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1. Seclusion and restraint.
Policy:
Sometimes a patient must be restrained or secluded for either his or other patients' safety.
Action:
SB
130 (Chesbro) contains provisions which would improve monitoring the use of this practice to
improve safety, but would also dictate medical practice with respect to types of restraint used. We
are supportive of lessening the need for seclusion or restraint, but oppose legislating the details
of medical and nursing practice. CPA proposed amendments to reflect this. All were accepted, and CPA
became neutral in August.
2. Psychologists and other non-physician mental health professionals practicing medicine.
Policy:
Protect public safety by opposing attempts by psychologists to expand their scope of practice to
practice medicine without full medical school training, including their efforts to acquire authority
to prescribe brain medications and to release involuntary LPS holds. (AB 348, Chu).
Action:
A. CPA negotiated amendments with the Psychological Association which enabled us to withdraw
our opposition to AB 348 (Chu). These amendments provide that for patients who are being treated by
both a psychiatrist and a psychologist, either may release the hold with the concurrence of the
other, and if they disagree, the medical director of the LPS facility makes the final decision. The
bill has passed the legislature and is on its way to the Governor.
B. CPA also opposed AB 652 (Leno), which modified marriage and family therapists' scope of
licensure to include "diagnosis." As a result of opposition by CPA, CMA and the
psychological association, the bill was amended to delete those provisions. However, the LCSWs are
seeking such authority in another bill, SB 347 (Perata), which will not be moved until January,
2004.
C. We are working with the Union of American Physicians and Dentists and the Department of Mental
Health to maintain medical integrity in the state hospitals. This has included testifying at several
hearings, the most recent of which was a hearing about hospital care for children at Metropolitan
State Hospital.
3. Human Resources.
Policy:
CPA supports increasing the numbers of psychiatrists being trained, assuring adequate numbers of
psychiatrists in managed care programs and in public programs, increasing access to telepsychiatry,
expanding efforts to train and support primary care physicians, and supporting efforts to increase
the numbers of psychiatric specialist nurse practitioners and physician assistants.
Action:
CPA supports AB 1196 (Montanez) which would authorize nurse
practitioners to furnish Schedule II medications pursuant to patient-specific and diagnosis-specific
protocols with their supervising physician. The bill is pending in the Senate.
4. Powers of Protection and Advocacy Agencies
California's protection and advocacy agency (PAI) is sponsoring SB 577 (Kuehl), which they have
advertised as conforming California law to federal laws governing their actions. CPA and numerous
other organizations question whether the bill is federal conformity or an expansion of their powers.
Under current law, the PAI employees have access to mentally ill persons only if they are in 24-hour
institutions. This bill would give them access, in certain circumstances, to physicians' offices and
homes where a disabled person lives.
CPA is opposing the bill unless it is amended to address several concerns. Those are (1) limiting
access of protection and advocacy agents to medical offices; (2) limiting access of their agents to
homes; and (3) protecting confidentiality and privileges of the physician-patient and
psychotherapist-patient relationships.
5. State Budget issues:
A. Medi-Cal
Proposal:
The Governor proposed to reverse the 15% physician fee increase enacted a few years ago,
taking Medi-Cal physician fees back to 1986. Physician fees are so low now, that few physicians
can see these patients, as they cost more to see than the physicians are paid. Any lowering of
these fees will worsen the problem and increase the burden on our already-overburdened and
financially troubled emergency rooms.
Action:
CPA is participating in a large coalition organized by the California Medical Association
(CMA) involving medicine, patient groups, and nonprofit caregiver groups. The legislature cut
MediCal fees by 5% in the state budget. CPA is part of a coalition seeking to have that cut
rescinded. The coalition has identified savings to offset it.
B. Patient Access to Needed Medications (Formulary issues):
Policy:
CPA has a strong policy that the treating physician needs the ability to prescribe the most
effective medication for the individual patient. Cost control should be obtained through
management approaches, such as clinically-sound algorithms, rather than through artificial
financial restrictions which may or may not work and which jeopardize patient safety.
Action:
CPA recently protested a Request for Proposals by the state Department of General Services
(DGS) to create what appeared to be a formulary under another name for antipsychotic medications
to be used in prisons, state hospitals, and the youth authority. The protest was based on CPA
policy and on the fact that the bill that authorized DGS to do bulk purchasing, SB 1315 (Sher)
from 2002, had contained authority at one point for DGS to use formularies and the authority was
specifically deleted at CPA's request. This continues to be a difficult issue.
C. Preservation of publicly-funded, effective mental health programs:
Policy:
CPA supports maintaining and expanding two Important current state programs: (1) Homeless and
jail outreach programs, known as "AB 34 programs", have been shown effective in reducing
homelessness and crime and returning the mentally ill persons treated in them to being productive
citizens. These programs are also supported by law enforcement, especially the county
sheriffs.
(2) The Children's System of Care (CSOC) reaches children who face potential institutionalization
if they are not treated in these intensive programs.
(3) CPA has gone on record in support of a ballot measure that will be placed on the November,
2004 ballot to give persons with mental illnesses greater access to treatment, and fund that
treatment.
Both AB 34 and CSOC are highly cost effective. The Governor has proposed to freeze both these
programs and move them to the county level. This could result in these programs having no more
growth, which is likely to result in the persons who could have been, but were not, served by
these programs, getting sicker and ending up in more expensive settings, such as inpatient
facilities, state hospitals, jails or prisons. The programs nearly pay for themselves and need to
be preserved.
Action:
CPA is working with a coalition seeking to preserve these programs and to promote the
initiative.
D. Public Mental Health System "realignment:"
Background: (1) The Governor proposed in January to send many programs to the
counties without adequate funding. A recent report to the legislature from the Department of
Mental Health, issued in response to legislation from 2001, has found that the 1991 realignment of
programs has improved mental health care in the state, but that mental health programs have been
shortchanged because more monies have gone to social programs. The May budget revision seems to
have eliminated the Governor's January proposal.
(2) AB 1470 (Vargas) would allow In Home Supportive Services (IHSS) workers to go to the ballot to
get increases in wages or benefits. The bill in its current form is likely to result in those
funds coming from health and mental health programs.
Policy:
(1) If any more realignment is done, it must preserve or improve the funding for mental health
programs. As part of this, CPA supports restoring the Vehicle License Fee (VLF) to the historic
level of 2%, originally enacted in 1939, as being necessary to funding these public health
programs. The VLF is guaranteed as a city-county tax by the state constitution. In 1998, it was
cut to 0.67%, and the state backfilled the cities and counties for the difference. The state
Department of Finance recently "pulled the trigger" to restore it to 2%.
Action:
(1) CPA is part of a coalition of groups opposing the Governor's proposal to take back the
VLF backfill, while not restoring the VLF. The legislature rejected on a bipartisan basis the
taking of the backfill, and passed, by majority vote (the Republicans did not vote for it) the
restoration of the VLF. The Governor threatened to veto it, but recognized in his May budget
revision that the "trigger" in current law to restore the 2% rate would be pulled
without any further legislative action. Without the restoration of this tax to the counties,
health care and mental health care are facing disastrous cuts.
(2) CPA and other mental health advocacy organizations oppose AB 1470, since a ballot measure
adopted under its provisions could "rob Peter [mental health] to pay Paul" [IHSS]. The
Senate Appropriations Committee held the bill in committee on August 29, thereby hopefully
rejected the bill this year.
6. Workers' compensation:
Because of the spiraling cost of workers' compensation in California, reform of the system,
which costs more than most states and has fewer benefits, is a major issue this year in the
legislature.
Action:
CPA has successfully resisted measures that would exacerbate the already-existing discrimination
in the workers' compensation system against psychiatric claims. We have also been a participant in
2 efforts to improve the physician fee schedule, one are pending in a conference committee, in
which we are participating. Expected changes to the system include putting all medical services on
a fee schedule and utilization review, among other potential changes.
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