HOUSE OF REPRESENTATIVES

H.B. NO.

303

THIRTY-FIRST LEGISLATURE, 2021

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to advanced practice registered nurses.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. The legislature finds that advanced practice registered nurses provide a wide variety of health care services to people across the State. The legislature further finds that existing law requires each hospital within the State to allow advanced practice registered nurses to practice at the hospital within the full scope of their authorized practice, including practice as primary care providers. Advanced practice registered nurses are also recognized as participating primary care providers for insurance purposes under the State's insurance code. Despite these facts, certain sections of existing law fail to include advanced practice registered nurses from definitions or designations of health care entities, including the lists of those who may examine defendants with respect to physical or mental disease, disorder, or fitness to proceed under criminal proceedings, which presently only includes psychiatrists, licensed psychologists, and qualified physicians. Accordingly, the purpose of this Act is to improve patient access to medical care and services by clarifying the circumstances under which advanced practice registered nurses may practice to the fullest extent of their training and education to authorize advanced practice registered nurses to participate in the fitness to proceed process.

SECTION 2. Chapter 704, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"704-   Definitions of terms in this chapter. In this chapter, unless a different meaning is plainly required:

"Advanced practice registered nurse" means an advanced practice registered nurse with prescriptive authority licensed pursuant to section 457-8.6 and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization.

"Licensed psychologist" means an individual authorized to practice psychology under chapter 465 and includes psychologists exempted from licensure by section 465-3(a)(3).

"Qualified advanced practice registered nurse" means a person licensed pursuant to chapter 457 and qualified by the court for the specific evaluation ordered.

"Qualified physician" means a person licensed to practice medicine under chapter 453 who is qualified by the court for the specific evaluation ordered."

SECTION 3. Section 704-404, Hawaii Revised Statutes, is amended by amending subsection (2) to read as follows:

"(2) Upon suspension of further proceedings in the prosecution, the court shall appoint three qualified examiners in felony cases, and one qualified examiner in nonfelony cases, to examine and report upon the defendant's fitness to proceed. In felony cases, the court shall appoint as examiners at least one psychiatrist or advanced practice registered nurse and at least one licensed psychologist. The third examiner may be a psychiatrist, licensed psychologist, advanced practice registered nurse, or qualified physician. One of the three examiners shall be a psychiatrist or licensed psychologist designated by the director of health from within the department of health. In nonfelony cases, the court may appoint as examiners either a psychiatrist, advanced practice registered nurse, or a licensed psychologist. All examiners shall be appointed from a list of certified examiners as determined by the department of health. The court, in appropriate circumstances, may appoint an additional examiner or examiners. The examination may be conducted while the defendant is in custody or on release or, in the court's discretion, when necessary the court may order the defendant to be committed to a hospital or other suitable facility for the purpose of the examination for a period not exceeding thirty days, or a longer period as the court determines to be necessary for the purpose. The court may direct that one or more qualified physicians, advanced practice registered nurses, or psychologists retained by the defendant be permitted to witness the examination. [As used in this section, the term "licensed psychologist" includes psychologists exempted from licensure by section 465-3(a)(3) and "qualified physician" means a physician qualified by the court for the specific evaluation ordered.]"

SECTION 4. Section 704-406, Hawaii Revised Statutes, is amended by amending subsection (3) to read as follows:

"(3) When the court, on its own motion or upon the application of the director of health, the prosecuting attorney, or the defendant, has reason to believe that the defendant has regained fitness to proceed, for a defendant charged with the offense of murder in the first or second degree, attempted murder in the first or second degree, or a class A felony, the court shall appoint three qualified examiners and may appoint in all other cases one qualified examiner, to examine and report upon the physical and mental condition of the defendant. In cases in which the defendant has been charged with murder in the first or second degree, attempted murder in the first or second degree, or a class A felony, the court shall appoint as examiners at least one psychiatrist and at least one licensed psychologist. The third examiner may be a psychiatrist, licensed psychologist, advanced practice registered nurse, [or] qualified physician[.], or qualified advanced practice registered nurse. One of the three examiners shall be a psychiatrist or licensed psychologist designated by the director of health from within the department of health. In all other cases, the one qualified examiner shall be a psychiatrist or licensed psychologist designated by the director of health from within the department of health. The court, in appropriate circumstances, may appoint an additional examiner or examiners. All examiners shall be appointed from a list of certified examiners as determined by the department of health. After a hearing, if a hearing is requested, if the court determines that the defendant has regained fitness to proceed, the penal proceeding shall be resumed and the defendant shall no longer be committed to the custody of the director of health. In cases where a defendant is charged with the offense of murder in the first or second degree, attempted murder in the first or second degree, or a class A felony, upon the request of the prosecuting attorney or the defendant, and in consideration of information provided by the defendant's clinical team, the court may order that the defendant remain in the custody of the director of health, for good cause shown, subject to bail or until a judgment on the verdict or a finding of guilt after a plea of guilty or nolo contendere. Thereafter, the court may consider a request from the director of health to rescind its order maintaining the defendant in the director's custody, for good cause shown. [As used in this section, the term "qualified physician" means a physician qualified by the court for the specific evaluation ordered.] If, however, the court is of the view that so much time has elapsed since the commitment or release on conditions of the defendant that it would be unjust to resume the proceeding, the court may dismiss the charge and:

(a) Order the defendant to be discharged;

(b) Subject to section 334-60.2 regarding involuntary hospitalization criteria, order the defendant to be committed to the custody of the director of health to be placed in an appropriate institution for detention, care, and treatment; or

(c) Subject to section 334-121 regarding assisted community treatment criteria, order the defendant to be released on conditions the court determines necessary."

SECTION 5. Section 704-407.5, Hawaii Revised Statutes, is amended by amending subsection (2) to read as follows:

"(2) The court shall appoint three qualified examiners in felony cases and one qualified examiner in nonfelony cases to examine and report upon the physical or mental disease, disorder, or defect of the defendant at the time of the conduct. In felony cases, the court shall appoint at least one psychiatrist or advanced practice registered nurse and at least one licensed psychologist. The third examiner may be a psychiatrist, licensed psychologist, qualified advanced practice registered nurse, or qualified physician. One of the three examiners shall be a psychiatrist, advanced practice registered nurse, or licensed psychologist designated by the director of health from within the department of health. In nonfelony cases, the court may appoint as examiners either a psychiatrist, advanced practice registered nurse, or a licensed psychologist. All examiners shall be appointed from a list of certified examiners as determined by the department of health. The court, in appropriate circumstances, may appoint an additional examiner or examiners. The court may direct that one or more qualified advanced practice registered nurses, qualified physicians, or psychologists retained by the defendant be permitted to witness the examination. [As used in this section, the term "licensed psychologist" includes psychologists exempted from licensure by section 465-3(a)(3) and "qualified physician" means a physician qualified by the court for the specific evaluation ordered.]"

SECTION 6. Section 704-409, Hawaii Revised Statutes, is amended to read as follows:

"704-409 Access to defendant by examiners of defendant's choice. When, notwithstanding the report filed pursuant to section 704-404, the defendant wishes to be examined by one or more qualified physicians, advanced practice registered nurses, qualified advanced practice registered nurses, or other experts of the defendant's own choice, such examiner or examiners shall be permitted to have reasonable access to the defendant for the purposes of such examination."

SECTION 7. Section 704-410, Hawaii Revised Statutes, is amended by amending subsection (1) to read as follows:

"(1) At the hearing pursuant to section 704-405 or upon the trial, the examiners who reported pursuant to section 704-404 may be called as witnesses by the prosecution, the defendant, or the court. If the issue is being tried before a jury, the jury may be informed that the examiners or any of them were designated by the court or by the director of health at the request of the court, as the case may be. If called by the court, the witness shall be subject to cross-examination by the prosecution and the defendant. Both the prosecution and the defendant may summon any other qualified physician, advanced practice registered nurse, qualified advanced practice registered nurse, or licensed psychologist or other expert to testify, but no one who has not examined the defendant shall be competent to testify to an expert opinion with respect to the physical or mental condition of the defendant, as distinguished from the validity of the procedure followed by, or the general scientific propositions stated by, another witness."

SECTION 8. Section 704-411, Hawaii Revised Statutes, is amended by amending subsection (3) to read as follows:

"(3) When ordering a hearing pursuant to subsection (2):

(a) In nonfelony cases, the court shall appoint a qualified examiner to examine and report upon the physical and mental condition of the defendant. The court may appoint either a psychiatrist or a licensed psychologist. The examiner may be designated by the director of health from within the department of health. The examiner shall be appointed from a list of certified examiners as determined by the department of health. The court, in appropriate circumstances, may appoint an additional examiner or examiners; and

(b) In felony cases, the court shall appoint three qualified examiners to examine and report upon the physical and mental condition of the defendant. In each case, the court shall appoint at least one psychiatrist and at least one licensed psychologist. The third member may be a psychiatrist, a licensed psychologist, advanced practice registered nurse, qualified advanced practice registered nurse, or a qualified physician. One of the three shall be a psychiatrist, advanced practice registered nurse, or licensed psychologist designated by the director of health from within the department of health. The three examiners shall be appointed from a list of certified examiners as determined by the department of health.

To facilitate the examination and the proceedings thereon, the court may cause the defendant, if not then confined, to be committed to a hospital or other suitable facility for the purpose of examination for a period not exceeding thirty days or a longer period as the court determines to be necessary for the purpose upon written findings for good cause shown. The court may direct that advanced practice registered nurses, qualified advanced practice registered nurses, qualified physicians, or psychologists retained by the defendant be permitted to witness the examination. The examination and report and the compensation of persons making or assisting in the examination shall be in accordance with section 704-404(3), (5)(a) and (b), (7), (8), (9), (10), and (11). [As used in this section, the term "licensed psychologist" includes psychologists exempted from licensure by section 465‑3(a)(3) and "qualified physician" means a physician qualified by the court for the specific evaluation ordered.]"

SECTION 9. Section 704-413, Hawaii Revised Statutes, is amended by amending subsection (3) to read as follows:

"(3) Any person granted conditional release pursuant to this chapter may apply to the court ordering the conditional release for discharge from, or modification of, the order granting conditional release on the ground that the person is no longer affected by a physical or mental disease, disorder, or defect and may be discharged, or the order may be modified, without danger to the person or to others. The application shall be accompanied by a letter from or supporting affidavit of a qualified physician, advanced practice registered nurse, qualified advanced practice registered nurse, or licensed psychologist. A copy of the application and letter or affidavit shall be transmitted to the prosecuting attorney of the circuit from which the order issued and to any persons supervising the release, and the hearing on the application shall be held following notice to such persons. If the court denies the application, the person shall not be permitted to file another application for either discharge or modification of conditional release until one year after the date of the denial."

SECTION 10. Section 704-414, Hawaii Revised Statutes, is amended by amending subsection (1) to read as follows:

"(1) Upon filing of an application pursuant to section 704-412 for discharge or conditional release, or upon the filing of an application pursuant to section 704-413 for discharge, the court shall appoint three qualified examiners in felony cases, and one qualified examiner in nonfelony cases, to examine and report upon the physical and mental condition of the defendant. In felony cases, the court shall appoint at least one psychiatrist or advanced practice registered nurse and at least one licensed psychologist. The third member may be a psychiatrist, a licensed psychologist, advanced practice registered nurse, qualified advanced practice registered nurse, or a qualified physician. One of the three shall be a psychiatrist, advanced practice registered nurse, or licensed psychologist designated by the director of health from within the department of health. The examiners shall be appointed from a list of certified examiners as determined by the department of health. To facilitate the examination and the proceedings thereon, the court may cause the defendant, if not then confined, to be committed to a hospital or other suitable facility for the purpose of the examination and may direct that advanced practice registered nurses, qualified advanced practice registered nurses, qualified physicians, or psychologists retained by the defendant be permitted to witness the examination. The examination and report and the compensation of persons making or assisting in the examination shall be in accordance with section 704-404(3), (5)(a) and (b), (7), (8), (9), (10), and (11). [As used in this section, the term "licensed psychologist" includes psychologists exempted from licensure by section 465-3(a)(3) and "qualified physician" means a physician qualified by the court for the specific evaluation ordered.]"

SECTION 11. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 12. This Act shall take effect upon its approval.

 

INTRODUCED BY:

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Report Title:

Advanced Practice Registered Nurses; Fitness to Proceed; Examinations

 

Description:

Amends provisions concerning fitness to proceed examinations in criminal proceedings to include qualified advanced practice registered nurses or advanced practice registered nurses with prescriptive authority who hold an accredited national certification in an advanced practice registered nurse psychiatric specialization.

 

 

 

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