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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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

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BILL NUMBER: AB 1340	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 20, 2014
	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:   Assembly Members
  Perea   and Yamada  )
   (Coauthors: Senators Anderson, Beall,  Evans,  and Wolk)

                        FEBRUARY 22, 2013

   An act  to amend Section 1250 of, and  to add
 and repeal  Section 1265.9  to,   of,
 the Health and Safety Code, and to amend Sections 4100 and 7200
of, and to add Sections  4142.5 and 4143  
4143, 4144, and 4145  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  pilot  enhanced treatment 
pilot  programs (ETPs), as defined, for the treatment of
patients who are at high risk of most dangerous behavior, as defined,
and when  safe  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.   authorize
the State Department of Public Health to approve, on or after July 1,
2015,   an ETP, which meets specified requirements and
regulations, as a supplemental service for an acute psychiatric
hospital that submits a completed application and is operated by the
State Department of State Hospitals. 
   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  at least 
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.  The bill
would also   require, if the FNAP determines that the
patient requires continued ETP placement, that the patient's case be
referred to a forensic psychiatrist or psychologist outside of the
State Department of State Hospitals for independent review, that a
hearing be conducted, and notice given, as specified.  
   The bill would require the State Department of State Hospitals to
monitor the ETPs, evaluate outcomes, and report its findings and
recommendations to the Legislature. 
    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 
pilot  enhanced treatment  pilot  programs
 (ETP)  for those patients determined to be at high risk of
most dangerous behavior against other patients or hospital staff. The
goal of these  enhanced treatment pilot programs 
 pilot ETPs  is to evaluate the effectiveness of
concentrated, evidence-based clinical 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   the pilot ETPs  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
  ETP  within the State Department of State
Hospitals cannot be used to circumvent the statutory and regulatory
criteria for use of seclusion and  restrains,  
restraints, as defined by Section 1180.1 of the Health and Safety
Code,  but is instead another level of continuum of care for the
patient receiving treatment in an  Enhanced Treatment Unit.
  ETP.  
  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 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.

   SEC. 3.  SEC. 2.   Section 1265.9 is
added to the Health and Safety Code, to read: 
   1265.9.  (a) (1) Commencing July 1, 2015, and until January 1,
2018, the State Department of State Hospitals may establish and
maintain a pilot Enhanced Treatment Program (ETP) to test the
effectiveness of providing treatment for patients who are at high
risk of most dangerous 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. 
    1265.9.    (a) On and after July 1, 2015, any acute
psychiatric hospital that submits a completed application and is
operated by the State Department of State Hospitals may be approved
by the State Department of Public Health to offer, as a supplemental
service, an Enhanced Treatment Program (ETP) that meets the
requirements of this section, Section 4144 of the Welfare and
Institutions Code, and applicable regulations.  
   (b) This section shall remain in effect for each pilot ETP until
January 1 of the fifth calendar year after each pilot ETP site has
admitted its first patient, and is repealed as of January 1 of the
fifth calendar year after each pilot ETP site has admitted its first
patient, unless a later enacted statute extending the program is
enacted prior to those dates. The State Department of State Hospitals
shall post a declaration on its Internet Web site when the condition
for repealing this section is met stating that this section is
repealed.  
   (c) (1) Prior to the admission of the first patient into the last
pilot ETP, the State Department of Public Health 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 Public Health is
hereby exempted for this purpose from the requirements of subdivision
(b) of Section 11346.1 of the Government Code. 
   (2) As an alternative to paragraph (1) and notwithstanding the
rulemaking provisions of Administrative Procedures Act (Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 3 of Title 2 of
the Government Code), the director of the State Department of Public
Health may implement this section, in whole or in part, by means of
an all facility letter or other similar instruction.  
   (b) 
    (d)  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 
 toilet and sink  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  treatment 
environment for  provision of  the patient's care
and treatment pursuant to Section  4143   4144
 of the Welfare and Institutions Code, but shall not be
considered seclusion  , as defined by subdivision (e) of Section
1180.1,  for purposes of Division 1.5 (commencing with Section
1180).
   (6) Provide emergency egress for ETP patients.
   (7)  All   In the event seclusion or
restraints, as defined by Section 1180.1, are used in an ETP, all
 state licensing and regulations shall be  followed when
a patient is experiencing behavior criteria consistent with the need
for seclusion and restraints.   followed. 
   (8)  Have a   A  full-time independent
 patient   patients' rights  advocate who
provides patients' rights advocacy services  shall be 
assigned to each ETP. 
   (c) 
    (e)  The  ETP   ETPs  shall
adopt and implement policies and procedures  consistent with
regulations adopted by the State Department of State Hospitals that
provide all of following:   necessary to encourage
patient improvement, recovery, and a return to a standard treatment
environment, and to create identifiable facility requirements and
bench marks. The policies and procedures shall also provide all of
the following: 
   (1) 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.   an ETP pursuant
to Section 4144 of the Welfare and Institutions Code. 
   (2) Clinical assessment and review focused on behavior, history,
high risk of most dangerous behavior, and clinical need for patients
to receive treatment in  the   an  ETP as
the least restrictive  treatment  environment.
   (3) A process for identifying  the   an 
ETP along a continuum of care that will best meet the patient's
needs, including least restrictive  treatment  environment.
   (4) A process for  development of   creating
and implementing  a treatment plan with regular clinical review
and reevaluation of placement back into a standard treatment
environment and discharge and reintegration planning  as
specified in subdivision (e) of Section 4144 of the Welfare and
Institutions Code  . 
   (d) 
    (f)  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).
  (d).  
   (e) (1) 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 annually under paragraph (1) is inoperative on
January 1, 2026.  
   (f) Notwithstanding paragraph (2) of subdivision (a), the State
Department of Public Health and the State Department of State
Hospitals shall jointly develop the regulations governing ETPs.
 
   (g) For purposes of paragraph (1) of subdivision (d), "staff"
means licensed nurses and psychiatric technicians providing direct
patient care. 
   SEC. 4.   SEC. 3.   Section 4100 of the
Welfare and Institutions Code is amended to read:
   4100.  The department has jurisdiction over the following
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.   SEC. 4.   Section 
4142.5   4143  is added to the Welfare and
Institutions Code, to read:
    4142.5.   4143.   Commencing July 1,
2015, and subject to available funding, the State Department of State
Hospitals may establish and maintain  pilot  enhanced
treatment  pilot  programs (ETPs), as defined in
 subdivision (o) of  Section  1250 
 1265.9  of the Health and Safety Code, and evaluate the
effectiveness of intensive, evidence-based clinical therapy and
treatment of patients described in Section  4143. 
 4144. 
   SEC. 6.   SEC. 5.   Section 
4143   4144  is added to the Welfare and
Institutions Code, to read:
    4143.   4144.   (a) A state hospital
psychiatrist or psychologist may refer a patient to  an
  a pilot  enhanced treatment  pilot
 program (ETP), as defined in  subdivision (o) of
 Section  1250   1265.9  of the
Health and Safety Code, for temporary placement and risk assessment
upon determining that the patient may be at high risk of most
dangerous behavior and when  safe  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.   after
admission to the State Department of State Hospitals, and after
sufficient and documented evaluation of violence risk of the patient,
with notice to the patients' rights advocate at   the time
of the referral. A patient shall not be placed into an ETP as a means
of punishment, coercion, convenience, or retaliation. 
   (b) Within three business days of placement in  the
  an  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  
patients' rights  advocate, the forensic needs assessment panel
(FNAP) shall conduct a placement evaluation meeting with the
referring psychiatrist or psychologist, the patient and 
patient's   patients' rights  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 of most
dangerous behavior and ETP treatment  can meet  
meets  the identified needs of the patient and  there
is no less restrictive   safe  treatment 
options.   is not possible in a standard treatment
environment. 
   (B) Factors used to determine a patient's high risk  for
  of  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   an  ETP, the FNAP may delay its
 certification  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   patien   ts'
rights  advocate as soon as possible, but no later than three
business days after the decision is made.
   (e) (1) Upon admission to  the   an 
ETP, a forensic needs assessment team (FNAT) psychologist who is not
on the patient's  multidisciplinary  treatment team shall
perform an in-depth violence risk assessment and make  a
  an individual  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.  
assessment. The individual treatment plan shall:  
   (A) Be in writing and developed in collaboration with the patient,
when possible. The initial treatment plan shall be developed as soon
as possible, but no later than 72 hours following the patient's
admission. The comprehensive treatment plan shall be developed
following a complete violence risk assessment.  
   (B) Be based on a comprehensive assessment of the patient's
physical, mental, emotional, and social needs, and focused on
mitigation of violence risk factors.  
   (C) Be reviewed and updated no less than every 10 days.  

   (2) The individual treatment plan shall include, but is not
limited to, all of the following:  
   (A) A statement of the patient's physical and mental condition,
including all mental health and medical diagnoses.  
   (B) Prescribed medication, dosage, and frequency of
administration.  
   (C) Specific goals of treatment with intervention and actions that
identify steps toward reduction of violence risk and observable,
measurable objectives.  
   (D) Identification of methods to be utilized, the frequency for
conducting each treatment method, and the person, or persons, or
discipline, or disciplines, responsible for each treatment method.
 
   (E) Documentation of the success or failure in achieving stated
objectives.  
   (F) Evaluation of the factors contributing to the patient's
progress or lack of progress toward reduction of violence risk and a
statement of the multidisciplinary treatment decision for followup
action.  
   (G) An activity plan.  
   (H) A plan for other services needed by the patient, such as care
for medical and physical ailments, which are not provided by the
multidisciplinary treatment team.  
   (I) Discharge criteria and goals for an aftercare plan in a
standard treatment environment and a plan for post-ETP discharge
follow up.  
   (2) 
    (3)  An ETP patient shall receive treatment from a 
multidisciplinary  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.   necessary staff who shall meet as often as
necessary, but no less than once a week, to assess the patient's
response to treatment.  
   (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.  
   (4) The staff shall observe and note any changes in the patient's
condition and the treatment plan shall be modified in response to the
observed changes.  
   (5) Social work services shall be organized, directed, and
supervised by a licensed clinical social worker.  
   (6) (A) Mental health treatment programs shall provide and conduct
organized therapeutic social, recreational, and vocational
activities in accordance with the interests, abilities, and needs of
the patients, including the opportunity for exercise.  
   (B) Mental health rehabilitation therapy services shall be
designed by and provided under the direction of a licensed mental
health professional, a recreational therapist, or an occupational
therapist.  
   (7) An aftercare plan for a standard treatment environment shall
be developed.  
   (A) A written aftercare plan shall describe those services that
should be provided to a patient following discharge, transfer, or
release from an ETP for the purpose of enabling the patient to
maintain stabilization or achieve an optimum level of functioning.
 
   (B) Prior to or at the time of discharge, transfer, or release
from an ETP, each patient shall be evaluated concerning the patient's
need for aftercare services. This evaluation shall consider the
patient's potential housing, probable need for continued treatment
and social services, and need for continued medical and mental health
care.  
   (C) Aftercare plans shall include, but shall not be limited to,
arrangements for medication administration and follow-up care. 

   (D) A member of the multidisciplinary treatment team designated by
the clinical director shall be responsible for ensuring that the
aftercare plan has been completed and documented in the patient's
health record.  
   (E) The patient shall receive a copy of the aftercare plan when
referred to a standard treatment environment. 
   (f) Prior to the expiration of 90 days from the date of placement
in  the   an  ETP and with 72-hour notice
provided to the patient and the  patient's  
patients' rights  advocate, the FNAP shall convene a treatment
placement meeting with a psychologist from the treatment team, a
 patient   patients' rights  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 
whether  the patient clinically requires continued treatment in
 the   an  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   patients' rights  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  at least  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   patients' rights 
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   patients'
rights  advocate, the FNAP shall convene a treatment placement
meeting with the treatment team, the  patient  
patients' rights  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   patients' rights 
advocate within  three business days   24 hours
 of the meeting. 
   (i) If after the treatment placement meeting described in
subdivision (h), and after discussion with the patient, the patients'
rights advocate, patient's ETP team members, and review of documents
and records, the FNAP determines that the patient clinically
requires continued ETP placement, the patient's case shall be
referred outside of the State Department of State Hospitals to a
forensic psychiatrist or psychologist for an independent medical
review for the purpose of assessing the patient's overall treatment
plan and the need for ongoing ETP treatment. Notice of the referral
shall be provided to the patient and the patients' rights advocate
within 24 hours of the FNAP meeting as part of the FNAP
determination. The notice shall include instructions for the patient
to submit information to the forensic psychiatrist or psychologist
conducting the independent medical review.  
   (1) The forensic psychiatrist or psychologist conducting the
independent medical review shall be provided with the patient's
medical and psychiatric documents and records, along with any
additional information submitted by the patient, within five business
days from the date of the FNAP's determination that the patient
requires continued ETP placement.  
   (2) After reviewing the patient's medical and psychiatric
documents and records, along with any additional information
submitted by the patient, but no later than 14 days after the receipt
of the patient's medical and psychiatric documents and records, the
forensic psychiatrist or psychologist conducting the independent
medical review shall provide the State Department of State Hospitals,
the patient, and the patients' rights advocate with a written notice
of the date and time for a hearing. At least one FNAP member is
required to attend the hearing. The notice shall be provided at least
72 hours in advance of the hearing, shall include a statement that
at least one FNAP member is required to attend the hearing, and
advise the patient of his or her right to a hearing or to waive his
or her right to a hearing. The notice shall also include a statement
that the patient may have assistance of a patients' rights advocate
or staff member at the hearing. Seventy-two-hour notice shall also be
provided to any individuals whose presence is requested by the
forensic psychiatrist or psychologist conducting the independent
medical review in order to help assess the patient's overall
treatment plan and the need for ongoing ETP treatment.  
   (3) If the patient waives his or her right to a hearing, the
forensic psychiatrist or psychologist conducting the independent
medical review shall make recommendations to the FNAP on whether or
not the patient should be certified for ongoing ETP treatment. 

   (4) If the patient does not waive the right to a hearing, both of
the following shall be provided:  
   (A) If the patient elects to have the assistance of a patients'
rights advocate or a staff person, including the patients' rights
advocate, the requested person shall provide assistance relating to
the hearing, whether or not the patient is present at the hearing,
unless the forensic psychiatrist or psychologist conducting the
hearing finds good cause why the requested person should not
participate. Good cause includes a reasonable concern for the safety
of a staff member requested to be present at the hearing.  
   (B) An opportunity for the patient to present information,
statements, or arguments, either orally or in writing, to show either
that the information relied on for the FNAP's determination for
ongoing treatment is erroneous, or any other relevant information.
 
   (5) The conclusion reached by the forensic psychiatrist or
psychologist who conducts the independent medical review shall be in
writing and provided to the State Department of State Hospitals, the
patient, and the patients' rights advocate within three business days
of the conclusion of the hearing.  
   (6) If the forensic psychiatrist or psychologist who conducts the
independent medical review concludes that the patient requires
ongoing ETP treatment, the patient shall be certified for further
treatment for an additional year.  
   (7) If the forensic psychiatrist or psychologist who conducts the
independent medical review determines that the patient no longer
requires ongoing ETP treatment, the FNAP shall identify appropriate
placement and transfer the patient within 30 days of determination.
 
   (i) 
    (j)  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) 
    (k)  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.
  State Department of State Hospitals.  
   (k) 
    (   l   )  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  
supplemental treatment unit as defined in Section 1265.9  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   "Patients' rights 
advocate" means the advocate contracted under Sections 5370.2 and
5510.
   (6) "Patient at high risk 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. 
   (m) The State Department of State Hospitals may adopt emergency
regulations in accordance with the Administrative Procedures Act
(Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code) to implement the treatment
components of 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. 
   SEC. 6.    Section 4145 is added to the  
Welfare and Institutions Code   , to read: 
   4145.  (a) The State Department of State Hospitals shall monitor
the pilot enhanced treatment programs (ETP), evaluate outcomes, and
report on its findings and recommendations. This report shall be
provided to the fiscal and policy committees of the Legislature
annually, beginning on January 10 of the first year after which the
first ETP is opened and services have commenced, and shall be in
compliance with Section 9795 of the Government Code. The evaluation
shall include, but is not limited to, all of the following:
   (1) Comparative summary information regarding the characteristics
of the patients served.
   (2) Compliance with staffing requirements.
   (3) Staff classification to patient ratio.
   (4) Average monthly occupancy.
   (5) Average length of stay.
   (6) The number of residents whose length of stay exceeds 90 days.
   (7) The number of patients with multiple stays.
   (8) The number of patients whose discharge was delayed due to lack
of available beds in a standard treatment environment.
   (9) Restraint and seclusion use, including the number of incidents
and duration, consistent with paragraph (3) of subdivision (d) of
Section 1180.2 of the Health and Safety Code.
   (10) Serious injuries to staff and residents.
   (11) Serious injuries to staff and residents related to the use of
seclusion and restraints as defined under Section 1180 of the Health
and Safety Code.
   (12) Staff turnover.
   (13) The number of patients' rights complaints, including the
subject of the complaint and its resolution.
   (14) Type and number of training provided for ETP staff.
   (15) Staffing levels for ETPs.
   (b) The State Department of State Hospitals' reporting
requirements under Section 4023 of the Welfare and Institutions Code,
shall apply to the ETPs.
  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.