S.B. NO.



S.D. 2
















SECTION 1. The legislature finds that the initiation of treatment for patients admitted to the Hawaii state hospital needs to be expedient in order to address patients' medical symptoms and protect the safety of the patient and others. The legislature further finds that the Hawaii state hospital is utilized primarily for forensic commitments, and that addressing patients' medical symptoms quickly at the initiation of treatment will help maintain a safe and secure therapeutic environment for patients and staff as well as have a positive impact on patients' length of stay.

The legislature notes that the current method to obtain an authorization to provide treatment over a patient's objection is by a judicial hearing. Although unpredictable, on average the time between petition and judicial hearing is nearly seventeen days. Other states have responded to such unpredictability and delay by developing a non-judicial, administrative mechanism to review and authorize requests for treatment over a patient's objection.

The purpose of this Act is to permit an administrative order to overcome a patient's objection to medical treatment, establish criteria for issuance of the administrative order, and establish criteria for an administrative authorization process to determine whether the administrative order should be issued.

SECTION 2. Chapter 334, Hawaii Revised Statutes, is amended by adding a new part to be appropriately designated and to read as follows:

"Part    . Administration of treatment over objection

334-A Criteria for medical treatment over objection. A patient who has been committed to a psychiatric facility for involuntary hospitalization or who is in the custody of the director and residing in a psychiatric facility may be ordered to receive treatment over the patient's objection, including the taking or application of medication, if the court or an administrative panel, by means of the administrative authorization process established pursuant to section 334-B, finds that:

(1) The patient suffers from a physical or mental disease, disorder, or defect;

(2) The patient is dangerous to self or others;

(3) The proposed treatment is medically appropriate; and

(4) After considering less intrusive alternative treatments for the patient's condition, the proposed treatment is essential to forestall the danger posed by the patient's condition.

334-B Criteria for administrative authorization process. (a) A patient who is in the administrative custody of the director in a psychiatric facility may be ordered to receive medical treatment over objection through an administrative process that includes the following due process safeguards:

(1) The facility shall give notice to the patient of the authorization process and the reasons for initiating the process;

(2) The administrative panel shall consist of three members with relevant clinical training and experience, and who are not involved with the current treatment of the patient;

(3) The patient shall have the right to attend the hearing, receive assistance from an advisor, cross-examine witnesses, and present testimony and the patient's own witnesses;

(4) The patient shall have the right to appeal the decision of the administrative panel; and

(5) The panel shall issue a finding that, if left untreated, the patient's illness would likely result in negative effects on the health of the patient, and that lack of treatment alone cannot satisfy the requirement in section 334-A that the patient is dangerous to self or others.

(b) Determinations made under the administrative process specified in this section shall not be subject to contested case proceedings under chapter 91.

(c) The department may adopt rules, pursuant to chapter 91, consistent with this part to effectuate this part."

SECTION 3. Section 334E-2, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Any patient in a psychiatric facility shall be afforded rights; and any psychiatric facility shall provide the rights to all patients; provided that when a patient is not able to exercise the patient's rights, the patient's legal guardian or legal representative shall have the authority to exercise the same on behalf of the patient. The rights shall include[,] but not be limited to[,] the following:

(1) Access to written rules and regulations with which the patient is expected to comply;

(2) Access to the facility's grievance procedure or to the department of health as provided in section 334-3;

(3) Freedom from reprisal;

(4) Privacy, respect, and personal dignity;

(5) A humane environment;

(6) Freedom from discriminatory treatment based on race, color, creed, national origin, age, and sex;

(7) A written treatment plan based on the individual patient;

(8) Participation in the planning of the patient's treatment plan;

(9) Refusal of treatment except in emergency situations or where a court order or administrative order issued pursuant to section 334-A exists;

(10) Refusal to participate in experimentation;

(11) The choice of physician if the physician chosen agrees;

(12) A qualified, competent staff;

(13) A medical examination before initiation of non-emergency treatment;

(14) Confidentiality of the patient's records;

(15) Access to the patient's records;

(16) Knowledge of rights withheld or removed by a court or by law;

(17) Physical exercise and recreation;

(18) Adequate diet;

(19) Knowledge of the names and titles of staff members with whom the patient has frequent contact;

(20) The right to work at the facility and fair compensation for work done; provided that work is available and is part of the patient's treatment plan;

(21) Visitation rights, unless the patient poses a danger to self or others; provided that where visitation is prohibited, the legal guardian or legal representative shall be allowed to visit the patient upon request;

(22) Uncensored communication;

(23) Notice of and reasons for an impending transfer;

(24) Freedom from seclusion or restraint, except:

(A) When necessary to prevent injury to self or others; [or]

(B) When part of the treatment plan; or

(C) When necessary to preserve the rights of other patients or staff;

(25) Disclosure to a court, at an involuntary civil commitment hearing, of all treatment procedures, which have been administered prior to the hearing; and

(26) Receipt by the patient and the patient's guardian or legal guardian, if the patient has one, of this enunciation of rights at the time of admission."

SECTION 4. In codifying the new sections added by section 2 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 6. This Act shall take effect on July 1, 2050.


Report Title:

Medical Treatment; Treatment Over Objection; Administrative Authorization Process; Administrative Orders



Permits an administrative order to overcome a patient's objection to medical treatment. Establishes criteria for medical treatment over objection and the administrative authorization process for administratively ordering medical treatment over objection. Effective 7/1/2050. (SD2)




The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.