Around a year ago, I was sitting in our hospital’s daily safety meeting. I listened as our nurse manager described how a patient had decompensated over the long weekend, became increasingly paranoid, injured a staff member, damaged property, and wound up in restraints. The patient was very ill. The staff were on edge. The nurse manager was demoralized.
In fact, we all felt demoralized because of a problem that was out of our control. The patient had been “Riesed” (our field’s slang for a patient who is under a Riese petition to receive involuntary medication when they lack capacity) during his 14-day hold and was making progress. But the hospital and treatment team had “lost” the Riese authority when he advanced to a 30-day hold, due to the imperfections of the CA statute that inadvertently created a gap as we awaited his next capacity hearing. He refused to take his medications, and the outcome was rather predictable as we had seen this happen many times before. We’ve known of the “Riese Gap” for decades but felt powerless to fix it. I had seen it as a resident, and as an attending, and now as a hospital administrator.
Enter CSAP, Paul Yoder and SYASL, and a year of incredibly strong advocacy and persistence to fix this problem. Senate Bill 1184 (Eggman) was signed into law by Governor Gavin Newsom on September 27,2024 – this was CSAP’s bill that effectively plugs the Riese Gap. What started as an identified problem in one hospital, was brought to the attention of SCPS’s government affairs committee, who upon investigation with CSAP (and the other CA district branches) verified that this was not just an LA County or a regional issue, but a statewide issue with significant impact on patients as well as providers and facilities.
SB 1184 had a significant uphill journey through four committees, from the State’s Senate Health Committee and Judiciary Committee, to the Assembly’s counterparts. Each committee saw escalating levels of passionate, strong opposition from Disability Rights CA, the ACLU, and others. Nonetheless, the negotiations between CSAP’s team, Senator Eggman’s staff, and each of the committee’s bill analysts (for whom I now have the utmost deference, as they are the ones behind the scenes who really shape the laws in this State), were a lesson in the highest forms of diplomacy. The evolution of SB 1184 by CSAP and Eggman’s staff was artful, skillful, technical, and enduring over many months of meetings. A very finely crafted sausage, as they say.
Having been to the frontlines of advocacy, I am amazed at how these amendments and laws get made, but moreover humbled and appreciative of the strength of CSAP’s legislative advocacy for mental health. At the end of the day, CSAP held true to the ultimate goal of hammering out a viable solution to the Riese Gap, a win for the most severely ill of our fellow citizens and the psychiatrists and hospital staff who dedicate themselves to their patients’ recovery.
Erick H. Cheung, MD, DFAPA
Chief Medical Officer
UCLA Resnick Neuropsychiatric Hospital
Vice Chair of Clinical Affairs
Associate Clinical Professor of Health Sciences
Department of Psychiatry and Biobehavioral Sciences
UCLA David Geffen School of Medicine
CSAP is indebted to Dr. Cheung: for bringing this forward, and for all the time and energy he spent on it in 2024. CSAP’s Governmental Affairs Committee (GAC) met on October 1 to consider sponsored proposals for 2025, and will meet again on October 17 to refine and prioritize issues. If you have an idea that could be impactful, please don’t hesitate to contact Paul Yoder at SYASL.