Assigned to HHS AS
PASSED BY COW
Assigned to HHS AS
PASSED BY COW
ARIZONA STATE SENATE
Fifty-Third Legislature, Second Regular Session
AMENDED
application; emergency admission; nonevaluating hospitals
Purpose
Modifies and establishes requirements for court-ordered mental health evaluation and emergency admission for evaluation.
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
Applications for Court-Ordered Evaluation
1. Requires that an application for evaluation be presented to a screening agency and 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 and compliance with 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 likely to cause or endure serious physical harm or injury during the time would take to complete a prepetition screening report, including supporting information; and
e) 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. Requires screening agencies to take necessary actions to allow completion of an application within three days after initial contact by the applicant.
4. Permits, if the person to be screened is located at a hospital, a screening agency to perform the screening and examination at a hospital, in person or by telemedicine, if the hospital and screening agency have the appropriate equipment and personnel.
5. Establishes that screenings conducted while a patient is located at a hospital must be proceeded by providing the patient with a written and oral statement that the screener is not affiliated with the hospital, that the hospital is not providing medical services to the person and that the screening is not subject to physician-patient confidentiality.
6. Requires a screening report to be reviewed by the medical director of the screening agency, or their designee, if the report indicates no reasonable cause exists to believe the person is in need of an evaluation, and requires screening agencies to provide to the applicant and proposed patient information regarding involuntary screening, the evaluation and treatment process, legal decision-making and alternative mental health resources in the community.
7. Requires a screening agency, if a determination is made that no reasonable cause exists to believe that a person is in need of an evaluation, to immediately issue a written notice to the applicant setting forth the reasons for not proceeding with the petition for court-ordered evaluation.
8. Permits the proposed patient to request a copy of the notice.
9. Requires a screening agency to recommend specific services in a proposed patient's area and make a direct referral to those services, if the agency determines that no reasonable cause exists to believe the allegations of the applicant but finds reasonable cause to believe that the proposed patient has a mental disorder, would benefit from further evaluation and treatment and is willing and able to accept evaluation and treatment services.
10. 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.
11. Permits a screening agency to seek immediate admission in an evaluation agency if the following criteria are met:
a) a determination is made that there is reasonable cause to believe that the proposed patient is, as a result of a mental disorder, a danger to self or others and is unwilling to undergo voluntary evaluation; and
b) during the time to complete the required screening procedures, and without immediate admission for evaluation, the proposed patient is likely to suffer or inflict serious injury or harm.
12. Requires a screening agency to prepare and file a petition for court-ordered evaluation if the following criteria are met:
a) a determination is made that there is reasonable cause to believe that a proposed patient is, as a result of a mental disorder, a danger to self or others, or has an acute or grave disability; and
b) the proposed patient is unwilling or unable to voluntarily receive an evaluation.
13. Permits evaluation agencies to contact the county attorney for assistance with preparing petitions for court-ordered evaluations and for advice in reaching a decision as to whether an evaluation is justified.
14. 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.
15. 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.
Voluntary Evaluation
16. Allows a voluntary evaluation to be performed if it is determined that a proposed patient is capable of consenting to and will voluntary receive an evaluation, and is unlikely to present a danger to self or others pending an evaluation.
17. Permits a voluntary evaluation to be performed by an evaluation agency provided by the county, a private mental health provider or licensed mental health treatment agency, if the provider or agency accepts the patient's insurance or the patient can pay privately.
18.
Establishes that an evaluation
agency must be immediately notified and provide the evaluation within five days
after the notice is received.
19. Requires the screening agency to supply a time and place to the patient for evaluation.
20. Requires the screening agency to inform the patient that if they do submit to the evaluation, and the agency has reasonable cause to believe that the patient is a danger to self or others, has a persistent, acute or grave disability, and is likely to deteriorate without an evaluation, that a peace officer may take the patient into custody and delivered to an agency for screening or evaluation.
21. Directs the screening agency to contact the evaluation agency to determine if the patient received evaluation and to discuss the results of the evaluation.
22. Allows a screening agency to apply for court-ordered evaluation if a proposed patient fails to participate in a scheduled evaluation or if the evaluation confirms that court-ordered treatment is needed.
Emergency Admission for Evaluation
23. Requires an application for emergency admission to include a statement by the applicant that there is reasonable cause to believe 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.
24. Allows a peace officer, in addition to a health care provider, to file an application for emergency admission.
25. Grants an application for emergency admission 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.
26. Requires that denied applications be reviewed and approved by the medical director of the evaluation agency or their designee, and requires the medical director to provide a written denial of the application to the applicant and the proposed patient.
27. Directs a non-evaluating hospital to provide a patient written notice that an application for emergency admission will be filed if the admitting officer of the hospital finds reasonable cause to believe the patient needs admission to an evaluation agency and is a danger to self or others as a result of a mental disorder.
28. Requires the admitting officer to review and make a determination on an application for emergency admission of a patient located at a nonevaluating hospital within four hours after receiving the application.
29. Permits an admitting officer to interview an applicant, proposed patient or any involved medical personnel as part of the application determination process.
30. Establishes that an interview with a proposed patient at a non-evaluating hospital must be preceded by providing the patient written and oral notification that the interviewer is not affiliated with the hospital, is not providing medical services to the patient and that any statements made are not protected by physician-patient confidentiality.
31. Allows a patient to be involuntarily detained in a non-evaluating hospital or emergency room for the length of time necessary for a determination to be made on an application for emergency admission and for the patient to be transported.
32. Prohibits the transfer of a person who is in a non-evaluating hospital and not medically ready for discharge until the person is medically ready for discharge and permits a person to be detained until they are medically ready for discharge as determined by the non-evaluating hospital.
33. Requires a non-evaluating hospital to immediately notify the evaluation agency in writing after the proposed patient is confirmed medically ready for discharge, and specifies that the proposed patient may be held involuntarily at the non-evaluating hospital only for the time necessary to transport the patient to the evaluation agency.
34. Establishes that an evaluation agency must arrange transportation of a patient who has been approved for emergency evaluation and who is medically ready for discharge within nine hours.
35. 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, and requires the admitting officer making the determination to notify the non-evaluating hospital of the denial.
36. Specifies that, on receipt of a denial from an evaluation agency, a person cannot be detained in a hospital for reasons related to the court-ordered evaluation process and must be discharged from the non-evaluating hospital absent any medical necessity.
37. Prohibits an admitting officer from denying an application based on the possibility that there may be causes for the behavior that have not been rules out by additional medical testing.
38. Allows a patient to continue care and treatment in an evaluation agency if the patient signs a voluntary application or consents to further treatment or if the application or consent is signed by the patient's court-appointed guardian.
39. Prohibits a hospital and its agents, employees, contracted providers, medical professionals and admitting officer from being held liable for the involuntary detention or discharge of a person, unless they have not complied in good faith.
40. Requires each 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 non-evaluating hospitals and be publicly accessible.
41. Allows a patient who requires treatment that is not offered by an evaluation agency to be held at a non-evaluating hospital until a hearing is held and an order is issued.
42. Directs the evaluation agency to consult with the non-evaluating hospital to determine if a patient can be transferred to and treated in an evaluation agency during the court-ordered evaluation period, if the admitting officer of an evaluation agency believes a patient in a non-evaluating hospital has a condition or requires treatment that is not on the list but that cannot be properly provided by the agency.
43. Requires, if the receiving agency and non-evaluating hospital cannot agree on a transport or treatment plan, that the medical directors of the facilities must consult regarding the patient's
plan.
44. Directs the receiving agency to provide the non-evaluating hospital with documentation listing reasons the agency cannot receive and care for the patient, if no agreement can be made regarding the proposed patient's transport or treatment plan.
45. Specifies that required consultations must occur within 24 hours after receipt of an application for emergency admission.
46. Directs the screening or evaluation agency to file a request for an emergency status conference with the court to determine the procedural due process that is applicable to the case, if the patient is not able to be transported or placed in an evaluation agency due to their medical condition.
47. Requires the court to conduct a conference on the same or next court day and permits the court to direct how and where to evaluate the proposed patient.
Miscellaneous
48. Requires screening agencies to provide assistance to applicants who are not medical professionals to develop the relevant mental health history and factual background appropriate for completion of an application.
49. Requires that applications received by screening agencies and evaluation agencies be immediately time and date stamped and logged.
50. Defines relevant terms.
51. Makes technical and conforming changes.
52. Becomes effective on the general effective date.
Amendments Adopted by Committee
· Adopted the strike-everything amendment.
Amendments Adopted by Committee of the Whole
1. Eliminates language permitting an admitting officer of a screening agency to issue a certificate of hold if certain criteria are met.
2. Restores references to pre-petition screening as it relates to the court-ordered evaluation process. Requires screening agencies to provide assistance to applicants for court-ordered evaluation and emergency admission for evaluation.
3. Stipulates that if screening is provided in a hospital the disclosure provided must state that the screening is not subject to physician-patient confidentiality.
4. Requires a screening agency, upon receipt of an application for evaluation and before filing a petition for court-ordered evaluation, to determine whether the person is in need of an evaluation within 48 hours.
5. Prescribes information that must be provided to an applicant of a denied screening application.
6. Provides an admitting officer, upon receiving an application for emergency admission from a non-evaluating hospital, four hours to review and grant or deny the application.
7. Extends the timeframe that an admitting officer has to arrange for a patient to be transported to an evaluation agency from six hours to nine hours.
8. Requires an evaluation agency to request an emergency status conference to determine applicable procedural due process in a cases where a proposed patient cannot be placed in an evaluation agency.
9. Defines relevant terms.
10. Makes technical and conforming changes.
Senate Action
HHS 2/16/18 DPA/SE 6-1-0
3rd Read 3/8/18 19-10-1
Prepared by Senate Research
March 13, 2018
CRS/lat