AB 1300

Page 1

Date of Hearing: May 27, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 1300

Author:(Ridley-Thomas) – As Amended Ver:May 20, 2015

Policy Committee: / Health / Vote: / 18 - 0
Judiciary / 10 - 0

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

SUMMARY:

This bill makes numerous changes and specifies numerous aspects of the Lanterman-Petris-Short (LPS) involuntary detention process (known as "5150" for the Welfare and Institutions Code section in which the process is established.) Specifically, this bill:

1)  Modifies provisions related to holds, detention, and transfer of individuals.

2)  Creates a construct called "local or regional liaison," and spells out the duties of the liason, which include facilitating communication between the county mental health system and health facilities.

3)  Contains sections encouraging counties to take various actions, including establishing more robust community mental health services and designating liaisons.

4)  Allows correctional health facilities to be "designated facilities" for purposes of 5150 holds.

5)  Distinguishes psychiatric medical emergencies (which are subject to federal law requiring a hospital to treat and stabilize any individual requiring treatment) from evaluation and treatment services pursuant to 5150.

6)  Allow counties to designate ambulatory facilities, and requires the Department of Health Care Services (DHCS) to encourage counties to use appropriate ambulatory facilities for evaluation and treatment.

7)  Allows an emergency physician to release a 5150 hold if the physicians finds there is no longer probable cause to determine the detention for evaluation and treatment. Prohibits probable cause determinations for detention, or to continue detention, from considering the availability of beds or services.

8)  Exempts facilities, physicians, and other professionals from civil or criminal liability for injury resulting from their decisions related to detention and release of a person, or the terms and conditions of detention. Exempts the same from liability relating to injury caused by, or to, an eloping person who has been detained, and from liability relating to their wrongful death.

9)  Specifies a 72-hour hold begins upon detention. Specifies conditions under which an individual must be released from detention, including lack of specified paperwork accompanying the individual

10) Defines new terms and reorganizes definitions.

11) Requires DHCS to create specified forms for use statewide.

FISCAL EFFECT:

1)  Significant cost pressure, likely exceeding $200,000 GF, to DHCS for a complex, high-interest regulatory effort to adapt current regulations to the new statutory framework, and to further clarify or specify the law, including developing related forms. In addition, the department would likely incur unknown, significant costs for legal analysis and to assist counties in complying with the new protocols and processes established in this bill. DHCS is charged with administration of the LPS Act and is required under current law to adopt rules, regulations, and standards as necessary.

2)  To the extent this bill may result in fewer individuals being detained in hospital emergency departments, or being detained for a shorter length of time, potential cost pressure to the law enforcement agencies including the California Highway Patrol to respond to additional incidents, as well cost pressure for county mental health crisis teams and related services, to the extent they are available. Likelihood and magnitude of additional costs are unknown; local costs appear non-reimbursable.

3)  Counties and cities, particularly behavioral health agencies and law enforcement, may incur significant, non-reimbursable one-time costs to adjust current practices (including costs for analyzing, training personnel, and ensuring compliance), and ongoing costs to modify response patterns to behavioral health incidents due to the changes in this bill.

COMMENTS:

1)  Purpose. According to the author, in the 48 years since the LPS Act's passage, there have been significant changes in the mental health delivery system, adversely impacting a patient’s ability to obtain prompt evaluation and treatment as required by current law. In addition, the fragmented and inconsistent application of the LPS Act by California’s 58 counties has led to an increasing and often inappropriate dependence on hospital Emergency Departments (ED's) to care for this population, without the necessary resources. The author states that this has resulted in individuals with mental illness languishing for hours, days, and sometimes weeks, awaiting psychiatric assessment and treatment.

2)  5150 of the LPS Act. Welfare and Institutions Code (WIC) Section 5150 of the LPS Act allows peace officers and other specified persons to take an individual into custody and place him or her in a facility for 72-hour evaluation and treatment if they believe that, due to a mental disorder, the individual is a danger to himself, herself, or others, or is gravely disabled—i.e., unable to provide for basic personal needs for food, clothing, or shelter due to a mental disability. Counties designate facilities for the purposes of the initial evaluation and treatment services. Many emergency departments are designated facilities. Some individuals in crisis are not able to be transported to a designated facility and are instead taken to non-designated emergency departments, where county staff must perform an evaluation. This bill makes numerous changes to the 5150 process, many of which appear designed to reduce the role of emergency departments in the process, while putting pressure on counties to develop adequate infrastructure to serve the need for mental health treatment.

3)  Support. The sponsor of this bill, the California Hospital Association (CHA), writes in support of the bill that this bill would modernize the 5150 process to more closely conform to the evolving community health care delivery system, while ensuring consistent civil liberty protections for individuals subject to detention. Cosponsors of the bill, the California Chapter of the American College of Emergency Physicians, and the Association of California Healthcare Districts note that this measure increases the emphasis on the prompt provision of services in both LPS-designated and non-LPS designated facilities. The California Medical Association adds in support that the current system is failing psychiatric patients by forcing them through a fragmented medical delivery system that is inefficient and wastes valuable ED resources.

4)  Opposition. Numerous core stakeholders in the 5150 arena have significant concerns with this bill. The California State Association of Counties and the Urban Counties Caucus state this bill moves in the opposite direction of the progress made in the last four years by imposing new silos, costs, and liabilities surrounding the timely treatment for mentally ill individuals. National Alliance for Mental Illness (NAMI) California cites significant concerns that the bill limits access to emergency departments, which may be the only place someone in crisis can turn. They cite several specific provisions they believe put their mentally ill loved ones at risk, including the provision starting the 72-hour clock upon detention and provisions related to non-designated hospitals. County Behavioral Health Directors Association cites numerous serious concerns, including that it will be easier to release individuals in crisis, resulting in increased incarceration rates for individuals living with mental health conditions. They add that the LPS Act was modernized two years ago through SB 364 (Steinberg), Chapter 567, Statues of 2014, with broad stakeholder support, and note this bill does nothing to increase available services.

5)  Prior Legislation.

a)  SB 364 revised the law related to 5150 holds by adding to the types of facilities that a county is allowed to designate to provide services, allowing county mental health directors to develop procedures for the designation and training of professionals who can perform 5150 functions, and making other clarifying and substantive changes.

b)  AB 110 (Blumenfield), Chapter 20, Statutes of 2013, the 2013-14 Budget Act, included, among its other provisions, $206 million ($142 million General Fund one-time) for a major investment in mental health services, including additional residential treatment capacity, crisis treatment teams, and triage personnel.

6)  Staff Comments. Challenges in this area appear to largely be related to the sufficiency of community and inpatient behavioral health services. Both public and private inpatient psychiatric services are often insufficient compared to the need, largely due to the lack of reimbursement and profitability for these services, respectively. It appears even though an individual may be evaluated as needing treatment, the unavailability of beds or other appropriate services causes individuals to be detained longer than is ideal in emergency departments. This inability to direct individuals to the most appropriate level of care appears to be a source of frustration for all stakeholders—hospitals, county behavioral health, law enforcement, families of mentally ill individuals, and the individuals themselves.

The LPS Act appears to be operationalized differently in different counties depending on local resources and other factors. It is unclear whether lack of standardized application of 5150-related processes is a problem to be solved, or a sensible adaptation to very different local conditions. It may be a combination.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081