BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                       AB 918

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          918 (Mark Stone)

          As Amended  May 28, 2015

          Majority vote

          |Committee       |Votes |Ayes                |Noes                  |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |Health          |18-0  |Bonta, Maienschein, |                      |
          |                |      |Bonilla, Burke,     |                      |
          |                |      |Chávez, Chiu,       |                      |
          |                |      |Gomez, Gonzalez,    |                      |
          |                |      |Lackey, Nazarian,   |                      |
          |                |      |Patterson,          |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |
          |                |      |Ridley-Thomas,      |                      |
          |                |      |Rodriguez,          |                      |
          |                |      |Santiago,           |                      |
          |                |      |Steinorth,          |                      |
          |                |      |Thurmond, Waldron,  |                      |
          |                |      |Wood                |                      |
          |                |      |                    |                      |
          |Appropriations  |17-0  |Gomez, Bigelow,     |                      |
          |                |      |Bonta, Calderon,    |                      |
          |                |      |Chang, Daly,        |                      |
          |                |      |Eggman, Gallagher,  |                      |
          |                |      |                    |                      |


                                                                       AB 918

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          |                |      |                    |                      |
          |                |      |Eduardo Garcia,     |                      |
          |                |      |Gordon, Holden,     |                      |
          |                |      |Jones, Quirk,       |                      |
          |                |      |Rendon, Wagner,     |                      |
          |                |      |Weber, Wood         |                      |
          |                |      |                    |                      |
          |                |      |                    |                      |

          SUMMARY:  Requires the Secretary of California Health and Human  
          Services to establish a system of mandatory, consistent, timely,  
          and publicly accessible data collection related to data on  
          seclusion and restraint in community facilities serving aged and  
          developmentally disabled persons, as specified.  Requires the  
          Department of Developmental Services (DDS) to publish on its Web  
          page the number of incidents of physical and chemical restraint in  
          community facilities, as specified. Requires community facilities  
          to report every death or serious injury of a person in seclusion  
          or in physical or chemical restraint no later than the close of  
          business day following the death or serious injury.  

          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, this bill would have minor and absorbable costs to DDS,  
          assuming facilities comply with reporting requirements.  If  
          facilities don't comply, there could be cost pressure to enforce  
          the reporting requirements or to provide additional education and  
          training.  Any cost pressure for enforcement or provider education  
          would depend on the robustness of the activities.  

          COMMENTS:  According to the author, while existing law protects  
          individuals with developmental disorders in developmental centers  
          (DCs) from unreported use of seclusions and restraint, the  
          populations in these facilities are changing.  State facilities  
          are beginning to close and more people are living in community  
          facilities.  The author states that this move can be heralded as  


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          an important and beneficial move for those with developmental  
          disabilities, but it also leaves them vulnerable to the use of  
          seclusion and behavioral restraint as tactics to control behavior.  

          The author also states that the Legislature has made findings and  
          declarations indicating that the use of seclusions and restraints  
          is not a treatment nor does it positively change behavior.  When  
          the state first implemented reporting and publishing requirements,  
          most individuals were living in DCs.  However, now California is  
          moving individuals to community facilities, where no such  
          requirement exists.  According to the author, California must  
          protect these vulnerable individuals, give consumers more  
          information when choosing a facility, and allow the government and  
          the designated protection and advocacy agency, Disability Rights  
          California (DRC), the ability to compare the use of seclusion and  
          restraint across facilities. 

          1)DCs.  California provides services and support to individuals  
            with developmental disabilities in two ways.  The vast  
            majorities of people live in their families' homes or other  
            community settings and receive state-funded services that are  
            coordinated by one of 21 non-profit corporations known as  
            regional centers.  More than 99% of DDS consumers receive  
            services in this way under the Community Services Program.  A  
            smaller number of individuals, or less than 1% of the DDS  
            caseload, live in three state-operated DCs and one  
            state-operated community facility.  DDS operates three DCs:   
            Fairview (Orange County); Porterville (Tulare County); and,  
            Sonoma (Sonoma County).  Among other services, Porterville also  
            provides secure treatment services.  A fourth DC, Lanterman,  
            transitioned its last resident into community living on December  
            23, 2014.  Services at all facilities involve the provision of  
            active treatment through residential and day programs on a  
            24-hour basis, including appropriate medical and dental care,  
            health maintenance activities, and assistance with activities of  
            daily living, training, education, and employment.


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          2)Population Transitions.  During a period of recent budget  
            deficits, the Legislature enacted numerous DDS budget reductions  
            and cost savings measures to yield General Fund savings.  The  
            2012-13 budget imposed a moratorium on admissions to DCs except  
            for individuals involved in the criminal justice system, and  
            consumers in an acute crisis needing short-term stabilization.   
            The high costs to maintain and staff these facilities, coupled  
            with an emphasis on transitioning individuals back into their  
            community, have led to the closure and/or restructuring of many  
            DCs.  The moratorium on DC admission as well as the need for the  
            availability of services in the community have led to a shift in  
            spending from the DCs to the community services programs.  The  
            2015-16 budget reflects this change, as the budget for DCs has  
            decreased and the Community Services budget has increased.

          DRC, the sponsors of the bill, write in support of the bill that  
          residents in DCs are moving from large state facilities and into  
          smaller community facilities.  Family members and advocates are  
          concerned about the unknown and unreported use of behavioral  
          restraint and seclusion; dangerous practices that often result in  
          serious injuries, even death.  The concern continues to grow as  
          individuals with behavioral challenges migrate from DCs where  
          there is public reporting and accountability to isolated community  
          settings where there is no public accountability regarding as to  
          the use of seclusion and behavioral restraint. People with  
          disabilities should live in the community with appropriate  
          services and supports; and there should be appropriate oversight  
          of community facilities that use dangerous restraint and seclusion  

          The National Association of Social Workers (NASW) writes that  
          through previous legislation, the state has attempted to reduce or  
          eliminate the use of seclusion or behavior restraints at state  
          facilities. Efforts have also been made to make the data on the  
          use of seclusion and restraints available to the public.  
          Currently, these laws do not apply to community facilities.  NASW  
          argues this bill will require information about deaths or serious  


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          injury available to the protection and advocacy agency designated  
          by the Governor. 

          There is no known opposition to this bill.

          Analysis Prepared by:                                               
                          Paula Villescaz / HEALTH / (916) 319-2097  FN: