Joint Legislative Audit

Yep. There you go. Well, you learn something new every day. Thank you very much, everyone. Good afternoon. Welcome to the oversight hearing of the Joint Legislative Audit Committee. Appreciate everyone for being here. Appreciate the Members for joining as well, as well as Senator Jones for being here today.

We will discuss, and of course, my Vice Chair, Senator Laird. We will discuss the findings and recommendations identified by the State Auditor in a recent audit report. The report is titled Conditional Release Program for Sexually Violent Predators. Program participants are less likely to reoffend while the state has difficulty finding suitable housing.

This audit goes without saying, certainly worthy of our attention given the importance of the topic as well as the concerns in our various communities affected by this program.

Just want to very briefly thank two Members in particular who have joined us here, and that is Senator Jones, who requested this audit, and he also has a few bills related to this topic.

And also Senate Member Carrillo, who has really encouraged this hearing today and has been very diligent about making sure that this audit came to light and was discussed in this forum. So thank you to Senator Carrillo, thank you to Senator Jones for everything that you have done.

I know, Senator Carrillo, this issue is very important in your district. And why don't we just very briefly pause. I'll let my Vice Chair make any opening remarks and then I will. I will then relay it to Senator Jones and Assembly Member Carrillo.

Thank you. I think you have to. There. That should be it. Thank you for the opportunity. And I appreciate the fact that you, you did some summary that I would have otherwise done. And I think the audit is really good and I think the Department has started to be really responsive.

The 1.0 I wanted to make is for those of us that have districts that have very rural parts, the state practices many times because of prohibitions in certain ways, put the placement of sexually violent predators in some of the most rural areas.

And it has been some of the biggest disputes in my home district because they can't be within a certain number of feet of schools or other things. And yet they're in a. There's one particular high profile one that's just a few miles from my home where there's just a block of a very few people.

It's in a completely rural, almost remote area. And yet that was one of the few places that fit in our placement. And so it's my misfortune that it's the Vice President of a startup, my personal physician, all those people are the ones that happen to live on that block.

And so I have heard over and over and over again about the risk from that placement. And so I think in reading the audit, it was very important because it's very easy to make those rules and then you see what the consequences are of how they're implemented. And I think that's what today's hearing is about.

So I want to thank everybody that got us to this.

Thank you, Mr. Vice Chair. Senator Jones, thank you, Chairman.

I appreciate it. As most people know, when I first got elected to the Senate in 2018, this is one of the very first constituent calls I received was about a sexually violent predator being placed in my district.

And I was somewhat familiar with the system from serving in the Assembly before that, but not as aggressively familiar with it as my constituents at that point in time made it clear. And then after that, several other situations in San Diego County that caused very. Caused a lot of concerns about this program.

I want to thank and recognize Assemblymember David Alvarez, who was the chair of the Audit Committee at that point in time when the audit, when I brought the audit request helped to get that approved. And I'm pretty sure it was unanimous at the time that we did that. Thanks, Assembly Carrillo, for asking for this oversight.

You know, oftentimes we do these oversight or ask for these audits and then the audit report comes and then we never do anything about it. So I'm thankful that we're actually doing something today to follow up on the audit request.

The audit revealed some very systematic problems that need to be fixed and I'm hoping that we're all going to be able to work together to that end.

Unfortunately, it appears from some of the responses to the audit from the Department of State Hospitals that rather than reform the broken Con Rep program to keep California safe, there continues to be a tendency to shirk some responsibility and hide from account. The Con Rep system is broken and we need serious reforms.

We need DHS to take a more active role in the placement and process. From the beginning. We need to explore new approaches to placement like transitional housing, internally conducted site searches, alternative vendors and multiple third party partners for different services and more.

We need to explore and execute new ways to conduct this program because this program is broken and, and it puts our communities at risk with each passing day that we don't fix it.

I hope that it makes it clear where I'm coming from on this issue and that our presenters today will be willing and ready to answer some tough questions and provide some detailed information so that we may come away from here today with the beginnings of some solutions. Thank you, Mr. Chair.

Thank you, Senator Jones and Senator Carrillo.

Thank you, Mr.

Chair. I want to start by thanking you for convening us here today. I believe that I heard Senator Jones and Senator Lehrer saying that they have one of those individuals in their district. I have three in the High Desert, and that's of high concern for us.

The original intent for me being here today with the rest of you is so that not only I can understand better what the process is for the placement, but also for our constituents to know what the process is.

There seems to be, in my view, and some of the people have come talk to me in the district, ambiguity on how the process works, how a judge has a discretion to place these individuals based on their own judgments.

My understanding, again, that's why I'm here, so that I can get educated and also for my constituents that have reached out to me with a big concern of why I see that we in the High Desert, which is about 60 miles from LA, we keep getting these individuals in our communities. Like I said, it's three of them.

One of them was there 10 years ago, I believe, and he violated his conditional release and he's back again. So again, for me, understanding what the process is and also question the way that this is handled from an organization that is out of Florida, that is not even in the state.

I understand that there was a process on how this happened, how it got selected, but it's just unclear to me how we in California selected a company out of Florida to manage this program.

I asked for maybe an RFP and RFQ to start this process again to see how we can get agencies or these organizations been interested from managing this program that are right here in California, not on the other side of the nation. Again, thank you, Mr. Chair, for allowing us to have this conversation.

Look forward for this conversation again. I see this as informational, a learning experience for me as well, but also for those constituents in the 39th Assembly District, the High Desert, where we have three of those individuals being placed there. Thank you again.

Thank you, Senator Carrillo, and for everything you have done again to bring us here. We are going to get this process started again. I think all of us want to learn a little bit more about the conditional release program we have brought forward here.

Our Auditor, Mr. Grant Parks, thank you for being here today and you will come up here shortly to actually go over that and please take a seat as we're kicking this off. And we've also brought Liberty Healthcare, who actually runs the program as well as the Department of State Hospitals who oversees the program.

And again, I think all of us have many questions and the audit has brought forward some information that we'd like some clarification and bring other things to light before we get into testimony and questions. Just a few housekeeping rules to ensure we hear from everyone. Would ask that any panelists keep their remarks to the allocated time.

For Mr. Auditor, if you could keep it under 10 minutes, that would be great. And for the Department of State Hospitals and Liberty health care, also, 10 minutes.

I do know that some Members up here have a time crunch and would like to ask questions and make statements and to the extent that any Member is is reaching that that time expiration, just give me a, give me a indication that you need to leave.

We will then have Members ask questions and we will Reserve time for public comment and we will not permit obviously any disruptions or disturbances or any anything that would impede this this meeting. So any questions for the Members? If not, I'm going to let State Auditor Parks actually delve into the.

Sorry, is Liberty Healthcare here? There you go. And here's how the order is going to go. He's going to be on the next panel. The State Auditor is the first. And then after that, we will have responses and comments from Liberty. Department of Hospitals will be on that next panel as well. Yep. Thank you very much. Mr. Parks, please, the floor is yours.

Good afternoon, Chairman Harabedian and members. It's a pleasure to be here today. In October 2024, my office issued an audit report examining the Department of State Hospitals Administration of the California Forensic Conditional Release Program, otherwise known as CONREP, as it applies to individuals classified by the courts as sexually violent predators.

By way of a very brief background, beginning in 1996, state law allowed the courts to civilly commit individuals following their prison sentences to an indeterminate length of time at state hospitals for treatment if they were convicted of a sexually violent offense and have a diagnosed mental disorder, increasing their risk to reoffend.

And in 2003, the state started the CONREP program for SVPs where courts can order that certain SVPs who are receiving treatment at state hospitals to instead be housed in the community under DSH's supervision. DSH contracts with Liberty Healthcare for a significant portion of the CONREP program, including treatment, security and housing location assistance.

And if these CONREP participating SVPs demonstrate poor behavior while in the community or do not follow program rules, a court or a judge may revoke their participation and return them to a Department of State Hospitals facility. And courts may also unconditionally release SVPs from state hospitals without the SVP's participation in the CONREP program at all.

Since the inception of the program, there have been 56 SVPs who have been placed in the community through CONREP. That's 2003 through roughly April 2024. And separate from that, there have been 125 SVPs where the courts have unconditionally released SVPs without placement through CONREP back into the community.

And finally, I'd mention in 2023, state law added a requirement that for the SVP CONREP program, it requires the Department of State Hospitals to consult with and receive assistance from local officials when locating and securing community housing for SVPs.

So, the audit request was requested by Senator Jones, and if I was to paraphrase the driving force behind it, it was generally three primary areas, the first one being public safety. Senator Jones was interested in getting information on the number of new convictions by category of offense committed by SVPs placed in the community via CONREP and the number of SVPs who violated the terms of conditions of their housing placements in the CONREP program and had been returned to state hospitals.

Secondly, the Senator was interested in knowing whether counties were effectively participating in the community placement process and third, there was interest in understanding more about state hospitals oversight of Liberty Healthcare.

So, to get to the audit results with respect to issue one public safety, we found that SVP's participating in the CONREP program were convicted of new offenses less frequently than SVPs who were unconditionally released by the courts and did not participate in CONREP.

Two of the 56 SVPs that were placed in the community under CONREP were convicted of a new offense. One was for the failure to report as a sex offender and the other one was for the possession of child pornography.

None of the remaining 54 participating SVPs were convicted of new offenses during their time in CONREP and of those, 21 of those SVPs were subsequently unconditionally released by the courts into the community and none of them were convicted of a new offense within 10 years.

In contrast, the rate of new offenses was higher for SVPs who were unconditionally released by the courts without participating in the CONREP program. 24 of the 125 unconditionally released SVPs were convicted of a new crime and these 24 SVPs were convicted of 55 new offenses, 42 of them were felonies and 13 of them were misdemeanors.

22 of the 42 felonies were unrelated to sexual related offenses, 13 of the 42 were for failure to report as a sex offender, and seven of the 42 were for sexual or sexually violent acts.

The lower conviction rates for SVPs participating in the CONREP program may be partly explained by courts returning SVPs to state hospitals before they commit new crimes if they start to demonstrate negative behavior, such as by failing to appear for therapy, failing to appear for therapy sessions, failing to take medication, failing to submit to drug screenings and the courts have revoked and returned to state hospitals 18 of the 56 SVPs who have been placed in the community since the program started, or roughly 32%.

We reviewed court records to determine the specific violations that prompted the revocations. But court records commonly cited generic terms like noncompliance with program rules and terms and conditions and did not cite more specific information of the specific violations that caused the revocation.

And some of the SVPs who were returned to state hospitals have been authorized by the court to again participate in CONREP, generally three to 17 years after participation was revoked. Some of those SVPs are in the community today, some are awaiting placement, and others have been unconditionally released by the courts.

In terms of issue two, how effective is the community placement process and to what extent are local governmental officials participating, I would mention at the outset that at the start of my audit or during my audit, my office interpreted state laws generally requiring that SVPs be placed in the community within 30 days following a court's determination that an SVP should participate in the CONREP program.

However, following my audit's public release, a subsequent court decision ruled that the 30-day placement requirement actually begins when the court has approved a specific housing placement for SVPs.

But regardless of this ruling, our primary conclusion in the audit remains the same, which is that it takes a long time for the Department of State Hospitals and Liberty to find suitable housing for SCPs in the community.

And secondly, we found that local officials we spoke to were at times unclear of their role on this housing committee and some didn't want to participate in the process publicly.

So, with respect to how long does it take to find housing for SVPs, we found that the state took on average 17 months to place current SVP participants in the community, as measured by the time elapsing between when a court approves the SVP's participation in the program and when the court ultimately approves the housing location.

For two of those SVPs, it took more than three years to find housing and as of April 2024, there are 20 additional SVP's who are awaiting housing placements and the average wait time for this group was 20 months.

One of these SVPs has been waiting for four and a half years and, in our view, that's a long time to keep an SVP in the more restrictive environment of state hospitals when a court has already authorized them to be placed in the community subject only to finding suitable housing.

Other information we learned in response to Senator Jones questions is our audit noted that Liberty Healthcare charges up to $2,800 per month for each SVP who's awaiting preplacement services.

Housing search costs preplacement in fiscal year 22-23 was $485,000 and cost to hold housing under consideration was $415,000 for fiscal year 2223 and when we looked at where SVPs are actually placed in the community, we found that generally they are not located near each other.

However, we did identify a small number of placements that were within five miles of another placement. But given the limited number of SVPs in the program and various legal restrictions, it prohibited us from going into greater detail in the audit report discussing the details of those placements.

We also talked to DSH about barriers to timely community placement of SVPs. And according to DSH, one of the reasons for its challenges in finding housing is the limited number of landlords who are willing to rent for the purpose of housing an SVP.

And another issue that can cause delays are the presence of home schools that may be near an SVP. And sometimes those home schools aren't discovered until after a judge has already decided to make a placement decision.

And in the report, we go through an example where a judge had made a ruling to place somebody only to reverse it and restart the housing process because a home school was located. We also found that the local housing committee process enacted in law faces two hurdles to greater effectiveness.

This housing committee is made up of local officials like the District Attorney, county council, law enforcement, and their role is to advise and consult DSH on the placement of SBPs in the community.

However, state law does not define any specific deliverables for this committee for when they convene, so identifying what specific help these local committees should be providing to DSH is challenging. And at the time of our audit, DSH hadn't provided clear guidance to local officials on how they could best help in the housing selection process.

We also interviewed county committee members from Sacramento, San Diego, and Stanislaus counties, and they explained to us that they did not always clearly understand how to participate on the housing committee and what DSH and Liberty Health were actually looking for in terms of guidance.

From January 2023, when the law changed to require these housing committees to April 2024, DSH convened 15 committee meetings in 10 different counties.

We reviewed the meeting minutes, but we didn't see a lot of detail on the nature of these discussions or what was specifically discussed in these hearings with respect to specific placement options or what was considered. We also saw evidence that local representatives did not always want to participate in local meetings called for by DSH.

For example, the Stanislaus Sheriff's Office didn't participate in one of the meetings we reviewed, delegating to the county's council. And in San Diego, a representative from the Sheriff's office told us that if an SVP reoffended, the sheriff would not want to be on the record of having endorsed the placement.

And as a result, the sheriff's office official didn't want to support any SVP placement in the community, and we noted that both San Diego District Attorney and the sheriff's office have notices on their website explaining that they are not involved or responsible for selecting SVP placement locations.

So, what this got us to during the audit is a question of transitional housing. During our audit we noted that California doesn't have an alternative housing option for when courts, DSH and local housing communities can't locate or agree on a suitable housing location and instead SVPs must remain in the more restrictive state hospital setting.

Our audit noted that other states don't operate this way. Washington, Minnesota, Kansas, and Texas, for example, all use state owned or contracted transitional housing to serve as an intermediate step between receiving treatment in state hospitals and receiving treatment in a community setting.

The final issue that I'll briefly talk about by answering your questions we looked at DSH's oversight of Liberty Healthcare. Our audit looked at whether or not the SVPs in the community had current treatment plans. We found that most of them did. There were 19 in the community at the time of our audit in April 2024.

17 of the 19 had up to date treatment plans. The two others were updated the day after we requested them. And these treatment plans are really important because they define treatment goals and objectives.

And we also did testing to ensure that a selection of these SVPs in the community were actually receiving core treatment services called for under their plan, such as therapy sessions, unscheduled home visits, substance abuse screenings, and sexual interest screenings. And we found that these services were largely provided.

An area where we saw room for improvement with state hospitals was in terms of holding Liberty accountable for correcting deficiencies that DSH itself had identified.

We noted that DSH had concerns that clinicians who are working in the field didn't consistently have access to necessary documents, such as patient records and court reports, when making treatment decisions that could impact public safety.

And we also noted that according to DSH, Liberty's electronic document repository system was not functioning in a manner that would allow service providers to see all the necessary information before making treatment decisions.

Another issue that DSH raised in its own reviews of Liberty was the lack of standard documentation practices where DSH was, at times, unable to discern if a particular document they expected to see in an SVP's file was missing or did not exist.

And it's not clear to us during the audit when these issues or others will get fixed because DSH did not require.

Mr. Park, just one more minute if you can. If you can, wrap it up. Thank you.

DSH didn't have a process to ensure that Liberty responded promptly to its concerns. And we noted that DSH didn't prioritize audit findings to make sure that Liberty was proactively making corrections.

We made five or so recommendations to Liberty Health in terms of providing clear expectations to the community, among other areas. They implemented four of the five recommendations.

The one recommendation DSH has not implemented and said that they will not implement is to explore the feasibility of establishing transitional housing facilities as that interim step between state hospitals and community placement. And I have Ben Ward with me, our audit principal, and we'd be happy to answer any questions you may have.

Thank you, Mr. Parks. Thank you, Mr. Ward, for being here. I know members will have questions, so appreciate that. And we'll be able to explore some of the things that maybe you didn't get to touch upon in questions. I know Senator Jones, Senate Carrillo and then DeMaio have questions.

So, let's just go quickly to Senator Jones, Carrillo, then DeMaio.

Thank you. Not a question, just a quick comment. I'm the audit was very well done, provided a lot of great information. Actually answered, provided some information we didn't even ask for that was even better.

The one exception I take, which I think is a very important exception because it's in the title that the program is alluding that it's successful with only two re-offenses. But we need to add up the total numbers. Yes, there were two people that reoffended and were convicted.

But as was stated in the auditor's comments, 18 people were returned to the Department of State Hospitals because they failed the CONREP program. And so, if you add those two numbers together, that's actually a 37% failure rate. And so that's the one exception I have with the audit is it is not working.

It is a broken system and does need to be fixed.

Thank you, Senator Jones. Assemblymember Carrillo.

You did answer one of the questions that I had and that was in the recommendations that you stated. I was going to ask about the intermediate housing that other states have implemented; now the answer to that is that DHS did not want to take that as a recommendation. Correct?

DSH did not want to take that recommendation.

Can you elaborate as to how that in your experience be a better option to have these SVPs in place?

I think from our perspective on the audit, we're looking at SVPs where a judge has ordered that they be placed in the community and the delay is finding where that suitable housing is to be.

We looked at other states and we found that they have state operated transitional housing that allows you to get an SVP as a midway point into that housing out of the less restrictive state hospital environment before they're placed in the community. So, it allows the community placement process to continue to, to go forward.

But while that's going on, they're no longer in the state hospital. They're in a secure but appropriately secure transitional facility.

And the last question or comment is on the worst use suitable housing.

And I guess that's something that may not be a question for you, but to the other presenters and when we talk about suitable housing for these individuals, why is it suitable housing anywhere in the state where these areas that again, the ones that we represent, keep getting selected as suitable housing. Does that mean that our resident's constituents are not equal to everybody else in the state?

And maybe a rhetorical question, and again, I don't expect you to answer, but you can comment if you like.

One of the things that we try to be very clear about in the audit report is it's not the community and it's not liberty that or DSH that are ultimately making the placement decisions. It's a judge that's making the placement decisions. And it's a process that's going on in court where DSH is having its say.

The local as represented by the District Attorney or County Council or law enforcement are having their say. And ultimately a judge decides as part of this audit.

And it wasn't part of our audit objectives or scope is we did not audit the judicial decision making behind how judges make their decisions about where they place SBP's in the community.

When we go back to those two worst suitable housing, why are urban areas not suitable for them? Why is it that always it's going to be rural areas which in which we have our own challenges. As Senator Lehrer said, urban areas seem to be where they get to be. Again, it's not in you.

It's on the judges that that one individual that makes that decision. But when they get placed in rural areas where law enforcement access is even not as accurate, as rapid in urban areas because they have better time response.

Whereas in my case where they're placed in Lake Los Angeles, where we have a sheriff's office in Pondo, which is a long distance for them to respond. Also what you mentioned on your study, that you report that homeschooling also being another problem, we're going to continue to see that more homeschooling be more permanent, I believe.

Again, I'm just trying to let you know how I feel when we talk about suitable housing and Again, I want to reiterate that it's on the one individual making that decision.

The judge seems to be unfair that those suitable housing, our areas are in the areas that some of us represent, which are rural and continue to be placement for those that violate their conditional release. And then they get released again and they just come back to the same area again. Not on you. Thank you.

Before we go to Assembly Member DeMaio, Senator Jones, did you want to make a clarifying comment?

Yeah, I just wanted to address the transitional housing. I do have a Bill that is now in Assembly Appropriations, SB380 that will require Department of State hospitals to start considering or to start developing a program for transitional housing. So I'll look forward to your support that.

Senator DeMaio.

Thank you. I too had a problem with the title of this report because I think it does not - it's misleading. It doesn't even - it's not supported by your own research methodology. And I'm glad that you clarified things, but unfortunately the title is still there.

And I think people, if they just glance at it, will think, "Oh, this is a great program." I've seen a lot of bad government programs in my day, some good ones, too. But as it relates to the bad ones, this is perhaps one of the worst programs I have ever come across.

Not only is it a boondoggle waste of money, hemorrhaging taxpayer money, but it is a severe risk to public safety. And as Assemblymember Carrillo points out, something is completely off when you have this constant placement of SVPs in the same areas.

Since 2015, 90% of SVP's have been released into San Diego County, and all but one of them have been in my assembly district. Like Assemblymember Carrillo, I represent a district that has a lot of rural areas. And while you say that the judges are in charge of placement, that's not true. The judge has to sign off.

But the judge is leaning on Liberty Healthcare to come forward and say, "Hey, here's a placement option." And so, to say that it's the judge deciding, no, it's Liberty Healthcare going out there, teeing up a location and then bringing it before a judge to get a final approval. And it is a broken system. It doesn't work.

That's why I do believe at the very least, we need to consider the transitory housing model. But in the interim, I think we need to put this entire program on suspense. There is too much money being wasted and too many placements that are being done in a haphazard way.

As it relates to your audit methodology, did you talk to any of the homeowners who changed their minds where they were hooked by Liberty Healthcare on signing these very lavish leases, very expensive leases, way above market rate, and for some reason, they changed their mind. Something must have happened with that homeowner to walk away from so much money above market rate.

Did you talk to any homeowners who walked away from the placement contracts that they signed?

We did work to answer the audit objectives as we understood them, but the answer is no to your question.

Because if you talk to those homeowners, you know what they'll say? Liberty lied. Liberty misled me. I did not know what I was signing up on. And if you take a look at the last several placements, half of them got pulled.

Not by the judge, by the homeowner who said, I didn't know that this was what I was signing up to. And yet Liberty continues to get taxpayer money for these bogus placements. Did you talk to any of the neighbors who opposed the placement of these individuals in their communities?

Whether the placement was defeated and overruled by the judge or was approved by the judge? Any neighbors, people who live on the same city block?

Our audit focused on the housing committee and the county participants on that committee, not the neighbors.

But you'll hear from the neighbors is that they had no knowledge whatsoever. Liberty didn't knock on a door. Liberty didn't give them a warning. They didn't say, "Hey, this is what we're thinking about doing." What they found out was later on in the process, maybe through the media, that this placement was happening again. That is absolutely disrespectful.

If we're going to operate as a government, it has to be an open and transparent process. And again, to Mr. Carrillo's question, 90% in San Diego County. All but one in my district, which overlaps with Senator Jones's district.

I understand that you say the judges are the ones approving it, but a judge can't just decide, "Well, I'm gonna go out there and interview homeowners and figure out where to place them." And so, I think that we have a fundamentally flawed program. I don't think you can put a band aid on this one.

I think we need to immediately suspend this program. I am calling on Governor Newsom, stop placing sexually violent predators in residential communities. Stop. You have the power, Governor, to stop this practice. And my question will remain; how many victims will result from an improper placement?

You did point out that 18 out of the 56 were flagged for violations and removed from the program. And if you add that up, as Senator Jones pointed out, it's 37% failure rate.

And so, I'm very worried about people walking away with a false impression that somehow if we just improve this program, that it works overall, but we just need refinements. There's no evidence to suggest that residential community placement and Liberty Healthcare is protecting anyone.

What there is evidence to suggest is that it's upsetting a lot of communities and the process isn't being done right. I think the only way to save, salvage this is to look at a transitory housing model. Final point, to make sure everyone is clear on. You didn't look at changes in state law.

You took what state law currently requires, and you said, "How is this program performing under current state law?" Is that correct?

We also made a recommendation to change state law, on transitional housing.

Correct. But as it relates to the fundamental practice of having people placed in residential communities, having them placed in close proximity to tribal nations without consultation, none of that was considered in terms of your audit criteria.

I'm not sure I would agree with that. We had objectives from Senator Jones that asked us to go into how is the community housing committee process working during our audit period. We selected three counties as required by that audit.

We spoke to the officials that participated on those committees from those local jurisdictions, and we got their perspectives on how that committee placement process was working.

I would hope that given the feedback in your own testimony that you may. I know you don't do this very often. I don't know if you've ever done it, but that you may refine the title and the subtitle. And the false impression this report leaves that somehow that this is an effective program.

I think no evidence exists to call it an effective program in terms of public safety.

Thank you, Mr. Demaio. Senator Valladares.

Thank you, Mr. Chair. So, what I think is important in terms of the makeup of this committee. Can you hear me? What I think is important in the makeup of this committee is you have legislators here whose communities are being disproportionately impacted by the placement of SVPs. I represent the high desert area: Adelanto, Victorville, Palmdale, Lancaster.

And since 2021, every single SVP in Los Angeles County has been placed in the Antelope Valley. We are more than frustrated. My community lives in fear, and sometimes they feel like they don't have a voice and they're becoming the SVP zone of Los Angeles County. So, the data in your report is very important.

To us because our communities are impacted. And we're going to hopefully legislate and create some policy that protects our communities. So, how, to ask some specific questions about the numbers, how many SVPs of the 56 that have been placed have been placed in LA County and in the High Desert region?

We have a answer in that bendy now. So, we don't have the breakdown of all of those numbers. And part of it was a limitation of what we were allowed to legally report. We had two sources of information. One source was Department of State Hospitals, which is a hospital, and it's considered medical records.

So we had to limit the level of information.

Yeah. So, in the audit report I think we talk about how as of April 2024, there were roughly 19 individuals that were placed in the community at that time. We have an appendix in the back of the audit report that talks about what counties were there were placement for 17 of those 19 individuals.

With respect to Los Angeles County, there were two.

Which were both in the Antelope Valley.

Our report doesn't go into detail on the specific locations. And there were two placements that we don't disclose in that table because not all of the court records that we looked at are considered public information. Some of those court orders are nonpublic confidential documents.

So, in your audit does - or from your audit, are there any existing state policies right now that ensure equitable geographic disbursement of SVPs?

State and I think state hospitals would be able to answer your question in more depth. But I believe existing law currently prescribes a pretty detailed process about how you determine the county of commitment, the county of placement, what factors judges are supposed to consider when deciding when to place SVPs in the community.

One of the things that our audit did not do, nor were we asked to do it was to evaluate how judges were making decisions about where to place SVPs in the community.

So, in the placement process, do our local behavioral health authorities, are they given input on whether or not a proposed placement has adequate support services?

There is a housing committee that advises DSH. And Ben, I don't know if you're able to go into further detail, but I do believe we have a table in our report that talks about the factors that they consider when making placement decisions. One of those I believe is considering availability of treatment services.

Another one would be access to a GPS tracking detail so that the placement of these SVPs in the community could be monitored. But there's a number of different things that go into the consideration of where an SVP is placed.

What's deeply concerning to me is I don't think any of that is actually being utilized, and we see it in our community. Because if you look at the specifics, we live in what's known as a healthcare desert. We don't have adequate behavioral health services yet alone the ability of law enforcement to report to these areas.

In Juniper Hills, there was a - our sheriff noted when we had one of the last SVPs placed there this past March, that a normal routine call takes the sheriff's department about two hours to respond to; a priority call, 45 minutes.

So, I think we have some serious concerns with not only the effectiveness of this program because our communities are being impacted, but some serious concerns about why our communities are being the dumping grounds for SVPs. Thank you.

Thank you, Senator. Any other questions for our auditor before we transition to the next panel? I want to just say thank you to both of you for being here and presenting. I think there were some very good questions, many of which I agree with.

I guess my last one before you leave, obviously this is an extremely expensive program. $1.6 million per year per participant, I think is a number that I read.

Do we have a cost comparison between those who are in the conditional release program, so the individuals that go through this program versus those that just stay in state hospitals, what the cost is for the state in comparison if they stay versus, they go into this program?

We don't have a cost comparison in our audit report. The 1.6 million per year that you reference, I don't believe is accurate. I think it's 1.6 million per SVP over the 20 years on average. I think it gets closer to $200,000 per year or something. If you look at some of the other tables in our report.

Not to take away from your point that it's is an expensive program,

I agree. Yeah, I'm sorry about that. Yeah, it wasn't per year, but it was over the lifetime. So, I appreciate that clarification. Appreciate you being here and obviously we'll transition to the next panel and if you are able to stay, that would be great. But understand if you have to leave. So, thank you again, Mr. Parks, Mr. Ward.

Now we'll bring up the Department of State Hospitals. We have the Director, Stephanie Clendenin, and then we have Chris Edens, who's the Chief Deputy Director, Program Services. And from Liberty Healthcare, we have Kenneth Carabello, who's a Senior Vice President. Welcome to each of you.

I do know that you will be fielding questions from the members, and I think between the state hospitals, I will give you guys 10 minutes and Liberty Healthcare, I will give you 10 minutes. So, Director, the floor is yours. Thank you.

Thank you, Chair. I just note that we plan to include give a few minutes of our time for Liberty, so we'll kind of work that into our, into our statement. So good afternoon, Chair, Vice Chair, and committee members. Thank you for the opportunity to appear at today's hearing.

My name is Stephanie Clendenin and I'm the Director for the Department of State Hospitals. And I'm joined by Ms. Chris Edens, who is our Chief Deputy Director of program services, and Mr. Ken Carabello, who is the Senior Vice President for Liberty Healthcare.

First, we'd like to thank the California State Auditor and his team for their review of the department's conditional release program for individuals committed under the Sexually Violent Predator Act, which we will refer to as CONREP SVP going forward.

The state auditors team approached this audit with the utmost courtesy and professionalism, and we appreciate their recognition of the challenges that that are presented when placing SVP individuals into communities in a manner that upholds the tenets of safety and responsibility.

Before I move into the rest of my comments, I do want to give Mr. Carabello a moment to say a few words on behalf of Liberty Healthcare.

Good afternoon. My name is Ken Carabello. I'm a Senior Vice President with Liberty Health Care. And Liberty has operated the California Conditional Release Program for civilly committed sex offenders since 2003. I was the first Community Program Director for the CONREP SVP and continued to have oversight for the program while moving into corporate, Liberty Corporate leadership positions.

I was instrumental in forming the Sex Offender Civil Commitment Program Network, a professional association of states that have sex offender civil commitment programs. I initiated the formation of the network steering committee and served on the board of directors.

I have familiarity with civil commitment programs for sex offenders throughout the country as well as personal involvement in the California program for over 20 years. Liberty is proud of its work as a partner to the State of California for these last 22 years and proud of the successful program we've operated together in partnership.

Thank you, Ken. Next, I will provide a brief background about our Conditional Release Program and then provide an update regarding our response to the Auditor's recommendations. With respect to the SVP commitment, individuals who have completed a criminal sentence for specified sexual offenses and who are still in need of additional treatment and rehabilitation upon release from prison may be civilly committed as patients to the Department of State Hospital for care and treatment.

The CONREP SVP program is an intensive community based treatment and 24 hours per day supervision and monitoring program designed to safely reintegrate individuals designated as an SVP back into the community when ordered by a court to be conditionally released from the State Hospital.

It is the last step in DSH's Sex Offense Treatment Program, which is about applying the skills learned while in the hospital to a supervised outpatient treatment setting through our Conditional Release Program and ultimately supporting a safe reintegration of the individual back to the community.

DSH contracts with Liberty Healthcare to operate the CONREP SVP program and both the Department and Liberty are committed to administering the CONREP SVP program in a manner that protects public safety while also providing the opportunity for individuals to reintegrate into the community when a court has determined it is safe and appropriate to do so, as required by the SVP Act.

The Department is heavily involved in the operation of the program and provides close oversight of Liberty Healthcare in the performance of their duties. The DSH team is involved in daily discussions regarding client treatment, their supervision and housing, and reviews court reports and participates in hearings.

The team also participates in weekly coordination meetings with Liberty, conducts quarterly reviews and site visits, and provides after hours support as well. CONREP is the safest discharge pathway from the State Hospital back into the community. Individuals who have been treated in CONREP present lower recidivism rates compared to those unconditionally released from from the State Hospital.

The only pathway for an SVP patient to be released to the CONREP SVP program is through a court order when the court has determined that the individual to not be a danger to others due to their diagnosed mental health condition while under supervision and treatment in the community.

The court orders the specific terms and conditions for the patient's community release and a patient must agree to these to participate in the CONREP program. Patients who do not adhere to their terms and conditions while living in the community can be revoked back to the State Hospital.

Over the life of the program, the average time from SVP commitment to DSH to CONREP release is about 12 years. And for those currently ordered out to the CONREP program and awaiting placement, 43% have been in the State Hospital for more than 20 years. This time is in addition to the time that they served in prison for their crime.

Very few SVP patients ultimately achieve conditional release. Since the inception of the program in 1996, there have been now a total of 60 individuals released to CONREP. Currently there are 21 clients living in communities statewide. And for comparison, we currently have 954 individuals who have been committed to DSH's State Hospital in Coalinga under the SVP Act.

Lastly, I would also note that the SVP Commitment Program has been found by the California Supreme Court to be constitutional because there is a pathway for outpatient treatment and release back to the community via our CONREP program. Now moving on to the audit recommendations. In its report, the State Auditor made five recommendations.

Of the four recommendations that DSH agreed to implement, all have been fully implemented in accordance with the timelines that were identified in the report. The Department developed and implemented guidance for the Housing Committee designees in November of 2024.

It conducted a formal program review of Liberty Healthcare in February of 2025 and has determined that it will conduct formal program reviews on a going forward basis every two years. The Department also developed and implemented a process to track the outcomes from formal and quarterly program reviews.

The new outcome tracker was implemented in December of 2024. And lastly, the Department finalized an analysis in March 2025 on utilizing separate contracts for specific services performed by Liberty and evaluated the cost effectiveness of absorbing some of those contracted activities internally as well.

With respect to the State Auditor's recommendation number two, which was that DSH should explore establishing state owned transitional housing similar to other states by September of 2025. We formally disagreed with this recommendation, as transitional housing would not address many of the challenges that currently exist that contribute to the lengthy average times to placement in the community and we believe could further delay placements of individuals.

We are familiar with the housing facility utilized by the State of Washington that has been cited as an example to consider for California. DSH informally met with Washington State contacts prior to the audit to learn more about their model. And for a number of reasons, we determined that this type of facility would not fix a number of the challenges we experience in placing individuals into the community.

And some of those reasons include that site citing locations for transitional facilities to house multiple individuals in one facility would not be easier and likely would be more difficult than for the current types of individuals placements utilized. Statutory residency restrictions and individual risk factors continue to make certain areas of the state unsuitable for this type of facility. There would also still be the risk that homeschools, other private or public schools, or parks being developed in the vicinity of any transitional facility we developed could render it unusable for this purpose at any time.

Community protests over the potential placement of multiple individuals designated as an SVP in one facility location in a community or in one county would be expected, thus delaying the development of a facility of this type. Absent extraordinary circumstances, the law requires that individuals be placed into their county of domicile, and and for most counties, there are not enough individuals to support establishing an SVP transitional facility in each county.

At any given time, DSH may have around 20 patients in the program, with very few counties having more than one SVP patient released to CONREP in the county at the same time. If individuals could be placed in transitional facilities in alternate counties, any county identified for potential placement of these types of facilities would likely respond with significant protest against the placement of the facility into their county and against housing individuals designated as an SVP from other counties.

Lastly, absent significant statutory changes, developing transitional facilities would also not resolve the problem of individuals ultimately being required to be placed into the community after treatment in a transitional facility. As such, developing the transitional housing would serve to add significant increased cost to the General Fund without a significant resolution to the current challenges of ultimately placing individuals in the community. Thank you for the opportunity to share some information about our program and to provide you with a brief update on the Department's response to the audit recommendations, and we are happy to take any questions you may have.

Thank you, Director Clendenin. Assembly Member Chair Harabedian had to present a bill, and so I'm going to pinch hit in the meantime until Vice Chair Laird comes back. I think that, Senator Jones, you had a question or do you want to wait until after Mr. Carabello makes his presentation?

Are you... Were you having some more comments also?

No.

Oh, okay. I'm happy to yield to the, to the panel if they have more comments or I can just go ahead. I have a, Mr. Chair, probably a series of questions both for State Hospitals and for Liberty. You want me just kind of go in line? Okay, great. So, for State Hospitals, as you know, I'm currently working on legislation to ensure that the State Hospitals, and particularly the Director, take more personal and active role in the placement process. Can you tell us if, about if anything you've done since the audit to take a more active role in the review process for potential placement sites prior to a lease being signed?

Yeah, so the Department actually takes a very active role in placement locations. So Liberty Healthcare does, we do contract with Liberty Healthcare to do the placement process and to provide the treatment, monitoring, and supervision. But the Department is actively involved in the operation of the program and works very closely, as I mentioned before, with Liberty in all of the operations of the program, including placement locations.

With respect to when a site assessment is performed, so let's say that we are ordered to place an individual into a county and there is statutory placement requirements that are laid out in statute. So Liberty must, does the searching for the housing and they have to follow the statute.

And they look not only not just in specific communities, they look county wide. They are required to place in a domicile county, and they look county wide. They look through thousands, often thousands of properties to identify potential placement locations. They prepare a site analysis and a forensic analysis of that of a potential location, and then those are then presented to the Department for its review and approval before it's presented to the court.

I think. I'm sorry to interrupt, but a lot of the processes I think most of us are familiar with. I think what I'm kind of driving to on since the audit and coming to this oversight hearing, you know, what is you personally as the Director and then maybe more broadly as the Department, we're expecting more oversight and accountability from Department of State Hospitals over the actions of Liberty Healthcare and the steps they're taking in finding these placements. So specifically what we want to know is, are the potential placement sites, are you looking at those before the leases are being signed?

Because that's brought up in the audit, how much money is being spent on that. And what has the Department done to increase the outreach in these communities that these sites are being considered? So I guess two things here is what's the review process for potential placement sites from the Department and what are you doing to reach out to the communities to have the communities have a stronger input into these sites, citing potentials?

Thank you. I was getting to that portion of the placement review process, which... So once the Liberty completes their site analysis, it goes through a three stage review at the Department. It goes through three levels of review. The first level is by the program.

We have a team of consulting psychologists that provide the oversight over the program and they do the first level review. If they have any feedback back to Liberty, then Liberty will take and address that feedback and look at their... It can be anything from, we have questions, further questions about the property, about the documentation.

It can be, it can run the gamut. Once they respond to the consulting psychologist's feedback, then it comes in for program leadership and then the legal office review. And then same thing, they can find additional questions, they may have additional comments and then that goes back to Liberty for them to address. And then it ultimately finally comes into the Director's office and our chief counsel for review and we do the final review. And we often have many questions as well before we approve a project to be submitted to the court.

But currently you don't personally sign off on that placement? I'm trying to find out between the review and the actual taking responsibility for the placement. There's a discrepancy there.

So the... Before our, before our team will approve Liberty to move it forward to take it to the housing committee meeting first and then to the court. It has to be approved by the Director's office before. Our internal policies are that the Director's office has to sign off before they submit it to the housing committee for its consideration and to the court.

Okay. We heard from the Auditor that the Department of State Hospital is currently spending about $2,800 a month on contract to Liberty to find the placements. In addition to that expense, there's also expense for when Liberty signs a lease and then is deemed unsuitable by a judge or for other reasons.

What's being done by State Hospitals to hold those costs accountable? Especially basically, I think the perception is Liberty has a blank check here to go spend as much time as they need to spend to find these placements. And then once the placement is the lease is signed, there's still no accountability on that lease payment that could be four to six or more thousand dollars a month. So what's being done by State Hospitals to hold Liberty accountable on those issues?

Yeah. Thank you. And I think it's important to note that there's kind of like a two parts to this process. There's a housing hold and then there's the formal lease when the house is approved. So initially we will, the Liberty Healthcare, often with the approval from the court, will put in a, put a housing hold on the property and enter into an agreement with the owner in order to start that evaluation process so that the owner cannot rent the property until we've done our vetting.

And basically we have a hold on that property so that we can go through in our process with Liberty to go through all of the vetting in order to go through all of the process that happens. Right. The process is really laid out in statute and we have to follow that entire process, which is going through the evaluations, the site assessments. We have to go to the housing committee, we have to go to the court. There's a 30 day notification period once we notice the court that we have to do with the community.

Oftentimes there are things that happen with the court that will generate continuances so that home can be on hold for a period of time while we are working to do through the entire statutory process. And then once the court has approved and the lease gets executed, and then the, you know, then we have 30 days to move the individual into the community if the court approves the housing.

So do you have some thoughts on, is there a way to increase the accountability on those expenses or are you comfortable with the way it's being handled now?

Yeah, we are, like I said, we're heavily involved in working very closely with Liberty throughout this process. So they aren't off on their own doing it without oversight. We are, we are actively engaged as they move through, step by step through the process.

Okay, I'll segue over to... I've got a couple. I had some questions about transient release and all that, but I know that that's not relevant really to the conversation today in the audit. The, for Liberty Healthcare. You know, as has been stated, the audit shows that there's, you know, about a 36% of conditionally released SVPs either reoffend or return to State Hospitals. A 36% failure rate of costs that keep rising. Why should taxpayers trust Liberty Healthcare to administer this program in a way that protects public safety and responsibly utilizes taxpayer money?

Thank you, Senator. You know, the conditional release program model, actually California pioneered its current version of it in the 80s and it's really been a star amongst the whole country in terms of its outcomes and approach. Of course later an adaptation of an SVP CONREP came into play, but the same principles are involved.

It's been extensively studied actually by the old Department of Mental Health as they implemented this model. And in fact, they did find if you conditionally release someone, you have more failures to terms and conditions of release than you do actual reoffenses.

And, and so up until this point, that's been viewed as a positive of conditional release program. In other words, those two things aren't lumped into one category of failure. In fact, we prefer having a failure because someone failed a term and condition rather than progressed on past that failure to a point of reoffense.

So if you do have a conditional relief program, you will have more failures due to terms and conditions. That's a trade, however, to less actual crimes being committed. So up until this point, that's been viewed as a positive and in fact the outcome that you get from a conditional release program.

That's why you implement a conditional release program so that you catch earlier in the process of declining and you reinstitutionalize that person who is now on track toward a reoffense. So that's what I guess I would suggest that you may be getting a gain from that.

Well, I think, you know, one of the arguments that we're trying to get to here is that this program is safe. And I'm trying to argue that it's not. Liberty Healthcare, you placed Douglas Badger, a serial predator, next to a family with children, two of them deaf. Deaf. And I'm just wondering how can we consider that safe? How is that a responsible placement?

Well, I'm sorry, I can't speak exactly to that exact placement process. I would return to the processes that we have in place for determining where this housing is. This is obviously a very upsetting process, right? To take someone entitled a sexually violent predator and return them to the community.

And there are passions and emotions that have to be gone through. So we've implemented a process of determining where that would be. By the way, we do this because we're asked to search for this, for these housing, just because someone has to look for it.

So we have designated, you know, people that go out and search for it. By the way, to let you know, we provide treatment, we provide supervision. Those we use on our supervision end of things, we hire people with probation experience, parole experience, law enforcement experience, because that's the expertise you need in kind of considering these locations. I just point back to the process.

Well, I'm pointing that one just specifically because I'm sure Assembly Member DeMaio and I would agree that Borrego Springs is not a, is a particularly safe place to release sexually violent predators for the same reasons that Senator Valladares mentioned her area, as has been stated on the dais.

And we're hearing from our constituents that Liberty Healthcare is lying to our constituents. They're lying to the homeowners. They're lying to the communities. They're misleading to secure these placements. Why are we tolerating this and what are you doing to correct it or prevent it from happening anymore?

So I'm very concerned about allegations against Liberty Healthcare. I want to hear about them. I want to know any allegation against this program that there's been a misdeed. We will look at that. We will uncover that. If we make mistakes, we will be accountable for that. So I welcome hearing about things that we need to look into. And Liberty Healthcare will be transparent and participate in all searches. So what we bring, we will be transparent in what our processes are in terms of this.

Well, I want to bring up one specific example, SVP Gary Snavely. You told the homeowner it was either a witness protection or a violent criminal and that he was in his 70s when he was actually 61. You also offered $6,000 a month when the market rate was $4,000 a month. This seems like deliberate deception.

In finding a landlord, we go out, we search for available housing. We have an entire process of informing that landlord that, listen, we're looking for a house. This person has committed some offenses. Okay. I'm okay with that. This person's committed some sex offenses. Okay. Okay. This person is a sexually violent predator.

Sexually violent predator places can become very litigious, very. A lot of community opposition. We introduce that to the landlords. They understand that before moving forward. We are often, in fact, maybe always pay over market rate because the only reason that landlords are willing to do this, and sometimes the opposition is more overwhelming than they thought it was.

And that opposition can come from family members. It can come against any other business interests that they have. It can come from all sorts of levels that they just did not anticipate was going to happen. So we do inform the landlords that. But they sometimes don't feel informed because later on it's just not, it's far beyond what they even thought it would be.

Mr. Chair, I'll wrap up. I've got some more questions. But you know, the bottom line is and has been shared here this program needs some major overhauls. And you know, that's why I'm carrying legislation to address two points of the audit. I think things that we can fix and so far have bipartisan support on. And I'll continue working on these issues until my last day here in the Legislature. Thank you.

Thank you, Senator Jones. Next is Senator Valladares, and then Assembly Member DeMaio.

Thank you, Mr. Chair. So I have a few questions both for DSH and also Liberty. So to DSH, do you track any regional trends on SVP placement?

With respect to like the number of individuals that are placed in the community and in areas?

Yes. And any tracking and data you might have on the, on the percentage of placement in rural areas.

So I do want to kind of talk about the rural placement because I recognize that is a concern. And in many cases individuals are placed in rural areas. I can assure you that it's not that the Department is targeting rural areas, nor is Liberty Healthcare.

As I mentioned before, we are searching the entire county. So it really is a process of what the statute lays out. So ultimately the individual has to be placed in the county of domicile and that's often within the county of commitment. And then the statute requires that for certain individuals with certain types of offenses, we cannot place them within a quarter mile of a public or private school.

And that public or so that often right there within the quarter mile of a public or private school limits our ability to place in dense urban areas and often generates a a limits of much of the county, a good portion of the county that we will be able to place an individual into.

And then I, and then I would also note that the that definition of public private school was recently interpreted by an appellate court to also include home school. So we're also now have to search to determine with the Department of Education whether there is a home school in the area as well.

And so it really when you start to lay out the, if you took the map of the county and you lay out the census tracts and the rural and urban areas and then lay over the schools and the quarter miles around them. Ultimately, we find that there is not much of a county that is actually accessible for us to be able to place an individual into the into the community.

So is there less community resistance or political power in rural areas, one? And two, do you find that that's the case? And two, what consideration is given to law enforcement response times?

So with respect to your question about less community resistance, I would say no. I would say that we see very consistently across all the placements, the community resistance and the community feedback. And that's part of the process. So the process laid out in statute requires us to notice the sheriff. And once we have... Let me back up.

Once we have notified the court that we have a potential placement and the court is going to hear that potential placement, or we then have to notify the sheriff and the district attorney of that specific location.

And then the sheriff and the district attorney then will, generally it's the district attorney, will notify the public of that placement location and solicit community feedback. And all of that feedback is very important to the process because we actually receive all of that feedback from the district attorney.

And often we receive feedback directly into our offices and directly into Liberty Healthcare. And all of that feedback is not only considered by the Department, but it's also considered by the court in reviewing that placement.

And I can tell you there has been times where the community feedback was extremely important and it caused us to pull a location because there was enough information that had us concerned about whether we could safely treat the individual in that community.

But we have to take all of that community feedback and then provide a response to the court. And then sometimes that community feedback may have us change our decision about a placement.

Sometimes it requires us to at Liberty to update the terms and conditions and make recommendation for more stringent terms or different terms and conditions for the individual. So the community's feedback and process is very important and I'd say we see it consistently across the counties.

And I have one more question and then I'm going to have two questions for Liberty Healthcare. So in the final step, one of the final steps of placement, you go through your process, you present the order or suggestion to the courts, and quite often judges...

Is it true that quite often judges will make that placement outside of their usual, outside of their own communities? Because what we're seeing is that in the case of the Antelope Valley, the Pillowcase Rapist, there's a judge from Santa Clara that's making decisions for our community and that impact our community.

So you're talking about the out of county placements into another county. So prior to SB 1034, the statute did not have a very clear process for a court to follow in determining extraordinary circumstances.

And so the statute lays out that, prior to SB 1034, if a court had determined that there was extraordinary circumstances in the case, they could order the Department. We and Liberty do not search for out of a county unless we're ordered to.

That is not something that even prior to the law change by SB 1034 that we ever did, only if we were ordered to look in another county. SB 1034 changed the law and and the process and provided the specific process that must be followed in order for a court to consider extraordinary circumstances.

And now it requires that the district attorney of the county of commitment to, the domicile county, to file a petition for extraordinary circumstances. Prior sometimes judges would find that without a petition. But the district attorney now has to file.

There is specific information they have to provide the court about what their process has been and how they have participated in the housing search process and how they've been participating in the housing committee meetings and specific information to the court for the court to determine that basically there really isn't any suitable housing in this county in order to move to order us to search. And that law took effect in January 2022.

And so my last question is for liberty. You know, we have Christopher Hubert, the pillowcase rapist that raped, admitted to raping dozens of women that was placed in our community against our community's voice, to be honest with you, placed in our community in 2014, he violated his terms and then was sent back I think three times. Right.

This is the third time in his placement this past March or this past winter. So my question to you is one, how did the recommendation for him to come back into our community, let alone just be released, happen? Two, what protocols are in place if the high Desert SBP violates their terms? What's the process?

What does that look like?

Actually, can I step in first and then I'll turn it over to Ken, because I do want to just talk a little bit about the process that happens at the state hospital. So when somebody is returned back to the revoke back into the state hospital, that individual is again engages in treatment.

And that individual has the right under the statute to petition the court for conditional release again. So they petition. If a court denies them conditional release, they can petition. They have to wait a year before they can petition again. So the individual can always petition the court under the statute.

And so an individual who's been revoked and we've had multiple individuals who have gone back into the state hospital, received more treatment and then ultimately petitioned and been placed back out in the community and been successful in the community. So there is a.

They do, when they are, if they, once they're revoked, if they go back to the state hospital, they have the opportunity to re-engage in treatment and you know, and work again, those skills to try to petition the court again and then get released. So now I'll turn it over to Ken.

Does that answer the first part of the question in terms of how they get out, that they petition that release. So maybe I'll focus in on the how do they go back in.

Correct. But I would imagine that your liberty is providing services and treatment during that entire process.

When they're out, we take over the treatment when they come into the community.

Okay.

Yeah. So inside the institution, the state hospital is the Department of State Hospitals providing that treatment. And then they come out into the community, the petition is held, the court finds that they can be safely, they can safely continue their treatment into the community for housing, we set up the services.

So then they are placed into the community.

So when in this particular, and I guess in any instance, when they go back into state hospital and they're going through the process to be released again, I Would imagine that having worked with that patient previously, you would be a part of the process and the recommendation. And why would that recommendation come back to the community?

That they violated terms.

So that's correct. We do have liaisons that go into the state hospital and work with persons that are working their way towards release. So there is communication between the conditional release program and the state hospital in discussing their progress. Team meetings are held in discussion, discussing risk assessments.

Kind of complicated decisions about, you know, how is someone prepared to go back in. Previous failures are certainly taken into account. Ultimately, teams and Clinicians come up with their opinion. Can the person be safely treated in the community? Those, those opinions are written and go before a court and the court decides it.

So I hope that gives insight into what that looks like, then the person comes back out. So I do want to be clear. We are engaged with the state hospital. Let's say someone goes back in to make sure that they understand what the failures were.

There is communication back and forth between the state hospital and the conditional release program once they go back in. There's an affirmative obligation by the state to provide treatment. That's the context of this law. Remember, it's a civil commitment for, you know, disorders that make people predisposed to offense and you have to treat them.

It's a medical thing that we've decided to do do treat someone for their illness that makes them, you know, potentially reoffend. So we are, there's an obligation to treat them, they progress in treatment, they petition again, considerations are made, assessments are made, and the court may find that, okay, they can be safely treated again.

We then have those terms and conditions. We may have adjusted some of the terms and conditions because of their previous activities. We continue with the very rigorous supervision we have.

Okay, so, but you didn't answer my question at all as to if someone, what are your safety protocols for when someone is in a community and yes.

Yes, so our supervisory activities include case managers. Over these cases. We have very small caseloads as compared to say, other settings. Right. Where we have again, we utilize former probation parole officers over these cases. They have a caseload of say, three people. They have additional staff that work to support and supplement that. There's multiple contacts every day.

There's GPS monitoring where we're tracking where they are. Every day there's tracking of all their spending. It's a very intensive supervision program, probably the most intensive supervision program that exists. Supervising and looking for terms and condition violations or any suspicious or out of bounds activities. That's a big part of the job.

The other wing of this is the treatment aspect, right. Where we have clinicians that are providing that treatment, supplementing, trying to help them establish pro social lifestyles that we know mitigate against re offense. So it's a dual approach of accountability and treatment to try to shore up their own pro social decisions with rigorous supervision.

If we find any violations that they stray for any sorts of long list of reasons, we move on that and we act on that. And quite frankly, back to the issue of kind of failure, we're actually relatively conservative on that.

So small violations we take very seriously because even though they're small, we know that's a step down the wrong path and we will reinstitutionalize somebody.

Thank you. It's just all this human capital, state resources, and still our communities are less safe. Thank you.

Thank you. Senator Valladares. Next Assembly Member DeMaio. Defer to my colleague for time. Okay. And then Assembly Member Carrillo and then Assembly Member Ransom. Or actually I'm going to let her go first and then, then I'll come back.

Thank you. I appreciate that. So thank you for being here. I know these are really tough questions and, and I have some questions in regards to this. So I'm trying to understand. It seems like we're spending 11 million or so per year.

Is 56 the number, the average number or is that just the number that has gone through the program?

Yes, go ahead, Chris.

56 is over the life of the program since operation in 2003.

Okay. And as you're serving these the folks, what is the ultimate goal is for them to somehow be treated well enough to be released or they intended to kind of be like wards of the state through this program in perpetuity. Can you help me understand that? Sure.

Yeah. No, it is, it's not. To oversee them in perpetuity is to help support, as Mr. Carabello said, pro social behaviors. To demonstrate and put into practice the skills and the behaviors that they had learned and gained in the hospital and put that into practice in the community.

But in a very controlled state setting, ultimately, you know, with significant progress, that individual could then achieve conditional release. We have had a number of individuals unconditionally released from the program.

Okay. And those include some of the ones that we've heard about today. Some of the stories that we are probably concerned about are those people who were in the program. Those weren't conditional releases. Those were people that were continuously being served that.

I would say the examples that, that that have been discussed today have not been unconditionally released.

Okay, thank you. And then as we look at, I looked at, there's a number of people that are waiting and they're waiting like it says, an average of 20 months. But some of them are, are just years waiting to get into this program.

And so I understand that you are highlighting, you know, kind of some of your, what you have deemed as some of your successes.

But given that you clearly have a really long waiting list and a very high, you know, per capita amount, I'm just trying to wonder, so what's happening to the people that are waiting to get in the program? Are you treating them just in the hospital, but waiting for them to get out? And so is that.

It's my understanding that's how that's happening. Right.

There's currently 19 individuals that are pending placement. And yes, they are. They remain in the state hospital in pre-placement status receiving treatment until they are we find a suitable housing location that gets approved by the court.

Okay, is this treatment is a difference like their location? Is it like you're giving the pretty much the same treatment but in the hospital setting versus in the the home setting?

Yeah. So you know, at the hospital you're going to have more intensive inpatient treatment where an individual in the hospital will have a team of clinicians that are there every single day.

They have a treatment team that is generally made up of a psychiatrist, a psychologist, a social worker, rehab therapist, and, and they're providing an intensive kind of inpatient treatment. When you move into the conditional release program, this is how individuals will now receive treatment in a supervised treatment program in the community.

And so they will still have a psychiatrist, they will still have a psychologist, they're still gonna have a team, but those services may not. They're not gonna be every single day on site all the time like we do in a state hospital. It's gonna be more delivered like we would would a community treatment model.

So I don't know, Ken, if you want to talk about that treatment.

Sure. So it moves into weekly individual sessions, also group sessions, more of an outpatient model of treatment where they continue on in the same themes, but now it's adapted to a community setting and the focus becomes community success. Right.

Public safety being the highest priority, the establishment of this pro social life, and it's part of a rehabilitation process and hopefully they can pass through it successfully.

Okay, so I'm just wondering, just kind of based on the model and so I'm talking as a person who's run a nonprofit that provides mental health services in outpatient settings, you know, cbt, all kinds of different types of offenses. And I'm wondering what is there an alternative where.

Because clearly the community setting, the waiting list is long even when you're trying to place someone who's just should be on the regular sexual, you know, without the violence piece. It's really not. The communities don't really are really open to sounds like most of your. We're not serving a lot of people.

So I'm just wondering is there an alternative model that could be in a controlled setting similar to what you have in your hospital where you can actually get these people off of the waiting list and you know, serve more people and also keep the community safe? Have you.

I briefly saw something about alternatives, but is there something transitory?

Transitory housing model, yes. So they don't support it.

That's what I was gonna say. Is there something in between. I know I saw that the Auditor put something or there was maybe it was two years ago. There was something about state owned property or something like that. Is there something in between that you've considered or would consider?

Yeah, I appreciate. And we're happy to continue the dialogue with the Legislature about this program and solutions to the challenges. It's a delicate balance of, you know, the individual has a constitutional liberty, right. They have served their time in prison, they have completed their treatment program and the court has ordered them to outpace patient treatment status.

And so ultimately balancing that right to liberty as well as our desire and need to protect public safety, it's a delicate balance to achieve.

And so ultimately, you know, the transitional facility for the reasons that I presented in my opening comments is Assembly Member Demaio mentioned we did not agree with the Auditor's recommendation, but we are happy to continue the dialogue and to consider and have conversations about potential solutions.

Okay, I thank you for that. And I just want to kind of end on when we're talking about the civil liberties of people who should have been released because they've served their time. But then we have list people that have been on this list for, you know, upwards of two years. We really have to reconcile that.

And the cost of this program is definitely something that's very concerning. And the rising costs is going to continue to rise. So I definitely want to continue this dialogue and I do thank you guys for your patience. I know these are tough questions, but we're trying to figure out where to go from here as well.

So thank you for being here. Thank you Assembly Member DeMaio.

Thank you, Assembly Member Ransom. Assembly Member Demaio. Thank you.

I'm struggling with the responses just because I have dealt with this program up close and personal, organizing the opposition to stop your placements, talking to the property owners and discovering the truth that they believe that they were misled. And so I don't know how much faith I have. I don't have any.

I'll just say I have no faith in Liberty Health Care in particular to give me an honest answer. In 2022 in Rancho Bernardo, Liberty Health Care tried to place an SVP, Doug Badger, in that community, in Rancho Bernardo, near, in an elderly community near a school, near a park. Two after school programs in the immediate area.

One block away from a school bus stop, a special needs child lived on the street of the placement and ultimately the property owner withdrew the property from the program and told me that he was told that this was a placement as part of a government health care program, not a criminal justice program, a health care program.

And this is not just one person. I would perhaps give you the benefit of the doubt that someone just invents a story that they weren't knowledgeable as to what they were doing.

But consistently we're hearing this from the, the unsuccessful placements where the property owners themselves terminate and leave the program and don't want to rent their property anymore.

That's why I asked the Auditor whether they had spoken to these property owners who left the program because I think that failure to place might illustrate that we have a bigger problem than just internal controls and processes. This is not a policy or a management weakness.

There is a fundamental integrity problem with the vendor that we're dealing with here. And I have to be blunt because that's what I have personally experienced. You can improve policies, you can implement internal controls. You can't change an integrity problem. You've got the wrong vendor.

So the question that I have is we've got the wrong vendor, but I think we also have the wrong agency overseeing the program. The audit reads, quote, DSH has allowed several known deficiencies to persist since at least 2019 without holding liberty Health Care accountable for implementing timely resolutions.

Now, this is not a program regarding welfare benefits, a program regarding environmental assessments. This is a program dealing with the worst offenders that we know, people who are clinically diagnosed by the experts to have a high proclivity to reoffend sexually against members of the community.

And the idea that DSH knowingly allowed deficiencies to persist for years without correction, I mean, this is gross negligence of the highest order. So not only do I not trust the vendor, I don't trust the government agency implemented implementing the contract itself. Again, I speak to the Governor here because only the Governor can take immediate action.

It will take time to get the Legislature to act. But the Governor could put an end to this high risk program today with an Executive order declaring an emergency. I want to talk about this issue of transitory placement because I think that potentially becomes a solution, at least an improvement over our status quo.

Has Liberty Health Care or DSH signed off on transient placement in a court of law in the past five years?

Thank you for that question. So with respect to individuals who've been ordered out transient DSH nor Liberty proposes transit and we do not support transient releases. We are, we will continue somebody in that pre placement process while we continue to look for a home until we find a suitable house and that it gets approved by the court.

However, courts have ordered us to prepare transient release plans and when we are ordered to prepare a transient release plan, then Liberty Healthcare along with the Department will work to do that. So the Department and Liberty do not propose to the court. No.

Let me be very specific. Have you engaged in ex parte communication with the courts regarding how transient placement would work prior to the judge's order? Have you facilitated, provided a judge that option for the judge to consider? Yes or no?

I want an honest answer because we're going to be going down that road because these are all discoverable questions.

I don't think I'm fully understanding the question because I understood the question to be about transient releases.

Has this idea come from BSH or Liberty as it relates to ex parte communications with the judge, not in a courtroom to give the judge another option besides residential placement? I don't think I'm fully understanding the question then. Okay, I think the.

I will tell you this, that, that where this program has now broken down is we now have a government agency and a vendor supporting transient placement which means we don't have a location that they're just out there in the community wandering around and saying well we can still support that. We don't advocate for it wink nod, but we still support that.

Oh, I can guarantee you that the Department and Liberty go on record in the court that we do not propose and we do not support placements and the documents that Liberty files with the court indicates that it does not support.

But you have no problem cashing checks if a placement's made transient, you have no problem cashing those checks and proceeding forward and implementing. Is that right?

Yeah, we don't support transient releases. That is not. But you'll do the work if asked to do it. We will supervise the course. Court orders. It will super. We provide the conditional release program. Yes, we have to do it when the court orders it.

I frankly disagree with that. If a vendor says that's simply not ethical, it's not something that I will engage in. You don't have to engage in that practice. SB 1034 provides for extraordinary circumstances for out of county release. Can the Legislature modify statutory law to allow for out of county placement in a more streamlined manner?

Are there refinements that we can make in statute to make it easier for out of county, out of original domicile County placement.

To make it easier for original. I don't have any recommendations with respect to that today, but we'd be happy to have a conversation.

The Legislature has the power to remove that barrier that you have brought up regarding transitory housing. In other words, if we find a location, a specific spot in the state, what you're saying is, well, the reason why that doesn't work, it's not practical, is we're going to have opposition.

Well, you can have opposition no matter where you try to place these folks. But if you have a specific location, a specific facility that can be pre planned, pre thought out, far away, what you're saying is, well, it's. We can't do that because we can't place them outside of their original domicile county, Is that correct?

Under state law, unless there's been extraordinary. Circumstances, the Legislature can always fix that problem for you. Correct. If we remove that problem, that would not be an objection to transitory housing placement.

The Department would be happy to continue conversations around it.

What's so frustrating about this is it seems as though we have a failed program and the people in charge of the program are kind of dead set, digging their feet and their nails in saying, no, we're just going to do a better job. I don't trust you to do a better job.

I don't trust your representations because I have. I've heard too many horror stories about people being told one thing, community members not being given the truth. I went out to Borrego Springs Liberty in the court hearing, said we're going to do monitoring by electronic device.

Borrego Springs has some of the worst cell service of any part of my district. It's in the middle of nowhere. You go out there, there is no cell service. Brian Jones has been out there. We don't have the cell service to continue to monitor folks. And so time after time, representations are made.

Community members know that it's not true. And so today, when I hear, yes, we've implemented four out of the five audit recommendations, don't buy it. I don't think you're going to keep your word. And yet every idea that comes up that seems to move it out of the old paradigm, there's a reason why we can't implement it.

So my. My most sincere call to action is first to the Governor to immediately stop this program through an Executive order, an emergency Executive order, and secondly, to my colleagues in the Legislature who don't represent rural districts, as several of us do, understand what a crisis situation this is for our districts.

If it were happening in your district, you would be sitting in this room arguing these points and asking the tough questions. And it is my hope that we not see this as a partisan issue. This has got to be a bipartisan commitment to deal with this.

I understand that this is perhaps one of the worst challenging programs out there. These are people, as you say to your point, have completed their criminal sentence, but that the experts have diagnosed as having a high risk potential for re offense. And so in the interest of public safety, we. We are trying to balance rights and procedures.

It's not an easy program to implement, but surely this model that we have before us is not the way to go. And I urge your Department, take the blinders off. Give the legislators the clear answers that we need. And one of them will be transitory housing and a fix to SB 1034 to clarify that extraordinary circumstances are.

The whole damn thing's extraordinary. I think we've made the public findings we need to make in order to allow your department to place people in a specific faraway location that the state can micromanage day in and day out to ensure public safety.

Thank you, Assemblymember Demaio. Assembly Member Carrillo.

Thank you, Assembly Member Hart for Liberty Healthcare. Are you located? Is your headquarters placed in Florida?

It's not. The corporation is based in Pennsylvania.

Pennsylvania, yes. Still outside of California it is. Your presence here is on the case management of the SBP's, is that correct? You have a presence here in the state?

We have a presence here in the state for SBPs. We also have other contracts in the state. State.

My next question was on other states. And in those other states that you manage these type of programs, do they have these transitory housing for SBPs?

In the. The other state where we do the conditional release program, it does not have transitional housing?

No. Okay. Well, I. I do share the same concerns that everybody BO is here Today, different parts of the state, regions, maybe in the high desert. Again, having not one, but three placements is very concerning. When you were granted this program, was it 2003, I believe you said yes, since 2003.

And my understanding is that you were granted this program because you were the only respondent to the RFP. Correct. Part of what I wanted to discuss. Conversation started with me trying to see if there were other vendors that would be able to provide this type of service.

In your experience, do you think there'll be a difficult time finding somebody else if we were to open that up?

Yeah, I'd actually like to hand this over to Chief Deputy Director Edens to provide because she's had conversations with other vendors. I would note that the Department has solicited multiple times throughout the years, in the most recent years, tried to solicit for additional vendors and have not received responses with respect to the audit itself.

And that recommendation for us to do an analysis with respect to the would it be more cost effective for the Department to provide the services or, you know, analysis of whether we could kind of bid the program out differently and look at separating out services or doing regional services. We did.

You know, in thinking about it from a regional program, as we've noted, we have 21 individuals in the. In the community. And so from an economies of scale, kind of breaking this into smaller pieces, it becomes a little bit more difficult.

But it also becomes a challenge of having multiple vendors doing the entire program and trying to keep all the vendors coordinated and keeping the program's services and meeting the expectations with respect to the program. But when we did the analysis, we did determine that we do think that you could peel out portions of this. Right.

So the two areas we thought we could split out was the housing search process and to contract with a vendor to do the housing search and let Liberty Healthcare do the rest. And also in the enhanced supervision piece of it could potentially be split out.

So we did proceed with sub sending out a request for information to vendors to see if we could gain some interest in those. In those services. And we did not receive any response on from any vendors on the enhanced supervision. We did receive one response for the placement services, the housing search services.

And we are in the process of reviewing that proposal and the. And the vendor itself to see if this is a viable option.

Taking into account the comments from other Members and hearing that making improvements to the program is something that obviously you're willing to do. Breaking up those services entirely that are being provided by Liberty Healthcare. Do you see that as an advantage of having different services being provided.

To the extent that you just explained there'd still be a difficulty getting respondents?

Yeah, I think we're still going to have difficulty getting respondents. And I do want to hand it over to Ms. Edens because she has had conversations with, with vendors and can share what some of the feedback has been about, why we may not be getting responses.

Yeah, sure. You know, in addition to, we have issued, in addition to what the Director had just described, we had issued four solicitations in the last several years. One in 2015, two in 2022 and one in 2023. And we didn't receive any responses other than from Liberty Healthcare. We have also actively reached out to prospective providers.

We do run other programs within the Department and some of the providers that we do work with have experience in treating and serving individuals who have sex offenses in their history. We have also reached out and shared our solicitations with national organizations for the treatment of sex offenders, just to kind of get the word out.

Again, we haven't received a lot of feedback other than the FUSA vendors that we have connected with. Really boils down to this program in terms of size and scale. It is at this point very small.

And so from an economy of scale, it is difficult to, to manage knowing that there needs to be sort of a network of providers across the state.

And then really also I think just the sort of the political high profile nature of the program that sort of deters some of the vendors from wanting to kind of step up and participate.

And I think that I heard you say that from now there's going to be a review or another audit every two years. Is that correct? That's on what Liberty Health will perform. Will be performing, yes.

Well, again, I'm sure you know the frustration that we have, particularly those of us that have rural communities with real concerns that have been expressed. I'm looking forward to Learning more about SB 380, see how we can work on that, and hopefully we'll continue the conversation because it's something that we really need to figure out. Yeah.

Thank you. Thank you, Mr. Chair. Thank you, Assembly Member Carrillo. Next we'll go to public comment if there's anyone who'd like to address the Committee. I don't see anyone. I appreciate there was a lot of conversation here today and I really appreciate the panelists answering challenging, direct, forthright questions from all the members.

Director Clendenin, Deputy Director Edens and Mr. Carabella. Thank you for being here. Thanks to the State Auditor for the Audit and the great work and for the team here on the Committee. Appreciate everybody being here, and this has been a really informative discussion. And with that, we are adjourned.