MOORLACH UPDATE — ALS/CCW/CCP/AOT — March 5, 2014

Yesterday’s Board meeting had a few stimulating items that provided for good discussion. In the first article below, the Voice of OC covers a recent ruling that no longer allows the County to delegate the selection of ambulance providers to the Orange County Fire Authority (OCFA). The current contracts are set to expire at the end of August, so the Health Care Agency’s Orange County Emergency Medical Services Agency (OCEMS) does not have much time to conclude the selection process. In the preparation of the request for proposal (RFP) it was requested that the Board consider two options on billing those who use the ambulance after calling 9-1-1. The OCFA charges individuals $387.50 for responding to these calls for Advanced Life Support (ALS). The ambulance companies charge for their services for what is called Basic Life Support (BLS) emergency medical transport services. Option 1 was to have the ambulance carrier charge for both the ALS and the BLS and remit the ALS to the OCFA. Option 2 was to have OCFA bill separately for the ALS. Consequently, the bigger question jumps out: Why do taxpayers who are paying for public safety through their property taxes (directly or indirectly) have to pay for this emergency service in their time of need?

In the second piece below, the Voice of OC provides an update on the CCW application backlog status that I brought up last week (see MOORLACH UPDATE — CCW Suggestion — February 26, 2014). The CCW topic was a major cause for concern early in Sheriff Hutchen’s role as County Sheriff. Due to her predecessor having granted permits in exchange for campaign contributions, the Sheriff began a process of revoking those permits. I disagreed with the Sheriff, but tried to explain to the public that the Board of Supervisors could not dictate the policies of an independently elected official. That is why I am praising her now for being proactive as a result of the recent Peruta v. County of San Diego court decision.

The third Voice of OC piece addresses concerns about early release of jail inmates who are monitored by GPS devices. A request was made to engage in a thorough discussion on the matter with the Orange County Community Corrections Partnership (CCP), a body established after the passage of AB 109 (realigning state prisoners out of prisons and into counties of origin). As pointed out near the conclusion of the article, Supervisor Spitzer does not serve on the CCP executive committee. He recently replaced me as Chairman of the Orange County Criminal Justice Coordinating Counsel and voluntarily attends the CCP meetings. The Board does have a position on the overall CCP, which usually meets once a year, on which I still serve.

The fourth piece below is the top story in MintPress News, a news website out of Minnesota. It provides its take on the implementation of Laura’s Law and is a very thorough analysis of the topic. I usually do not edit articles, but I have modified a quote from my friend and colleague, Alameda County Supervisor Keith Carson, who was quite emotional at a recent Alameda County Board of Supervisors’ meeting. Mental illness, once you become sensitive to the topic, comes up often and affects many families. Last evening my wife and I watched the History Channel documentary on Albert Einstein (see “Einstein” at

). It made you wonder what became of his two sons. Einstein’s second son, Eduard, was a classic case of a promising young student who would be afflicted with a mental illness at the age of twenty. Yesterday’s LA Times had an interesting article, titled “Nearly 1 in 5 had mental illness before enlisting in Army, study says – The study raises questions about the military’s screening of recruits. Another study looks at rising suicide rates among soldiers.” And, here in the OC, Pastor Rick Warren will be providing a community conference on a range of mental health concerns (see http://mentalhealthandthechurch.com/). The Board of Supervisors will be considering a resolution to implement Laura’s Law sometime in May. I look forward to lending my support to this important effort as another tool that can be used in the efforts to assist in dealing with the severe adverse impacts of mental illness to certain individuals, their families and our community.

Supervisors Take Aim at Paramedic Fee

By NICK GERDA

The fate of a $388 fee charged when Orange County Fire Authority paramedics respond to an emergency call was called into question Tuesday, with two county supervisors showing strong opposition to its very existence.

“The taxpayers pay for service. They deserve it when they finally need it,” said Chairman Shawn Nelson.

“It’s kind of an insult” to send a bill, he added.

Supervisor John Moorlach called the fee “double taxation,” and at one point wondered aloud if he and his colleagues should try to cut or eliminate the fee altogether.

“Why am I being charged twice, when I’m paying for the whole infrastructure?” Moorlach asked.

The advanced life support, or ALS, fee is charged to people transported by ambulance, with the money going to the Fire Authority for its paramedic response.

The fee, which is in addition to those collected for the private ambulance service, amounts to $4.5 million per year for the Fire Authority.

Fire Authority officials say the fee only recoups 60 percent of their marginal costs for paramedics.

Supervisor Pat Bates was comfortable with the fee, and worried aloud that if the county doesn’t include the fee collection in upcoming ambulance contracts, the Fire Authority could try to pass on to the county its costs for collecting the fee.

“If they’re already 40 percent underfunded,” Bates said, supervisors are “adding another assignment to them.

But in Nelson’s view, the fire authority is simply playing budget games.

“It’s not a reimbursement,” Nelson said. “It’s just an opportunity to get some more money.”

Supervisors ended up delaying a decision on the issue until their March 25 meeting.

The debate comes as county officials gear up to take over ambulance contracting from the county Fire Authority in 19 cities.

That came as the result of a state determination that the Fire Authority was improperly overseeing the process.

As part of its new role, the county has to submit a proposed request for bids, known as an RFP, for state approval.

State officials are requiring that the contract be awarded to the highest-ranked bidder, possibly cutting out county supervisors from the decision.

That didn’t sit well with Supervisor Todd Spitzer.

“All we can do is either accept the recommendations or throw them out,” Spitzer said.

So he suggested that supervisors themselves serve on the review panel.

“The board needs to talk about whether we should be on the panel, plus some experts,” Spitzer said.

“That way at least we’ll be able to weigh in” on who will provide service in our areas, he added.

Nelson disagreed.

He said the state is tired of seeing the highest-ranked firms not getting contracts because of a “lobbying effort” by a lower-ranked firm.

So the state isn’t really cutting decision makers out, Nelson said, instead wanting supervisors to set up “a righteous process” that they stick with.

“That’s completely valid and we need to go through that,” said Nelson.

The county is also being required to develop an emergency management plan, with three community meetings planned to gather public input.

The ALS fee is currently $387.50 and was raised to that level last September by supervisors.

While they’re in charge of raising the fee, it’s unclear if the supervisors have the legal authority to eliminate it entirely.

Please contact Nick Gerda directly at ngerda and follow him on Twitter: @nicholasgerda.

OC Supervisors Back Sheriff Plan to Speed Gun Permits

The Orange County Board of Supervisors. (Nick Gerda / Voice of OC)

By NORBERTO SANTANA JR.

Orange County Supervisors on Tuesday unanimously endorsed Sheriff Sandra Hutchen’s plan to speed up consideration of permits to carry concealed weapons.

Given a recent decision by the U.S. Ninth Circuit Appeals Court that has seemingly struck down a longstanding legal precedent requiring stringent good-cause requirements for a gun permit, Hutchens has moved to aggressively implement a new standard.

The decision is being challenged and could change.

In the interim, no other sheriff in the state has moved so quickly to implement the new legal standard for concealed weapons permits.

Ironically, Hutchens – who will stand for reelection later this year – ran into a torrent of opposition when she was first appointed to office in 2008 and significantly tightened up standards for approvals of gun permits.

"If you want more guns and CCWs (concealed weapon permits), then you should vote for one of my opponents," Hutchens said in 2010 at a candidates’ forum organized by the Orange County Young Republicans.

Hutchens would go on to win handily with 52 percent of the vote against two opponents, who each garnered about 20 percent.

At the time, Hutchens responded to a series of newspaper exposes on the nexis between weapons permits and campaign contributions to former Sheriff Mike Carona by tightening the policy and bringing it inline with policies found in Los Angeles County.

Carona – who was adored by the gun rights community for his CCW policies – was indicted in 2008 on corruption charges that also highlighted the link between CCW permits and contributions.

Hutchens’ more restrictive CCW policies drew significant opposition at the time from a majority of county supervisors, who held three separate hearings on the issue.

At one point, SWAT officers were called out to one of the meetings because of the intensity of protests from the gun rights community.

At the time, Hutchens defended her actions saying she would support and implement state law.

On Tuesday, she stood in front of county supervisors and said the same standard applies today.

“My position has always been that I will follow the law,” said Hutchens.

Today’s Hutchens is much better received at the dais.

“When we have a backlog, where people are legally entitled to have a consideration because of the lack of for-cause, I do believe it’s incumbent upon us to process those applications in a timely manner,” said County Supervisor Todd Spitzer. “People should not have to wait a year to have their application considered.”

On Tuesday, Supervisor John Moorlach – who first asked about the issue last month – thanked Hutchens for her proactive approach to the issue.

While Moorlach was opposed to her 2008 gun permit policy, he was a staunch and key supporter on the board of supervisors at the time. Supervisors Chris Norby and Janet Nguyen were Hutchens’ most vocal opponents.

On Tuesday, Hutchens told supervisors the department would shift 15 retired employees already working under contract to conduct concealed weapons permit background investigations.

Supervisors’ Chairman Shawn Nelson – who usually protests the use of retired workers – was supportive and told his colleagues that Hutchens already had budgetary authority through the end of the fiscal year in June to speed up consideration of permits.

At last count, permit applications were nearing 1,000 but Hutchens told supervisors she expected “that will level out at some point.”

Her advice to permit seekers seemed simple: It will be easier to do a renewal than to start at square one for those applying.

Despite being inundated, Hutchens told supervisors she saw gun permits as a service, “just like our job to do civil process.”

She said the department would work diligently to move a backlog forward.

“We do want to be diligent,” Hutchens said. “We want to make sure we are giving them to people who don’t have a criminal record, mental issues.”

Spitzer: Prisoner Programs Should Be Reassessed

By NICK GERDA

As local jails absorb a wave of new inmates, a top county official is calling for a re-examination of efforts to lower the county’s jail population.

“I really think that we should take a comprehensive look at all of these programs,” Supervisor Todd Spitzer said at Tuesday’s county supervisors meeting.

He called for an informal workshop on the issue at the Community Corrections Partnership, a county panel that recommends programs to fund with a pot of state-provided money for the extra prisoner responsibilities.

“I would appreciate that discussion occurring, so we could lay out for the board a long-term approach for dealing with overcrowding and what options are available that make sense,” added Spitzer, who also sits on the corrections panel.

His remarks came during a discussion of the county’s home detention program, in which people incarcerated for misdemeanors can serve the end of their sentence in a form of house arrest while wearing GPS location trackers.

Supervisors ultimately voted 3-2 to re-approve the rules for their home detention program and direct the corrections partnership to review them and report back with any suggested changes.

Spitzer and Supervisor John Moorlach opposed, with Spitzer taking issue with some of the rules’ language.

The GPS tracking contract, with Satellite Tracking of People, was also renewed on a 4-1 vote, with Spitzer opposing. The company is set to be paid up to $520,000 over the next year to monitor as many as 300 people at once.

Orange County is grappling with hundreds of extra of jail inmates, in the wake of the U.S. Supreme Court ordering the state to cut its prison population amid severe overcrowding.

With local jails now getting tight on space, county officials have turned to programs like home detention.

Among its provisions, people on home detention are allowed, subject to the approval of Sheriff Sandra Hutchens, to leave their home to apply for jobs, go to work or get medical help.

The sheriff is also allowed to let detainees attend psychological counseling, educational classes or vocational training.

Spitzer took issue with those provisions, saying people on home detention should not be allowed to leave, nor have access to the internet.

“If it’s home confinement, it should be home confinement,” he said.

Sheriff Sandra Hutchens felt differently.

She said that allowing detainees to work is important for reducing their chance of committing crimes again.

“This is part of reducing recidivism,” Hutchens told supervisors, adding that at some point they won’t be on home monitoring.

“I think it would be wise of us” to allow someone to continue at their job, she said.

Supervisors’ Chairman Shawn Nelson pointed out another potential benefit.

“Perhaps that would keep the rest of their family from ending up in a different county program,” Nelson said.

Under the home detention program, inmates being held for misdemeanors are given an option to serve the “tail end” of their sentence at home, Hutchens said.

“They’re technically still in custody,” she added.

“These are tools for me to use to manage that jail population and balance the ability to keep people in custody and not overcrowd our jails and subject this county” to a lawsuit like the state experienced, Hutchens told supervisors.

Supervisors recently rejected a request by Hutchens to expand the home detention program to inmates who were convicted of non-violent felonies and had limited criminal records.

On Tuesday, Spitzer also publicly took issue with the staff report simply listing penal code sections without explaining what they mean, something Spitzer said Giancola had previously agreed to change.

“You literally could not understand this agenda item” without looking up the penal code sections’ meaning, Spitzer said.

Giancola replied that he’ll make sure that future staff reports explain the meanings.

“This one got by,” Giancola said.

Spitzer also questioned a provision of the rules on searches and seizures, saying it could conflict with court orders.

Amid the influx of inmates, sheriff’s officials are also looking at reducing their contract to hold federal immigration detainees, which currently requires the county to house between 500 and 838 people.

The state’s shifting of responsibilities, known as prisoner realignment or AB 109, is forcing counties across California to come up with more cost-effective approaches to criminal justice.

Many of those approaches have been profiled by the California State Association of Counties, which put together a series of videos on various counties’ efforts.

“Smart justice” programs, CSAC says, center on “evidence-based practices that identify individual offender’s risk factors and providing services, treatment and other resources to help reduce the risk of reoffending.”

A recent UC Irvine forum also highlighted a series of programs aimed at lowering recidivism.

Under realignment, each county is given money for their extra prisoner obligations.

Orange County’s share is $67 million this year, according to the county’s latest realignment report.

It’s unclear in the report how much of the funding is going towards recidivism reduction programs.

The plan is created by the Community Corrections Partnership, whose executive committee is empowered as voting members.

That executive committee is comprised of Chief Probation Officer Steve Sentman, Sheriff-Coroner Sandra Hutchens, District Attorney Tony Rackauckas, Health Care Agency Deputy Director Mary Hale, Public Defender Frank Ospino and Garden Grove Police Chief Kevin Raney.

The next Community Corrections Partnership meeting is scheduled for Thursday, March 27 at 2 p.m., at the probation department’s Grand Avenue office (1001 S. Grand Ave., Santa Ana).

Closer to the meeting, its agenda should be available here.

Please contact Nick Gerda directly at ngerda and follow him on Twitter: @nicholasgerda.

Calif. Moves To Expand Forced Treatment For Severely Mentally Ill

More California counties are turning attention to an 11-year-old law allowing judges to order involuntary outpatient treatment for people with severe mental illness.

By Matthew Heller

LOS ANGELES — At a public meeting on Feb. 25, the Alameda County, Calif., Board of Supervisors wrestled with a decision that could have a major impact not only on the mentally ill in their jurisdiction but also those across the state.

Before the five supervisors was a proposal to adopt an 11-year-old state law — dubbed “Laura’s Law” for a college student who was murdered by a mentally ill man — that allows judges to order involuntary outpatient treatment for those persons whose “mental illness is so severe it prevents them from seeking help.”

Since Assembly Bill 1421 was passed in August 2002, only rural Nevada County, where Laura Wilcox was killed, has fully implemented the law amid concerns over funding and possible civil rights abuses. California had previously permitted only “5150” holds — 72-hour detentions of mentally ill adults who are considered a danger to themselves or others.

If Alameda becomes the first large, urban county in California to approve a Laura’s Law program, the law might finally gain some traction. The county used 5150s on 10,849 occasions last year.

“I need to protect him but I can’t,” Liz Rebensdorf, head of the East Bay chapter of the National Alliance on Mental Illness, told the supervisors, referring to her mentally ill son. “I can’t protect him from his inner demons, or from his own self.”

The financial concerns have been eased since the Legislature clarified last year that money from Proposition 63, a ballot initiative passed by California voters in 2004, can be used to support “assisted outpatient treatment” programs. Nevada County has said its program saved more than $500,000 in hospital and incarceration costs over a period of 31 months.

At the Alameda County meeting, however, emotions ran high as one important constituency — the mentally ill themselves — expressed their opposition to Laura’s Law.

“I want to have a say-so in my recovery,” said Christina Murphy, a 35-year-old woman who has struggled with mental illness and argued that forcing the mentally ill to seek treatment is ineffective.

In Orange County, another of California’s largest counties, momentum has been building to adopt Laura’s Law since Kelly Thomas, a homeless schizophrenic, died after a brutal altercation with Fullerton police in 2011.

“Had Kelly Thomas been receiving the intensive services provided by ‘Laura’s Law,’ it is likely Kelly Thomas would not have been on the street to be beaten to death,” Carla Jacobs, a long-time advocate for the mentally ill and an Orange County resident, told MintPress in an interview.

But with the issue of whether the mentally ill should be compelled to receive treatment still so polarizing, the future of the law remains in doubt.

“Both sides are afraid and the stakes are high,” said Randall Hagar, legislative director of the California Psychiatric Association.

“The patient group fears, sometimes to the point of terror, a return to the bad old days of state [mental] hospitals,” he noted. “Involuntary treatment is the boogeyman.”

“Life-saving services”

It was on Jan. 11, 2001 that Scott Harlan Thorpe went on a shooting rampage in the Nevada County social services building, killing three people. He was a registered client of the behavioral health clinic, but his attendance at counseling sessions was purely voluntary and his family had been trying to get more intensive treatment for him. One of his victims was Laura Wilcox, a 19-year-old intern at the clinic.

In the “bad old days,” Thorpe very likely would have been confined to a mental hospital. But in the 1960s, California, like many other states, had adopted a policy known as “deinstitutionalization,” whereby the mentally ill were taken out of hospitals and treated in their communities, instead. The Lanterman-Petris-Short Act of 1967 ended indefinite, involuntary commitment to hospitals and provided for only 72-hour commitments of those deemed to have a dangerous mental disorder.

Those who weren’t dangerous, but “very, very sick,” says Jacobs, were left “out in the cold,” often condemned to cycling through 5150s and the criminal justice system after being arrested for minor offenses. In the five years leading up to his death, for example, Kelly Thomas was arrested more than 20 times.

AB 1421 was designed to plug the gap in the LPS Act by helping those whose mental disorder is so severe that it prevents them from even recognizing that they need help.

Under existing law, the bill’s author said, there was no way to allow such people access to a court-ordered outpatient program, “even though they have a history of repeated holds, deteriorating symptoms without treatment and repeatedly refused offers to engage in voluntary treatment.”

Laura’s Law allows a judge to order involuntary outpatient treatment for a person 18 years or older who is severely mentally ill, who refuses voluntary treatment and who appears to be at risk for self-harm or grave disability. The mentally ill person is represented at court hearings by a public defender and has other due-process protections.

The law “is useful for a very narrow segment of the population that can’t be helped effectively by other, voluntary means,” Hagar told MintPress. “Just over 50 percent of those with severe mental illness don’t believe they are sick and Laura’s Law is targeted at those folks at that moment in time when they are deteriorating and refusing treatment.”

Jacobs notes that 72-hour hospitalizations do not provide nearly enough time to even stabilize a severely mentally ill person. “Three days is nothing more than a shave and a shower,” she said.

No state funding, however, was appropriated for the law and the Legislature left it up to individual counties to “opt in” to it.

Only Nevada County initially accepted the invitation. Since the county began to offer assisted outpatient services in May 2008, 55 people have been referred and evaluated, with the majority engaging in treatment without a court order.

“Laura’s Law has provided life-saving services to individuals suffering from mental illness and kept many from the trauma and brain damage associated with involuntary commitments to mental health facilities,” Thomas M. Anderson, the presiding judge of Nevada County, wrote in a letter to the Orange County Board of Supervisors in September 2011.

The law, he added, had provided a return of $1.80 for every $1.00 spent.

But other counties have shied away from the law, including Mendocino County, where a mentally disturbed man, Aaron Bassler, murdered two foresters in September 2011 before being shot to death by a police SWAT team. Los Angeles and Yolo counties have implemented only pilot Laura’s Law programs.

“It is a very emotional issue,” Jacobs observed. “And it’s something that has to be emotional because you’re talking about people’s rights and people’s lives.”

Watershed year

Things certainly got emotional at the recent Alameda County Board of Supervisors meeting. One speaker was Candy Dewitt, whose son has been charged with killing a stranger in Berkeley after repeated 5150s due to his schizophrenia.

“I hope for my son what you have one day,” she told a group of Alameda County constituents who have been successful in battling their mental illnesses. “But he can’t do that and there are many others who can’t do that. We need something else.”

An anguished Board President Keith Carson didn’t mince words in sharing his own experience of dealing with a schizophrenic family member. “I have personally seen that person force-fed medication and I continue to live with that person’s disability,” he said. “This is not something I read about. It’s something I f

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