AMENDED
ARIZONA STATE SENATE
RESEARCH STAFF
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CHERIE STONE |
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LEGISLATIVE RESEARCH ANALYST HEALTH & HUMAN SERVICES COMMITTEE Telephone: (602) 926 -3171
NICHOLAS WILLIS |
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LEGISLATIVE RESEARCH INTERN |
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DATE: February 16, 2018
SUBJECT: Strike-everything amendment to S.B. 1195, relating to psychiatric hospitalization; screening
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Purpose
Modifies and establishes requirements for court-ordered mental health screening and psychiatric hospitalization.
Background
Statute permits any responsible individual to apply for a court-ordered evaluation of a person who is alleged to be, because of a mental disorder, a danger to themselves or to others. Similarly, any responsible individual may apply for a court-ordered evaluation of a person with a persistent, acute or grave disability who is unwilling or unable to undergo a voluntary psychiatric evaluation. The application for the evaluation must include a statement that the proposed patient is believed to be, because of a mental disorder, a danger to themselves or others, or a patient with a persistent, acute or grave disability and the facts on which the statement is based. Additionally, the application must include a statement that the applicant believes the proposed patient needs supervision, care and treatment and must provide related supporting facts.
When a screening agency receives an application for a court-ordered evaluation they must provide prepetition screening within 48 hours of the filing of the application, excluding weekends and holidays, prior to filing a petition for court-ordered evaluation. If the applicant for the court-ordered evaluation presents the person to be evaluated at the screening agency, the agency must conduct a prepetition screening examination. Except in cases where emergency evaluations are necessary, the person being evaluated cannot be detained or forced to undergo a screening against the person's will. If the screening agency determines there is reasonable cause to believe that the proposed patient does meet the criteria for a court-ordered evaluation the agency must file the petition with the appropriate county attorney. Additionally, if the screening agency determines that the person is likely to harm themselves or others without immediate hospitalization the screening agency must take reasonable action to procure emergency hospitalization (A.R.S.§ 36-520).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Screening Applications for Court-Ordered Evaluation
1. Requires that an application for screening include the following information, if available, regarding a proposed patient:
a) the name and address of the patient's agent under a health care or mental health care power of attorney;
b) a statement of relevant history of the patient's mental health treatment;
c) copies of all documents relating to guardianship or powers of attorney that allow consent for inpatient psychiatric treatment;
d) a statement that the patient is exhibiting behaviors consistent with a mental health disorder;
e) a statement that the patient is likely to cause or endure serious physical harm or injury without a period of inpatient observation; and
f) the names and contact information of other individuals who have witnessed the behavior exhibited by the patient cited in the application.
2. Exempts applications for court-ordered evaluations made by peace officers and specified licensed health care providers from the requirement that the application be notarized and states that the applicant's original signature is acceptable.
3. Allows a hospital to hold a person for up to two hours in order to prepare and submit the application to the appropriate screening or evaluation agency, if an application for screening is submitted by a hospital and the attending physician has good cause to believe the proposed patient is a danger to themselves or others due to a mental disorder or grave disability.
4. Permits a screening agency to perform the screening and examination at a hospital, in person or by telemedicine, as prescribed, if the person to be screened is located at a hospital.
5. Requires denied applications to be reviewed and approved by the medical director of the screening agency or their designee.
6. Allows a screening agency to deny an application if the agency determines that a patient does not meet the criteria for court-ordered evaluation and requires that the agency issue a written denial, as prescribed.
7. Requires the screening agency to recommend specific services and make a direct referral to those services, if the agency determines that the patient does not meet the criteria for court-ordered evaluation but does determine that there are reasonable grounds to believe that the proposed patient has a mental disorder and is in need of further evaluation and treatment, and is willing and able to accept evaluation and treatment services.
8. Allows a screening agency to perform a voluntary evaluation, if the screening agency determines that the proposed patient needs an evaluation, can provide consent to undergo the evaluation and is otherwise is unlikely to present a danger to themselves or others pending the evaluation.
9. Permits the screening agency to submit a petition for a court-ordered evaluation if the patient fails to participate or if the evaluation confirms that the patient needs treatment.
10. Establishes that informed consent for inpatient or outpatient evaluation may be given by the proposed patient, the patient's court appointed guardian or other specified agents with authority to consent to evaluation or treatment.
11. Requires the petition for a court-ordered evaluation to be accompanied by any certificate of hold issued.
Certificate of Hold
12. Stipulates that, if an admitting officer of a screening agency determines that the criteria for inpatient assessment, observation and stabilization are met, that the screening agency must act to secure the admission of the patient to the screening agency in order to issue a certificate of hold (certificate).
13. Permits the admitting officer of a screening agency that is equipped and licensed for performing assessment, observation and stabilization services to issue a written certificate if all of the following criteria are determined to exist:
a) the patient is, as a result of a mental disorder, a danger to self or others or has a grave disability;
b) the patient is likely to suffer or cause serious harm or illness without a period of inpatient services; and
c) the patient is unable or unwilling to voluntarily receive inpatient services.
14. Specifies that a certificate may be issued if a proposed patient's behaviors are consistent with a mental disorder even if it cannot be determined if the behavior is a result of a mental disorder or is substance-induced.
15. Requires, if a certificate is issued and the patient is present at the screening agency, that the admitting officer hold the patient for inpatient screening.
16. Requires, if a certificate is issued and the patient is not present at the screening agency, that the admitting officer have the patient immediately detained and transported to the agency for inpatient screening.
17. Stipulates that a certificate must include a summary of facts and medical opinion that the admitting officer relied on to make their determination to issue the certificate and requires that a patient be given a copy of the certificate upon admission.
18. Requires that a screening agency note the time and date of the issuance of a certificate and the time and date of a patient's detention, and further requires that the information be logged into a record of applications received by the agency.
19. Requires that the admitting officer file a copy of the certificate, a copy of the screening application and the screening report with the Superior Court of the appropriate country on the same day of issuance of the certificate or next court day.
20. Specifies that the 48-hour limitation on involuntary holds begins to toll upon arrival of the patient at the screening agency.
21. Requires the medical director of a screening agency to file a petition for court-ordered evaluation no later than the expiration of the 48-hour involuntary holding period, unless the person has been discharged or has become a voluntary patient.
22. Requires the screening agency to file a notice of discharge with the Superior Court if a determination is made that a petition for court-ordered evaluation is unnecessary.
23. Stipulates that a certificate expires if the person is not admitted within 14 days after issuance of the certificate.
24. Requires a person who is admitted to a screening agency in relation to a certificate to be examined, and directs the screening agency to perform observation, stabilization and assessment procedures that are necessary to provide an opportunity to restore the person to a level of function that will likely mitigate the need for emergency psychiatric hospitalization.
25. Requires a screening agency to seek alternatives to court-ordered involuntary confinement for evaluation or treatment and to provide counseling to the person and their family.
26. Prohibits subsequent admittance to an evaluation agency on an application for emergency psychiatric hospitalization for a person who is held pursuant to a certificate, with certain exceptions.
27. Requires the admitting officer of the screening agency to review an application for a person who is currently admitted to or located at a hospital to receive inpatient screening or emergency psychiatric hospitalization within two hours after receiving the application.
28. Directs the admitting officer, if there is reasonable cause to believe that a certificate is necessary, to do one of the following within two hours:
a) advise the hospital that the application has been accepted and cause the patient to be transported from the hospital to the screening agency within six hours;
b) immediately cause the patient to be detained and transported; or
c) immediately file an application for emergency psychiatric hospitalization if reasonable grounds are found that the patient needs emergency psychiatric hospitalization.
29. Provides that a patient may be involuntarily detained in a hospital or emergency department for the time necessary for a determination to be made on the application and for the patient to be transported.
30. Limits the time a person, who is the subject of a certificate, who is located in a hospital and who is medically ready for discharge, may be held involuntarily at a hospital to only the time necessary to transport the person to the screening agency.
31. Prohibits a person who is in a hospital and not medically ready for discharge from transfer until the person is medically ready for discharge.
32. Requires an admitting officer of a screening agency to deny an application for a certificate if it is determined, after a doctor-to-doctor consultation, that the patient does not require inpatient screening or emergency psychiatric hospitalization.
33. Prohibits, upon receiving denial for a certificate, the person from being detained in the hospital for reasons related to the procedures for court-ordered screening or evaluation, and requires that the person be discharged.
34. Directs the admitting officer of the screening agency to make a determination based on the information presented at time of the assessment and prohibits the officer from denying an application based on the possibility that there are more causes for the alleged behavior than have been ruled out by additional medical testing.
Voluntary Evaluation
35. Allows a patient who is not a danger to self or other and is capable of consenting to and will voluntary receive an evaluation to follow up within five days with an evaluation agency by the county or a private agency that is covered by the patient's insurance.
36. Requires the screening agency to supply a time and place to the patient for evaluation and inform the patient that if they do not follow up, are thought to be deteriorating or is a danger to self or others, a peace officer may take the patient into custody.
37. Directs the screening agency to contact the evaluation agency to determine if the patient received evaluation and to discuss the results of the evaluation.
Emergency Psychiatric Hospitalization
38. Requires an application for emergency psychiatric hospitalization to include a statement by the applicant that the patient is unable or unwilling to undergo voluntary evaluation and a summary of facts and data that support the assertion that the person is suffering from a mental disorder.
39. Allows a peace officer, in addition to a health care provider, to file an application for emergency psychiatric hospitalization.
40. Grants an application for emergency psychiatric hospitalization if the admitting officer determines there is reasonable grounds to believe the person has a mental disorder, is unwilling to undergo evaluation, is likely to suffer serious physical harm or illness, or is likely to inflict harm, without immediate hospitalization.
41. Requires the admitting officer to review an application for emergency psychiatric hospitalization of a person who is currently admitted to or located at a hospital within two hours after receiving the application.
42. Directs the admitting officer to advise the hospital that the application has been accepted and cause the patient to be transported within six hours.
43. Allows a patient to be involuntarily detained in a hospital or emergency department for the time necessary for a determination to be made and the patient to be transported.
44. Prohibits the transfer of a a person who is in a hospital and not medically ready for discharge until the person is medically ready for discharge.
45. Requires denial of an application for emergency psychiatric hospitalization if the admitting officer finds, after a doctor-to-doctor consultation, that the patient does not require emergency psychiatric hospitalization.
46. Prohibits the person from being detained in the hospital for reasons related to the procedures for court-ordered screening or evaluation once the application for emergency psychiatric hospitalization has been denied.
47. Allows a patient to continue care and treatment in the screening agency or evaluation agency if the patient signs a voluntary application or consent to further treatment or if the application or consent is signed by the patient's court-appointed guardian.
48. Prohibits a hospital and its agents, employees, contracted providers, medical professionals and admitting officer from being held liable for the detention or discharge of a person, unless they have not complied in good faith.
49. Requires each screening agency and evaluation agency to annually compile and maintain a list of medical conditions and treatments that cannot be properly provided for in the agency and provide to list to local hospitals and be publicly accessible.
50. Requires a patient to be held at a hospital until the hearing and order is issued if there is not an agency who can provide a specifically needed treatment.
51. Determines that, if the admitting officer believes that the patient in the hospital has a condition that requires treatment which is not on the list but an agency can provide, the admitting officer can consult with the treating physician to determine if the patient can be transferred and treated at the agency, within 24 hours.
52. Directs the medical directors of both facilities to consult regarding a patient's plan, within 24 hours, if the treating and receiving physicians cannot agree on a transport or treatment plan.
53. Directs the receiving agency to provide the hospital with documentation listing the reasons the agency cannot receive the patient if an agreement cannot be made.
54. Directs the screening or evaluation agency to file a request for an emergency hearing if the patient is not able to be transported or placed in an evaluation due to their medical condition.
55. Requires the court to have a telephonic hearing on the next court day and direct how and where to evaluate the proposed patient.
Miscellaneous
56. Eliminates references to prepetition screening.
57. Defines relevant terms.
58. Makes technical and conforming changes.
59. Becomes effective on the general effective date.
Amendments Adopted by Committee
· Adopted the strike-everything amendment.
Senate Action
HHS 2/16/18 DPA/SE 6-1-0