HB2745 - 562R

Be it enacted by the Legislature of the State of Arizona:

Section 1. Section 36-540, Arizona Revised Statutes, is amended to read:

START_STATUTE36-540. Court options; immunity; rules

A. If the court finds by clear and convincing evidence that the proposed patient, as a result of mental disorder, is a danger to self, is a danger to others or has a persistent or acute disability or a grave disability and is in need of treatment, and is either unwilling or unable to accept voluntary treatment, the court shall order the patient to undergo one of the following:

1. Treatment in a program of outpatient treatment.

2. Treatment in a program consisting of combined inpatient and outpatient treatment.

3. Inpatient treatment in a mental health treatment agency, in a hospital operated by or under contract with the United States department of veterans affairs to provide treatment to eligible veterans pursuant to article 9 of this chapter, in the state hospital or in a private hospital, if the private hospital agrees, subject to the limitations of section 36-541.

B. The court shall consider all available and appropriate alternatives for the treatment and care of the patient. The court shall order the least restrictive treatment alternative available.

C. The court may order the proposed patient to undergo outpatient or combined inpatient and outpatient treatment pursuant to subsection A, paragraph 1 or 2 of this section if the court:

1. Determines that all of the following apply:

(a) The patient does not require continuous inpatient hospitalization.

(b) The patient will be more appropriately treated in an outpatient treatment program or in a combined inpatient and outpatient treatment program.

(d) The patient will not likely become dangerous or suffer more serious physical harm or serious illness or further deterioration if the patient follows a prescribed outpatient treatment plan.

2. Is presented with and approves a written treatment plan that conforms with the requirements of section 36-540.01, subsection B. If the court determines that the patient meets the requirements of section 36-550.09, the court may order the patient to be placed in a secure behavioral health residential facility that is licensed by the department pursuant to section 36-425.06. If the treatment plan presented to the court pursuant to this subsection provides for supervision of the patient under court order by a mental health agency that is other than the mental health agency that petitioned or requested the county attorney to petition the court for treatment pursuant to section 36-531, the treatment plan must be approved by the medical director of the mental health agency that will supervise the treatment pursuant to subsection E of this section.

D. An order to receive treatment pursuant to subsection A, paragraph 1 or 2 of this section shall not exceed three hundred sixty-five days. The period of inpatient treatment under a combined treatment order pursuant to subsection A, paragraph 2 of this section shall not exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section.

E. If the court enters an order for treatment pursuant to subsection A, paragraph 1 or 2 of this section, all of the following apply:

1. The court shall designate the medical director of the mental health treatment agency that will supervise and administer the patient's treatment program.

2. The medical director shall not use the services of any person, agency or organization to supervise a patient's outpatient treatment program unless the person, agency or organization has agreed to provide these services in the individual patient's case and unless the department has determined that the person, agency or organization is capable and competent to do so.

3. The person, agency or organization assigned to supervise an outpatient treatment program or the outpatient portion of a combined treatment program shall be notified at least three days before a referral. The medical director making the referral and the person, agency or organization assigned to supervise the treatment program shall share relevant information about the patient to provide continuity of treatment.

4. The court may order the medical director to provide notice to the court of any noncompliance with the terms of a treatment order.

5. During any period of outpatient treatment under subsection A, paragraph 2 of this section, if the court, on its own motion or on motion by the medical director of the patient's outpatient mental health treatment facility, determines that the patient is not complying with the terms of the order or that the outpatient treatment plan is no longer appropriate and the patient needs inpatient treatment, the court, without a hearing and based on the court record, the patient's medical record, the affidavits and recommendations of the medical director, and the advice of staff and physicians or the psychiatric and mental health nurse practitioner familiar with the treatment of the patient, may enter an order amending its original order. The amended order may alter the outpatient treatment plan or order the patient to inpatient treatment pursuant to subsection A, paragraph 3 of this section. If the court determines that the patient meets the requirements of section 36-550.09, the court may order the patient to be placed in a secure behavioral health residential facility that is licensed by the department pursuant to section 36-425.06. The amended order shall not increase the total period of commitment originally ordered by the court or, when added to the period of inpatient treatment provided by the original order and any other amended orders, exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section. If the patient refuses to comply with an amended order for inpatient treatment, the court, on its own motion or on the request of the medical director, may authorize and direct a peace officer to take the patient into protective custody and transport the patient to the agency for inpatient treatment. Any authorization, directive or order issued to a peace officer to take the patient into protective custody shall include the patient's criminal history and the name and telephone numbers of the patient's case manager, guardian, spouse, next of kin or significant other, as applicable. When reporting to or being returned to a treatment agency for inpatient treatment pursuant to an amended order, the patient shall be informed of the patient's right to judicial review and the patient's right to consult with counsel pursuant to section 36-546.

6. During any period of outpatient treatment under subsection A, paragraph 2 of this section, if the medical director of the outpatient treatment facility in charge of the patient's care determines, in concert with the medical director of an inpatient mental health treatment facility who has agreed to accept the patient, that the patient is in need of immediate acute inpatient psychiatric care because of behavior that is dangerous to self or to others, the medical director of the outpatient treatment facility may order a peace officer to apprehend and transport the patient to the inpatient treatment facility pending a court determination on an amended order under paragraph 5 of this subsection. The patient may be detained and treated at the inpatient treatment facility for a period of not more than forty-eight hours, exclusive of weekends and holidays, from the time that the patient is taken to the inpatient treatment facility. The medical director of the outpatient treatment facility shall file the motion for an amended court order requesting inpatient treatment not later than the next working day following the patient being taken to the inpatient treatment facility. Any period of detention within the inpatient treatment facility pending issuance of an amended order shall not increase the total period of commitment originally ordered by the court or, when added to the period of inpatient treatment provided by the original order and any other amended orders, exceed the maximum period allowed for an order for inpatient treatment pursuant to subsection F of this section. If a patient is ordered to undergo inpatient treatment pursuant to an amended order, the medical director of the outpatient treatment facility shall inform the patient of the patient's right to judicial review and to consult with an attorney pursuant to section 36-546.

F. The maximum periods of inpatient treatment that the court may order, subject to the limitations of section 36-541, are as follows:

1. Ninety days for a person found to be a danger to self.

2. One hundred eighty days for a person found to be a danger to others.

3. One hundred eighty days for a person found to have a persistent or acute disability.

4. Three hundred sixty-five days for a person found to have a grave disability.

G. If, on finding that the patient meets the criteria for court-ordered treatment pursuant to subsection A of this section, the court also finds that there is reasonable cause to believe that the patient is an incapacitated person as defined in section 14-5101 or is a person in need of protection pursuant to section 14-5401 and that the patient is or may be in need of guardianship or conservatorship, or both, the court may order an investigation concerning the need for a guardian or conservator, or both, and may appoint a suitable person or agency to conduct the investigation. The appointee may include a court-appointed guardian ad litem, an investigator appointed pursuant to section 14-5308 or the public fiduciary if there is no person willing and qualified to act in that capacity. The court shall give notice of the appointment to the appointee within three days after the appointment. The appointee shall submit the report of the investigation to the court within twenty-one days. The report shall include recommendations as to who should be guardian or who should be conservator, or both, and a report of the findings and reasons for the recommendation. If the investigation and report so indicate, the court shall order the appropriate person to submit a petition to become the guardian or conservator, or both, of the patient.

H. In any proceeding for court-ordered treatment in which the petition alleges that the patient is in need of a guardian or conservator and states the grounds for that allegation, the court may appoint an emergency temporary guardian or conservator, or both, for a specific purpose or purposes identified in its order and for a specific period of time not to exceed thirty days if the court finds that all of the following are true:

1. The patient meets the criteria for court-ordered treatment pursuant to subsection A of this section.

2. There is reasonable cause to believe that the patient is an incapacitated person as defined in section 14-5101 or is in need of protection pursuant to section 14-5401, paragraph 2.

3. The patient does not have a guardian or conservator and the welfare of the patient requires immediate action to protect the patient or the ward's property.

4. The conditions prescribed pursuant to section 14-5310, subsection B or section 14-5401.01, subsection B have been met.

I. The court may appoint as a temporary guardian or conservator pursuant to subsection H of this section a suitable person or the public fiduciary if there is no person qualified and willing to act in that capacity. The court shall issue an order for an investigation as prescribed pursuant to subsection G of this section and, unless the patient is represented by independent counsel, the court shall appoint an attorney to represent the patient in further proceedings regarding the appointment of a guardian or conservator. The court shall schedule a further hearing within fourteen days on the appropriate court calendar of a court that has authority over guardianship or conservatorship matters pursuant to this title to consider the continued need for an emergency temporary guardian or conservator and the appropriateness of the temporary guardian or conservator appointed, and shall order the appointed guardian or conservator to give notice to persons entitled to notice pursuant to section 14-5309, subsection A or section 14-5405, subsection A. The court shall authorize certified letters of temporary emergency guardianship or conservatorship to be issued on presentation of a copy of the court's order. If a temporary emergency conservator other than the public fiduciary is appointed pursuant to this subsection, the court shall order that the use of the monies and property of the patient by the conservator be restricted and not be sold, used, transferred or encumbered, except that the court may authorize the conservator to use monies or property of the patient specifically identified as needed to pay an expense to provide for the care, treatment or welfare of the patient pending further hearing. This subsection and subsection H of this section do not:

1. Prevent the evaluation or treatment agency from seeking guardianship and conservatorship in any other manner allowed by law at any time during the period of court-ordered evaluation and treatment.

2. Relieve the evaluation or treatment agency from its obligations concerning the suspected abuse of a vulnerable adult pursuant to title 46, chapter 4.

J. If, on finding that a patient meets the criteria for court-ordered treatment pursuant to subsection A of this section, the court also learns that the patient has a guardian appointed under title 14, the court with notice may impose on the existing guardian additional duties pursuant to section 14-5312.01. If the court imposes additional duties on an existing guardian as prescribed in this subsection, the court may determine that the patient needs to continue treatment under a court order for treatment and may issue the order or determine that the patient's needs can be adequately met by the guardian with the additional duties pursuant to section 14-5312.01 and decline to issue the court order for treatment. If at any time after the issuance of a court order for treatment the court finds that the patient's needs can be adequately met by the guardian with the additional duties pursuant to section 14-5312.01 and that a court order for treatment is no longer necessary to ensure compliance with necessary treatment, the court may terminate the court order for treatment. If there is a court order for treatment and a guardianship with additional mental health authority pursuant to section 14-5312.01 existing at the same time, the treatment and placement decisions made by the treatment agency assigned by the court to supervise and administer the patient's treatment program pursuant to the court order for treatment are controlling unless the court orders otherwise.

K. The court shall file a report as part of the court record on its findings of alternatives for treatment.

L. Treatment shall not include psychosurgery, lobotomy or any other brain surgery without specific informed consent of the patient or the patient's legal guardian and an order of the superior court in the county in which the treatment is proposed, approving with specificity the use of the treatment.

M. The medical director or any person, agency or organization used by the medical director to supervise the terms of an outpatient treatment plan is not civilly liable for any acts committed by a patient while on outpatient treatment if the medical director, person, agency or organization has in good faith followed the requirements of this section.

N. A peace officer who in good faith apprehends and transports a patient to an inpatient treatment facility on the order of the medical director of the outpatient treatment facility pursuant to subsection E, paragraph 6 of this section is not subject to civil liability.

O. If a person has been found, as a result of a mental disorder, to constitute a danger to self or others or to have a persistent or acute disability or a grave disability and the court enters an order for treatment pursuant to subsection A of this section, the court shall transmit the person's name, sex, date of birth, social security number, if available, and date of the order for treatment to the supreme court. The supreme court shall transmit the information to the department of public safety to comply with the requirements of title 13, chapter 31 and title 32, chapter 26. The department of public safety shall transmit the information to the national instant criminal background check system. The superior court may access the information of a person who is ordered into treatment to enforce or facilitate a treatment order.

P. On request, the clerk of the court shall provide certified copies of the commitment order to a law enforcement or prosecuting agency that is investigating or prosecuting a prohibited possessor as defined in section 13-3101.

Q. If the court does not find a person to be in need of treatment and a prosecutor filed a petition pursuant to section 13-4517, the evaluation agency, within twenty-four hours, shall notify the prosecuting agency of its finding. The court shall order the medical director to detain the person for an additional twenty-four hours to allow the prosecuting agency to be notified. If the court has retained jurisdiction pursuant to section 13-4517, subsection C, the court may remand the person to the custody of the sheriff for further disposition pursuant to section 13-4517, subsection A, paragraph 2 or 3.

R. After an order for treatment has been issued pursuant to this section, the superior court in a county where a patient under a court order for treatment is found or resides has concurrent jurisdiction with the court in the county that issued the court order for treatment for the purposes of enforcing the court order for treatment, ordering changes to the treatment plan or amending the order to require the patient to undergo further inpatient treatment. If the court in which proceedings are commenced to enforce or administer the order for treatment is not the court that originally entered the order for treatment, unless prevented by an emergency, the court in which the proceedings are pending shall consult with the court of original entry and determine whether to hold hearings and enter orders to facilitate enforcement or administration of the court order, whether to refer the case back to the court of original entry for further proceedings or whether to transfer the entire case to the court of original entry in that county for all further proceedings. The supreme court may adopt rules to govern the procedures to be used in enforcing and administering court orders for treatment in the various counties of this state and the transfer of cases between counties involving court orders for treatment.

S. Pursuant to the authority granted in subsection R of this section, for the purpose of enforcing or facilitating treatment of a patient under an active order for treatment, the supreme court shall adopt a rule to establish a program to enable the judges of the superior court, county attorneys, patients' attorneys, health care institutions as defined in section 36-401 that provide services subject to the federal emergency medical treatment and active labor act (42 United States code section 1395dd), the regional behavioral health authority and behavioral health service providers in any county to determine the existence of an active court order for treatment and the history of court orders for treatment entered for a patient by a superior court in any county in this state. The program shall ensure that the information shared with other persons or entities is necessary only for the purposes stated in this subsection and shall require that the information shared be maintained as confidential by the receiving person or entity. END_STATUTE

Sec. 2. Title 36, chapter 5, article 5, Arizona Revised Statutes, is amended by adding section 36-540.03, to read:

START_STATUTE36-540.03. Enhanced treatment services; plan; determination of need; order; definition

A. The court may enter an order for enhanced treatment services as prescribed in this section. The order for enhanced treatment services may be entered by the court as an initial order for treatment or on entering an amended or renewed order for treatment. An order for enhanced treatment services shall incorporate a written enhanced treatment services plan that is approved by the court, prepared by staff who are familiar with the patient's case history and approved by the medical director of the person, agency or organization designated to administer and supervise the patient's treatment program. The enhanced treatment services plan shall conform with the requirements of section 36-540.01, subsection B and shall contain other specific orders for enhanced treatment services.

B. The court may enter an order for enhanced treatment services if the court finds by clear and convincing evidence the patient is chronically resistant to treatment pursuant to section 36-550.09, subsection B.

C. If the court enters an order for enhanced treatment services, the court shall advise the patient orally and in writing that the enhanced treatment services plan approved by the court is part of the court order enforceable by the court and that noncompliance with the court's order or the terms and conditions of the enhanced treatment services plan may result in the issuance of an order for the patient to be placed in or returned to inpatient treatment and an order for a peace officer to detain the patient for that purpose.

D. The court shall order the medical director of the mental health treatment agency designated to administer and supervise the patient's enhanced treatment services plan to provide notice to the court of specific instances of noncompliance with the enhanced treatment services plan and order the medical director to file written progress reports with the court at least every sixty days. The court may require the patient and a representative of the treatment team to appear in court, in person or virtually, at times designated by the court, to address the patient's compliance and the services provided. the court may change or modify the patient's enhanced treatment services plan at any such appearance on motion of any party or on the court's own motion.

E. In order to receive any enhanced treatment services ordered by the court, the patient may not be required by any agency or provider to agree or consent to the enhanced treatment services if the court specifically finds that the patient's mental disorder significantly impairs the patient's capacity to make an informed decision regarding treatment.

F. For the purposes of this section, "enhanced treatment services" means services identified in a written enhanced treatment services plan that is approved by the court and that includes INFORMATION regarding all of the following:

1. Assignment of the patient to a treatment team with an intensive case manager for any outpatient services who is required, among other duties, to have in-person contact with the patient at such frequency that will facilitate the patient's adherence to and compliance with the treatment plan and will allow for regular firsthand assessment of the patient's progress and condition.

2. Housing or residential placement that provides the patient with a stable, safe and, if necessary, secure residence to enhance compliance with the treatment plan and protect the safety of the patient and the public.

3. Safe, reliable and adequate transportation for the patient to successfully comply with the treatment plan.

4. Any other services the patient is eligible to receive that the medical director believes are necessary to improve and prevent deterioration of the patient's condition and to protect the patient and the public. END_STATUTE