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H0669.................................................by HEALTH AND WELFARE
MENTAL ILLNESS - Amends existing law relating to mental illness treatment
to remove language referencing medical attendance upon the mentally ill; to
revise definitions; to define "director of a facility"; to revise
provisions applicable to the authority to admit voluntary patients; to
reference voluntary patients admitted for certain purposes related to
mental illness; to revise provisions applicable to the authority to receive
involuntary patients; and to revise provisions applicable to a detention
without a hearing.
02/13 House intro - 1st rdg - to printing
02/14 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature Second Regular Session - 2006
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 669
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO MENTAL ILLNESS; AMENDING SECTION 39-4501, IDAHO CODE, TO REMOVE
3 LANGUAGE REFERENCING MEDICAL ATTENDANCE UPON THE MENTALLY ILL; AMENDING
4 SECTION 66-317, IDAHO CODE, TO REVISE DEFINITIONS, TO DEFINE "DIRECTOR OF
5 A FACILITY" AND TO MAKE TECHNICAL CORRECTIONS; AMENDING SECTION 66-318,
6 IDAHO CODE, TO REVISE PROVISIONS APPLICABLE TO THE AUTHORITY TO ADMIT VOL-
7 UNTARY PATIENTS AND TO MAKE TECHNICAL CORRECTIONS; AMENDING SECTION
8 66-320, IDAHO CODE, TO REFERENCE VOLUNTARY PATIENTS ADMITTED FOR CERTAIN
9 PURPOSES RELATED TO MENTAL ILLNESS AND TO MAKE TECHNICAL CORRECTIONS;
10 AMENDING SECTION 66-324, IDAHO CODE, TO REVISE PROVISIONS APPLICABLE TO
11 THE AUTHORITY TO RECEIVE INVOLUNTARY PATIENTS AND TO MAKE A TECHNICAL COR-
12 RECTION; AMENDING SECTION 66-326, IDAHO CODE, TO REVISE PROVISIONS APPLI-
13 CABLE TO A DETENTION WITHOUT A HEARING AND TO MAKE TECHNICAL CORRECTIONS;
14 AND AMENDING SECTION 66-601, IDAHO CODE, TO REVISE A CODE REFERENCE.
15 Be It Enacted by the Legislature of the State of Idaho:
16 SECTION 1. That Section 39-4501, Idaho Code, be, and the same is hereby
17 amended to read as follows:
18 39-4501. PURPOSES -- APPLICATION. (1) The primary purposes of this chap-
19 ter are:
20 (a) To provide and codify Idaho law concerning consent for the furnishing
21 of hospital, medical, dental or surgical care, treatment or procedures,
22 and concerning what constitutes an informed consent for such care, treat-
23 ment or procedures; and
24 (b) To provide certainty and clarity in the law of medical consent in the
25 furtherance of high standards of health care and its ready availability in
26 proper cases.
27 (2) Nothing in this chapter shall be deemed to amend or repeal the provi-
28 sions of chapter 3, title 66, Idaho Code, as those provisions pertain to medi-
29 cal attendance upon or hospitalization of the mentally ill, nor the provisions
30 of chapter 6, title 18, Idaho Code, pertaining to the provision of examina-
31 tions, prescriptions, devices and informational materials regarding prevention
32 of pregnancy or pertaining to therapeutic abortions and consent to the perfor-
33 mance thereof.
34 (3) Nothing in this chapter shall be construed to permit or require the
35 provision of health care for a patient in contravention of the patient's
36 stated or implied objection thereto upon religious grounds nor shall anything
37 in this chapter be construed to require the granting of permission for or on
38 behalf of any patient who is not able to act for himself by his parent, spouse
39 or guardian in violation of the religious beliefs of the patient or the
40 patient's parent or spouse.
41 SECTION 2. That Section 66-317, Idaho Code, be, and the same is hereby
42 amended to read as follows:
2
1 66-317. DEFINITIONS. As used in this chapter, terms shall have the fol-
2 lowing meanings:
3 (a1) "Department director" means the director of the state department of
4 health and welfare.
5 (b2) "Voluntary patient" means an individual admitted to a facility for
6 evaluation of mental illness pursuant to section 18-211 or 20-520, Idaho Code,
7 or admitted to a facility for treatment of mental illness pursuant to section
8 66-318, Idaho Code.
9 (c3) "Involuntary patient" means an individual committed pursuant to
10 section 18-212, 66-329 or 66-1201, Idaho Code, or committed pursuant to sec-
11 tion 16-1619 or 20-520, Idaho Code, and admitted to a facility for the treat-
12 ment of minors.
13 (d4) "Licensed physician" means an individual licensed under the laws of
14 this state to practice medicine or a medical officer of the government of the
15 United States while in this state in the performance of his official duties.
16 (e5) "Designated examiner" means a psychiatrist, psychologist, psychiat-
17 ric nurse, or social worker and such other mental health professionals as may
18 be designated in accordance with rules promulgated pursuant to the provisions
19 of chapter 52, title 67, Idaho Code, by the department of health and welfare.
20 Any person designated by the department director will be specially qualified
21 by training and experience in the diagnosis and treatment of mental or men-
22 tally related illnesses or conditions.
23 (6) "Director of a facility" means the administrator or chief executive
24 officer of the facility or his or her delegate.
25 (f7) "Dispositioner" means a designated examiner employed by or under
26 contract with the department of health and welfare and designated by the
27 department director to determine the appropriate location for care and treat-
28 ment of involuntary patients.
29 (g8) "Facility" means any public or private hospital, sanatorium, insti-
30 tution, mental health center or other organization designated in accordance
31 with rules adopted by the board of health and welfare as equipped to initially
32 hold, evaluate, rehabilitate or to provide care or treatment, or both, for the
33 mentally ill. Nothing in this chapter shall require public or private hospi-
34 tals or other institutions to provide mental health care services, to provide
35 personnel, equipment or physical facilities for mental health care services,
36 or to otherwise qualify for licensing to provide mental health care services.
37 (h9) "Lacks capacity to make informed decisions about treatment" means
38 the inability, by reason of mental illness, to achieve a rudimentary under-
39 standing after conscientious efforts at explanation of the purpose, nature,
40 and possible significant risks and benefits of treatment.
41 (i10) "Inpatient treatment facility" means a facility in which an individ-
42 ual receives medical and mental treatment for not less than a continuous
43 twenty-four (24) hour period.
44 (j11) "Supervised residential facility" means a facility, other than the
45 individual's home, in which the individual lives and in which there lives, or
46 are otherwise on duty during the times that the individual's presence is
47 expected, persons who are employed to supervise, direct, treat or monitor the
48 individual.
49 (k12) "Likely to injure himself or others" means either:
50 (1a) A substantial risk that physical harm will be inflicted by the pro-
51 posed patient upon his own person, as evidenced by threats or attempts to
52 commit suicide or inflict physical harm on himself; or
53 (2b) A substantial risk that physical harm will be inflicted by the pro-
54 posed patient upon another as evidenced by behavior which has caused such
55 harm or which places another person or persons in reasonable fear of sus-
3
1 taining such harm.
2 (l13) "Mentally ill" means a person, who as a result of a substantial dis-
3 order of thought, mood, perception, orientation, or memory, which grossly
4 impairs judgment, behavior, capacity to recognize and adapt to reality,
5 requires care and treatment at a facility.
6 (m14) "Gravely disabled" means a person who, as the result of mental ill-
7 ness, is in danger of serious physical harm due to the person's inability to
8 provide for any of his basic needs for nourishment, or essential medical care,
9 or shelter or safety.
10 (n15) "Outpatient commitment" means a court order directing a person to
11 comply with specified mental health treatment requirements, not involving the
12 continuous supervision of a person in an inpatient setting, that are reason-
13 ably designed to alleviate or to reduce a person's illness or disability, or
14 to maintain or prevent deterioration of the person's mental or emotional func-
15 tioning. The specified requirements may include, but need not be limited to,
16 taking prescribed medication, reporting to a facility to permit monitoring of
17 the person's condition, or participating in individual or group therapy or in
18 educational or vocational programs. Outpatient commitment may be up to one (1)
19 year.
20 (o16) "Protection and advocacy system" means the agency designated by the
21 governor as the state protection and advocacy system pursuant to 42 U.S.C.
22 section 15043 and 42 U.S.C. sections 10801 et seq.
23 SECTION 3. That Section 66-318, Idaho Code, be, and the same is hereby
24 amended to read as follows:
25 66-318. AUTHORITY TO ADMIT VOLUNTARY PATIENTS -- DENIAL OF ADMISSION.
26 (a1) The director of any facility may admit the following as a voluntary
27 patient for purposes of providing observation, diagnosis, care or treatment of
28 mental illness:
29 (1a) Any person who is eighteen (18) years of age or older;
30 (2b) Any individual fourteen (14) to eighteen (18) years of age who may
31 apply to be admitted for observation, diagnosis, evaluation and treatment,
32 and provided the facility director of the facility will notify the parent,
33 parents or guardian of the individual of the admission; and provided fur-
34 ther that a parent or guardian may apply for the individual's release and
35 the facility director of the facility will release the patient within
36 three (3) days, excluding Saturdays, Sundays and legal holidays, of the
37 application for discharge, unless the time period for diagnosis, evalua-
38 tion, care or treatment is extended pursuant to section 66-320, Idaho
39 Code;
40 (3c) Any emancipated minor;
41 (4d) Any individual under fourteen (14) years of age upon application of
42 the individual's parent or guardian, provided that admission to an inpa-
43 tient facility shall require a recommendation for admission by a desig-
44 nated examiner;
45 (5e) Any individual who lacks capacity to make informed decisions about
46 treatment upon application of the individual's guardian; provided that
47 admission to an inpatient facility shall require a recommendation for
48 admission by a designated examiner; or
49 (6f) Any individual confined for examination pursuant to section 18-211
50 or 20-520, Idaho Code.
51 (b2) The director of any facility must refuse admission to any applicant
52 under this section whenever:
53 (1a) The applicant is determined not to be in need of observation, diag-
4
1 nosis, evaluation, care or treatment at the facility;
2 (2b) The applicant lacks is determined to lack capacity to make informed
3 decisions about treatment unless the application is made by a guardian
4 with authority to consent to treatment; or
5 (3c) The applicant's welfare or the welfare of society, or both, are bet-
6 ter protected by the provisions of section 66-329, Idaho Code.
7 SECTION 4. That Section 66-320, Idaho Code, be, and the same is hereby
8 amended to read as follows:
9 66-320. RIGHT TO RELEASE ON APPLICATION -- EXCEPTIONS. (a1) A voluntary
10 patient admitted for purposes of observation, diagnosis, examination or treat-
11 ment of mental illness in accordance with the procedure outlined in section
12 66-318, Idaho Code, who requests his release or whose release is requested, in
13 writing, by his legal guardian, parent, spouse, or adult next of kin shall be
14 released except that:
15 (1a) iIf the patient was admitted on his own application and the request
16 for release is made by a person other than the patient, release may be
17 conditioned upon the agreement of the patient thereto, and
18 (2b) iIf the patient, by reason of his age, was admitted on the applica-
19 tion of another person, his release prior to becoming sixteen (16) years
20 of age may be conditioned upon the consent of his parent or guardian, or
21 (3c) iIf the director of the facility determines that the patient should
22 be hospitalized under the provisions of this chapter, the patient may be
23 detained up to three (3) days, excluding Saturdays, Sundays and legal hol-
24 idays, for the purpose of examination by a designated examiner and the
25 filing of an application for continued care and treatment.
26 (b2) Notwithstanding any other provision of this chapter, judicial pro-
27 ceedings authorized by this chapter shall not be commenced with respect to a
28 voluntary patient unless release of the patient has been requested by himself
29 or the individual who applied for his admission.
30 (c3) The date and time of any request for release under this section
31 shall be entered in the patient's clinical record. If the request for release
32 is denied, the reasons for denial also shall be entered in the patient's clin-
33 ical record.
34 (d4) A patient admitted for examination pursuant to section 20-520 or
35 18-211, Idaho Code, may not be released except for purposes of transportation
36 back to the court ordering, or party authorizing, the examination.
37 SECTION 5. That Section 66-324, Idaho Code, be, and the same is hereby
38 amended to read as follows:
39 66-324. AUTHORITY TO RECEIVE INVOLUNTARY PATIENTS. The director of any
40 facility is authorized to receive therein for observation, diagnosis, care and
41 treatment of mental illness any individual committed to the department direc-
42 tor pursuant to sections 16-1619, 20-520, 18-212, 18-214 or 66-329, Idaho
43 Code, or transferred pursuant to section 66-1201, Idaho Code, or placed in or
44 detained by a facility under section 66-326, Idaho Code.
45 SECTION 6. That Section 66-326, Idaho Code, be, and the same is hereby
46 amended to read as follows:
47 66-326. DETENTION WITHOUT HEARING. (a1) No person shall be taken into
48 custody as an alleged emergency patient for observation, diagnosis, care or
49 treatment for mental illness unless and until the court has ordered such
5
1 apprehension and custody under the provisions outlined in section 66-329,
2 Idaho Code; provided, however, that a person may be taken into custody by a
3 peace officer and placed in a facility, or the person may be detained by a
4 facility at which the person presented to receive medical or mental health
5 care, if the peace officer or director of the facility has reason to believe
6 that the person is gravely disabled due to mental illness or the person's con-
7 tinued liberty poses an imminent danger to that person or others, as evidenced
8 by a threat of substantial physical harm; provided, under no circumstances
9 shall the proposed patient be detained in a nonmedical unit used for the
10 detention of individuals charged with or convicted of penal offenses. Whenever
11 a person is taken into custody or detained under this section without court
12 order, the evidence supporting the claim of grave disability due to mental
13 illness or imminent danger must be presented to a duly authorized court within
14 twenty-four (24) hours from the time the individual was placed in custody.
15 (b2) If the court finds the individual to be gravely disabled due to men-
16 tal illness or imminently dangerous under subsection (a1) of this section, the
17 court shall issue a temporary custody order requiring the person to be held in
18 a facility, and requiring an examination of the person by a designated exam-
19 iner within twenty-four (24) hours of the entry of the order of the court.
20 Under no circumstances shall the proposed patient be detained in a nonmedical
21 unit used for the detention of individuals charged with or convicted of penal
22 offenses.
23 (c3) Where an examination is required under subsection (b2) of this sec-
24 tion, the designated examiner shall make his findings and report to the court
25 within twenty-four (24) hours of the examination.
26 (d4) If the designated examiner finds, in his examination under this sec-
27 tion, that the person is mentally ill, and either is likely to injure himself
28 or others or is gravely disabled due to mental illness, the prosecuting attor-
29 ney shall file, within twenty-four (24) hours of the examination of the per-
30 son, a petition with the court requesting the patient's detention pending com-
31 mitment proceedings pursuant to the provisions of section 66-329, Idaho Code.
32 Upon the receipt of such a petition, the court shall order his detention to
33 await hearing which shall be within five (5) days (including Saturdays, Sun-
34 days and legal holidays) of the detention order. If no petition is filed
35 within twenty-four (24) hours of the designated examiner's examination of the
36 person, the person shall be released from the facility.
37 (e5) Any person held in custody or detained under the provisions of this
38 section shall have the same protection and rights which are guaranteed to a
39 person already committed to the department director. Upon taking a person into
40 custody, notice shall be given to the person's immediate relatives of the
41 person's physical whereabouts and the reasons for detaining or taking the per-
42 son into custody.
43 (6) Persons or entities that act in good faith with a reasonable basis
44 for their actions shall be immune from civil and criminal liability for
45 detaining or placing, or failing to detain or place, a person in custody under
46 the authority granted by this section.
47 SECTION 7. That Section 66-601, Idaho Code, be, and the same is hereby
48 amended to read as follows:
49 66-601. DEFINITIONS. For the purposes of this chapter, the following def-
50 initions shall apply:
51 (1) "Agent" means an adult properly appointed to make mental health
52 treatment decisions for a principal under a declaration for mental health
53 treatment and also means an alternative agent.
6
1 (2) "Attending physician" means the licensed physician who has primary
2 responsibility for the care and treatment of the declarant.
3 (3) "Facility" means:
4 (a) A designated treatment facility, as defined in section 66-317(g),
5 Idaho Code;
6 (b) A nursing home; or
7 (c) An assisted living home.
8 (4) "Incapable" means that, by order of a court in a guardianship pro-
9 ceeding under section 66-322, Idaho Code, or in the opinion of two (2) physi-
10 cians that include a psychiatrist, or in the opinion of a physician and a pro-
11 fessional mental health clinician, a person's ability to receive and evaluate
12 information effectively or communicate decisions is impaired to such an extent
13 that the person currently lacks the capacity to make mental health treatment
14 decisions.
15 (5) "Mental health treatment" means electroconvulsive treatment, treat-
16 ment with psychotropic medication or short-term admission to a treatment
17 facility for a period not to exceed seventeen (17) days.
18 (6) "Mental illness" means a substantial disorder of thought, mood, per-
19 ception, orientation or memory, which grossly impairs judgment, behavior, or
20 capacity to recognize and adapt to reality.
21 (7) "Professional mental health clinician" means an individual who holds
22 an earned master's level or higher degree in social work from an accredited
23 program; a registered nurse with an earned master's degree or higher degree in
24 nursing with a specialization in psychiatric or mental health nursing from an
25 accredited program; an individual who holds an earned master's level or higher
26 degree in psychology from an accredited program; or an individual who holds an
27 earned master's level or higher degree in counseling, marriage and family
28 therapy or other closely related degree. Additionally, professionals in each
29 category must have at least two (2) years experience in a clinical mental
30 health setting.
STATEMENT OF PURPOSE
RS 16039
Idaho Code, 66-301, concerns the hospitalization of persons
with mental illness. A problem arises under the current
statute when a gravely disabled patient (i.e., one who poses
a risk to themselves or others) refuses care or seeks to
leave the facility.
The purpose of this legislation is to clarify certain
statutory provisions and authorize hospital directors (or
their delegees) to detain a gravely disabled person for 24
hours, thereby giving the Department of Health and Welfare
an opportunity to conduct an exam and, if necessary,
initiate appropriate court proceedings. The same conditions
and limits would apply to hospitals as currently apply to
law enforcement. Accordingly, the proposed amendment would:
(1) protect gravely disabled persons, health care providers,
and the public; (2) reduce the demands on law enforcement;
and (3) retain the substantive and procedural protections
currently afforded to individuals who would otherwise be
detained by law enforcement.
FISCAL NOTE
There is no impact on the state General Fund.
CONTACTS
Name: Steven A. Millard
Idaho Hospital Association
Phone: (208) 338-5100 ext. 203
Name: Representative Kathie Garrett
Phone: 332-1000
STATEMENT OF PURPOSE / FISCAL IMPACT H 669