BILL ANALYSIS
SB 857
Date of Hearing:June 27, 1995
Counsel: Martin Gonzalez
ASSEMBLY COMMITTEE ON PUBLIC SAFETY
SB 857 (Thompson) - As Amended: June 21, 1995
ISSUE: SHOULD TWO HOSPITAL-BASED TRAINING CENTERS FOR MEDICALLY
EXAMINING VICTIMS OF CHILD SEXUAL ABUSE OR NEGLECT, SPOUSAL
ABUSE, AND ELDER ABUSE BE ESTABLISHED, AS SPECIFIED?
DIGEST
Current law:
1) Provides that the Office of Criminal Justice Planning (OCJP)
has established protocols for the examination and treatment of
victims of sexual assault, including child molestation. (Penal
Code Section 13823.5.) This includes the collection and
preservation of evidence in these cases. ( Id.) Current law
specifies certain provisions which must be contained in the
protocols developed by OCJP. (Penal Code Section 13823.7.)
These generally include notification to law enforcement;
obtaining consent for examination, treatment, and collection of
evidence; taking a patient's history; performance of the
physical exam for evidence of sexual assault; collection of
physical evidence of assault, and other medical specimens; and
procedures for the preservation and disposition of physical
evidence. ( Id.)
2) Provides that OCJP also is statutorily required to develop
information guidelines containing general reference information
on evidence collection, examination of victims and
psychological and medical treatment for victims of sexual
assault and molestation, as specified. (Penal Code Section
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13823.5.) OCJP is required to distribute this information to
every general acute care hospital, law enforcement agency, and
prosecutor's office in the state. ( Id.) Current law requires
professionals conducting physical exams of sexual assault
victims use a standard form prepared by OCJP. ( Id.)
3) Establishes specified minimum standards for the examination and
treatment of sexual assault victims. (Penal Code Section
13823.11.)
4) Requires OCJP to develop a training course for health care
professionals regarding the examination and treatment of
victims of sexual assault, as
specified. (Penal Code Section 13823.13.)
5) The Medical Practice Act provides for the licensure and
regulation of physicians and surgeons administered by the
Medical Board of California. Among other things, each
applicant for a physician's and surgeon's certificate shall
demonstrate that he/she has successfully completed a course on
child abuse detection and treatment and spousal or partner
abuse detection and treatment. (Business and Professions Code
Section 2089.)
This bill:
1) Establishes two training centers, one in northern California
and one in southern California, through a competitive bidding
process, to train medical personnel on how to perform medical
evidentiary examinations of child victims of physical abuse or
neglect.
2) Provides that the centers shall also provide training for
investigative and court personnel involved in dependency and
criminal proceedings on how to interpret the findings of
medical evidentiary examinations.
3) Provides that the centers shall train medical personnel on how
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to perform medical evidentiary examinations for victims of
sexual assault, victims of spousal abuse, and victims of elder
abuse.
4) Provides that the training centers shall be established over a
two-year period; the center in northern California is to be
established in the first year and the southern California
center is to be established in the second year.
5) States that it is the intent of the Legislature that three
consultations centers be established in future years subject to
appropriations being made.
6) Requires training centers to have specified criteria.
7) Specifies the duties of the training centers.
8) Specifies legislative declarations and findings.
COMMENTS
1) Purpose. According to the author:
The response of California's health system to victims of
violence, especially violence against women and children,
is uneven with respect to both access and competence.
While services encountered in some metropolitan centers can
be excellent, access to trained medical practitioners is
restricted and unevenly distributed throughout the state.
Many rural, mid-size counties and geographically large
urban areas lack trained health professionals in the
provision of evidentiary examinations, collection and
preservation of evidence, interpretation of findings, and
are inexperienced in collaboration
with law enforcement agencies and investigative social workers.
As a result, many victims of child molestation, domestic
violence, and elder abuse in under-served areas must wait
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several days and travel long distances to obtain competent
exams. In many instances when proper evidence collection
procedures are not followed, district attorneys are forced
to drop charges against dangerous perpetrators for lack of
evidence, rather than rely on the testimony of a small
child.
This bill aims to address this inequity through the funding
of two hospital-based training centers which would provide
both training to medical personnel on how to perform child
physical/sexual abuse, domestic violence, and elder abuse
medical evidentiary exams. The centers would provide both
initial training and ongoing support through advanced
educational programs and case consultation.
Training and consultation would occur through on-site
training and clinical supervision of trainees,
teleconferences, and a telecommunication network, including
video transmission of examination findings from remote
hospitals and clinics to the centers.
2) Legislative Findings and Declarations. This bill contains the
following legislative declarations and findings:
a) The response of California's health care system to victims
of violence, especially women and children, is inconsistent
in terms of access to services and competence of health
care workers. While services provided in some metropolitan
centers may be excellent, access to trained medical
practitioners is restricted and unevenly distributed
throughout the state.
b) Many specified areas lack health professionals properly
trained to provide evidentiary examinations and related
forensic procedures. This results in victims being
improperly examined and law enforcement agencies lacking
critical evidence.
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c) To appropriately respond to the medical needs of victims
of domestic violence, child abuse, elder abuse and sexual
assault, and to provide comprehensive, competent
evidentiary examinations for use by law enforcement
agencies, it is necessary to take immediate steps to ensure
there are appropriately trained medical professionals
throughout California.
3) Background. The author has provided the following relevant
1993 statistics from the Department of Justice:
a) 117,306 child sexual abuse reports.
b) 20,731 child sexual abuse criminal investigations.
c) 212,138 child physical abuse reports.
d) 30,815 child physical abuse criminal investigations.
e) 11,754 forcible rapes.
f) 196,183 general neglect reports.
g) 47,505 severe child neglect reports.
h) 2,349 child neglect investigations.
i) 238,895 domestic violence-related calls for assistance.
4) OCJP's Current Duties. Current law already requires OCJP to
establish protocols and training for medical examinations of
sexual assault victims, including child molestation. OCJP's
written guidelines, most recently published in 1987, include
sections specific to child victims.
5) Medical Examinations. The unique difficulties of medically
examining child molestation victims was discussed in a July
1994 California Attorney General's Office report, Child Victim
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Witness Investigative Pilot Projects: Research and Evaluation
Final Report:
In the past, and today in some locations, medical
evaluations regarding child sexual abuse were performed by
medical personnel untrained in this complex and evolving
field of expertise. Lack of proper training appears to be
a particular problem in acute cases and in areas where
multidisciplinary teams are not readily available. Lack of
expertise can have several deleterious consequences.
First, professionals who lack experience with the delicate
nature of such evaluations may psychologically traumatize
children. Second, professionals who are unfamiliar with
recently developed techniques may erroneously call normal
genital structures abnormal or fail to recognize legally
significant medical findings. In such cases, the child may
have to undergo a second examination. Third, the
relatively simple act of collecting medical evidence can be
botched in the hands of untrained personnel. ( Id. at 91.)
Some experts state that few pediatricians receive adequate
training to identify some indicators of child sexual abuse:
Reporting is also hindered by most pediatricians' lack of
knowledge about and inability to identify abnormalities in
pediatric anogenital anatomy that might be indicative of
child sexual abuse. (Kerns et al., The Role of Physicians
in Reporting and Evaluating Child Sexual Abuse Cases, 4 The
Future of Children: Sexual Abuse of Children No. 2(1994).)
6) Domestic Violence. According to a recently published book, one
study has found that only 5% of 107 victims of domestic
violence seen in a metropolitan emergency department were
correctly identified as such by
physicians on the department's report. (Salber and Taliaferro,
The Physician's Guide to Domestic Violence (1995).)
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7) No Funding Provision. As drafted, this bill contains no
funding provision. Should not one be included?
8) Prior Legislation. AB 890 (B. Friedman), Chapter 1234,
Statutes of 1994, provided, among other things, that after
January 1, 1995, medical school graduates must complete course
work in spousal abuse detection and treatment as a condition of
licensure.
9) Potential Effect. Establishes two training centers which are
to train medical personnel on how to perform examinations to
uncover child physical/sexual abuse, domestic violence, and
elder abuse. The centers would also provide initial training
and ongoing support through advanced educational programs and
case consultation.
SOURCE: California Children's Lobby
SUPPORT: Office of the Attorney General
Doris Tate Crime Victims Bureau
California Children's Hospital Association
California State Sheriffs' Association
California District of the American Academy of
Pediatrics
Children Now
California Medical Association
OPPOSITION: None on file
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