Hospitalization of mentally ill persons.

WORKING DRAFT
2014
STATE OF
WYOMING
14LSO-0390

SENATE FILE

NO.

SF0114

Hospitalization of mentally ill persons.

by
:
Senator
(s)
Senator(s) Dockstader and Representative(s) Barlow

A BILL

for

AN ACT relating to
hospitalization of mentally ill patients; providing for convalescent status of formerly hospitalized patients; requiring the state hospital to maintain capacity to treat
persons detained for mental illness on an emergency or involuntary basis; requiring a preliminary examination be done by a different examiner than the one who initiated the detention; requiring action within seventy
-
two hours of the preliminary examination; providing for notification and action by county attorneys;
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)(
i
), 25
‑
10
‑
103, 25
‑
10
‑
104(a)(vii), 25
‑
10
‑
105(a)(ii), (iii) and by creating a new paragraph (iv), 25
‑
10
‑
109(b)(intro), (c) through (f),
by creating a new subsection (h)
, by amending and renumbering (h) as (j), by renumbering (j) and (k) as (k) and (m) and by amending and renumbering (m) as (n)
, 25
‑
10
‑
110(a)(intro) and (c), 25
‑
10
‑
112(a)(intro), (c)(intro), (e), (g) and by creating a new subsection (h), 25
‑
10
‑
116(b) and by creating a new subsection (d), 25
‑
10
‑
122 by creating a new subsection
(c)
and 25
‑
10
‑
127(a) through (c) and by creating a new subsection (e) are amended to read:

25
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10
‑
101.

Definitions.

(a)

As used in this act:

(
i
)

"Court" means the district court which
considered or
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;

25
‑
10
‑
103.

Admission of persons with mental illness to hospital.

Subject to the rules and regulations of the hospital,
the head of a hospital
may

shall
admit persons who have symptoms of mental illness pursuant to W.S. 25
‑
10
‑
106, 25
‑
10
‑
109 or 25
‑
10
‑
110.

25
‑
10
‑
104.

Duties of department of health and social services as to hospitals other than state hospital.

(a)

The department, with respect to designated hospitals or other licensed treatment facilities other than the state hospital, shall:

(vii)

Promulgate rules and regulations, including rules regarding reimbursement under W.S. 25
‑
10
‑
112
and convalescent status under W.S. 25
‑
10
‑
127
.

25
‑
10
‑
105.

Duties of department of health as to state hospital.

(a)

The department shall:

(ii)

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

and

(iii)

Investigate complaints made by or on behalf of state hospital patients
;
.

and

(iv)

Ensure
the state hospital maintains reasonable capacity to admit, evaluate and treat persons detained under W.S. 25
‑
10
‑
109 and patients under W.S. 25
‑
10
‑
110 from the county where it lies, from adjacent counties and from counties without a designated county or district hospital.

25
‑
10
‑
109.

Emergency detention.

(b)

Immediately after detaining the person, the officer shall
contact
notify

an examiner
, providing the
notified
examiner shall not be the examiner who initiated the detention
. A preliminary examination of the person shall be conducted by an examiner within twenty
‑
four (24) hours after the detention
, providing that the preliminary examination shall not be conducted by the examiner who initiate
d
the detention
.
If a preliminary examination is not conducted within twenty
‑
four (24) hours the detained person shall be released.
If the examiner giving the preliminary examination finds that the person:

(c)

No person shall be detained for more than seventy
‑
two (72) hours, excluding Saturdays, Sundays and legal holidays, without a hearing under subsections
(h) through (k)

(
h
) through (m)
of this section.

(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.
All county and district hospitals shall receive persons from within their county or district under W.S
.
25
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10
‑
109 and 25
‑
10
‑
110 by January 1, 2015.
The person shall not be detained in a nonmedical facility used for detention of persons charged with or convicted of penal offenses except in 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 shall make a written statement of the facts of the emergency detention.
Prior to the preliminary examination, a
copy of the statement shall be given to the detained person
, the county attorney
where the person is detained
and to
any subsequent

the
examiner
conducting the preliminary examination
.
If the person is detained in a county other than his county of residence, the county attorney of the county where the person is detained shall provide a copy of the statement to the county attorney where the person resides if the person is a resident of the state of Wyoming.

(f)

When a person is detained under emergency circumstances, treatment may be given during the emergency detention period if the person voluntarily and knowingly consents. The parent or guardian of a minor or incompetent person 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 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. Prior to treatment, the person shall be fully advised of the scope of treatment, and a report of the treatment shall be filed

with the county attorney where the person is detained and
with the court if involuntary hospitalization proceedings are commenced. An examiner or a
physician 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.

(h)

Proceedings under this section shall be entitled "In the
I
nterest of

...
.
".
The county attorney of the county where the person is initially detained shall file the written application, appear in the proceedings and pursue the continued detention if the county attorney is satisfied that there is reasonable cause to believe that the detained person is mentally ill. Proceedings may also be initiated by the county attorney where the person resides or the county attorney
for the county
in which there is a designated hospital.

(h)
(j)

When a person is detained in emergency detention and an application for involuntary hospitalization is filed

by the county attorney
, the 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 examiner for an involuntary hospitalization hearing.

(j)
(k)

At the hearing the court shall advise the 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 for involuntary hospitalization.

(k)
(m)

The standard of proof in an emergency detention hearing shall be by a preponderance of the evidence. If the court finds at an emergency detention hearing that:

(
i
)

The person is not mentally ill, the court shall order the person released;

(ii)

The person is mentally ill and has applied for voluntary admission, the court may dismiss the proceedings; or

(iii)

The person is mentally ill, it shall order continued detention of the person for not more than ten (10) days. The court may extend the detention period at the request of the proposed patient or his attorney.

(m)
(n)

If the court finds the person is mentally ill pursuant to paragraph
(k
)(
iii)

(m)(iii)
of this section, the court shall make findings as to the person's competence to make informed choices regarding treatment and the person's need for prescribed psychotropic medication. If the court finds the person incompetent to make an informed decision, the court may order the administration of prescribed psychotropic medication for the period of the emergency detention for
restabilization
of the person's mental health.

25
‑
10
‑
110.

Involuntary hospitalization proceedings.

(a)

Proceedings for the involuntary hospitalization of a person
may

shall
be commenced by the filing of a written application

by the county attorney
with the court in the county in which the person is initially detained. Proceedings may also be initiated 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.

The application shall be accompanied by either:

(c)

Proceedings under this section shall be entitled "In the Interest of ....
".
The county attorney of the county where the
application is filed shall appear in the public interest

person is initially detained shall file the written application, appear in the proceedings and pursue the involuntary hospitalization if the county attorney is satisfied that there is reasonable cause to believe that the detained person is mentally ill. Proceedings may also be initiated by the county attorney where the person
resides or the county attorney for the county in which there is a hospital
. The court shall expedite the proceedings.

25
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10
‑
112.

Liability for costs of detention, involuntary hospitalization and proceedings therefor.

(a)

Subject to the provisions of subsections (d) and (e) of this section, the county in which a person is detained
or in which involuntary hospitalization proceedings are brought
shall pay the costs of:

(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)

25
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10
‑
109(m)(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. All
costs of treatment, transportation 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:

(e)

When a person is detained under W.S. 25
‑
10
‑
109, 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)

25
‑
10
‑
109(m)(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.

(g)

Each board of county commissioners
, in consultation with the county attorney,
may establish a single point of responsibility to identify, make referrals to, intervene and coordinate with community or regional resources prior to and after an emergency detention. The
single point of responsibility may be assigned to a community mental health center, designated hospital or other entity that is able to provide treatment as defined under this act.

(h)

The county or department may attempt to recover all costs of treatment from public and private health insurance, from patients and from government benefit programs
if the costs are not recovered under subsection (d) of this section
.

25
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10
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116.

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

(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 no longer exist, he shall report his determination to the

court, the county attorney, the district attorney, family members and the mental health center which were involved in the initial proceedings.
Unless, within three (3) days after the notice is sent, the court upon motion orders a hearing on
continuing the patient's hospitalization, the head of the hospital shall discharge the patient.
The
Within seven (7) days, any of the notified
persons
may file with the court a written objection to the head of the hospital's findings and the patient's discharge. If an objection is filed with the cou
r
t, a
hearing shall be 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).

The court on its own motion may also order a hearing without having received an objection by any
person
. If no objection is filed, or no hearing is ordered by the court, within ten (10) days after the notice is sent, the head of the hospital shall discharge the patient.

(d)

All patients discharged from involuntary hospitalization shall be provided a post hospitalization plan of care. In preparation for discharge, the hospital shall make significant efforts to coordinate any recommended post hospitalization care for the patient with a local mental health provider. The plan of care shall be filed with the court, the county attorney who initiated the proceedings, local law enforcement and the local mental health provider. The plan of care shall also be provided to the county attorney for the county where the person
resides if the person is a resident of the state of Wyoming.

25
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10
‑
122.

Records to be kept confidential; exceptions.

(c)

The
district court
shall record all
court proceedings

under
this act
, shall
annually
report to the
s
upreme
c
ourt
the number and type of proceedings
reported and
shall
maintain a
database of those proceedings
.

25
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10
‑
127.

Convalescent status; discharge;
readmittance
.

(a)

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

All
patients discharged pursuant to W.S. 25
‑
10
‑
116 shall be released by
the hospital
may release an improved patient

on convalescent status. Release on convalescent status 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

At
the end of one (1) year on convalescent status, and not less than annually thereafter,
the hospital shall reexamine
the facts relating to the hospitalization of
the patient
.

on convalescent status and

I
f the hospital determines
hospitalization is no longer anticipated

the patient's mental illness has not relapsed
, the hospital shall
discharge the patient

terminate the patient's convalescent status
and make a report of
discharge

the hospital's action
to the court and county attorney involved in ordering the hospitalization, if any.

(b)

The hospital from which the patient is given convalescent status
may

shall
readmit to the hospital an involuntary hospitalized patient who has been released on convalescent status if the hospital reasonably believes that it is
in the best interests of

necessary to ensure public safety, the patient's mental illness has relapsed or
the patient

has violated subsection (e) of this section
.

The
hospital
shall notify the court immediately upon
readmittance
.
The person readmitted shall have all the rights he had upon admission to the hospital. Upon readmission he shall be given notice of his rights pursuant to W.S. 25
‑
10
‑
116. 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 status.

(c)

The hospital shall
discharge

terminate the convalescent status of
any patient who has remained on convalescent status for a period of two (2) continuous years.

(e)

All patients on convalescent status shall strictly follow the post hospitalization plan of care established by the hospital pursuant to W.S. 25
‑
10
‑
116(
d). Failure to follow the plan shall be cause for the extension or revocation of the patient's convalescent status.

Section 2.

This act is effective July 1, 2014.

(END)

1
SF0114