Involuntary hospitalization and treatment.

WORKING DRAFT
2014
STATE OF
WYOMING
14LSO-0075

SENATE FILE
NO.
SF0040

Involuntary hospitalization
and treatment
.

Sponsored by:
Joint Judiciary Interim Committee

A BILL

f
or

AN ACT relating to hospitalization
and treatment
of mentally ill
persons
; modifying procedures for involuntary hospitalization; providing for
involuntary
outpatient treatment;
providing for and
modifying definitions; amending provisions relating to representation by the state
and county
; amending provisions relating to payment by the county and by the state;
repealing provisions;
and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1.

W.S. 25
‑
10
‑
101(a)
by creating a new paragraph
(i)
, by creating a new paragraph (iii), by
amending and
renumbering (i) as (v), by creating new
paragraphs (vi) and (vii), by renumbering (iii) as (ix), by creating new paragraphs (x) through (xiv), by renumbering paragraphs (v) and (vi) as (xv) and (xvi), by creating a new paragraph (xvii), by renumbering (vii) as (xviii), by amending and renumbering (ix) and (x) as (xix) and (xx), by creating a new paragraph (xxi), by renumbering (xi)
and (xv)
as (xxii)
and
(xxiii), by creating a new paragraph (xxiv), by renumbering (xii) as (xxv), by amending and renumbering (xiii) as (xxvi), by creating a new paragraph (xxvii) and by amending and renumbering (xiv) as (xxviii)
,
25
‑
10
‑
103, 25
‑
10
‑
104
(a)(intro),
(i) through (iv), (vi) and (vii), 25
‑
10
‑
105(a)(i) and (ii), 25
‑
10
‑
106(b)
(i)
,
(ii)
and by creating a new subsection (c)
, 25
‑
10
‑
109(a)
, (b)(intro), (c)
through (j), 25
‑
10
‑
110(a)
, (b),
(d)
(intro), (ii), (iv) through (vi)
, (g)
, (h),

(j)
(intro), (i)(intro), (A), (ii), by creating a new paragraph (iv), (k) and (n)
,

25
‑
10
‑
112(a)(intro), (i), (ii), (b), (c)(intro), (d)(intro) and (e), 25
‑
10
‑
116(a), (b) and by creating a new subsection (d), 25
‑
10
‑
122(a)(intro), (ii) and (b), 25
‑
10
‑
125,
25
‑
10
‑
127
by creating a new subsection (a) and by amending and renumbering (a) and (d) as (d) and (e)
and 42
‑
4
‑
103(a)(xvi) are amended to read:

25
‑
10
‑
101.

Definitions.

(a)

As used in this act:

(
i
)

"
Certifier" means
a law enforcement officer or a licensed
:

(A)

P
sychiatrist or p
hysician
;

(
B)

P
sychologist
;

(C)

P
rofessional couns
elor,
addictions therapist,
c
linical social
worker or
marriage
and
family therapist;

(D)

P
hysician's assistant;

(E)

Advanced
practice registered nurse
with
a clinical specialty in psychiatric and mental health nursing working in collaboration with a licensed physician
; or

(F)

Nurse practitioner
.

(i
i
i)

"County attorney" means the county attorney or the
county and prosecuting attorney
;

(i)
(
v
)

"Court" means the district court

which ordered detention or hospitalization of the person pursuant to this act, or the district court in the county where the person resides, is found or is hospitalized

of the county in which
an
application for involuntary hospitalization or involuntary
outpatient
treatment is filed
;

(v
i
)

"Danger to himself" means that a person, as evidenced by his
current or past behavior
,

is likely
i
n the reasonably foreseeable future
:

(A)

To
attempt suicide
or
to inflict
serious
bodily harm on himself
;
or

(B)

T
o
suffer serious physical harm as a result of his actions or inaction.

(v
ii
)

"Danger to others" means that a person, as evidenced by his
current or past
behavior,
is likely
in the reasonably foreseeable future, to cause or attempt to cause harm to another. Evidence that a person is a danger to others may include, but is not limited to:

(A)

That he has inflicted, attempted or threatened in an objectively serious manner to inflict bodily harm on another;

(B)

That
he has presented a danger to another person
by his actions or inaction
; or

(C)

That he has recently and intentionally caused significant damage to the substantial property of others.

(iii)
(
ix
)

"Department" means
the state department of health;

(x)

"
Designated h
ospital" means a
hospital
designated pursuant to W.S. 25
‑
10
‑
104;

(x
i
)

"Emergency detention
certification
"
means a form provided by the
d
epartment
used to certify
the
need
for emergency detention of a
patient
;

(xii)

"Emergency medical facility" means an emergency unit of a hospital as defined in paragraph (xvi) of this subsection or an emergency unit of a hospital as defined in W.S. 35
‑
2
‑
901;

(xi
i
i
)

"
Evaluator" means a
person who is employed by a
treatment facility
or
who has a
contract with the department
to conduct evaluations and who is a licensed
:

(A)

Psychiatrist or p
hysician
;

(B)

P
sychologist
;

(C)

P
rofessional couns
elor,
addictions therapist,
c
linical social
worker or marriage and family therapist;

(D)

P
hysician's assistant;

(E)

Advanced
practice registered nurse
with
a clinical specialty in psychiatric and mental health nursing working in collaboration with a licensed physician
;

(F)

Nurse practitioner
.

(
xiv
)

"Gravely disabled" means
:

(A)

A person h
as a
substantial disorder of thought
, mood, perception, orientation
or memory
;

(B)

The disorder
grossly impairs
the person's
judgment, behavior
, capacity to recognize reality
or ability to me
et the ordinary demands of life
;
and

(C)

T
he disorder has
contributed to beha
vior
that
indicates
the person is unlikely

to
satisfy his need for
nourishment,
essential

personal

or

medical care, shelter
, self-protection
or safety
. No person

shall be deemed unable to satisfy his need for
nourishment,
essential
personal
or
medical care, shelter
, self-protection
or safety
if he is willing and able to meet those needs with the supervision and assistance of others who are willing and available to assist him.

(v)
(
xv
)

"Head of hospital" means the individual in charge of a hospital or his designee. When this act requires or authorizes the head of a hospital to perform an act which involves the practice of medicine, the act shall be performed by a physician;

(vi)
(x
v
i
)

"Hospital" means a
facility

designated pursuant to W.S. 25
‑
10
‑
104
or the state hospital;

(xvi
i
)

"Medically cleared" means
a physician
or his designee
has examined the patient and the physician has determined the patient:

(A)

Does not need emergency
medical
treatment
; and

(B)

Is not
actively intoxicated by
a substance
or drug
.

"Actively intoxicated" means the
intoxication
i
s causing symptoms of mental illness

and
i
s causing the patient to be a danger to himself or others.

(vii)
(xv
ii
i
)

"Mental health center" means a community human services program for the prevention, treatment and amelioration of mental illness under W.S. 35
‑
1
‑
611 through 35
‑
1
‑
627 or an equivalently staffed and equipped student health service;

(ix)
(x
i
x
)

"Mental illness"
and "mentally ill"

mean
:

a physical, emotional, mental or behavioral disorder which causes a person to be dangerous to himself or others and which requires treatment, but

(A)

A person has a
substantial disorder of thought
, mood, perception, orientation
or memory
;

(B)

The disorder
grossly impairs
the person's
judgment, behavior
, capacity to recognize reality
or ability to me
et the ordinary demands of life; and

(C)

Because of the disorder, the person is:

(I)

A danger to himself or others; or

(II)

G
ravely disabled.

(
D)

"
Mental illness" and "mentally ill"
d
o not include addiction to drugs or alcohol, drug or alcohol intoxication or developmental disabilities, except when one (1) or more of those conditions co-occurs as a secondary diagnosis with a mental illness
.
;

(x)
(
x
x
)

"Patient" means
an individual receiving treatment
a
person admitted to a hospital under W.S. 25
‑
10
‑
106
or
a
person who is detained

pursuant
to this act;

(xx
i
)

"Person
responsible for the care
and
custody of the
patient" means a parent, step
-parent, guardian, relative, friend or other person who has provided for the patient's basic personal needs for food, clothing or shelter
;

(xi)
(x
x
ii
)

"Physician" means an individual licensed under the laws of this state to practice medicine, or a physician in the service of the United States government while in this state in the performance of his official duties;

(xv)
(xx
i
ii
)

"Resident" means a United States citizen who has been a resident of and domiciled in Wyoming for not less than ninety (90) days and who has not claimed residency elsewhere for the purpose of obtaining medical or psychiatric services during that ninety (90) day period immediately preceding the date when services under this act were sought or imposed. "Resident" also includes any alien who has resided continuously in Wyoming for at least ninety (90) days immediately prior to the date when services under this act were sought or imposed. "Resident" also includes any active duty member, the spouse or minor child of any active duty member of the armed forces of the United States who is stationed in Wyoming
;

(xx
i
v
)

"
Rule" means a
rule promulgated by the department pursuant to this act;

(xii)
(xx
v
)

"State hospital" means the Wyoming state hospital at Evanston, Wyoming;

(xiii)
(xx
v
i
)

"Treatment" means

diagnosis, evaluation,
care and

intervention
.
,

which

Treatment

may include psychiatric medication, individual and group mental health counseling
,
illness management diversion services
such as immediate linkages to mental health services in the community and discharge planning. T
reatment shall begin at the time of detention, if the person knowingly and voluntarily consents, and shall continue throughout involuntary hospitalization. Treatment may be given without the consent of the detained person or his parent or guardian when treatment is limited to diagnosis or evaluation or when treatment is necessary to prevent immediate and serious physical harm to the person or others
and discharge planning
.
T
reatment may be inpatient or outpatient. Outpatient treatment may include
mental health services in the community
,
housing
, residential treatment, crisis stabilization
and
related support
.

"Treatment" does not include observation or supervision;

(xx
v
ii
)

"T
reatment facility"
means a community mental health center under contract with the department to provide outpatient treatment
;

(xiv)
(xxv
i
ii
)

"This act" means W.S. 25
‑
10
‑
101 through
25
‑
10
‑
305
;

25
‑
10
‑
127.

25
‑
10
‑
103.

Admission
and treatment
of persons with mental illness.

Subject to the rules and regulations of the
hospital

department
, the
head of
a hospital

or
a
treatment facility
may admit
persons

and
treat patients
who have symptoms of mental illness pursuant to
W.S. 25
‑
10
‑
106, 25
‑
10
‑
109 or 25
‑
10
‑
110

this act
.

25
‑
10
‑
104.

Duties of department of health as to
treatment facilities and

designated
hospitals
.

(a)

The department, with respect to designated hospitals
or o
ther licensed

and

treatment facilities
other than the state hospital,
shall:

(i)

Adopt standards for the
designation of
hospitals
or
other li
censed
and

treatment facilities as qualified to accept patients
and
provide treatment under this act;

(ii)

Designate hospitals
or o
ther l
icensed

and

treatment facilities which qualify under the standards adopted pursuant to paragraph (i) of this subsection
. The designated hospitals and
treatment facilities shall be posted on the department's website
;

(iii)

Enter into contracts with designated hospitals
or other

licensed
and

treatment facilities for the inpatient
and outpatient

treatment of
persons
patients
with mental illness
,

and
for

other
services incident to
the hospitalization

and treatment
of patients. Designated hospitals
or other
licensed

treatment facilities

having a contract with the department
and treatment facilities

shall
treat and

receive
individuals detained

patients
under
W.S. 25
‑
10
‑
109

this act
;

(iv)

Require reports from designated hospitals
and other
licensed

and

treatment facilities concerning the services rendered to patients under the provisions of this act;

(vi)

Investigate complaints made by or on behalf of patients
with mental illness

under this act
; and

(vii)

Promulgate rules and regulations
, including rules regarding reimbursement under W.S. 25
‑
10
‑
112

necessary to implement this act
.

25
‑
10
‑
105.

Duties of department of health as to state hospital.

(a)

The department shall:

(i)

Adopt standards governing the state hospital;

and

(ii)

Visit the state hospital to review methods of treatment of patients
.
; and

25
‑
10
‑
106.

Voluntary applications for admission.

(b)

A person who has symptoms of mental illness but because of minority or incompetency is not capable of making a responsible, voluntary application for admission may be admitted for treatment upon application by a parent or guardian if the application:

(i)

Is accompanied by a statement of an
examiner

evaluator

that the person is mentally ill; and

(ii)

An
examiner

at the hospital
evaluator
,

based on a personal interview, determines that the person is mentally ill.

(c)

N
otwithstanding an
y
other provision of this act, n
either the department nor any county
shall
be
liable
under this act
for costs associated with evaluation or treatment of a person voluntarily
admitted under this section.

25
‑
10
‑
109.

Emergency detention; evaluation; treatment.

(a)

When
a
law enforcement officer or examiner

certifier

has reasonable cause to believe a
person
is mentally ill
pursuant to

as defined by

W.S. 25
‑
10
‑
101, the
certifier
may detain the

person
may be detained

by completing an emergency detention
certification
.

(b)

I
mmediately after detaining the person
,

the o
fficer shall c
ontact an
examiner

T
he patient shall be examined by a physician or his designee
immediately after he is detained
.
If the patient was not detained at a
n

emergency medical
facility
, the certifier

shall

facilitate the transfer
of the patient

to
a
n

emergency medical
facility
for a
medical examination
.
O
nce the patient has been medically cleared by
a
physician, the physician shall

notify the evaluator
.

A preliminary
examination

evaluation
of the
person
patient

shall be conducted by an
examiner

evaluator
within
twenty
‑
four
(24)

four (4)
hours after
the

detention.

If
a preliminary examination

is not conducted withi
n twenty
‑
fou
r (24) hours

the detained person shall be released. If
the examiner

giving the preliminary
examination

patient has been medically cleared
.
If the evaluator finds that the
patient
is
mentally
ill,
the patient shall remain detained
.
A
patient
who remains detained

shall be transferred as soon as possible to
the nearest
h
ospital

with

capacity to treat
the patient
.

The
patient
shall be released if an evaluation is not timely conducted or if the
evaluator
finds that the
person
:

patient
is not
mentally
ill.

(c)

No person
A
second evaluation
of the
patient

shall be
detained for more than seventy-two (72) hours, excluding Saturdays, Sundays and legal holidays, without a hearing under subsections
(h) through (k) of this section

conducted by an evaluator
no less than
twenty
-
four (24) hours
and no more than thirty-six (36) hours
after the
first
evaluation
.
If the evaluator finds that the
patient
is
mentally
ill, the
patient
shall remain detained.
The
patient
shall be released if an evaluation is not timely conducted or if the
evaluator finds that the patient
is
not mentally
ill.

(d)

A
person
taken into custody under this section

may be detained in a hospital or other suitable facility which is appropriate under the circumstances.
The
person
patient
shall not be detained in a nonmedical facility used for detention of persons charged with or convicted of penal offenses except in
cases of

extreme emergency
.

or if there are no other reasonable alternatives
. The law enforcement officer who detained the person shall immediately notify the person responsible for the care and custody of the detained person, if known, of the time and place of detention.

(e)

The
law enforcement officer or examiner

who initially detained the person

certifier
shall make a written statement of the facts of the emergency detention. A copy of the statement shall be given to the
detained person

county attorney,
the
p
atient
,
the
person
responsible for the care and custody of the
patient
, if known
,

the department
and to any subsequent
examiner

evaluator
.

(f)

When
a
person
patient

is detained under
emergency circumstances

this section
, treatment may be given during the emergency detention period if the
person

patient
voluntarily and knowingly consents. The parent or guardian of a minor or incompetent
person
patient

may consent to treatment. If the parent or guardian of a minor patient does not consent to treatment, a petition may be filed under the Child Protection Act. Treatment may be given without the consent of the
detained person

patient
or his parent or guardian when treatment is limited to diagnosis or evaluation or when treatment is necessary to prevent immediate and serious physical harm to the
person
patient
or others. Prior to treatment, the
person
patient

shall be fully advised of the scope of treatment, and a report of the treatment shall be filed with the court if
involuntary hospitalization
proceedings are commenced

under W.S. 25
‑
10
‑
110
. An
examiner

or a physician

evaluator or provider

who provides treatment in good faith pursuant to this subsection shall be immune from civil liability for the treatment except there shall be no immunity from liability for negligent acts or deliberate misconduct.

(g)

At the time of emergency detention the
person
patient

shall be informed orally and in writing of his right to contact his family and an attorney, of his right to appointed counsel if he is indigent, of his right to remain silent and that his statements may be used as a basis for involuntary hospitalization
or involuntary
outpatient
treatment
.

(h)

When

a
person

is
If a patient

detained in emergency detention
and
i
s not released after the
first
evaluation
or second
evaluation
, the county
attorney may
file

an application for involuntary hospitalization
is filed
,
t
he court shall appoint an attorney to represent the detained person unless he has his own attorney, and the court shall
conduct a hearing within seventy-two (72) hours, excluding Saturdays, Sundays and legal holidays, of the initial detention

to determine whether continued detention is required pending
involuntary hospitalization proceedings. Notice of the preliminary hearing shall be given to the detained person and his attorney. The court may delay the hearing only at the request of the detained person or his parent, guardian or his attorney. An emergency detention hearing may be waived at the request of the detained person or the detained person's attorney, except in cases where a licensed physician's assistant was the only
examiner

for the emergency detention. If an emergency detention hearing has been waived, the court may immediately conduct the involuntary hospitalization hearing, provided that a licensed physician's assistant shall not be the e
xaminer

for an involuntary hospitalization hearing

or involuntary outpatient treatment under W.S. 25
‑
10
‑
110
.

(j)

At the hearing the court shall advise
If the evaluator finds that
t
he
detained person

and his parent, guardian
or attorney of the contents of the written statement of emergency detention required in subsection (e) of this section and the application f
or involuntary hospitalization
patient is
mental
ly
ill, the patient
or the person responsible for his care
and
custody and the county attorney may agree to a
voluntary
outpatient treatment plan if the evaluator finds that the
patient

is likely to follow a

voluntary treatment plan and will not likely harm himself or others while subject to the plan
.
Treatment under this subsection shall be subject to the following:

(i)

The treatment plan shall be prepared by the evaluator.
In preparing the plan, t
he evaluator shall consult the treating providers
,
the patient
and

the
person
responsible for the care and custody of the
patient
, if known;

(ii)

Th
e treatment plan shall set forth the period of treatment. The plan may require periodic reporting, continuation of medication and submission to testing and restriction of travel, consumption of alcoholic beverages or drugs, associations with other persons
or other reasonable conditions;

(iii
)

Treatment shall be
provided by a treatment facility
if public funds are paid for treatment
;

(iv)

The

treatment facility
or treatment provider
shall immediately report to the
county attorney
any material noncompliance by the patient with
the
treatment
plan;

(v
)

If the p
atient
fails to comply with the conditions or complete the treatment plan, the county attorney may file an application for
involuntary hospitalization or involuntary
outpatient
treatment under
W.S.
25-10-110
.

25
‑
10
‑
110.

Involuntary hospitalization
or involuntary o
utpatient treatment proceedings.

(a)

P
roceedings for
the
involuntary hospitalization

of a person

or
involuntary
outpatient treatment

may

be commenced

by the filing of a written application with the court
by the county attorney

in the county in which the
person

patient
is initially detained
. Proceedings may also be initiated

or

in the county
in which
there is a
designated

hospital

if there is a written agreement executed by the county in which the person resides and the designated hospital stating that the county in which the person

resides will be responsible for costs of treatment under W.S. 25
‑
10
‑
112(e) that are not covered by the state

or treatment facility
.
The county attorney shall
appear o
n behalf of the state
. The p
roceedings shall be commenced
by filing a written application with the court

captioned
"In the Interest of ...".
The
application shall be accompanied by either:

(i)

A
certificate

statement

of
an
examiner stating

evaluator setting
forth
:

(A)

That he has
examined the p
roposed

evaluated the

patient
,

not more than fifteen (15) days prior to the date that the application was filed under this subsection
reviewed the patient's
medical and treatment
records and consulted with the treating p
roviders where the patient
is detained
;

(B)

His findings and the
proposed

patient's history; and

(C)

His opinion that the
proposed
patient is mentally ill; or

(ii)

A written statement by the
applicant and by an examine
r

evaluator
that the
proposed
patient has refused to submit to
examination

by an examiner

an evaluation
,
together with a statement of the facts and circumstan
ces supporting the application.

(b)

E
xcept as provided in subsection (g) of this section, t
he court shall conduct a hearing within
ninety-six
(
96
) hours, excluding Saturdays, Sundays and legal holidays, of the
initial detention
under W.S. 25
‑
10
‑
109
(a)
.

Unless the
proposed
patient is represented by counsel, the court shall appoint an attorney to represent him.

(d
)

Upon
receipt of an

filing the
application, the
court

county attorney
shall
issue
serve

notice thereof to the
proposed
patient, the person responsible for the care
or

and
custody of the
proposed
patient
,
if known,
the department
and other persons designated by the court. The notice shall be served as provided by the Wyoming Rules of Civil Procedure. The notice shall apprise the
proposed
patient:

(ii)

Of the identity of the appointed
examiner
, and his authority to conduct an examination

evaluator
;

(iv)

Of the requirements for an
That the court may order

involuntary hospitalization

order

or involuntary outpatient treatment

under
subsection (j) of

this section;

(v)

Of the basis for the
proposed
hospitalization
or involuntary outpatient treatment
, including a detailed statement of the facts and supporting testimony; and

(vi)

That a

The time and date of the
hearing
.

will be held if warranted by the report of the exami
nation of the proposed patient.

(g
)

Within
five (5) days

twenty-four (24) hours
of receipt of the notice of hearing, the
proposed

patient or his counsel may request a hearing before a jury.
The
hearing
shall begin
within fifteen (15) days of
the jury request
.

The patient shall
remain
involuntaril
y detained until the completion
of the
hearing
.

If upon the basis of the appointed
examiner's

evaluator's
report or from other information available to the court, the court concludes that the
proposed

patient does not understand his rights, the court may call a jury upon its own motion or upon the request of the person responsible for the care and custody of the
proposed

patient. A jury shall be selected pursuant to W.S. 1
‑
11
‑
101 through 1
‑
11
‑
129, and the proceedings shall follow the Wyoming Rules of Civil Procedure.

(h)

The
proposed

patient, the
applicant

county attorney
, and all others to whom notice is required may appear at the hearing
to testify

and may present witnesses. The court may receive the testimony of other persons. The
proposed

patient shall be present at the hearing unless he waives his right to appear. All persons not necessary to protect the rights of the parties shall be excluded from the hearing. The hearing shall be conducted in as informal a manner as is consistent with orderly procedure and in a physical setting which will not have a harmful effect on the mental health of the
proposed

patient.
Reliable hearsay evidence shall be admissible, including evidence upon which the evaluator relied in forming his opinion.

Any hearing conducted under this subsection shall be recorded by the court reporter or by electronic, mechanical or other appropriate means.
The county attorney shall provide the department with all
final
orders entered by the court
requiring involuntary hospitalization or involuntary outpatient treatment
.

(j)

If, upon completion of the hearing and consideration of the record, the court or the jury finds by clear and convincing evidence that the
proposed

patient is
mentally ill
the court shall consider the least restrictive and most therapeutic alternatives
, including involuntary outpatient treatment,
and shall:

(i)

Order his

If
hospitalization
, assign him to a hospital, and

is ordered
:

(A)

Send to the hospital, with the patient a certified copy of the findings of fact and order and a copy of the
examiner's

evaluator's
report;

(ii)

Suspend the proceedings pending voluntary treatment as approved by the examiner and by the facility or individual who will provide the treatment
.

If the court finds that the
proposed
patient does not require
continuous
inpatient hospitalization
,

would be more appropriately treated in an

and that
the
patient is likely to comply with an outpatient treatment order and will not likely cause harm to
him
self or others while subject to an outpatient treatment order
, the court may order involuntary
outpatient treatment
.

program or a combination of outpatient and inpatient treatment

or will be able to appropriately control his illness by following a prescribed treatment plan, the court shall consider such treatment options. If the court finds that the proposed patient does not require continuous hospitalization and the funding is available, it shall consider conditional outpatient treatment for a period of time deemed appropriate and may designate an outpatient care provider, including mental health
centers.
C
onditional outpatient treatment

Involuntary outpatient treatment shall be subject to the following:

(A)

The court shall
set forth the period of treatment
in the order
and require the patient to comply with a
treatment plan
p
repared by the evaluator;

(B)

The evaluator shall consult the treating providers
,
the patient
and
the
person
responsible for the care and custody of the
patient
, if known,
in preparing the plan;

(C)

Treatment shall be pr
ovided by a treatment facility
if public funds
are paid
for treatment
;

(D)

The
court
shall order

the patient to comply
with
all directives and treatment required by the treatment facility
or treatment provider
. The court

may require periodic reporting, continuation of medication and submission to testing and restriction of travel, consumption of alcoholic beverages or drugs, associations with other persons or other reasonable conditions as the court may specify
;

provided the court may suspend the imposition of the conditional outpatient treatment order for failure to meet the conditions and order involuntary hospitalization under this section; or

(
E
)

The

treatment facility
or treatment provider
shall immediately report to the
county attorney
any material noncompliance by the patient with the outpatient treatment order
;

(F
)

The court retain
s
jurisdiction to modify or revoke the outpatient treatment
order
at any time
;

(
G
)

U
pon motion of the county attorney
to modify or revoke the
outpatient treatment
order
, t
he court
may enter an ex parte order for immediate detention if the court finds that the patient is a danger to himself or others. If the court enters an ex parte order of detention, the matter shall be set for hearing within ninety-six
(96)
hours
,
excluding Saturdays, Sundays and legal holidays,
of the time the
patient is taken into custody;

(H
)

Notice of a
hearing
on a motion to modify or revoke the order for outpatient treatment
shall be
given as provided in subsection (
d
) of this section.

I
f the court finds by
a preponderance of
evidence that the patient violated any condition of the outpatient treatment order, the court may
modify the conditions of treatment or may
enter an order for inpatient
hospitalization
.

(iv)

S
uspend the proceedings pending voluntary treatment as approved by the
evaluator
and by
a treatment
facility or the treatment
provider
if the court finds the patient
will
not
likely harm

him
self or others
while subject to
voluntary treatment.

(k)

The court is authorized to appoint a special commissioner to assist in the conduct of
involuntary

hospitalization
and involuntary outpatient

proceedings. In proceedings under this act, regularly appointed court commissioners may exercise the authority granted by W.S.
5
‑
3
‑
307
. In any case in which the court refers an application to the commissioner, the commissioner shall conduct the involuntary hospitalization

and out
patient treatment
proceedings under this section and on the basis thereof shall either recommend dismissal of the application or hold a hearing as provided in this section and make recommendations to the court regarding the disposition of the
proposed

patient and of the proceedings.

(n)

The court shall inquire into the medical condition of every patient found to be mentally ill. If the court determines based upon the advice of a physician, that the patient's present primary need is for medical treatment or care and whose need for psychiatric care is secondary, the court
may
delay ordering the
commitment
involuntary hospitalization or involuntary
outpatient
treatment
of the patient
to the Wyoming state hospital
until such time as the patient receives medical care and the patient's need for psychiatric care is primary.

25
‑
10
‑
112.

Liability for
proceedings and
costs of detention, involuntary hospitalization
and

i
nvoluntary outpatient treatment
.

(a)

Subject to the provisions of subsections (d
)
and (e)

of this section

and W.S. 25
‑
10
‑
106
,
t
he
county in which a
person

is detained

or in which involuntary h
ospitalization proceedings are brought
patient
is a
reside
nt

shall pay the costs of

detention

as follows
:

(i)

The county shall pay
the costs of
t
he first seventy-two (72) hours of detention, in addition to any Saturday, Sunday or legal holiday that falls within the seventy-two (72) hours,
pursuant to W.S. 25
‑
10
‑
109
,

including

costs of

and 25
‑
10
‑
110
.

"Costs" means
the expenses

of transportation, involuntary outpatient treatment, involuntary hospitalization
and related

medical
treatment for those conditions:

(A)

That resulted in the
emergency
detention of the
person

patient
; or

(B)

That are attributable to affirmative actions taken by the
person
patient

that have placed the
person
patient

in danger of suicide or serious bodily harm and require immediate medical attention.

(ii)

Proceedings for
detention or
involuntary hospitalization
or involuntary
outpatient
treatment

pursuant to
W.S.

25
‑
10
‑
109 or
25
‑
10
‑
110. The costs of these proceedings

shall
include the cost of appointed counsel
,

and examiners

but shall not include the cost of t
he evaluator
;

(b)

Subject to the provisions of subsection (d) of this section,

W
hen a
detained person or proposed

patient is not a resident of Wyoming, the department shall pay the costs listed in
paragraphs (a)(i) through (iii)
subsection (a)

of
this section.

(c)

Subject to the provisions of subsections (d) and (e) of this section, if continued emergency detention is ordered pursuant to W.S. 25-10-109(k)(iii), the county's liability for any costs of detention, treatment or transportation shall terminate after the first seventy-two (72) hours of detention, in addition to any Saturday, Sunday or legal holiday. The department shall be responsible for those
costs after the expiration of the county's responsibility for payments of the costs. The county attorney shall notify the department of the continued emergency detention order or involuntary hospitalization order within twenty-four (24) hours.

A
fter the first seventy-two (72) hours of detention, in addition to any Saturday, Sunday or legal holiday

that falls within the seventy-two (72) hours
,

the department shall pay
a
ll costs of
transportation,
involuntary outpatient

treatment
,

t
ransportation
and continued emergency detention

incurred

after the first seventy-two (72) hours of detention, in addition to any Saturday, Sunday or legal holiday
,

shall be paid by
:

and involuntary hospitalization.

(d)

The hospital or
other treatment provider

treatment facility
shall attempt to recover all costs of treatment from public and private health insurance, from patients, and from government benefit programs prior to seeking payment from the county or the department. The hospital or
other treatment provider

treatment facility
shall have discharged its obligation to recover costs under this subsection if it:

(e
)

When a
person

patient
is detained under W.S. 25
‑
10
‑
109

or 25
‑
10
‑
110
, the

county in which the person resided shall be liable for costs of treatment for the first seventy-two (72) hours of detention, in addition to any Saturday, Sunday or legal holiday that falls within the seventy-two (72) hours. If
the person remains in detention after the hearing pursuant to W.S. 25
‑
10
‑
109(k)(iii), the department shall directly, or under contract with local providers, provide treatment for those conditions specified in paragraph (a)(i) of this section until the person is released from detention or involuntary commitment is ordered, subject to payment of costs as provided in this subsection or subsection (c) of this section

department shall pay the cost of the evaluator
and any treatment plan prepared by the evaluator
.

25
‑
10
‑
116.

Periodic examinations of patients; determination of discharge or continued hospitalization; notice; hearing.

(a)

Three (3) months after each patient's admission to the hospital, the head of the hospital shall evaluate the progress of each patient and shall reevaluate the treatment and progress every six (6) months thereafter.
The evaluation shall consider whether voluntary or involuntary outpatient treatment is appropriate.

(b)

When the head of a hospital determines after the examination required by subsection (a) of this section or by W.S. 25
‑
10
‑
113 that the conditions justifying
hospitalization of

involuntary
patients
hospitalization

no longer exist, he shall report his determination to the court, the
county
attorney
, the district attorney
,

f
amily members and the mental health center

which were involved in the initial proceedings
.
Unless,

if the patient is held under a
n
order of a court having criminal jurisdiction
,
the patient and the person responsible for the patient's care and custody, if known
.
The report shall include a discharge plan
. I
f
,

within
three (3)

five (5)
days after the notice is sent, the
county attorney, the patient or the person responsible for the patient's care
or custody
files an objection, the

court
upon
motion orders

shall order
a hearing on continuing the patient's hospitalization
.
,

The hearing shall be held
within fourteen (14) days of receipt of the objection.

Notice of the hearing shall
be given to the county attorney,
the
district attorney if the patient is held under an order of
a court having criminal jurisdiction,
the patient,
the person responsible for the patient's care
and custody
, if known,
and the hospital
.
The county attorney
shall
appear at the hearing to represent the county.

The attorney general may represent the department at the hearing.
The cou
rt may approve the discharge,
order involuntary outpatient treatment subject to the re
quirements of W.S. 25
‑
10
‑
110
(j)
or may order other appropriate relief
.
If
no objection is filed,
the head of the hospital shall discharge the patient
.

The hearing
shall b
e held as soon as practicable and shall follow the procedures in W.S. 25
‑
10
‑
118
.
Notice of the hearing shall conform with W.S. 25
‑
10
‑
116(c).

(d)

If the
patient
is
held on order of a court having criminal jurisdiction in any action or proceeding arising out of a criminal offense
, t
he court having criminal jurisdiction in the matter shall conduct
the
hearing
under subsection (c) of this section. In all events, the court shall conduct a hearing
not less than once each year to determine whether the continued hospitalization of the patient is necessary, based on the reports required under
this section
and any other information provided to the court by
a hospital
or
a
federal hospital under
W.S. 25
‑
10
‑
111
or the patient's counsel.
The county attorney shall represent the county at the hearing.

The attorney general may represent the department at the hearing.
After a hearing, the court shall make its findings and enter an or
der continuing hospitalization, requiring involuntary outpatient treatment subject to the requirements of W.S. 25
‑
10
‑
110(j) or may order other appropriate relief.

25
‑
10
‑
122.

Records to be kept confidential; exceptions.

(a)

Records and reports made under this act which directly or indirectly identify a patient, a former patient or an individual for whom an application for hospitalization
or
involuntary
outpatient
treatment

has been filed, shall be confidential and shall not be disclosed by any person unless:

(ii)

Disclosure is necessary to carry out this act
, including disclosure
to county or state officials responsible for payment of costs under this act and for enforcement of this
act. Disclosure shall be limited to the minimum necessary to carry out the purposes of this act
; or

(b)

Patient records identified in subsection (a) of this section may be provided without consent of the patient, parent or guardian by and between a
mental health center

treatment
facility
,
a treating
provider
,

the state hospital and hospitals designated under W.S. 25
‑
10
‑
104, only for the purpose of facilitating referral treatment, admission, readmission or transfer of the patient under this act

or for subsequent treatment of a patient for a mental illness
.

25
‑
10
‑
125.

Clothing and transportation upon discharge.

(a)

The department, pursuant to W.S. 25-10-112 shall insure that a patient
who is

discharged from the state's custody
after seventy-two (72) hours

has occurred
from the initial detention
possesses suitable clothing and adequate means to insure his arrival at the home from which he was admitted or another place within the state, which is in the best interests of the state and of the patient.

(b)

The county responsible for payment of costs pursuant to W.S. 25-10-112(a) shall insure that a patient discharged from
emergency
detention within seventy-two (72) hours
,
or upon expiration of emergency detention after seventy-two (72) hours without a court order for hospitalization under W.S. 25
‑
10
‑
110,

of
the initial detention

possesses suitable clothing and adequate means to insure his arrival at the home from which he was admitted or another place, which is in the best interests of the county and of the patient.

25
‑
10
‑
127.

Trial placement; c
onva
lescent
leave
;
discharge; readmittance.

(a)

During a period of
detention
of a patient under
W.S. 25
‑
10
‑
110
,
th
e state hospital or a
designated hospital may grant
a
patient placement into the community on a trial basis subject to the following:

(i)

The hospital has determined that the patient is likely to follow the conditions the hospital determines necessary for the patient and has determined that the patient will not likely harm himself or others during the trial placement;

(ii)

The trial placement shall not constitute a discharge from the hospital;

(
i
i
i)

The patient agrees to any conditions the hospital determines are necessary during the placement;

(iv
)

The hospital notifies the court and the county attorney prior to the trial placement:

(A)

Where the patient will reside;

(B)

How the patient will pay for his living expenses; and

(C)

Any conditions of
the
placement.

(
v)

The trial placement shall not exceed two (2) months;

(v
i
)

If medication management, monitoring or other outpatient services are required, a treatment facility has agreed to pr
ovide the treatment or services;

(v
i
i)

If the patient has successfully completed the trial placement, the hospital may transition the patient to convalescent
leave under this section.

(a)
(d
)

After providing fourteen (14) days notice to the court and county attorney who initiated involuntary hospitalization procedures, the
state

hospital
or a designated hospital
may release an improved patient on convalescent
status
.

leave
subject to the following:

(i)

The hospital has determined that the patient is likely to follow the conditions the hospital determines necessary for the patient and has determined that the patient will not likely harm himself or others during convalescent leave;

(ii)

Release on convalescent
status

leave
shall include a plan of treatment on an outpatient or nonhospital basis and other provisions for continuing responsibility to and by the hospital. Prior to the end of one (1) year on convalescent
status

leave
, and not less than annually thereafter, the hospital shall reexamine the facts relating to the hospitalization of the patient on convalescent
status

leave
and if the hospital determines hospitalization is no longer anticipated, the hospital shall discharge the patient and make a report of discharge to the court and county attorney involved in ordering the hospitalization, if any
;
.

(i
i
i)

The hospital from which the patient is given convalescent
leave
may readmit to the hospital an involuntary hospitalized patient who has been released on convalescent
leave
if the hospital reasonably believes that it is in the best interests of the patient. The
patient
readmitted shall have all the rights he had upon admission to the hospital. It is the responsibility of the hospital to provide or pay for any transportation or other services in connection with any revocation of a convalescent
leave
;

(iv
)

The hospital shall discharge any patient who has remained on convalescent
leave
for a period of two (2) continuous years.

(d)
(e)

This
section
shall not apply to a
person

patient
who has been committed to the hospital pursuant to a criminal proceeding.

42
‑
4
‑
103.

Authorized services and supplies.

(a)

Services and supplies authorized for medical assistance under this chapter include:

(xvi)

Services
and treatment

provided by an institution

or treatment facility
as defined by W.S. 25
‑
10
‑
101(
a
)
(xxv
i
i
)
for mental illnesses;

Section 2.
W.S. 25
‑
10
‑
101(a)(ii) and (iv),
25
‑
10
‑
104(
a)(v), 25
‑
10
‑
105(a)(iii),
25
‑
10
‑
109(b)(
i) through (iii),
(k) and (m)
,

25
‑
10
‑
110
(c),
(e), (f),
(j)(iii) and

(m), 25
‑
10
‑
112(c)(i)
,
(ii)
and (g)
, 25
‑
10
‑
123
, 25
‑
10
‑
127
(b) and (c)
are repealed.

Section 3.

This act is effective July 1, 2014.

(END)

1
SF0040