Bill Text: CA AB1340 | 2013-2014 | Regular Session | Amended

California Assembly Bill 1340 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Enhanced treatment programs.

Spectrum: Slight Partisan Bill (Democrat 5-2)

Status: (Passed) 2014-09-28 - Chaptered by Secretary of State - Chapter 718, Statutes of 2014. [AB1340 Detail]

Download: California-2013-AB1340-Amended.html
BILL NUMBER: AB 1340	AMENDED
	BILL TEXT

	AMENDED IN SENATE  JULY 2, 2014
	AMENDED IN SENATE  JUNE 16, 2014
	AMENDED IN SENATE  APRIL 3, 2014
	AMENDED IN SENATE  JUNE 18, 2013
	AMENDED IN ASSEMBLY  MAY 24, 2013
	AMENDED IN ASSEMBLY  APRIL 10, 2013
	AMENDED IN ASSEMBLY  APRIL 1, 2013

INTRODUCED BY   Assembly Member Achadjian
   (Coauthor: Assembly Member Yamada)
   (Coauthors: Senators  Beall   Anderson, 
 Beall,  and Wolk)

                        FEBRUARY 22, 2013

   An act to amend Section 1250 of, and to add Section 1265.9 to, the
Health and Safety Code, and to amend Sections 4100 and 7200 of, and
to add Sections  4142   4142.5  and 4143
to, the Welfare and Institutions Code, relating to mental health.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 1340, as amended, Achadjian. Enhanced treatment programs.
   Existing law establishes state hospitals for the care, treatment,
and education of mentally disordered persons. These hospitals are
under the jurisdiction of the State Department of State Hospitals,
which is authorized by existing law to adopt regulations regarding
the conduct and management of these facilities. Existing law requires
each state hospital to develop an incident reporting procedure that
can be used to, at a minimum, develop reports of patient assaults on
employees and assist the hospital in identifying risks of patient
assaults on employees. Existing law provides for the licensure and
regulation of health facilities, including acute psychiatric
hospitals, by the State Department of Public Health. A violation of
these provisions is a crime.
   This bill would, commencing July 1, 2015, and subject to available
funding, authorize the State Department of State Hospitals to
establish and maintain enhanced treatment  pilot  programs
(ETPs), as defined, for the treatment of patients who are at high
risk  for   of  most dangerous behavior, as
defined, and when treatment is not possible in a standard treatment
environment. The bill would require, until January 1, 2018, that an
ETP meet the licensing requirements of an acute psychiatric hospital,
except as specified.  Commencing January 1, 2018, an ETP
that is operated by the State Department of State Hospitals would be
required to be licensed by the State Department of Public Health.

   The bill would authorize a state hospital psychiatrist or
psychologist to refer a patient to an ETP for temporary placement and
risk assessment upon a determination that the patient may be at high
risk for most dangerous behavior. The bill would require the
forensic needs assessment panel (FNAP) to conduct a placement
evaluation to determine whether the patient clinically requires ETP
placement and ETP treatment can meet the identified needs of the
patient. The bill would also require a forensic needs assessment team
(FNAT) psychologist to perform an in-depth violence risk assessment
and make a treatment plan upon the patient's admission to an ETP.
   The bill would require the FNAP to conduct a treatment placement
meeting with specified individuals prior to the expiration of 90 days
from the date of placement in the ETP to determine whether the
patient may return to a standard treatment environment or the patient
clinically requires continued ETP treatment. If the FNAP determines
that the patient clinically requires continued ETP treatment, the
bill would require the FNAP to certify the patient for further ETP
treatment for one year, subject to FNAP reviews every 90 days, as
specified. The bill would require the FNAP to conduct another
treatment placement meeting prior to the expiration of the one-year
certification of ETP placement to determine whether the patient may
return to a standard treatment environment or be certified for
further ETP treatment for another year.
    Because this bill would create a new crime, it imposes a
state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  (a) The Legislature finds and declares that the State
Department of State Hospitals delivers inpatient mental health
treatment to over 6,000 patients through more than 10,000 department
employees. Their goal is to improve the lives of patients diagnosed
with severe mental health conditions who have been assigned to their
hospitals and units. In the experience of the department, there can
be no effective clinical treatment without safety for its patients
and employees, and no safety without effective clinical treatment.
   (b) It is the intent of the Legislature in enacting this bill to
expand the range of available clinical treatment by establishing
enhanced treatment  pilot  programs for those patients
determined to be at  the highest risk for aggression
  high risk of most dangerous behavior  against
other patients or hospital staff. The goal of these enhanced
treatment  pilot  programs is to  deliver 
 evaluate the effectiveness of  concentrated, evidence-based
clinical  therapy,   therapy  and
treatment in an environment designed to improve these patients'
conditions and return them to the general patient population. 
   (c) The Legislature finds and declares that the purpose of the
establishment of a pilot program creating Enhanced Treatment Units
within the State Department of State Hospitals is to test the
effectiveness of providing improved treatment with a heightened
secure setting to patients with a demonstrated and sustained risk of
aggressive, violent behavior toward other patients and staff. 

   (d) It is the intent of the Legislature that the criteria
established for placement in an Enhanced Treatment Unit within the
State Department of State Hospitals cannot be used to circumvent the
statutory and regulatory criteria for use of seclusion and restrains,
but is instead another level of continuum of care for the patient
receiving treatment in an Enhanced Treatment Unit. 
  SEC. 2.  Section 1250 of the Health and Safety Code is amended to
read:
   1250.  As used in this chapter, "health facility" means any
facility, place, or building that is organized, maintained, and
operated for the diagnosis, care, prevention, and treatment of human
illness, physical or mental, including convalescence and
rehabilitation and including care during and after pregnancy, or for
any one or more of these purposes, for one or more persons, to which
the persons are admitted for a 24-hour stay or longer, and includes
the following types:
   (a) "General acute care hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care, including the following basic
services: medical, nursing, surgical, anesthesia, laboratory,
radiology, pharmacy, and dietary services. A general acute care
hospital may include more than one physical plant maintained and
operated on separate premises as provided in Section 1250.8. A
general acute care hospital that exclusively provides acute medical
rehabilitation center services, including at least physical therapy,
occupational therapy, and speech therapy, may provide for the
required surgical and anesthesia services through a contract with
another acute care hospital. In addition, a general acute care
hospital that, on July 1, 1983, provided required surgical and
anesthesia services through a contract or agreement with another
acute care hospital may continue to provide these surgical and
anesthesia services through a contract or agreement with an acute
care hospital. The general acute care hospital operated by the State
Department of Developmental Services at Agnews Developmental Center
may, until June 30, 2007, provide surgery and anesthesia services
through a contract or agreement with another acute care hospital.
Notwithstanding the requirements of this subdivision, a general acute
care hospital operated by the Department of Corrections and
Rehabilitation or the Department of Veterans Affairs may provide
surgery and anesthesia services during normal weekday working hours,
and not provide these services during other hours of the weekday or
on weekends or holidays, if the general acute care hospital otherwise
meets the requirements of this section.
   A "general acute care hospital" includes a "rural general acute
care hospital." However, a "rural general acute care hospital" shall
not be required by the department to provide surgery and anesthesia
services. A "rural general acute care hospital" shall meet either of
the following conditions:
   (1) The hospital meets criteria for designation within peer group
six or eight, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982.
   (2) The hospital meets the criteria for designation within peer
group five or seven, as defined in the report entitled Hospital Peer
Grouping for Efficiency Comparison, dated December 20, 1982, and has
no more than 76 acute care beds and is located in a census dwelling
place of 15,000 or less population according to the 1980 federal
census.
   (b) "Acute psychiatric hospital" means a health facility having a
duly constituted governing body with overall administrative and
professional responsibility and an organized medical staff that
provides 24-hour inpatient care for mentally disordered, incompetent,
or other patients referred to in Division 5 (commencing with Section
5000) or Division 6 (commencing with Section 6000) of the Welfare
and Institutions Code, including the following basic services:
medical, nursing, rehabilitative, pharmacy, and dietary services.
   (c) (1) "Skilled nursing facility" means a health facility that
provides skilled nursing care and supportive care to patients whose
primary need is for availability of skilled nursing care on an
extended basis.
   (2) "Skilled nursing facility" includes a "small house skilled
nursing facility (SHSNF)," as defined in Section 1323.5.
   (d) "Intermediate care facility" means a health facility that
provides inpatient care to ambulatory or nonambulatory patients who
have recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of continuous
skilled nursing care.
   (e) "Intermediate care facility/developmentally disabled
habilitative" means a facility with a capacity of 4 to 15 beds that
provides 24-hour personal care, habilitation, developmental, and
supportive health services to 15 or fewer persons with developmental
disabilities who have intermittent recurring needs for nursing
services, but have been certified by a physician and surgeon as not
requiring availability of continuous skilled nursing care.
   (f) "Special hospital" means a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental staff
that provides inpatient or outpatient care in dentistry or maternity.

   (g) "Intermediate care facility/developmentally disabled" means a
facility that provides 24-hour personal care, habilitation,
developmental, and supportive health services to persons with
developmental disabilities whose primary need is for developmental
services and who have a recurring but intermittent need for skilled
nursing services.
   (h) "Intermediate care facility/developmentally disabled-nursing"
means a facility with a capacity of 4 to 15 beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
intermittent recurring needs for skilled nursing care but have been
certified by a physician and surgeon as not requiring continuous
skilled nursing care. The facility shall serve medically fragile
persons with developmental disabilities or who demonstrate
significant developmental delay that may lead to a developmental
disability if not treated.
   (i) (1) "Congregate living health facility" means a residential
home with a capacity, except as provided in paragraph (4), of no more
than 12 beds, that provides inpatient care, including the following
basic services: medical supervision, 24-hour skilled nursing and
supportive care, pharmacy, dietary, social, recreational, and at
least one type of service specified in paragraph (2). The primary
need of congregate living health facility residents shall be for
availability of skilled nursing care on a recurring, intermittent,
extended, or continuous basis. This care is generally less intense
than that provided in general acute care hospitals but more intense
than that provided in skilled nursing facilities.
   (2) Congregate living health facilities shall provide one of the
following services:
   (A) Services for persons who are mentally alert, persons with
physical disabilities, who may be ventilator dependent.
   (B) Services for persons who have a diagnosis of terminal illness,
a diagnosis of a life-threatening illness, or both. Terminal illness
means the individual has a life expectancy of six months or less as
stated in writing by his or her attending physician and surgeon. A
"life-threatening illness" means the individual has an illness that
can lead to a possibility of a termination of life within five years
or less as stated in writing by his or her attending physician and
surgeon.
   (C) Services for persons who are catastrophically and severely
disabled. A person who is catastrophically and severely disabled
means a person whose origin of disability was acquired through trauma
or nondegenerative neurologic illness, for whom it has been
determined that active rehabilitation would be beneficial and to whom
these services are being provided. Services offered by a congregate
living health facility to a person who is catastrophically disabled
shall include, but not be limited to, speech, physical, and
occupational therapy.
   (3) A congregate living health facility license shall specify
which of the types of persons described in paragraph (2) to whom a
facility is licensed to provide services.
   (4) (A) A facility operated by a city and county for the purposes
of delivering services under this section may have a capacity of 59
beds.
   (B) A congregate living health facility not operated by a city and
county servicing persons who are terminally ill, persons who have
been diagnosed with a life-threatening illness, or both, that is
located in a county with a population of 500,000 or more persons, or
located in a county of the 16th class pursuant to Section 28020 of
the Government Code, may have not more than 25 beds for the purpose
of serving persons who are terminally ill.
   (C) A congregate living health facility not operated by a city and
county serving persons who are catastrophically and severely
disabled, as defined in subparagraph (C) of paragraph (2) that is
located in a county of 500,000 or more persons may have not more than
12 beds for the purpose of serving persons who are catastrophically
and severely disabled.
   (5) A congregate living health facility shall have a
noninstitutional, homelike environment.
   (j) (1) "Correctional treatment center" means a health facility
operated by the Department of Corrections and Rehabilitation, the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, or a county, city, or city and county law enforcement
agency that, as determined by the department, provides inpatient
health services to that portion of the inmate population who do not
require a general acute care level of basic services. This definition
shall not apply to those areas of a law enforcement facility that
houses inmates or wards who may be receiving outpatient services and
are housed separately for reasons of improved access to health care,
security, and protection. The health services provided by a
correctional treatment center shall include, but are not limited to,
all of the following basic services: physician and surgeon,
psychiatrist, psychologist, nursing, pharmacy, and dietary. A
correctional treatment center may provide the following services:
laboratory, radiology, perinatal, and any other services approved by
the department.
   (2) Outpatient surgical care with anesthesia may be provided, if
the correctional treatment center meets the same requirements as a
surgical clinic licensed pursuant to Section 1204, with the exception
of the requirement that patients remain less than 24 hours.
   (3) Correctional treatment centers shall maintain written service
agreements with general acute care hospitals to provide for those
inmate physical health needs that cannot be met by the correctional
treatment center.
   (4) Physician and surgeon services shall be readily available in a
correctional treatment center on a 24-hour basis.
   (5) It is not the intent of the Legislature to have a correctional
treatment center supplant the general acute care hospitals at the
California Medical Facility, the California Men's Colony, and the
California Institution for Men. This subdivision shall not be
construed to prohibit the Department of Corrections and
Rehabilitation from obtaining a correctional treatment center license
at these sites.
   (k) "Nursing facility" means a health facility licensed pursuant
to this chapter that is certified to participate as a provider of
care either as a skilled nursing facility in the federal Medicare
Program under Title XVIII of the federal Social Security Act (42
U.S.C. Sec. 1395 et seq.) or as a nursing facility in the federal
Medicaid Program under Title XIX of the federal Social Security Act
(42 U.S.C. Sec. 1396 et seq.), or as both.
   (l) Regulations defining a correctional treatment center described
in subdivision (j) that is operated by a county, city, or city and
county, the Department of Corrections and Rehabilitation, or the
Department of Corrections and Rehabilitation, Division of Juvenile
Facilities, shall not become effective prior to, or if effective,
shall be inoperative until January 1, 1996, and until that time these
correctional facilities are exempt from any licensing requirements.
   (m) "Intermediate care facility/developmentally
disabled-continuous nursing (ICF/DD-CN)" means a homelike facility
with a capacity of four to eight, inclusive, beds that provides
24-hour personal care, developmental services, and nursing
supervision for persons with developmental disabilities who have
continuous needs for skilled nursing care and have been certified by
a physician and surgeon as warranting continuous skilled nursing
care. The facility shall serve medically fragile persons who have
developmental disabilities or demonstrate significant developmental
delay that may lead to a developmental disability if not treated.
ICF/DD-CN facilities shall be subject to licensure under this chapter
upon adoption of licensing regulations in accordance with Section
1275.3. A facility providing continuous skilled nursing services to
persons with developmental disabilities pursuant to Section 14132.20
or 14495.10 of the Welfare and Institutions Code shall apply for
licensure under this subdivision within 90 days after the regulations
become effective, and may continue to operate pursuant to those
sections until its licensure application is either approved or
denied.
   (n) "Hospice facility" means a health facility licensed pursuant
to this chapter with a capacity of no more than 24 beds that provides
hospice services. Hospice services include, but are not limited to,
routine care, continuous care, inpatient respite care, and inpatient
hospice care as defined in subdivision (d) of Section 1339.40, and is
operated by a provider of hospice services that is licensed pursuant
to Section 1751 and certified as a hospice pursuant to Part 418 of
Title 42 of the Code of Federal Regulations.
   (o) (1) "Enhanced treatment program" or "ETP" means a health
facility under the jurisdiction of the State Department of State
Hospitals that provides 24-hour inpatient care for mentally
disordered, incompetent, or other patients who have been committed to
the State Department of State Hospitals and have been assessed to be
at high risk  for   of  most dangerous
behavior, as defined in subdivision (k) of Section 4143 of the
Welfare and Institutions Code, and cannot be effectively treated
within an acute psychiatric hospital, a skilled nursing facility, or
an intermediate care facility, including the following basic
services: medical, nursing, rehabilitative, pharmacy, and dietary
service.
   (2) It is not the intent of the Legislature to have an enhanced
treatment  pilot  program supplant health facilities
licensed as an acute psychiatric hospital, a skilled nursing
facility, or an intermediate care facility under this chapter.
   (3) Commencing July 1, 2015, and until January 1, 2018, an
enhanced treatment  pilot  program shall meet the licensing
requirements applicable to acute psychiatric hospitals under Chapter
2 (commencing with Section 71001) of Division 5 of the California
Code of Regulations, unless otherwise specified in Section 1265.9 and
any related emergency regulations adopted pursuant to that section.

   (4) Commencing January 1, 2018, an ETP shall be subject to
licensure under this chapter as specified in subdivision (a) of
Section 1265.9. 
  SEC. 3.  Section 1265.9 is added to the Health and Safety Code, to
read: 
   1265.9.  (a) On and after January 1, 2018, an enhanced treatment
program (ETP) that is operated by the State Department of State
Hospitals shall be licensed by the State Department of Public Health
to provide treatment for patients who are at high risk for most
dangerous behavior, as defined by subdivision (k) of Section 4143 of
the Welfare and Institutions Code. Each ETP shall be part of a
continuum of care based on the individual patient's treatment needs.
   (b) 
    1265.9.    (a)  (1)  Notwithstanding
subdivision (a), commencing   Commencing  July 1,
2015, and until January 1, 2018, the State Department of State
Hospitals may establish and maintain  an ETP for the
treatment of   a   pilot Enhanced Treatment
Program (ETP) to test the effectiveness of providing treatment for
 patients who are at high risk  for   of
 most dangerous  behavior, as described in Section 4142
of the Welfare and Institutions Code, if the ETP meets the licensing
requirements applicable to acute psychiatric hospitals under Chapter
2 (commencing with Section 71001) of Division 5 of the California
Code of Regulations, unless otherwise specified in this section or
emergency regulations adopted pursuant to paragraph (2). 
 behavior. 
   (2) Prior to January 1, 2018, the State Department of State
Hospitals may adopt emergency regulations in accordance with the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code) to
implement this section. The adoption of an emergency regulation under
this paragraph is deemed to address an emergency, for purposes of
Sections 11346.1 and 11349.6 of the Government Code, and the State
Department of State Hospitals is hereby exempted for this purpose
from the requirements of subdivision (b) of Section 11346.1 of the
Government Code. 
   (c) 
    (b)  An ETP shall meet all of the following
requirements:
   (1) Maintain a staff-to-patient ratio of one to five.
   (2) Limit each room to one patient.
   (3) Each patient room shall allow visual access by staff 24 hours
per day.
   (4) Each patient room shall have a bathroom in the room.
   (5) Each patient room door shall have the capacity to be locked
externally. The door may be locked when clinically indicated and
determined to be the least restrictive environment for provision of
the patient's care and treatment pursuant to Section 4143 of the
Welfare and Institutions Code, but shall not be considered seclusion
for purposes of Division 1.5 (commencing with Section 1180).
   (6) Provide emergency egress for ETP patients. 
   (7) All state licensing and regulations shall be followed when a
patient is experiencing behavior criteria consistent with the need
for seclusion and restraints.  
   (8) Have a full-time independent patient advocate who provides
patients' rights advocacy services assigned to each ETP. 

   (d) 
    (c)  The ETP shall adopt and implement policies and
procedures consistent with regulations adopted by the State
Department of State Hospitals that provide all of following:
   (1)  Policies and procedures   Criteria and
process  for admission into the ETP.  A person shall not be
placed into the ETP as a means of punishment, coercion, convenience,
or retaliation. 
   (2) Clinical assessment and review focused on behavior, history,
 dangerousness,   high risk of most dangerous
behavior,  and clinical need for patients to receive treatment
in the ETP  as the least restrictive environment .
   (3) A process for identifying  which   the
 ETP along a continuum of care  that  will best meet
the patient's needs  , including least restrictive environment
 .
   (4) A process for  development of  a treatment plan with
regular clinical review and reevaluation of placement back into a
standard treatment environment  that includes  
and  discharge and reintegration planning. 
   (e) 
    (d)  Patients who have been admitted to an ETP shall
have the  same rights guaranteed to patients not in an ETP
with the exception set forth in paragraph (5) of subdivision (c).

   (f) 
    (e)  (1)  Commencing January 1, 2018, the
department shall monitor the ETPs, evaluate outcomes, and report on
its findings and recommendations to the Legislature, in compliance
with Section 9795 of the Government Code, every two years. 
 The department shall monitor the pilot ETPs, evaluate outcomes,
and report on its findings and recommendations. The information shall
be provided to the fiscal and policy committees of the Legislature
annually, beginning on January 10 of the year in which the first ETP
is opened and services have commenced. The evaluation shall include,
but is not limited to, the following:  
   (A) Comparative summary information regarding the characteristics
of the patients served.  
   (B) Compliance with staffing requirements.  
   (C) Staffing ratios and staff mix.  
   (D) Average monthly occupancy.  
   (E) Average length of stay.  
   (F) The number of residents whose length of stay exceeds 90 days.
 
   (G) The number of patients with multiple stays.  
   (H) The number of patients whose discharge was delayed due to lack
of availability of less restrictive treatment environment. 

   (I) Restraint and seclusion use, including the number of incidents
and duration, consistent with paragraph (3) of subdivision (d) of
Section 1180.2.  
   (J) Serious injuries to staff and residents.  
   (K) Serious injuries to staff and residents related to use of
restraint or seclusion. 
   (L) Staff turnover.  
   (M) The number of patients' rights complaints, including the
subject of the complaint and its resolution.  
   (N) Type and number of training provided for ETP staff.  

   (O) Staffing levels for ETPs. 
   (2) The requirement for submitting findings and recommendations to
the Legislature  every two years   annually
 under paragraph (1) is inoperative on January 1, 2026. 

   (g) 
    (f)  Notwithstanding paragraph (2) of subdivision
 (b),   (a),  the State Department of
Public Health and the State Department of State Hospitals shall
jointly develop the regulations governing ETPs.
  SEC. 4.  Section 4100 of the Welfare and Institutions Code is
amended to read:
   4100.  The department has jurisdiction over the following 
institutions:   hospitals: 
   (a) Atascadero State Hospital.
   (b) Coalinga State Hospital.
   (c) Metropolitan State Hospital.
   (d) Napa State Hospital.
   (e) Patton State Hospital.
   (f) Any other State Department of State Hospitals facility subject
to available funding by the Legislature. 
  SEC. 5.    Section 4142 is added to the Welfare
and Institutions Code, to read:
   4142.  Commencing July 1, 2015, and subject to available funding,
the State Department of State Hospitals may establish and maintain
enhanced treatment programs (ETPs), as defined in subdivision (o) of
Section 1250 of the Health and Safety Code, for the treatment of
patients described in Section 4143. 
   SEC. 5.    Section 4142.5 is added to the  
Welfare and Institutions Code   , to read:  
   4142.5.  Commencing July 1, 2015, and subject to available
funding, the State Department of State Hospitals may establish and
maintain enhanced treatment pilot programs (ETPs), as defined in
subdivision (o) of Section 1250 of the Health and Safety Code, and
evaluate the effectiveness of intensive, evidence-based clinical
therapy and treatment of patients described in Section 4143. 
  SEC. 6.  Section 4143 is added to the Welfare and Institutions
Code, to read:
   4143.  (a) A state hospital psychiatrist or psychologist may refer
a patient to an enhanced treatment  pilot  program (ETP),
as defined in subdivision (o) of Section 1250 of the Health and
Safety Code, for temporary placement and risk assessment upon
determining that the patient may be at high risk  for
  of  most dangerous behavior and when treatment is
not possible in a standard treatment environment. The referral may
occur at any time after the patient has been admitted to a hospital
or program under the jurisdiction of the department, with notice to
the patient's advocate at the time of the referral.
   (b) Within three business days of placement in the ETP, a
dedicated forensic evaluator, who is not on the patient's treatment
team, shall complete an initial evaluation of the patient that shall
include an interview of the patient's treatment team, an analysis of
diagnosis, past violence, current level of risk, and the need for
enhanced treatment.
   (c) (1) Within seven business days of placement in an ETP and with
72-hour notice to the patient and patient's advocate, the forensic
needs assessment panel (FNAP) shall conduct a placement evaluation
meeting with the
referring psychiatrist or psychologist, the patient and patient's
advocate, and the dedicated forensic evaluator who performed the
initial evaluation. A determination shall be made as to whether the
patient clinically requires ETP treatment.
   (2) (A) The threshold standard for treatment in an ETP is met if a
psychiatrist or psychologist, utilizing standard forensic
methodologies for clinically assessing violence risk, determines that
a patient meets the definition of a patient at high risk 
for   of  most dangerous behavior and ETP treatment
can meet the identified needs of the patient  and there is no
less restrictive treatment options  .
   (B) Factors used to determine a patient's high risk for most
dangerous behavior may include, but are not limited to, an analysis
of past violence, delineation of static and dynamic violence risk
factors, and utilization of valid and reliable violence risk
assessment testing.
   (3) If a patient has shown improvement during his or her placement
in the ETP, the FNAP may delay its decision for another seven
business days. The FNAP's determination of whether the patient will
benefit from continued or longer term ETP placement and treatment
shall be based on the threshold standard for treatment in an ETP
specified in subparagraph (A) of paragraph (2).
   (d) (1) The FNAP shall review all material presented at the FNAP
placement evaluation meeting conducted under subdivision (c), and the
FNAP shall either certify the patient for 90 days of treatment in an
ETP or direct that the patient be returned to a standard treatment
environment in the hospital.
   (2) After the FNAP makes a decision to provide ETP treatment and
if the ETP treatment will be provided at a facility other than the
current hospital, the transfer may take place as soon as
transportation may reasonably be arranged, but no later than 30 days
after the decision is made.
   (3) The FNAP determination shall be in writing and provided to the
patient and patient's advocate as soon as possible, but no later
than three business days after the decision is made.
   (e) (1) Upon admission to the ETP, a forensic needs assessment
team (FNAT) psychologist who is not on the patient's treatment team
shall perform an in-depth violence risk assessment and make a
treatment plan for the patient based on the assessment within 14
business days of placement in the ETP. Formal treatment plan reviews
shall occur on a monthly basis, which shall include a full report on
the patient's behavior  and response to treatment  while in
the ETP.
   (2) An ETP patient shall receive treatment from a team consisting
of a psychologist, a psychiatrist, a nurse, a psychiatric technician,
a clinical social worker, a rehabilitation therapist, and any other
staff as  necessary, who   necessary. 
    (3)     The treatment team  shall meet
as often as necessary, but no less than once a week, to assess the
patient's response to treatment in the ETP.
   (f) Prior to the expiration of 90 days from the date of placement
in the ETP and with 72-hour notice provided to the patient and the
patient's advocate, the FNAP shall convene a treatment placement
meeting with a psychologist from the treatment team, a patient
advocate, the patient, and the FNAT psychologist who performed the
in-depth violence risk assessment. The FNAP shall determine whether
the patient may return to a standard treatment environment or the
patient clinically requires continued treatment in the ETP. If the
FNAP determines that the patient clinically requires continued ETP
placement, the patient shall be certified for further ETP placement
for one year. The FNAP determination shall be in writing and provided
to the patient and the patient's advocate within 24 hours of the
meeting. If the FNAP determines that the patient is ready to be
transferred to a standard treatment environment, the FNAP shall
identify appropriate placement within a standard treatment
environment in a state hospital, and transfer the patient within 30
days of the determination.
   (g) If a patient has been certified for ETP treatment for one year
pursuant to subdivision (f), the FNAP shall review the patient's
treatment summary every 90 days to determine if the patient no longer
clinically requires treatment in the ETP. This FNAP determination
shall be in writing and provided to the patient and the patient's
advocate within three business days of the meeting. If the FNAP
determines that the patient no longer clinically requires treatment
in the ETP, the FNAP shall identify appropriate placement, and
transfer the patient within 30 days of the determination.
   (h) Prior to the expiration of the one-year certification of ETP
placement under subdivision (f), and with 72-hour notice provided to
the patient and the patient's advocate, the FNAP shall convene a
treatment placement meeting with the treatment team, the patient
advocate, the patient, and the FNAT psychologist who performed the
in-depth violence risk assessment. The FNAP shall determine whether
the patient clinically requires continued ETP treatment. If after
consideration, including discussion with the patient's ETP team
members and review of documents and records, the FNAP determines that
the patient clinically requires continued ETP placement, the patient
shall be certified for further treatment for an additional year. The
FNAP determination shall be in writing and provided to the patient
and the patient's advocate within three business days of the meeting.

   (i) At any point during the ETP placement, if a patient's
treatment team determines that the patient no longer clinically
requires ETP treatment, a recommendation to transfer the patient out
of the ETP shall be made to the FNAT or FNAP.
   (j) The process described in this section may continue until the
patient no longer clinically requires ETP treatment or until the
patient is discharged from the state hospital.
   (k) As used in this section, the following terms have the
following meanings:
   (1) "Enhanced treatment program" or "ETP" means a health facility
as defined in subdivision (o) of Section 1250 of the Health and
Safety Code.
   (2) "Forensic needs assessment panel" or "FNAP" means a panel that
consists of a psychiatrist, a psychologist, and the medical director
of the hospital or facility, none of whom are involved in the
patient's treatment or diagnosis at the time of the hearing or
placement meetings.
   (3) "Forensic needs assessment team" or "FNAT" means a panel of
psychologists with expertise in forensic assessment or violence risk
assessment, each of whom are assigned an ETP case or group of cases.
   (4) "In-depth violence risk assessment" means the utilization of
standard forensic methodologies for clinically assessing the risk of
a patient posing a substantial risk of inpatient aggression.
   (5) "Patient advocate" means the advocate contracted under
Sections 5370.2 and 5510.
   (6) "Patient at high risk  for   of 
most dangerous behavior" means the individual has a history of
physical violence and currently poses a demonstrated danger of
inflicting substantial physical harm upon others in an inpatient
setting, as determined by an  evidence-based,  in-depth
violence risk assessment conducted by the State Department of State
Hospitals.
  SEC. 7.  Section 7200 of the Welfare and Institutions Code is
amended to read:
   7200.  There are in the state the following state hospitals for
the care, treatment, and education of the mentally disordered:
   (a) Metropolitan State Hospital near the City of Norwalk, Los
Angeles County.
   (b) Atascadero State Hospital near the City of Atascadero, San
Luis Obispo County.
   (c) Napa State Hospital near the City of Napa, Napa County.
   (d) Patton State Hospital near the City of San Bernardino, San
Bernardino County.
   (e) Coalinga State Hospital near the City of Coalinga, Fresno
County.
   (f) Any other State Department of State Hospitals facility subject
to available funding by the Legislature.
  SEC. 8.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.