding abuse,
unreasonable denial or punitive withholding of their rights;
b) monitoring mental health facilities, services and programs
for compliance with statutory and regulatory patients' rights
provisions; c) providing training and education about mental
health law and patients' right to mental health providers; and
d) ensuring that mental health clients in all licensed health
and community care facilities are notified of their rights.
3)Authorizes the court to impose a civil penalty on any person
or facility for specified patient's rights violations, in an
amount of $50 per day during the time in which the violation
is not corrected, not to exceed $1,000 for each violation.
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FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the intent of
the bill is to clarify the rights and responsibilities of
mental health advocates to create more uniformity in the
delivery of patient advocacy services, and to facilitate
responses to concerns forwarded by advocates to appropriate
state licensing entities. The author points to a recent
series of articles in the Los Angeles Times that revealed
incidents of neglect and abuse in homes for the mentally ill
throughout the state.
2)SUPPORT : The California Association of Mental Health
Patients' Rights Advocates (CAMHPRA) is sponsoring this bill
to clarify the responsibilities of patients' rights advocates
and consolidate into one provision all of those
responsibilities. County patients' rights advocates have
numerous duties that are not listed in the primary statutory
provision governing advocates' responsibilities. This bill
proposes to consolidate those functions in one section of the
law in order to clarify the advocates' role and diminish
confusion.
CAMHPRA argues that this bill ensures that patients who have
died, left the area, or are unconscious or otherwise unable to
consent to a release of confidential information are able to
have equal access to advocacy services. CAMHPRA asserts that
adequate monitoring of psychiatric facilities cannot be
accomplished without access to an appropriately sized randomly
selected data set of mental health records. While the current
law already allows advocates' access to confidential records
in that context, misinformed and misguided interpretations of
this access by certain parties who have a vested interest in
keeping advocates away from clients who may complain or from
records which may reveal noncompliance with laws and
regulations. They also state that sufficient confidentiality
protections are in place, and that advocates do not pursue
complaint investigations or seek access to confidential
records over the objections of their clients, which the bill
also makes clear.
Finally, CAMHPRA supports the bill's provision which extends
the basic patients' rights protections currently afforded to
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patients in mental health facilities to include persons with
psychiatric disabilities who reside in certain community care
facilities. The California Network of Mental Health Clients
states that one of the major barriers to treatment is the real
and perceived abuses of the mental health system... which is
experienced by many clients as abusive, disrespectful, and
hurtful. Protection and Advocacy, Incorporated (PAI) also
believes this bill will greatly improve mental health services
in California by improving the ability of patients' rights
advocates to advocate on behalf of their clients.
3)BACKGROUND . In 1974, the Legislature mandated the
establishment of mental health patients' rights.
Administrative regulations adopted in 1976 required county
mental health departments and state hospitals to provide
patients' advocacy services including educating patients about
their rights, investigating complaints and advocating on
behalf of patients whose rights were violated.
Counties are required to designate a county mental health
patients' rights advocacy office that is responsible for
offering the statutorily defined services. Advocates must meet
qualifications necessary to fulfill the responsibilities
established by state law but specific qualifications are not
defined. Advocates are mandated to attend annual training
sponsored by the State Office of Patients' Rights.
4)RECENT ABUSES . Following the realignment of responsibility
and payment for public mental health services in 1991,
counties gained the option of paying to place noncriminal
persons with severe mental illness in state-run hospitals, or
contracting out with private providers at the local level to
provide care. A recent Los Angeles Times article indicates
that many counties have chosen to redirect patients to private
facilities that tend to be less expensive than state hospital
care. This redirection has also resulted in a large increase
in the number of citations issued to a select group of private
facilities. DHS has issued 200 citations against 35 of the 45
facilities certified to provide care for the mentally ill
since 1992. Eight facilities received almost half of these
citations. The author believes that one of the solutions for
ensuring compliance with patients' rights laws is to clarify
the ability of the advocate to monitor facilities and take
action when there are abuses.
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5)OPPOSITION : A coalition comprised of the California Alliance
of Child and Family Services, California Association of Health
Facilities, California Healthcare Association, California
Mental Health Directors Association, and the California
Psychiatric Association (the Coalition), submitted a joint
letter opposing this bill unless it is amended. The Coalition
opposes any expansion of the duties of patients' rights
advocates without additional resources, and argues that this
bill sets the system up for failure.
The Coalition objects to the bill's provisions that would
allow, as part of their monitoring duties, patients' rights
advocates "to have unlimited access to inspect and copy
confidential medical records without specific authorization by
the patient or his or her guardian. The Coalition also
asserts that in cases where a child is involved, authorization
should be required of the patient's legal guardian prior to
any confidential records being disclosed. The Coalition also
argues that the definition of "routine monitoring" for
purposes of allowing advocates access to records and patient
information is too vague.
The Coalition is concerned that the requirements for training
of patients' rights advocates are limited, and notes that many
advocates appear to receive on-the-job training, which can
vary greatly from county to county. The Coalition recommends
a standardized training program to provide a basic knowledge
of the services to be provided and instruction on the
consistent application and interpretation of laws and
regulations.
Finally, the Coalition argues that expansion of the patients'
rights advocates' duties, without additional oversight, will
actually lead to services being an inconsistent manner
depending upon the strengths and weaknesses of each advocate.
The Coalition recommends that the county mental health
director exercise additional oversight when an advocate seeks
access to medical records.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Mental Health Patients' Rights
Advocates (sponsor)
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California Network of Mental Health Clients
Protection and Advocacy, Incorporated
Opposition
California Alliance of Child and Family Services
California Association of Health Facilities
California Healthcare Association
California Mental Health Directors Association
California Psychiatric Association
Analysis Prepared by : Ann Blackwood / HEALTH / (916) 319-2097