Report 2019-119 Recommendation 8 Responses

Report 2019-119: Lanterman-Petris-Short Act: California Has Not Ensured That Individuals With Serious Mental Illnesses Receive Adequate Ongoing Care (Release Date: July 2020)

Recommendation #8 To: Los Angeles County Department of Mental Health

To ensure that conservatorships do not terminate because of the absence of testimony from doctors, Los Angeles should immediately implement a comprehensive solution to this problem, such as using its own staff as expert witnesses when individuals' treating physicians are unable to testify. In addition, by no later than August 2021, it should develop a revised approach to scheduling conservatorship hearings and trials so that it significantly reduces the rate at which doctors' failures to testify result in terminated conservatorships.

1-Year Agency Response

LACDMH disagreed with this recommendation but can report that due to COVID the court adopted tele- testimony for LPS conservatorship hearings, eliminating the physical appearance of treating physicians or forensic evaluators at the mental health court. LACDMH continues to advocate for the use of tele-testimony but recently the court announced a return to in-person hearings for any contested hearings. The Office of the Public Defender also expressed their desire for in-person hearings so the future of tele-testimony is in doubt. Use of LACDMH doctors in the LPS conservatorship process will continue to be limited to outpatient conservatorship cases and other cases in which LACDMH doctors already serve as the treating physician.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

Both our audit and the county's own review of conservatorship proceedings found that termination of conservatorship because a doctor did not testify was a significant problem, causing care to end in six of ten terminated conservatorships we reviewed and 20 percent of terminated conservatorships the county reported for fiscal year 2017-18. Without changes to its practices, it is likely that the problems we observed will continue. We stand by our recommendation that Los Angeles change its practices to address this problem.

6-Month Agency Response

6 Month Agency Response

LACDMH disagreed with this recommendation but can report that due to COVID the court adopted tele- testimony for LPS conservatorship hearings, eliminating the physical appearance of treating physicians or forensic evaluators at the mental health court. Tele-testimony continues due to ongoing COVID orders. LACDMH has advocated strongly with the Los Angeles County Public Defender Office to allow tele-testimony to continue after COVID orders are lifted. Tele-testimony has been widely accepted and praised by physicians because they have increased opportunities to appear without negatively affecting their primary responsibility to treat their patient. LACDMH can report that a review of LPS Conservatorship Terminations data for Fiscal Year 2019-2020 as compared to FY 2018-2019 finds a nearly 50% decrease in the number of conservatorships terminated due to a lack of a doctor at the conservatorship hearing. LACDMH believes tele-testimony had some impact on this reduction. Unfortunately, due to COVID and the significant reductions in revenue for LACDMH and the County of LA, use of LACDMH doctors in the LPS conservatorship process will continue to be limited to outpatient conservatorship cases and other cases in which LACDMH doctors already serve as the treating physician.

California State Auditor's Assessment of 6-Month Status: Pending

As Los Angeles acknowledges, the temporary implementation of tele-testimony is due to pandemic conditions and does not guarantee a long-term solution to the county's problem of conservatorships that terminate due to the unavailability of doctors to testify. We maintain that the county should implement a comprehensive solution to this problem and look forward to reviewing its progress at the one year update on this recommendation.

60-Day Agency Response

LACDMH disagreed with this recommendation but can report that due to COVID the court has adopted tele- testimony for LPS conservatorship hearings, eliminating the physical appearance of treating physicians or forensic evaluators at the mental health court. LACDMH has advocated strongly with the Los Angeles County Public Defender Office to allow tele-testimony prior to COVID. This development has been widely accepted and praised by physicians because they have increased opportunities to appear without negatively impacting their primary responsibility to treat their patient. A preliminary review of terminated LPS cases shows a decrease in the number of cases terminated since March 2020 due to lack of a doctor testifying. Permanent adoption of tele-testimony will likely continue this trend of more doctors testifying and less cases being terminated due to lack of a doctor. This will require legislative action. Unfortunately, due to COVID and the significant reductions in revenue for LACDMH and the County of LA, use of LACDMH doctors in the LPS conservatorship process will be limited to outpatient conservatorship cases and other cases in which LACDMH doctors already serve as the treating physician.

California State Auditor's Assessment of 60-Day Status: Pending

Los Angeles describes a temporary change in court practices as having a beneficial effect on the availability of testimony from doctors. However, the solution is not guaranteed to continue once pandemic conditions subside. We look forward to Los Angeles's future updates about its long term proposed solution to the problem of conservatorships that terminate due to the unavailability of doctors to testify.

All Recommendations in 2019-119

Agency responses received are posted verbatim.