Existing law authorizes counties to establish interagency child death teams and elder death teams to assist local agencies in identifying and reviewing suspicious deaths and facilitating communications between local organizations for the purposes of reducing the incidence of abuse and neglect.

This bill would authorize counties to establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of specified information by a homeless death review committee.

Existing law authorizes counties to establish interagency child death teams and elder death teams to assist local agencies in identifying and reviewing suspicious deaths and facilitating communications between local organizations for the purposes of reducing the incidence of abuse and neglect.

This bill would authorize counties to establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of specified information by a homeless death review committee.

Existing law authorizes counties to establish interagency child death teams and elder death teams to assist local agencies in identifying and reviewing suspicious deaths and facilitating communications between local organizations for the purposes of reducing the incidence of abuse and neglect.

This bill would authorize counties to establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of specified information by a homeless death review committee.

Existing law authorizes counties to establish interagency child death teams and elder death teams to assist local agencies in identifying and reviewing suspicious deaths and facilitating communications between local organizations for the purposes of reducing the incidence of abuse and neglect.

This bill would authorize counties to establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of information by a homeless death review committee.

Existing law authorizes counties to establish interagency child death teams and elder death teams to assist local agencies in identifying and reviewing suspicious deaths and facilitating communications between local organizations for the purposes of reducing the incidence of abuse and neglect.

This bill would authorize counties to establish a homeless death review committee for the purposes of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services for the homeless population. The bill would establish procedures for the sharing or disclosure of information by a homeless death review committee.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 271

Author:(Quirk-Silva)

As Amended Ver:June 26, 2023

Majority vote

SUMMARY

Allows counties to establish homeless death review committees.

Senate Amendments

Allow the following information be made available to homeless death review committee teams:

1. Public services information for which grant-in-aid are received by this state from the federal government, as specified.
2. Medi-Cal information, as specified.
3. General relief information, as specified.
4. Reports of suspected elder or dependent adult abuse and information contained therein, and information relevant to the incident of abuse, except the identity of persons who have made reports, as specified.

COMMENTS

As Passed by the Assembly: This bill allowed counties to establish homeless death review committees.

Major Provisions

1. Allowed each county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals.
2. Allowed each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies on homeless individuals in the identification of the cause and mode of death for the individual.
3. Provided that written or oral communication, or, a document shared within or produced by a homeless death review committee information is confidential and not subject to third party discovery or disclosure;
4. Permitted the homeless death review committee to share recommendations upon the completion of a review at the discretion of a majority of the members on the committee.
5. Allowed an organization represented on the homeless death review committee to share with other members of the committee information that may be pertinent to review. Any information shared is confidential.
6. Stated that an individual or agency that has information governed by these provisions is not required to disclose information; the intent is to allow the voluntary disclosure of information by the individual or agency that has the information.
7. Allowed an individual or agency that has information requested by the homeless death review committee to reply on the committee's request as a basis for disclosing the information.
8. Permitted the following information to be disclosed to a homeless death review committee:
   1. Medical information, unless disclosure is prohibited by federal law;
   2. Mental health information;
   3. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
   4. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
   5. Information provided to probation officers in the course of the performance of their duties, including, but not limited to reports and the information on which these reports are based.
9. Stated that written or oral information may disclosed, notwithstanding the following:
   1. Willful, unauthorized violations of professional confidences which constitute unprofessional conduct;
   2. Confidential communications between a psychologist and client;
   3. Confidential communications between a licensed marriage and family therapists and client
   4. Attorney-client privilege;
   5. Lawyer-client privilege;
   6. Physician-patient privilege; and,
   7. Psychotherapist-patient privilege.
10. Required any information and recommendations gathered by the homeless death review committee be used by the county to develop education and prevention strategies that will lead to improved coordination of services for the homeless population.

Background on Death Review Teams: This proposed legislation is modeled after child death review teams and elder & dependent adult death review teams. Both teams authorize counties to establish death review teams for suspicious child, elder and dependent adult deaths.

Local Child Death Review Teams have been functioning since the early 1980s, with Los Angeles County starting in 1978. Some California counties maintain child death review teams, however while they are formally authorized in statute, they are not mandated. (Penal Code Section 11174.32.)

Elder and dependent adult death review teams were authorized in statute in 2001 (Penal Code Section 11174.5). According to the Sacramento District Attorney's Office "In July 1999, the District Attorney's Office partnered with Sacramento County Department of Health and Human Services to form the Elder Death Review Team (EDRT). EDRT is a multidisciplinary team with members representing law enforcement, social services, the coroner and community based organizations. Their purpose is to conduct in-depth reviews of elder and dependent adult abuse and neglect cases that resulted in death. They identify systemic needs, develop strategies, policies and procedures to improve communication between the organizations, and work toward preventing elder abuse and neglect. EDRT meets six times a year, and produces a report of findings for the Board of Supervisors." (https://www.sacda.org/victim-services/elder-abuse/elder-death-interdisciplinary-review-team/ )This team has reports on its website dating back to 2004.

This bill would allow counties to establish homeless death review committees with specific protocols and guidelines.

According to the Author

"Last year in one month, there were approximately 45 homeless individuals that died in my district alone. That is 45 too many. AB 271 would allow counties to establish death review committees that will specifically focus on uncovering underlying causes of deaths from our homeless population, and determine how these factors can be preventable. We must be active in making changes to ensure preventable deaths concerning homeless individuals does not occur in California."

Arguments in Support

According to the Orange County Sheriff's Department, the Sponsor of this bill, "Deaths among those experiencing homelessness has been on an increase in communities across our state. In Orange County, the number of homeless deaths increased from 103 in 2012 to 395 in 2021. In January 2022, in my role as Orange County Coroner, I announced the creation of Orange County's first Homeless Death Review Committee to determine what, if any, factors contributing to these deaths were preventable. The Homeless Death Review Committee consists of technical experts from both the public and non-profit sector. The committee met multiple times throughout 2022. In the course of their work it was determined the in-depth sharing of data that would be necessary to look at each individual homeless death would not be possible without authorization in statute. As a result, the Committee's first report will be based on aggregate data only.

"If approved, AB 271 will provide the necessary authorization for a more complete review of homeless deaths. Similar mortality review committees are authorized by State law. For example the penal code authorizes counties to create a child death review team and an elder death review team. These teams have proved helpful in identifying trends where deaths could be prevented and informing the development of public policy. The committee authorized in AB 271 is also in keeping with a best practice recommended by the National Health Care for the Homeless Council."

Arguments in Opposition

None Submitted.

FISCAL COMMENTS

Unknown. This bill is keyed non-fiscal by the Legislative Counsel.

VOTES:

ASM PUBLIC SAFETY: 8-0-0

YES: Jones-Sawyer, Alanis, Bonta, Bryan, Lackey, Ortega, Santiago, Zbur

ASSEMBLY FLOOR: 79-0-1

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

ABS, ABST OR NV: Gallagher

SENATE FLOOR: 37-0-3

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Durazo, Eggman, Glazer, Gonzalez, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

ABS, ABST OR NV: Dodd, Grove, Portantino

UPDATED

VERSION: June 26, 2023

CONSULTANT: Elizabeth Potter / PUB. S. / (916) 319-3744 FN: 0001225

 CONSENT  

Bill No: AB 271

Author: Quirk-Silva (D), et al.

Amended: 6/26/23 in Senate

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 5-0, 6/13/23

AYES: Wahab, Ochoa Bogh, Bradford, Skinner, Wiener

SENATE HUMAN SERVICES COMMITTEE: 5-0, 7/3/23

AYES: Alvarado-Gil, Ochoa Bogh, Hurtado, Menjivar, Wahab

ASSEMBLY FLOOR: 79-0, 3/6/23 (Consent) - See last page for vote

SUBJECT: Homeless death review committees

SOURCE: Orange County Sheriff's Department

DIGEST:

This bill permits counties to establish homeless death review teams.

ANALYSIS:

Existing law:

1. Defines “homeless” as any of the following:
   1. An individual or family who lacks a fixed, regular, and adequate nighttime residence;
   2. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including, but not limited to, a car, park, abandoned building, bus station, train station, airport, or camping ground;
   3. An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements, including hotels or motels paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, congregate shelters, or transitional housing;
   4. An individual who resided in a shelter or place not meant for human habitation and who is exiting an institution where the individual temporarily resided;
   5. An individual or family who will imminently lose their housing, including, but not limited to, housing they own, rent, or live in without paying rent, are sharing with others, or rooms in hotels or motels not paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, if any of the following criteria are met:
      1. The primary nighttime residence will be lost within 14 days, as evidenced by any of the following:
         1. A court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days;
         2. The individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; and,
         3. Credible evidence indicating that the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance that is found to be credible shall be considered credible evidence for purposes of this clause.
      2. The individual or family has no subsequent residence identified; and,
      3. The individual or family lacks the resources or support networks needed to obtain other permanent housing.
   6. Unaccompanied youth and homeless families with children and youth defined as homeless under any other federal statute, as of the effective date of this program, who meet all of the following:
      1. Have experienced a long-term period without living independently in permanent housing;
      2. Have experienced persistent instability as measured by frequent moves over that long-term period; and,
      3. Can be expected to continue in that status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or multiple barriers to employment. (Welfare & Institutions Code § 16523 (d).)
2. States that “homelessness” means the status of being homeless, as defined. (Welfare & Institutions Code § 16523 (e).)
3. Allows each county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Penal Code § 11174.32(a).)
4. Allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death, and in the proper reporting procedures for child abuse or neglect, including the designation of the cause and mode of death. (Penal Code § 11174.32 (b).) Permits the following information to be disclosed to a child death review team:
   1. Medical information, unless disclosure is prohibited by federal law;
   2. Mental health information;
   3. Information from child abuse reports and investigations, except the identity of the person making the report, which shall not be disclosed;
   4. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
   5. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
   6. Records of in-home supportive services, unless disclosure is prohibited by federal law. (Penal Code § 11174.32 (e)(2).)
5. Allows each county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Penal Code § 11174.5 (a).)

This bill:

1. Allows each county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals.
2. Allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies on homeless individuals in the identification of the cause and mode of death for the individual.
3. Provides that written or oral communication, or, a document shared within or produced by a homeless death review committee information is confidential and not subject to third party discovery or disclosure;
4. Permits the homeless death review committee to share recommendations upon the completion of a review at the discretion of a majority of the members on the committee.
5. Allows an organization represented on the homeless death review committee to share with other members of the committee information that may be pertinent to review. Any information shared is confidential.
6. States that an individual or agency that has information governed by these provisions is not required to disclose information; the intent is to allow the voluntary disclosure of information by the individual or agency that has the information.
7. Allows an individual or agency that has information requested by the homeless death review committee to reply on the committee’s request as a basis for disclosing the information.
8. Permits the following information to be disclosed to a homeless death review committee:
   1. Medical information, unless disclosure is prohibited by federal law;
   2. Mental health information;
   3. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
   4. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
   5. Information provided to probation officers in the course of the performance of their duties, including, but not limited to reports and the information on which these reports are based.
9. States that written or oral information may disclosed, notwithstanding the following:
   1. Willful, unauthorized violations of professional confidences which constitute unprofessional conduct;
   2. Confidential communications between a psychologist and client;
   3. Confidential communications between a licensed marriage and family therapists and client;
   4. Attorney-client privilege;
   5. Lawyer-client privilege;
   6. Physician-patient privilege; and,
   7. Psychotherapist-patient privilege.
10. Requires any information and recommendations gathered by the homeless death review committee be used by the county to develop education and prevention strategies that will lead to improved coordination of services for the homeless population.

FISCAL EFFECT: Appropriation: No Fiscal Com.: No Local: No

SUPPORT: (Verified 7/5/23)

Orange County Sheriff's Department (source)

Aids Healthcare Foundation

California Catholic Conference

California Long-Term Care Ombudsman Association

California State Sheriffs' Association

CalOptima

Illumination Foundation

Santa Clara Valley Water District

Tustin Police Department

OPPOSITION: (Verified 7/5/23)

None received

ARGUMENTS IN SUPPORT: The sponsor of this bill, the Orange County Sheriff's Department, states in support of this bill:

Communities across our state have witnessed the troubling rise of deaths among homeless individuals. In response, Orange County established its Homeless Death Review Committee in January 2022, consisting of experts from the public and non-profit sector to determine what, if any, factors contributing to deaths among homeless individuals were preventable. In the course of its work, it was determined that the complexity of in-depth data sharing to assess each homeless individual’s death would not be possible without express authorization in state statute.

AB 271 provides a necessary means for counties to conduct more complete reviews of deaths among unhoused individuals, and implements best practices recommended by the National Health Care for the Homeless Council. The information sharing authorized by AB 271 will result in more data being available to counties and provide them with the tools to make data-driven decisions rooted in best practices to prevent deaths of more homeless individuals.

ASSEMBLY FLOOR: 79-0, 3/6/23

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Cervantes, Chen, Connolly, Megan Dahle, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Friedman, Gabriel, Garcia, Gipson, Grayson, Haney, Hart, Holden, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, Mathis, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Rendon

NO VOTE RECORDED: Gallagher

Prepared by: Mary Kennedy / PUB. S. /

7/7/23 9:12:12

**** END ****

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Homeless death review committees

SUMMARY

This bill allows counties to establish homeless death review committees.

ABSTRACT

Existing Law:

1. Defines “homeless” as any of the following:
   
   1. An individual or family who lacks a fixed, regular, and adequate nighttime residence;
      
   2. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including, but not limited to, a car, park, abandoned building, bus station, train station, airport, or camping ground;
      
   3. An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements, including hotels or motels paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, congregate shelters, or transitional housing;
      
   4. An individual who resided in a shelter or place not meant for human habitation and who is exiting an institution where the individual temporarily resided;
      
   5. An individual or family who will imminently lose their housing, including, but not limited to, housing they own, rent, or live in without paying rent, are sharing with others, or rooms in hotels or motels not paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, if any of the following criteria are met:
      
      1. The primary nighttime residence will be lost within 14 days, as evidenced by any of the following:
         
         1. A court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days;
            
         2. The individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; and,
            
         3. Credible evidence indicating that the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance that is found to be credible shall be considered credible evidence for purposes of this clause.
            
      2. The individual or family has no subsequent residence identified; and,
         
      3. The individual or family lacks the resources or support networks needed to obtain other permanent housing.
         
   6. Unaccompanied youth and homeless families with children and youth defined as homeless under any other federal statute, as of the effective date of this program, who meet all of the following:
      
      1. Have experienced a long-term period without living independently in permanent housing;
         
      2. Have experienced persistent instability as measured by frequent moves over that long-term period; and,
         
      3. Can be expected to continue in that status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or multiple barriers to employment. (WIC 16523(d))
         
2. States that “homelessness” means the status of being homeless, as defined (WIC 16523 (e).)
   
3. Allows each county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (PC 11174.32(a))
   
4. Allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death, and in the proper reporting procedures for child abuse or neglect, including the designation of the cause and mode of death. Permits the following information to be disclosed to a child death review team:
   
   1. Medical information, unless disclosure is prohibited by federal law;
      
   2. Mental health information;
      
   3. Information from child abuse reports and investigations, except the identity of the person making the report, which shall not be disclosed;
      
   4. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
      
   5. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
      
   6. Records of in-home supportive services, unless disclosure is prohibited by federal law. (PC 11174.32)
      
5. Allows each county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (PC 11174.5(a))

This Bill:

1. Provides that counties may establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population.
   
2. Provides that when a county establishes such a death review committee, they may develop a protocol to be used as guidelines by persons performing autopsies on homeless individuals to assist coroners and other persons who perform autopsies in the identification of the cause and mode of death of the individual.
   
3. Provides that the following are confidential and not subject to disclosure or discoverable by a third party
   
   1. An oral or written communication or a document shared within or produced by a homeless death review committee related to a homeless death review is confidential and not subject to disclosure or discoverable by another third party.
      
   2. An oral or written communication or a document provided by a third party to a homeless death review committee, or between a third party and a homeless death review committee, is confidential and not subject to disclosure or discoverable by a third party.
      
4. Provides that the recommendations of a homeless death review committee upon the completion of a review may be disclosed at the discretion of a majority of the members of the homeless death review committee.
   
5. Provides that an organization represented on the homeless death review committee may share with other members of the committee information in its possession concerning the decedent who is the subject of the review or any person who was in contact with the decedent and any other information deemed by the organization to be pertinent to the review. Information shared by an organization with other members of a team is confidential.
   
6. Provides that written and oral information may be disclosed to a homeless death review committee established pursuant to this article. The team may make a request in writing for the information sought and any person with information may rely on the request in determining whether information may be disclosed to the team.
   
7. Provides that an individual or agency that has information is not required to disclose that information.
   
8. Permits the following information to be disclosed to a homeless death review committee:
   
   1. Medical information, unless disclosure is prohibited by federal law;
      
   2. Mental health information;
      
   3. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
      
   4. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct;
      
   5. Information provided to probation officers in the course of the performance of their duties, including, but not limited to reports and the information on which these reports are based;
      
   6. Public social services information for which grants-in-aid are received by this state from the United States government;
      
   7. Medi-Cal information;
      
   8. General relief information;
      
   9. Reports of suspected elder or dependent adult abuse and the information contained therein, and information relevant to the incident of abuse, except the identify of persons who have made reports;
      
9. Provides that written and oral information may be disclosed notwithstanding the following:
   
   1. Willful, unauthorized violations of professional confidences which constitute unprofessional conduct;
      
   2. Confidential communications between a psychologist and client;
      
   3. Confidential communications between a licensed marriage and family therapists and client ;
      
   4. Attorney-client privilege;
      
   5. Lawyer-client privilege;
      
   6. Physician-patient privilege; and,
      
   7. Psychotherapist-patient privilege.
      
10. States that information gathered by the homeless death review committee and any recommendations made by the committee shall be used by the county to develop education and prevention strategies that will lead to improved coordination of services for the homeless population.

FISCAL IMPACT

This bill was keyed non-fiscal by the Legislative Counsel.

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, "Last year in one month, there were approximately 45 homeless individuals that died in my district alone. That is 45 too many. AB 271 would allow counties to establish death review committees that will specifically focus on uncovering underlying causes of deaths from our homeless population, and determine how these factors can be preventable. We must be active in making changes to ensure preventable deaths concerning homeless individuals does not occur in California."

California Homelessness Data

Since 2016, homelessness in America, and particularly in California, has been growing at an increasing rate. Homelessness has been correlated with a number of negative effects, including high rates of chronic disease and acute illness, a broad range of mental health and substance use issues, greater exposure to violence, malnutrition, extreme weather, and criminal charges. The health, personal, and economic challenges that chronically homeless individuals and families face and the lack of effective, coordinated services to address these problems often lead to a cycle of housing instability and health deterioration. Persistent homelessness impedes access to needed health and employment services. Additionally, the conditions of homelessness often make it more difficult to exit homelessness, by creating barriers to the resources necessary to obtain income through training, education, and employment.

Each January, the U.S. Department of Housing and Urban Development (HUD) has local community Continuums of Care (CoCs) conduct a Point in Time (PIT) count of people experiencing homelessness. HUD defines homelessness as either “sheltered” or “unsheltered”. Sheltered homelessness is when a person is living in a temporary place, such as a temporary shelter and unsheltered homelessness is living out in the open or in places not designated for, or ordinarily used as, a regular sleeping accommodation for people (i.e. the streets, vehicles, or parks). The PIT count is required by HUD as a condition of receiving federal funding. According to the 2022 PIT count, 171,521 people experienced homelessness in California, representing 30 percent of the nation’s homeless population. Additionally, California accounted for 50 percent of all people experiencing unsheltered homelessness in the nation (115,491 people), more than nine times the number of unsheltered people in the state with the next highest number, Washington (12,668). The PIT count also showed:

• Major city CoCs had the largest percentage of people experiencing homelessness in unsheltered locations, 43 percent, followed by largely rural CoCs, 41 percent.
  
• In all categories of CoCs, nearly all unaccompanied youth experiencing homelessness (88-93 percent) were between the ages of 18 and 24. Largely rural CoCs had the highest percentage of unaccompanied youth experiencing homelessness under the age of 18 (12 percent).
  
• Nationwide, between 2020 and 2022, 35 states experienced an increase in the number of individuals with chronic patterns of homelessness, including California with an increase of 18.3 percent (8,948 individuals).
  
• More than two thirds of all people experiencing homelessness in the U.S. (72 percent) did so in households without children present.

Stakeholders typically feel the annual PIT count is limited, because while these numbers provide a snapshot of the state’s homeless population during a single night, they likely underestimate the scope of the crisis because: (1) the HUD PIT count only measures the homeless population on one day of the year, and (2) it does not capture everyone experiencing homelessness, as some do not wish to be counted, while others cannot be counted because their location is not known to the counters. These shortcomings were further highlighted by the Covid-19 pandemic related limitations on data collection efforts and resulting focus on sheltered homelessness in 2021. Additionally, as many of the Covid-19 restrictions on congregate care settings were relaxed in 2022, and later ended in 2023, we will likely see a continued increase in sheltered homelessness as capacity limitations are lifted at emergency shelters.

Homeless Deaths in California

Obtaining accurate numbers of homeless deaths is challenging as death certificate data do not provide a definitive indication of whether a decedent is homeless. The New York Times reported that in Los Angles in 2021, people experiencing homelessness died in record numbers, averaging five deaths per day.^[1] The article goes on to highlight that the process of tallying homeless deaths is painstaking and involves cross-referencing homeless databases and death reports. Even accounting for increases in homeless populations, homeless deaths increased at rates far exceeding population. For example, in Los Angeles County from 2015 to 2020 their homeless population grew by 50%, and homeless deaths increased 200%.

Alameda County led the first public study of homeless deaths, culminating in the 2022 publication of “Alameda County 2018-2020 Homeless Mortality Report.^[2]” In order to identify homeless deaths the report used data sources not traditionally used for mortality reviews, such as Vital Records Business Information System, multiple countywide sources of homelessness-related data and mortality reports. The report found from 2018-2020 809 people died while experiencing homelessness.

Studies done on deaths of people experiencing homelessness consistently find that this community dies at rates far higher than their housed counterparts. A study by the Los Angeles County Department of Public Health found that homeless people are 35 times as likely as the general population to die of a drug or alcohol overdose. They are also four times as likely to die of heart disease, 16 times as likely to die in a car crash, 14 times as likely to be murdered and eight times as likely to die of suicide.

The Orange County Experience

The increase in homeless deaths in Orange County, from 103 in 2012 to 395 in 2022, lead to an effort by the Orange County Sheriff to determine factors leading to those deaths. The Orange County Sheriff is also the Orange County Coroner, and in that role announced in January 2022 the county’s first Homeless Death Review Committee (Committee). The Committee consists of technical experts from non-profits and the public sector and met multiple times in 2022. Through that work the Committee found that the in-depth sharing of data would be necessary to look into each individual homeless death was not allowed under statute. The Committee’s report therefore was based only on aggregate data. This bill is a response to the challenges faced by the Committee.

Related/Prior Legislation:

AB 2654 (Lackey, 2021) would have reconvened the State Child Death Review Council by removing the requirement that funds are appropriated for it in the Budget Act in order to be operative. AB 2654 was held in the Assembly Appropriations Committee.

AB 2660 (Maienschein, 2021) would have required each county to establish an interagency child death review team no later than January 1, 2024. AB 2660 was vetoed by the governor.

SB 187 (Committee on Budget and Fiscal Review, Chapter 50, Statutes of 2022) required statistical information be recorded through the Department of Social Services in the statewide child information system on all cases of child death suspected to be related to abuse or neglect.

SB 863 (Min, Chapter 986, Statutes of 2022) authorizes a county domestic violence death review team to assist local agencies in identifying and reviewing domestic violence near-death cases, as defined.

COMMENTS

AB 271 will provide the authorization for sharing of information to allow homeless death review committees to more thoroughly evaluate data and develop strategies to prevent such deaths. The hope is that these homeless death review committees would collect and share data that would then help policymakers and counties identify factors contributing to preventable deaths as well as develop strategies to prevent such deaths.

This approach is not unprecedented in California statute. California law allows for the creation of elder and dependent adult death review teams (PC 11174.4 et seq). These death review teams can share information and use that information to make recommendations to develop education and prevention strategies to lead to improved coordination of services for families and the elder population. California law also creates the California State Child Death Review Council (PC 11174.34 et seq). This Council is comprised of various organizations and agencies and meets at least four times per year. The council analyzes and interprets local and state data on child death into an annual report. This bill builds on these models to create homeless death review committees.

PRIOR VOTES

POSITIONS

Support:

Aids Healthcare Foundation
California Long-term Care Ombudsman Association

California State Sheriffs' Association
Santa Clara Valley Water District

Oppose:

None received

-- END --

1. https://www.nytimes.com/2022/04/18/us/homeless-deaths-los-angeles.html ↑

2. https://www.achch.org/uploads/7/2/5/4/72547769/2018-2020_ac_homeless_mortality_report_final_4.11.2022.pdf ↑

SENATE COMMITTEE ON PUBLIC SAFETY

Senator Aisha Wahab, Chair

2023 - 2024 Regular

Bill No: AB 271 Hearing Date: June 13, 2023

Subject: Homeless death review committees

HISTORY

Source: Orange County Sheriff’s Department

Prior Legislation: AB 2654 (Lackey) held Assembly Approps. 2022

AB 2660 (Maienschein) Vetoed 2022

SB 187 (Budget), Chapter 50, Stats. 2022

SB 863 (Min), Chapter 986, Stats. 2022

Support: Aids Healthcare Foundation; CalOptima Health; California Long-term Care Ombudsman Association; California State Sheriffs' Association; Illumination Foundation; Tustin Police Department

Opposition: None known

Assembly Floor Vote: 79-0

PURPOSE

The purpose of this bill is to permit counties to establish homeless death review teams.

Existing law defines “homeless” as any of the following:

1. An individual or family who lacks a fixed, regular, and adequate nighttime residence;
2. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including, but not limited to, a car, park, abandoned building, bus station, train station, airport, or camping ground;
3. An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements, including hotels or motels paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, congregate shelters, or transitional housing;
4. An individual who resided in a shelter or place not meant for human habitation and who is exiting an institution where the individual temporarily resided;
5. An individual or family who will imminently lose their housing, including, but not limited to, housing they own, rent, or live in without paying rent, are sharing with others, or rooms in hotels or motels not paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, if any of the following criteria are met:
   1. The primary nighttime residence will be lost within 14 days, as evidenced by any of the following:
      1. A court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days;
         
      2. The individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; and,
      3. Credible evidence indicating that the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance that is found to be credible shall be considered credible evidence for purposes of this clause.
         
   2. The individual or family has no subsequent residence identified; and,
   3. The individual or family lacks the resources or support networks needed to obtain other permanent housing.
      
6. Unaccompanied youth and homeless families with children and youth defined as homeless under any other federal statute, as of the effective date of this program, who meet all of the following:
   
   1. Have experienced a long-term period without living independently in permanent housing;
   2. Have experienced persistent instability as measured by frequent moves over that long-term period; and,
   3. Can be expected to continue in that status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or multiple barriers to employment. (Welfare & Institutions Code § 16523 (d).)
      

Existing law states that “homelessness” means the status of being homeless, as defined (Welfare & Institutions Code § 16523 (e).)

Existing law allows each county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Penal Code § 11174.32(a).)

Existing law allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death, and in the proper reporting procedures for child abuse or neglect, including the designation of the cause and mode of death. (Penal Code § 11174.32 (b).) Permits the following information to be disclosed to a child death review team:

1. Medical information, unless disclosure is prohibited by federal law;
2. Mental health information;
3. Information from child abuse reports and investigations, except the identity of the person making the report, which shall not be disclosed;
4. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
5. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
6. Records of in-home supportive services, unless disclosure is prohibited by federal law. (Penal Code § 11174.32 (e)(2).)
   

Existing law allows each county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Penal Code § 11174.5 (a).)

This bill allows each county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals.

This bill allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies on homeless individuals in the identification of the cause and mode of death for the individual.

This bill provides that written or oral communication, or, a document shared within or produced by a homeless death review committee information is confidential and not subject to third party discovery or disclosure;

This bill permits the homeless death review committee to share recommendations upon the completion of a review at the discretion of a majority of the members on the committee.

This bill allows an organization represented on the homeless death review committee to share with other members of the committee information that may be pertinent to review. Any information shared is confidential.

This bill states that an individual or agency that has information governed by these provisions is not required to disclose information; the intent is to allow the voluntary disclosure of information by the individual or agency that has the information.

This bill allows an individual or agency that has information requested by the homeless death review committee to reply on the committee’s request as a basis for disclosing the information.

This bill permits the following information to be disclosed to a homeless death review committee:

1. Medical information, unless disclosure is prohibited by federal law;
2. Mental health information;
3. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
4. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
5. Information provided to probation officers in the course of the performance of their duties, including, but not limited to reports and the information on which these reports are based.
   

This bill states that written or oral information may disclosed, notwithstanding the following:

1. Willful, unauthorized violations of professional confidences which constitute unprofessional conduct;
2. Confidential communications between a psychologist and client;
3. Confidential communications between a licensed marriage and family therapists and client
4. Attorney-client privilege;
5. Lawyer-client privilege;
6. Physician-patient privilege; and,
7. Psychotherapist-patient privilege.
   

This bill requires any information and recommendations gathered by the homeless death review committee be used by the county to develop education and prevention strategies that will lead to improved coordination of services for the homeless population.

COMMENTS

1. Need for This Bill

According to the author:

Last year in one month, there were approximately 45 homeless individuals that died in my district alone. That is 45 too many. AB 271 would allow counties to establish death review committees that will specifically focus on uncovering underlying causes of deaths from our homeless population, and determine how these factors can be preventable. We must be active in making changes to ensure preventable deaths concerning homeless individuals does not occur in California

2. Homelessness in California

According to background information provided by the author’s office, “On average, approximately over 129,000 people experience homelessness throughout the state of California. According to the National Alliance on Homelessness, in Los Angeles alone, 49,995 people fall under the definition homeless on daily basis.” (California - National Alliance to End Homelessness). Given the affordable housing shortage throughout the state, this number could be higher.

A recent study by the University of California San Francisco concluded that people who first became homeless at age 50 or later were about 60 percent more likely to die than those who had become homeless earlier in life. But homelessness was a risk for everyone, and those who remained homeless were about 80 percent more likely to die than those who were able to return to housing. (https://www.ucsf.edu/news/2022/08/423551/older-homeless-people-are-great-risk-dying ) Because this study was prospective it was able to identify and gather important information prior to people dying such as medical history or drug and substance abuse problems.

In an article by CalMatters, provided to the committee by the author’s office, “Across the state, the U.S. Census shows about 6.5% of Californians identify as black or African American, but they account for nearly 40% of the state’s homeless, according to a Department of Housing and Urban Development report to Congress. Nationally, black people account for 13.4% of the population but are 39.8% of the homeless population.” In the same article, they point to deficiencies for those coming out of California Prisons. “Felony records, stagnant wages and a rising housing crisis combined with policies that exclude or punish marginalized groups can ensnare vulnerable black people in homelessness. Even without felony records, black people face more difficulties finding employment and housing than other races or ethnicities, the National Fair Housing Alliance (NFHA) demonstrated in a recent report.” (Black people disproportionately homeless in California - CalMatters)

3. Death Review Team

This bill is modeled after child death review teams and elder & dependent adult death review teams. Both teams authorize counties to establish death review teams for suspicious child, elder and dependent adult deaths.

Local Child Death Review Teams have been functioning since the early 1980s, with Los Angeles County starting in 1978. Some California counties maintain child death review teams, however while they are formally authorized in statute, they are not mandated. (Penal Code §11174.32.)

Elder and dependent adult death review teams were authorized in statute in 2001 (Penal Code § 11174.5). According to the Sacramento District Attorney’s Office “In July 1999, the District Attorney’s Office partnered with Sacramento County Department of Health and Human Services to form the Elder Death Review Team (EDRT). EDRT is a multidisciplinary team with members representing law enforcement, social services, the coroner and community based organizations. Their purpose is to conduct in-depth reviews of elder and dependent adult abuse and neglect cases that resulted in death. They identify systemic needs, develop strategies, policies and procedures to improve communication between the organizations, and work toward preventing elder abuse and neglect. EDRT meets six times a year, and produces a report of findings for the Board of Supervisors.” (https://www.sacda.org/victim-services/elder-abuse/elder-death-interdisciplinary-review-team/ )This team has reports on its website dating back to 2004.

This bill would allow counties to establish homeless death review committees with specific protocols and guidelines.

4. Argument in Support

The sponsor, the Orange County Sheriff’s Association states in support of this bill:

Communities across our state have witnessed the troubling rise of deaths among homeless individuals. In response, Orange County established its Homeless Death Review Committee in January 2022, consisting of experts from the public and non-profit sector to determine what, if any, factors contributing to deaths among homeless individuals were preventable. In the course of its work, it was determined that the complexity of in-depth data sharing to assess each homeless individual’s death would not be possible without express authorization in state statute.

AB 271 provides a necessary means for counties to conduct more complete reviews of deaths among unhoused individuals, and implements best practices recommended by the National Health Care for the Homeless Council. The information sharing authorized by AB 271 will result in more data being available to counties and provide them with the tools to make data-driven decisions rooted in best practices to prevent deaths of more homeless individuals.

-- END –

Date of Hearing: February 28, 2023

Consultant: Elizabeth Potter

ASSEMBLY COMMITTEE ON

Reginald Byron Jones-Sawyer, Sr., Chair

ABPCA Bill Id:

Author:() – As Ver:

SUMMARY:

Allows counties to establish homeless death review committees. Specifically, this bill:

1. Allows each county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals.
   
2. Allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies on homeless individuals in the identification of the cause and mode of death for the individual.
   
3. Provides that written or oral communication, or, a document shared within or produced by a homeless death review committee information is confidential and not subject to third party discovery or disclosure;
   
4. Permits the homeless death review committee to share recommendations upon the completion of a review at the discretion of a majority of the members on the committee.
   
5. Allows an organization represented on the homeless death review committee to share with other members of the committee information that may be pertinent to review. Any information shared is confidential.
   
6. States that an individual or agency that has information governed by these provisions is not required to disclose information; the intent is to allow the voluntary disclosure of information by the individual or agency that has the information.
   
7. Allows an individual or agency that has information requested by the homeless death review committee to reply on the committee’s request as a basis for disclosing the information.
   
8. Permits the following information to be disclosed to a homeless death review committee:
   
   1. Medical information, unless disclosure is prohibited by federal law;
      
   2. Mental health information;
      
   3. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
      
   4. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
      
   5. Information provided to probation officers in the course of the performance of their duties, including, but not limited to reports and the information on which these reports are based.
      
9. States that written or oral information may disclosed, notwithstanding the following:
   
   1. Willful, unauthorized violations of professional confidences which constitute unprofessional conduct;
      
   2. Confidential communications between a psychologist and client;
      
   3. Confidential communications between a licensed marriage and family therapists and client
      
   4. Attorney-client privilege;
      
   5. Lawyer-client privilege;
      
   6. Physician-patient privilege; and,
      
   7. Psychotherapist-patient privilege.
      
10. Requires any information and recommendations gathered by the homeless death review committee be used by the county to develop education and prevention strategies that will lead to improved coordination of services for the homeless population.

EXISTING LAW:

1. Defines “homeless” as any of the following:
   
   1. An individual or family who lacks a fixed, regular, and adequate nighttime residence;
      
   2. An individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including, but not limited to, a car, park, abandoned building, bus station, train station, airport, or camping ground;
      
   3. An individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements, including hotels or motels paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, congregate shelters, or transitional housing;
      
   4. An individual who resided in a shelter or place not meant for human habitation and who is exiting an institution where the individual temporarily resided;
      
   5. An individual or family who will imminently lose their housing, including, but not limited to, housing they own, rent, or live in without paying rent, are sharing with others, or rooms in hotels or motels not paid for by federal, state, or local government programs for low-income individuals or by charitable organizations, if any of the following criteria are met:
      
      1. The primary nighttime residence will be lost within 14 days, as evidenced by any of the following:
         
         1. A court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days;
            
         2. The individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; and,
            
         3. Credible evidence indicating that the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance that is found to be credible shall be considered credible evidence for purposes of this clause.
            
      2. The individual or family has no subsequent residence identified; and,
         
      3. The individual or family lacks the resources or support networks needed to obtain other permanent housing.
         
   6. Unaccompanied youth and homeless families with children and youth defined as homeless under any other federal statute, as of the effective date of this program, who meet all of the following:
      
      1. Have experienced a long-term period without living independently in permanent housing;
         
      2. Have experienced persistent instability as measured by frequent moves over that long-term period; and,
         
      3. Can be expected to continue in that status for an extended period of time because of chronic disabilities, chronic physical health or mental health conditions, substance addiction, histories of domestic violence or childhood abuse, the presence of a child or youth with a disability, or multiple barriers to employment. (Welf & Inst. Code, § 16523 subd. (d).)
         
2. States that “homelessness” means the status of being homeless, as defined (Welf & Inst. Code, § 16523 subd. (e).)
   
3. Allows each county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Pen. Code, § 11174.32, subd. (a).)
   
4. Allows each county to develop an autopsy protocol that may be used as a guideline to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death, and in the proper reporting procedures for child abuse or neglect, including the designation of the cause and mode of death. (Pen. Code, § 11174.32, subd. (b).)
   
5. Permits the following information to be disclosed to a child death review team:
   
   1. Medical information, unless disclosure is prohibited by federal law;
      
   2. Mental health information;
      
   3. Information from child abuse reports and investigations, except the identity of the person making the report, which shall not be disclosed;
      
   4. State summary criminal history information, criminal offender record information, and local summary criminal history information, as specified;
      
   5. Information pertaining to reports by health practitioners of persons suffering from physical injuries inflicted by means of a firearm or of persons suffering physical injury where the injury is a result of assaultive or abusive conduct; and,
      
   6. Records of in-home supportive services, unless disclosure is prohibited by federal law. (Pen. Code, § 11174.32, subd. (e)(2).)
      
6. Allows each county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Pen. Code, § 11174.5, subd. (a).)

FISCAL EFFECT:

Unknown

COMMENTS:

1. Author's Statement: According to the author, "Last year in one month, there were approximately 45 homeless individuals that died in my district alone. That is 45 too many. AB 271 would allow counties to establish death review committees that will specifically focus on uncovering underlying causes of deaths from our homeless population, and determine how these factors can be preventable. We must be active in making changes to ensure preventable deaths concerning homeless individuals does not occur in California."
   
2. Background on Death Review Teams: This proposed legislation is modeled after child death review teams and elder & dependent adult death review teams. Both teams authorize counties to establish death review teams for suspicious child, elder and dependent adult deaths.
   
   Local Child Death Review Teams have been functioning since the early 1980s, with Los Angeles County starting in 1978. Some California counties maintain child death review teams, however while they are formally authorized in statute, they are not mandated. (Pen. Code, §11174.32.)
   
   Elder and dependent adult death review teams were authorized in statute in 2001 (Pen. Code, § 11174.5). According to the Sacramento District Attorney’s Office “In July 1999, the District Attorney’s Office partnered with Sacramento County Department of Health and Human Services to form the Elder Death Review Team (EDRT). EDRT is a multidisciplinary team with members representing law enforcement, social services, the coroner and community based organizations. Their purpose is to conduct in-depth reviews of elder and dependent adult abuse and neglect cases that resulted in death. They identify systemic needs, develop strategies, policies and procedures to improve communication between the organizations, and work toward preventing elder abuse and neglect. EDRT meets six times a year, and produces a report of findings for the Board of Supervisors.” (https://www.sacda.org/victim-services/elder-abuse/elder-death-interdisciplinary-review-team/ )This team has reports on its website dating back to 2004.
   
   This bill would allow counties to establish homeless death review committees with specific protocols and guidelines.
   
3. Homelessness in California: According to background information provided by the author’s office, “On average, approximately over 129,000 people experience homelessness throughout the state of California. According to the National Alliance on Homelessness, in Los Angeles alone, 49,995 people fall under the definition homeless on daily basis.” (California - National Alliance to End Homelessness). Given the affordable housing shortage throughout the state, this number could be higher.
   
   A recent study by the University of California San Francisco concluded that people who first became homeless at age 50 or later were about 60 percent more likely to die than those who had become homeless earlier in life. But homelessness was a risk for everyone, and those who remained homeless were about 80 percent more likely to die than those who were able to return to housing. (https://www.ucsf.edu/news/2022/08/423551/older-homeless-people-are-great-risk-dying ) Because this study was prospective it was able to identify and gather important information prior to people dying such as medical history or drug and substance abuse problems.
   
   In an article by CalMatters, provided to the committee by the author’s office, “Across the state, the U.S. Census shows about 6.5% of Californians identify as black or African American, but they account for nearly 40% of the state’s homeless, according to a Department of Housing and Urban Development report to Congress. Nationally, black people account for 13.4% of the population but are 39.8% of the homeless population.” In the same article, they point to deficiencies for those coming out of California Prisons. “Felony records, stagnant wages and a rising housing crisis combined with policies that exclude or punish marginalized groups can ensnare vulnerable black people in homelessness. Even without felony records, black people face more difficulties finding employment and housing than other races or ethnicities, the National Fair Housing Alliance (NFHA) demonstrated in a recent report.” (Black people disproportionately homeless in California - CalMatters)
   
4. Argument in Support: According to the Orange County Sheriff’s Department, the Sponsor of this bill, “Deaths among those experiencing homelessness has been on an increase in communities across our state. In Orange County, the number of homeless deaths increased from 103 in 2012 to 395 in 2021. In January 2022, in my role as Orange County Coroner, I announced the creation of Orange County's first Homeless Death Review Committee to determine what, if any, factors contributing to these deaths were preventable. The Homeless Death Review Committee consists of technical experts from both the public and non-profit sector. The committee met multiple times throughout 2022. In the course of their work it was determined the in-depth sharing of data that would be necessary to look at each individual homeless death would not be possible without authorization in statute. As a result, the Committee's first report will be based on aggregate data only.
   
   “If approved, AB 271 will provide the necessary authorization for a more complete review of homeless deaths. Similar mortality review committees are authorized by State law. For example the penal code authorizes counties to create a child death review team and an elder death review team. These teams have proved helpful in identifying trends where deaths could be prevented and informing the development of public policy. The committee authorized in AB 271 is also in keeping with a best practice recommended by the National Health Care for the Homeless Council.”
   
5. Related Legislation: AB 253 (Maienschein), would require the Attorney General to submit to the Governor and the Legislature an annual budget that is sufficient to fund the State Child Death Review Council and county child death review teams. AB 253 is pending hearing in this committee.
   
6. Prior Legislation:
   
   1. AB 2654 (Lackey), of the 2021-2022 Legislative Session, would have reconvened the State Child Death Review Council by removing the requirement that funds are appropriated for it in the Budget Act in order to be operative. AB 2654 was held in the Assembly Appropriations Committee.
      
   2. AB 2660 (Maienschein), of the 2021-2022 Legislative Session, would have required each county to establish an interagency child death review team no later than January 1, 2024. AB 2660 was vetoed by the governor.
      
   3. SB 187 (Committee on Budget and Fiscal Review), Chapter 50, Statutes of 2022, required statistical information be recorded through the Department of Social Services in the statewide child information system on all cases of child death suspected to be related to abuse or neglect.
      
   4. SB 863 (Min), Chapter 986, Statutes of 2022, authorizes a county domestic violence death review team to assist local agencies in identifying and reviewing domestic violence near-death cases, as defined.
      

REGISTERED SUPPORT / OPPOSITION:

Support

California State Sheriffs' Association
Illumination Foundation
Orange County Sheriff's Department
Tustin Police Department

Opposition

None

Analysis Prepared by: