BILL ANALYSIS                                                                                                                                                                                                    



                                                                  SB 1534
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          Date of Hearing:   August 23, 2000

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS 
                              Carole Migden, Chairwoman

                   SB 1534 (Perata) - As Amended:  August 18, 2000 

          Policy Committee:                             JudiciaryVote:10-5
                       Health                                   8-5

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              Yes

           SUMMARY  

          This bill expands the responsibilities and authority of  
          patients' rights advocates and clarifies the rights of mental  
          health clients.  Specifically, this bill: 

          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 a patients' rights  
            advocate (PRA).  Gives PRAs access to mental health clients in  
            community care facilities.

          2)Specifies the duties of county PRAs include:

             a)   Representing clients in certification review hearings,  
               capacity hearings, and hearings on committing minors to  
               public hospitals, unless representation is already  
               provided.

             b)   Assisting minors in clinical review proceedings.

             c)   Assisting recipients of public mental health services  
               with grievances.

             d)   Providing outreach to mental health service recipients  
               to make them aware of their rights.

          3)Permits a PRA to inspect and copy confidential client  
            information and records, without authorization from the client  
            or guardian ad litem, in the course of investigating a  
            complaint made by or about a client.  Permits copying  








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            confidential medical information only if individually  
            identifying information is redacted or the patient consents to  
            the copying.  Denies access to confidential records if a  
            client objects.

          4)Requires the Department of Mental Health (DMH) annually  
            collect and publish data on patients' rights complaints.

           FISCAL EFFECT
           
          1)Unknown major state-reimbursable costs, at least $1 million,  
            from expanding PRA scope of responsibilities and requiring  
            additional training.

          2)Costs to DMH, about $500,000 GF, to collect and publish  
            specified data on complaints.

           COMMENTS  

           1)Purpose  . This bill is sponsored by the California Association  
            of Mental Health Patients' Rights Advocates to clarify the  
            rights and responsibilities of mental health advocates.  It  
            consolidates into one provision, the numerous duties of PRAs.   
            It specifies that persons with psychiatric disabilities living  
            in specified community care facilities are also within the  
            scope of responsibility of PRAs.  More importantly, it allows  
            a PRA to inspect and copy confidential patient records without  
            the consent of the patient, unless the patient objects.   
            Confidential medical information must be redacted to eliminate  
            individually identifying information, unless the patient  
            specifically consents to their copying.

           2)Opposition  .  The California Mental Health Directors  
            Association and several organizations of private mental health  
            providers oppose this bill unless amended to include the  
            additional resources necessary to expand the PRA duties.  They  
            object to the lack of oversight of PRA activities and  
            recommends that the county mental health director exercise  
            additional oversight when an advocate seeks access to medical  
            records.  

          Finally, opponents note the current training provided PRAs is  
            limited and varies from county to county.  They recommend a  
            standardized training program to provide basic knowledge of  
            services to be provided and instruction on consistent  








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            application of laws and regulations.

           Analysis Prepared by  :    Joyce Iseri / APPR. / (916) 319-2081