COMMITTEE ON HEALTH & HUMAN SERVICES
HOUSE OF REPRESENTATIVES AMENDMENTS TO H.B. 2316
(Reference to printed bill)
Strike everything after the enacting clause and insert:
"Section 1. Section 36-501, Arizona Revised Statutes, is amended to read:
36-501. Definitions
In this chapter, unless the context otherwise requires:
1. "Administration" means the Arizona health care cost containment system administration.
2. "Admitting officer" means a psychiatrist or other physician or psychiatric and mental health nurse practitioner with experience in performing psychiatric examinations who has been designated as an admitting officer of the evaluation agency by the person in charge of the evaluation agency.
3. "Chief medical officer" means the chief medical officer under the supervision of the superintendent of the state hospital.
4. "Contraindicated" means that access is reasonably likely to endanger the life or physical safety of the patient or another person.
5. "Court" means the superior court in the county in this state in which the patient resides or was found before screening or emergency admission under this title.
6. "Criminal history" means police reports, lists of prior arrests and convictions, criminal case pleadings and court orders, including a determination that the person has been found incompetent to stand trial pursuant to section 13‑4510.
7. "Danger to others" means that the judgment of a person who has a mental disorder is so impaired that the person is unable to understand the person's need for treatment and as a result of the person's mental disorder the person's continued behavior can reasonably be expected, on the basis of competent medical opinion, to result in serious physical harm.
8. "Danger to self":
(a) Means behavior that, as a result of a mental disorder:
(i) Constitutes a danger of inflicting serious physical harm on oneself, including attempted suicide or the serious threat thereof, if the threat is such that, when considered in the light of its context and in light of the individual's previous acts, it is substantially supportive of an expectation that the threat will be carried out.
(ii) Without hospitalization will result in serious physical harm or serious illness to the person.
(b) Does not include behavior that establishes only the condition of having a grave disability.
9. "Department" means the department of health services.
10. "Detention" means the taking into custody of a patient or proposed patient.
11. "Director" means the director of the administration.
12. "Evaluation" means:
(a) A professional multidisciplinary analysis that may include firsthand observations or remote observations by interactive audiovisual media and that is based on data describing the person's identity, biography and medical, psychological and social conditions carried out by a group of persons consisting of not less than the following:
(i) Two licensed physicians, who shall be are qualified psychiatrists, if possible, or at least experienced in psychiatric matters, and who shall examine and report their findings independently. The person against whom a petition has been filed shall be notified that the person may select one of the physicians. A psychiatric resident in a training program approved by the American medical association or by the American osteopathic association may examine the person in place of one of the psychiatrists if the resident is supervised in the examination and preparation of the affidavit and testimony in court by a qualified psychiatrist appointed to assist in the resident's training, and if the supervising psychiatrist is available for discussion with the attorneys for all parties and for court appearance and testimony if requested by the court or any of the attorneys.
(ii) Two other individuals, one of whom, if available, shall be is a psychologist and in any event a social worker familiar with mental health and human services that may be available placement alternatives appropriate for treatment. An evaluation may be conducted on an inpatient basis, an outpatient basis or a combination of both, and every reasonable attempt shall be made to conduct the evaluation in any language preferred by the person.
(b) A physical examination that is consistent with the existing standards of care and that is performed by one of the evaluating physicians or by or under the supervision of a physician who is licensed pursuant to title 32, chapter 13 or 17 or a registered nurse practitioner who is licensed pursuant to title 32, chapter 15 if the results of that examination are reviewed or augmented by one of the evaluating physicians.
13. "Evaluation agency" means a health care agency that is licensed by the department and that has been approved pursuant to this title, providing those services required of such agency by this chapter.
14. "Family member" means a spouse, parent, adult child, adult sibling or other blood relative of a person undergoing treatment or evaluation pursuant to this chapter.
15. "Grave disability" means a condition evidenced by behavior in which a person, as a result of a mental disorder, is likely to come to serious physical harm or serious illness because the person is unable to provide for the person's own basic physical needs.
16. "Health care decision maker" has the same meaning prescribed in section 12‑2801.
17. "Health care entity" means a health care provider, the department, the administration or a regional behavioral health authority that is under contract with the administration.
18. "Health care provider" means a health care institution as defined in section 36‑401 that is licensed as a behavioral health provider pursuant to department rules or a mental health provider.
19. "Independent evaluator" means a licensed physician, psychiatric and mental health nurse practitioner or psychologist who is selected by the person to be evaluated or by such that person's attorney.
20. "Informed consent" means a voluntary decision following presentation of all facts necessary to form the basis of an intelligent consent by the patient or guardian with no minimizing of known dangers of any procedures.
21. "Least restrictive treatment alternative" means the treatment plan and setting that infringe in the least possible degree with the patient's right to liberty and that are consistent with providing needed treatment in a safe and humane manner.
22. "Licensed physician" means any medical doctor or doctor of osteopathy who is either:
(a) Licensed in this state.
(b) A full‑time hospital physician licensed in another state and serving on the staff of a hospital operated or licensed by the United States government.
23. "Medical director of an evaluation agency" means a psychiatrist, or other licensed physician experienced in psychiatric matters, who is designated in writing by the governing body of the agency as the person in charge of the medical services of the agency for the purposes of this chapter and may include the chief medical officer of the state hospital.
24. "Medical director of a mental health treatment agency" means a psychiatrist, or other licensed physician experienced in psychiatric matters, who is designated in writing by the governing body of the agency as the person in charge of the medical services of the agency for the purposes of this chapter and includes the chief medical officer of the state hospital.
25. "Mental disorder" means a substantial disorder of the a person's emotional processes, thought, cognition or memory. Mental disorder is distinguished from:
(a) Conditions that are primarily those of drug abuse, alcoholism or intellectual disability, unless, in addition to one or more of these conditions, the person has a mental disorder.
(b) The declining mental abilities that directly accompany impending death.
(c) Character and personality disorders characterized by lifelong and deeply ingrained antisocial behavior patterns, including sexual behaviors that are abnormal and prohibited by statute unless the behavior results from a mental disorder.
26. "Mental health provider" means any physician or provider of mental health or behavioral health services who is involved in evaluating, caring for, treating or rehabilitating a patient.
27. "Mental health treatment agency" means the state hospital or a health care agency that is licensed by the department and that provides those services that are required of the agency by this chapter.
28. "Outpatient treatment" or "combined inpatient and outpatient treatment" means any treatment program not requiring continuous inpatient hospitalization.
29. "Outpatient treatment plan" means a treatment plan that does not require continuous inpatient hospitalization.
30. "Patient" means any person who is undergoing examination, evaluation or behavioral or mental health treatment under this chapter.
31. "Peace officers" means sheriffs of counties, constables, marshals and policemen of cities and towns.
32. "Persistent or acute disability" means a severe mental disorder that meets all the following criteria:
(a) If not treated has a substantial probability of causing the person to suffer or continue to suffer severe and abnormal mental, emotional or physical harm that significantly impairs judgment, reason, behavior or capacity to recognize reality.
(b) Substantially impairs the person's capacity to make an informed decision regarding treatment, and this impairment causes the person to be incapable of understanding and expressing an understanding of the advantages and disadvantages of accepting treatment and understanding and expressing an understanding of the alternatives to the particular treatment offered after the advantages, disadvantages and alternatives are explained to that person.
(c) Has a reasonable prospect of being treatable by outpatient, inpatient or combined inpatient and outpatient treatment.
33. "Prepetition screening" means the review of each application requesting court‑ordered evaluation, including an investigation of facts alleged in such the application, an interview with each applicant and an interview, if possible, with the proposed patient. The purpose of the interview with the proposed patient is to assess the problem, explain the application and, when indicated, attempt to persuade the proposed patient to receive, on a voluntary basis, evaluation or other services.
34. "Prescribed form" means a form established by a court or the rules of the administration in accordance with the laws of this state.
35. "Professional" means a physician who is licensed pursuant to title 32, chapter 13 or 17, a psychologist who is licensed pursuant to title 32, chapter 19.1 or a psychiatric and mental health nurse practitioner who is certified pursuant to title 32, chapter 15.
36. "Proposed patient" means a person for whom an application for evaluation has been made or a petition for court‑ordered evaluation has been filed.
37. "Prosecuting agency" means the county attorney, attorney general or city attorney who applied or petitioned for an evaluation or treatment pursuant to this chapter.
38. "Psychiatric and mental health nurse practitioner" means a registered nurse practitioner as defined in section 32‑1601 who has completed an adult or family psychiatric and mental health nurse practitioner program and who is certified as an adult or family psychiatric and mental health nurse practitioner by the state board of nursing.
39. "Psychiatrist" means a licensed physician who has completed three years of graduate training in psychiatry in a program approved by the American medical association or the American osteopathic association.
40. "Psychologist" means a person who is licensed under title 32, chapter 19.1 and who is experienced in the practice of clinical psychology.
41. "Records" means all communications that are recorded in any form or medium and that relate to patient examination, evaluation or behavioral or mental health treatment. Records include medical records that are prepared by a health care provider or other providers. Records do not include:
(a) Materials that are prepared in connection with utilization review, peer review or quality assurance activities, including records that a health care provider prepares pursuant to section 36‑441, 36‑445, 36‑2402 or 36‑2917.
(b) Recorded telephone and radio calls to and from a publicly operated emergency dispatch office relating to requests for emergency services or reports of suspected criminal activity.
42. "Regional behavioral health authority" has the same meaning prescribed in section 36‑3401.
43. "Screening agency" means a health care agency that is licensed by the department and that provides those services required of such agency by this chapter.
44. "Social worker" means a person who has completed two years of graduate training in social work in a program approved by the council of social work education and who has experience in mental health.
45. "State hospital" means the Arizona state hospital.
46. "Superintendent" means the superintendent of the state hospital.
Sec. 2. Title 36, chapter 5, article 4, Arizona Revised Statutes, is amended by adding section 36-521.01, to read:
36-521.01. Considerations for screening, evaluation and involuntary treatment
A. A person who has a substance use disorder without any co‑occurring mental disorder may not be considered for involuntary treatment pursuant to article 5 of this chapter. A person who initially presents with impairments consistent with both a mental disorder and substance use disorder is eligible for screening and evaluation pursuant to this article, and that person may be eligible for involuntary treatment pursuant to article 5 of this chapter if, after considering the person's history, an appropriate examination and a reasonable period of detoxification, the impairments of a mental disorder persist or recur.
B. A person who has an intellectual disability may not be considered for involuntary treatment pursuant to article 5 of this chapter unless, in addition to the intellectual disability, the person has a mental disorder that would benefit from treatment.
C. A person who presents with declining mental abilities that directly accompany impending death may not be considered for involuntary treatment pursuant to article 5 of this chapter.
D. A person with a character or personality disorder characterized by lifelong and deeply ingrained antisocial behavior patterns, including sexual behaviors that are abnormal and prohibited by statute, may not be considered for involuntary treatment pursuant to article 5 of this chapter unless the person also has a mental disorder that would benefit from treatment."
Amend title to conform