Involuntary commitment-gatekeeper pilot program.

2016
STATE OF WYOMING
16LSO-0357
Introduced
1.2

HOUSE BILL

NO.

HB0134

Involuntary commitment-gatekeeper pilot program.

Sponsored by:
Representative(s) Nicholas, B., Barlow and Harvey and Senator(s) Perkins and Ross

A BILL

for

AN ACT relating to involuntary commitment; providing for an involuntary commitment gatekeeper pilot program; amending involuntary commitment statutes to include gatekeepers as specified; requiring rulemaking; requiring reports; and providing for effective dates.

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

Section 1
.

W.S. 25
‑
10
‑
101(a) by creating a new paragraph (xvi), 25
‑
10
‑
109
(e), (f) and
(h), 25
‑
10
‑
110(d)
(intro), (v), (vi), by creating a new paragraph (vii), (f), (h), (j)(
i
)(E), (ii), (m)
and (
n
) and 25
‑
10
‑
112
(a)(ii) and
(g) are amended to read:

25
‑
10
‑
101
.

Definitions
.

(a)

As used in this act:

(xvi)

"Gatekeeper" means an entity that:

(A)

Serves as a single point of responsibility to provide guidance on the issue of
detention or
involuntary hospitalization and to

monitor and
coordinate
patient
treatment prior to, during and after an emergency detention or involuntary hospitalization;
and

(B
)

Does not provide inpatient psychiatric treatment for patients under
this act.

25
‑
10
‑
109
.

Emergency 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. A copy
of the statement shall be given to the detained person
, to any gatekeeper
and to any subsequent examiner.

(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

provided to any gatekeeper and
filed 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)

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,

shall designate a gatekeeper if available pursuant to rules adopted by the department
and
the cour
t
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. The county attorney of the county where the application is filed shall appear on behalf of the state at the hearing.

Any gatekeeper designated
by the court shall appear
at the hearing

and provide testimony concerning continued detention
and, if applicable, the issues outlined in subsection (m) of this section
.

Notice of the preliminary hearing shall be given to the county attorney,

any gatekeeper
designated
by the court,
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.

25
‑
10
‑
110
.

Involuntary hospitalization proceedings
.

(d)

Upon receipt of an application, the court shall issue notice thereof to the proposed patient, the person responsible for the care or custody of the proposed patient
, any gatekeeper
designated
by the court
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:

(v)

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

(vi)

That a hearing will be held if warranted by the report of the examination of the proposed patient
;
.

and

(vii)

Of the identity of any

designated
gatekeeper together with a description of the gatekeeper's duties as provided by W.S. 25
‑
10
‑
101(
a)(xvi)
.

(f)

If the examiner repo
rts the proposed patient is not
mentally ill, the court shall terminate the proceedings. If the examiner reports the proposed patient is mentally ill, the court shall fix a date for and give notice of a hearing to be held as soon as possible. The notice shall satisfy the requirements of paragraphs (d
)(
i
) through
(vi
)
(vii)
of this section.

(h)

The proposed patient, the applicant, and all others to whom notice is required may appear at the hearing to testify and may present witnesses. The court

shall
consider the testimony of any
designated
gatekeeper and
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. Any hearing conducted under this subsection shall be recorded by the court reporter or by electronic, mechanical or other appropriate means.

(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 and shall:

(
i
)

Order his hospitalization, assign him to a hospital, and:

(E)

Make findings as to his competence to make informed choices regarding treatment and his 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. The order for medication shall be reviewed by a physician upon commitment and by a psychiatrist upon admission to the hospital. The prescribed medication shall be continued if found medically appropriate by the investigation review committee of the hospital or institution, subject to review by the medical director of the hospital or institution. Any action by the medical director of the hospital or institution shall be reviewable pursuant to the Wyoming Administrative Procedure Act.

All orders for prescribed medication or a summary of the orders shall be provided to any
designated
gatekeeper.

(ii)

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

in consultation with any
designated
gatekeeper
. If the court finds that the proposed patient does not require continuous
inpatient hospitalization, would be more appropriately treated in an 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. Conditional outpatient treatment may require periodic reporting,

consultation with and reporting to a gatekeeper,
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

(m)

An appointed examiner shall receive for his services in each court ordered examination a reasonable fee fixed by the court.

A gatekeeper
designated
pursuant to
W.S. 25
‑
10
‑
109
shall receive compensation as established in rules promulgated by the department.

(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

and in consultation with any designated gatekeeper
, 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 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 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:

(ii)

Proceedings for detention or involuntary hospitalization pursuant to W.S. 25
‑
10
‑
109 or 25
‑
10
‑
110. The costs of these proceedings include the cost of appointed counsel
, gatekeepers
and examiners;

(g)

Each board of county commissioners 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.

The single point of responsibility may be a gatekeeper made available by rules promulgated by the department.
Any gatekeeper assigned pursuant to this subsection shall have the obligations and authority
provided to gatekeepers designated by the court pursuant to W.S. 25
‑
10
‑
109(
h).

Section 2
.

(a)

The department of health shall develop a
n involuntary commitment gatekeeper
pilot
program
to operate in state fiscal year 2017
. The program shall designate
gatekeepers

to
provide guidance
and testimony
,
to
coordinate and
to
monitor
issue
s

concerning
detention, i
nvoluntary hospitalization
and
patient care
under title 25, chapter 10 of the Wyoming statutes. The specific
program elements and the
availability,
obligations and duties of pilot program gatekeepers shall be provided by rules promulgated by the department
.
Consistent with the
amendments made
to W.S. 25
‑
10
‑
101, 25
‑
10
‑
109 and 25
‑
10
‑
110
in
section 1 of this act, the department's rules shall
develop a program and
assign
tasks
to gatekeepers
which
will improve the
effective and cost efficient operation of
Wyoming's
involuntary commitment system.

(b)

The gatekeeper program requir
ed by this section shall use

Wyoming
community mental health centers or substance abuse centers to act as gatekeepers.

(c)

Funding for the program, including any reimbursement authorized
for
gatekeeper
s
,
shall come from existing funds
available for community mental health center
s and substance abuse centers.

(d
)

The department shall regularly update any legislative committee, working group or subcommittee assigned to consider involuntary commitment under Title 25
. The department's updates shall include available information
on the development, implementation, funding, operation and performance of the involuntary commitment gatekeeper pilot program. If no legislative entity is assigned to consider involuntary commitment issues, the department shall report to the joint labor, health and social services interim committee.

Updates shall be made at each interim committee, working group or subcommittee meeting.
Unless regular updates have been provide
d
to the joint labor, health and social services interim committee prior to July 1, 2016, the department shall update the joint labor, health and social services interim committee on the development, implementation, funding, operation and performance of the involuntary commitment gatekeeper pilot
program on or before July 1, 2016 and again on or before October 1, 2016.
On or before
December
1, 2016, the department shall provide an update which includes a recommendation for the continuance or cessation of the involuntary commitment gatekeeper pilot program

on
June 30, 2017 together with any other recommendations
deemed relevant
.
The department shall continue to update any legislative entity assigned to consider involuntary commitment issues and the joint labor, health and social services interim committee
after the 2017 General Session as required by law or at the request of the entity or committee. These updates shall include any data which indicates the pilot program's impact on involuntary commitments and the costs of the involuntary commitment system in Wyoming.

Section

3
.

(a)

For the purpose of promulgating the rules authorized by this act and taking other actions necessary to
allow the operation of an involuntary commitment gatekeeper pilot program on or after July 1, 2016
, this act
is effective immediately upon completion of all acts necessary for a bill to become law as provided by Article 4, Section 8 of the Wyoming Constitution.

(b)

Except as specified in subsection (a) of this section, this act is effective July 1, 2016.

(END)

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HB0134