THE SENATE

S.B. NO.

916

THIRTY-SECOND LEGISLATURE, 2023

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to health.

 

 

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

 


SECTION 1. Section 334-59, Hawaii Revised Statutes, is amended as follows:

1. By amending subsection (b) to read:

"(b) Emergency examination. A patient who is delivered for emergency examination and treatment to a psychiatric facility or a behavioral health crisis center shall be provided an examination, which shall include a screening to determine whether the criteria for involuntary hospitalization listed in section 334-60.2 persists, by a licensed physician, medical resident under the supervision of a licensed physician, or advanced practice registered nurse without unnecessary delay, and shall be provided such treatment as is indicated by good medical practice[.], which may include long-acting psychotropic medication. If, after the examination, screening, and treatment, the licensed physician, medical resident under the supervision of a licensed physician, or advanced practice registered nurse determines that the involuntary hospitalization criteria persist, then a psychiatrist or advanced practice registered nurse who has prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization shall further examine the patient to diagnose the presence or absence of a mental illness or substance use disorder, further assess the risk that the patient may be dangerous to self or others, and assess whether or not the patient needs to be hospitalized. The psychiatric facility or hospital where the patient is held may request the director to file a petition for an order for treatment over the patient's objection. The request for petition shall include supporting information. The director shall review such request expeditiously and if the request appears to satisfy the four factors in section 334-161, the director shall file and pursue a petition to request an order for treatment over the patient's objection as soon as possible in court or upon request by the facility or hospital convene an administrative panel pursuant to section 334-162. If it is determined that hospitalization is not needed, an examination pursuant to section 334-121.5 shall be completed."

2. By amending subsection (d) to read:

"(d) Emergency hospitalization. If the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization who performs the emergency examination has reason to believe that the patient is:

(1) Mentally ill or suffering from substance abuse;

(2) Imminently dangerous to self or others; and

(3) In need of care or treatment, or both;

the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization shall direct that the patient be hospitalized on an emergency basis or cause the patient to be transferred to another psychiatric facility for emergency hospitalization, or both. The psychiatric facility or hospital where the patient is held may seek an order to treat pursuant to section 334-162 to provide treatment as is indicated by good medical practice, which may include long-acting psychotropic medication. The patient shall have the right immediately upon admission to telephone the patient's guardian or a family member including a reciprocal beneficiary, or an adult friend and an attorney. If the patient declines to exercise that right, the staff of the facility shall inform the adult patient of the right to waive notification to the family, including a reciprocal beneficiary, and shall make reasonable efforts to ensure that the patient's guardian or family, including a reciprocal beneficiary, is notified of the emergency admission but the patient's family, including a reciprocal beneficiary, need not be notified if the patient is an adult and requests that there be no notification. The patient shall be allowed to confer with an attorney in private."

SECTION 2. Section 334-60.3, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Any person may file a petition alleging that a person located in the county meets the criteria for commitment to a psychiatric facility. The petition shall be executed subject to the penalties of perjury but need not be sworn to before a notary public. The attorney general, the attorney general's deputy, special deputy, or appointee designated to present the case shall assist the petitioner to state the substance of the petition in plain and simple language. The petition may be accompanied by a certificate of the licensed physician, advanced practice registered nurse, or psychologist who has examined the person within two days before submission of the petition, unless the person whose commitment is sought has refused to submit to medical or psychological examination, in which case the fact of refusal shall be alleged in the petition. The certificate shall set forth the signs and symptoms relied upon by the physician, advanced practice registered nurse, or psychologist to determine the person is in need of care or treatment, or both, and whether the person is capable of realizing and making a rational decision with respect to the person's need for treatment. If the petitioner believes that further evaluation is necessary before commitment, the petitioner may request such further evaluation. If the petitioner believes that treatment over objection is necessary before or during commitment, the petitioner may join in the petition for a request for treatment pursuant to section 334-161."

SECTION 3. Section 334-161, Hawaii Revised Statutes, is amended to read as follows:

"[[]334-161[]] Criteria for issuance of court or administrative order for treatment over the patient's objection. (a) 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 or hospital; is subject to a court order under section 704-406(1); is transported to a psychiatric facility pursuant to a petition for emergency admission pursuant to section 334-59(a); or is delivered to a psychiatric facility or a behavioral health crisis center for an emergency examination under section 334-59(b) may be ordered to receive treatment over the patient's objection, including the taking or application of medication, if the court, or administrative panel through the administrative authorization process established pursuant to section 334-162, finds that:

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

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

(3) The proposed treatment is medically appropriate; and

(4) After considering less intrusive alternatives, treatment is necessary to forestall the danger posed by the patient.

(b) For the purposes of this section, "imminently dangerous to self or others" means that, without intervention, the person will likely become dangerous to self or dangerous to others within the next forty-five days.

(c) A psychiatric facility or hospital may request the director to file a petition for an order for treatment over the patient's objection. The request for petition shall include supporting information. The director shall review the request expeditiously and if the request appears to satisfy the four factors in subsection (a), the director shall file and pursue a petition to request an order for treatment over the patient's objection as soon as possible in court, or upon request by the facility or hospital, convene an administrative panel pursuant to section 334-162.

(d) If the director does not file and expeditiously pursue a request made pursuant to subsection (c), the psychiatric facility or hospital may file a petition in its own name for an order for treatment over the patient's objection. The petition may be filed in court or may request the director to convene an administrative panel pursuant to section 334-162.

(e) When involuntary commitment of the person is additionally sought pursuant to section 334-60.3, the petitioner shall combine the petition for involuntary commitment with the petition for an order for treatment over the patient's objection to reduce the time the patient is involuntarily hospitalized without treatment.

(f) The court or administrative panel shall set a hearing date on a petition, and any subsequent hearing dates, as soon as possible. Unless exigent circumstances exist, the court or administrative panel shall file a final order on the petition within thirty days after the petition is filed."

SECTION 4. Section 334-162, Hawaii Revised Statutes, is amended to read as follows:

"[[]334-162[]] Criteria for administrative authorization process. (a) A patient who is in the custody of the director and in a psychiatric facility or hospital; is the subject to a court order under section 704-406(1); or is subject to a petition for involuntary hospitalization under section 334-59(d) may be ordered to receive medical treatment over the patient's objection through an administrative authorization process that includes the following due process safeguards:

(1) The [facility] director 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, exhibits, and witnesses; and

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

(b) An administrative panel shall be convened by the director as soon as possible following a request from a psychiatric facility or hospital for an administrative order to treat a patient who appears to meet the standards for an order of treatment pursuant to section 334-161(a).

[(b)] (c) The administrative process described by this section is exempt from the contested case requirements of sections 91-8.5 to 91-15.

[(c)] (d) The department may adopt rules, pursuant to chapter 91, to effectuate this part."

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

SECTION 6. This Act shall take effect upon its approval.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

DOH; Administration of Treatment Over the Patient's Objection; Emergency Examination and Hospitalization; Long-acting Psychotropic Medication; Petitions

 

Description:

Authorizes long-acting psychotropic medication to be provided to patients who are subject to emergency examination or hospitalization. Expands the administration of treatment over a patient's objection to include persons in director of health custody at any hospital, subject to an emergency examination, subject of an application for involuntary hospitalization, and subject to a court order regarding fitness to proceed for a criminal trial. Requires orders for treatment over objection proceedings to be expedited. Expands who may file a petition for an order to treat over objection under certain circumstances.

 

 

 

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