2006 Legislation
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HOUSE BILL NO. 669 – Mentally ill, treatment

HOUSE BILL NO. 669

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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

Bill Text


                                                                        
                                                                        
  ]]]]              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 / Fiscal Impact


                    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