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21LSO-0191
2021
STATE OF WYOMING
21LSO-0191
Numbered
2.0
SENATE FILE NO. SF0031
Hospitalization of mentally ill persons-amendments.
Sponsored by: Joint Judiciary Interim Committee
A BILL
for
AN ACT relating to the hospitalization of mentally ill persons; amending provisions for the emergency custody of mentally ill persons and hearing requirements; establishing treatment coordinators to assume the functions of gatekeepers; requiring rulemaking; specifying review and hearing requirements; repealing a definition; and providing for effective dates.
Be It Enacted by the Legislature of the State of Wyoming:
Section 1
.
W.S. 25
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101(a)(xiii), by creating new paragraphs (xvii) and (xviii) and by renumbering (xvii) as (xix), 25
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103, 25
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104(a)(vi) and by creating a new
paragraph (viii), 25
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105(a)(ii) and by creating a new paragraph (iv), 25
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109(a)(intro), (b)(intro), (iii), (c) through (j), (k)(intro), (iii), (m), (n) and by creating a new subsection (o), 25
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110(a)(intro), (d)(intro), (vii), (h), (j)(intro), (i)(B), (E) and (n), 25
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110.1(a), (c), (d)(i), (f) and by creating a new subsection (k), 25
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112(a)(intro), (i)(A), (b), (c)(intro), (e), (g) through (j), 25
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120(d)(intro), 25
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125(b), 25
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127(a)(intro) and (iii) and 25
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128 are amended to read:
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101.
Definitions.
(a)
As used in this act:
(xiii)
"Treatment" means diagnosis, evaluation, intervention, which 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. Treatment shall begin at the time of
detention
placement in emergency custody
, if the person knowingly and
voluntarily consents, and shall continue throughout involuntary hospitalization or directed outpatient commitment. Treatment may be given without the consent of the
detained
person
placed in emergency custody
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. "Treatment" does not include observation or supervision;
(xvii)
"Emergency custody" means the status where a person is temporarily in the care and custody of the state subject to the requirements of W.S. 25
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109. "Emergency custody" shall include those times where a person is being transported to and held at a hospital, treatment center or mental health center. "Emergency custody" shall not include involuntary hospitalization;
(xviii)
"Treatment coordinator" means the entity or person designated by the department under W.S. 25
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112(g) that:
(A)
May appear at hearings and provide recommendations to the court regarding the custody and treatment of patients;
(B)
Monitors proceedings under this act;
(C)
Assists to achieve timely, efficient and effective treatment and discharge planning for patients.
(xvii)
(xix)
"This act" means W.S. 25
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101 through 25
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305.
25
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103.
Admission of persons with mental illness to hospital or treatment center; process continuum; court hearings; immunity for transportation.
(a)
Subject to the rules and regulations of the department, a hospital or any other treatment provider providing treatment under this act may admit persons who have symptoms of mental illness for treatment in their hospital or treatment center.
(b)
Emergency custody and treatment under this act shall be implemented to create a continuum of care process.
(c)
At any hearing held by a court pursuant to this act, the court may consider whether the requirements for emergency custody, involuntary hospitalization or outpatient treatment as provided in this act are met before entering an order of emergency custody, involuntary hospitalization or outpatient treatment. A court shall not order a proposed patient to be placed in involuntary hospitalization at an initial hearing under W.S. 25
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109(h) unless the patient waives the hearing for continued emergency custody and requests admission under W.S. 25
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106.
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104.
Duties of department of health as to hospitals other than state hospital.
(a)
The department, with respect to hospitals or other treatment providers other than the state hospital, shall:
(vi)
Investigate complaints made by or on behalf of patients with mental illness;
and
(viii)
Promulgate rules for the transportation of patients under this act. The rules shall include procedures for transportation from:
(A)
Law enforcement custody or a nonmedical facility to a treatment center or the state hospital;
(B)
A treatment center to the state hospital;
(C)
The state hospital or a treatment center to another treatment center;
(D)
The state hospital or a treatment center to the patient's residence or to the appropriate county for transfer to a county facility;
(E)
Any place specified in an order under W.S. 25
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110(j)(i)(B) to the state hospital or treatment center.
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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
(iv)
Promulgate rules for the transportation of patients in accordance with W.S. 25
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104(a)(viii).
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109.
Emergency custody.
(a)
A person may be
detained
placed in emergency custody
when:
(b)
Immediately after
detaining
placing
the person
in emergency custody
, the officer shall contact an examiner. A
preliminary examination of the person shall be conducted by an examiner within twenty
‑
four (24) hours after the
detention
placement in emergency custody
. If a preliminary examination is not conducted within twenty
‑
four (24) hours the
detained
person shall be released. If the person is
detained
held in emergency custody
following the preliminary examination, an examiner shall reexamine the person not less than every forty
‑
eight (48) hours until the hearing under subsections (h) through (k) of this section. If the examiner giving the preliminary examination, or any reexamination as required by this subsection, finds that the person:
(iii)
Is mentally ill, the person may be
detained
held in emergency custody
for seventy
‑
two (72) hours excluding Saturdays, Sundays and legal holidays.
(c)
No person shall be
detained
held in emergency custody
for more than seventy
‑
two (72) hours, excluding Saturdays, Sundays and legal holidays, without a hearing under subsections (h) through (k) of this section.
For persons placed in emergency custody on a Saturday, Sunday
or legal holiday, the court shall conduct the hearing not later than seventy
‑
two (72) hours after 8:00 a.m. on the next business day.
(d)
A person taken into
emergency
custody under this section may be
detained
placed
in a hospital or other care setting which is appropriate under the circumstances and which complies with subsection (n) of this section. The person shall not be
detained
placed
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 or examiner who
detained
placed
the person
in emergency custody
shall immediately notify the person responsible for the care and custody of the
detained
placed
person, if known, of the time and place of
detention
emergency custody
.
(e)
The law enforcement officer or examiner who initially
detained
placed
the person
in emergency custody
shall make a written statement of the facts of the emergency
detention
custody
. A copy of the statement shall
be given
by the law enforcement officer or examiner who prepared the statement
to the
detained
placed
person, his parent or guardian, to any attorney representing the person, to the county attorney in the county where the person is
detained
held in emergency custody
, to any
gatekeeper
treatment coordinator
designated by the department and to any subsequent examiner.
(f)
When a person is
detained under emergency circumstances
placed in emergency custody
, treatment may be given during the emergency
detention
custody
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 the county attorney, to any
gatekeeper
treatment coordinator
designated by the department and shall be filed with the court if continued
detention
emergency custody
is sought, or if directed outpatient commitment or 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.
(g)
At the time of emergency
detention
custody
the person 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 continued
detention
emergency custody
, directed outpatient commitment or involuntary hospitalization.
(h)
When a person is
detained
placed
in emergency
detention
custody
and continued
detention
emergency custody
is sought, or an application for directed outpatient
commitment or involuntary hospitalization is filed by the county attorney, the court shall appoint an attorney to represent the
detained
placed
person unless he has his own attorney. The court shall conduct a hearing within seventy
‑
two (72) hours, excluding Saturdays, Sundays and legal holidays, of the initial
detention
placement in emergency custody
to determine whether continued
detention
emergency custody
is required pending directed outpatient commitment or involuntary hospitalization proceedings.
For persons placed in emergency custody on a Saturday, Sunday or legal holiday, the court shall conduct the hearing not later than seventy
‑
two (72) hours after 8:00 a.m. on the next business day.
The county attorney of the county where the application is filed shall appear on behalf of the state at the hearing. Any
gatekeeper
treatment coordinator
designated by the department pursuant to W.S. 25
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112(g) shall appear at the hearing and provide testimony concerning continued
detention
emergency custody
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
treatment coordinator
designated by the department, the
detained
placed
person and his parent, guardian and attorney. The court may delay the hearing only at the request of the
detained
placed
person or his parent, guardian or his attorney. The hearing for continued
detention
emergency custody
may be waived at the request of the
detained
placed
person or the
detained
placed
person's parent, guardian or attorney. If a hearing for continued
detention
emergency custody
has been waived, the court may immediately conduct the directed outpatient commitment or involuntary hospitalization hearing.
(j)
At the hearing the court shall advise the
detained
placed
person and his parent, guardian or attorney of the contents of the written statement of emergency
detention
custody
required in subsection (e) of this section and the application for directed outpatient commitment or involuntary hospitalization.
(k)
The standard of proof in an emergency
detention
custody
hearing shall be by a preponderance of the evidence. If the court finds at an emergency
detention
custody
hearing that:
(iii)
The person is mentally ill, it shall order continued
detention
emergency custody
of the person for not more than ten (10) days. The court may extend the
detention
emergency custody
period at the request of the proposed patient or his attorney.
(m)
If the court finds the person is mentally ill pursuant to paragraph (k)(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
custody
for
restabilization
of the person's mental health.
(n)
Treatment provided as a result of an emergency or continued
detention
custody
pursuant to this section shall be provided in the least restrictive and most therapeutic setting available with consideration given to requests of
the
detained
person
placed in emergency custody
, his parent, guardian or attorney, and recommendations of any
gatekeeper
treatment coordinator
. Treatment may include the treatment options outlined in W.S. 25
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110.1(d).
(o)
When placing a minor in emergency custody in accordance with this section, the treatment center where the minor is placed shall attempt to notify the minor's parent or guardian that the minor is in emergency custody and the location of where the minor has been placed in emergency custody. If the treatment center is unable to successfully contact the minor's parent or guardian or if the parent or guardian does not contact the treatment center where the minor is located within twenty
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four (24) hours of the minor being placed in emergency custody, the treatment center shall report the emergency custody placement to the department of family services.
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110.
Involuntary hospitalization proceedings.
(a)
Proceedings for the involuntary hospitalization of a person may be commenced by the filing of a written
application with the court in the county in which the person is initially
detained
placed in emergency custody
. 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
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112(e) that are not covered by the state. The application shall be accompanied by either:
(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
treatment coordinator
designated by 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:
(vii)
Of the identity of any
gatekeeper
treatment coordinator
designated by the department pursuant to W.S. 25
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112(g).
(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
gatekeeper
treatment coordinator
designated by the department 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, give consideration to any recommendations by the
gatekeeper
treatment coordinator
and shall:
(i)
Order his hospitalization, assign him to a hospital, and:
(B)
Specify where he will be
detained
placed
pending transportation to the hospital. No person shall be
detained
placed
in a nonmedical facility used for detention of persons charged with or convicted of penal offenses except during an extreme emergency;
(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
may
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 all orders shall be provided to the
gatekeeper
treatment coordinator
designated by the department under W.S. 25
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112(g).
(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 or other qualified professional, and in consultation with any
gatekeeper
treatment coordinator
designated by the department pursuant to W.S. 25
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112(g), 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 directed outpatient commitment or involuntary hospitalization of the patient until such time
as the patient receives medical care and the patient's need for psychiatric care is primary.
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110.1.
Directed outpatient commitment proceedings.
(a)
If the court finds based upon the recommendation of an examiner or on its own determination that the proposed patient is mentally ill but does not require inpatient hospitalization, the court shall consider issuing a directed outpatient commitment order. The court shall require directed outpatient commitment for the proposed patient for a period of time as determined appropriate by the court, not to exceed two (2) years with review by the court
at a hearing held
at least
once
every six (6) months. The court may designate an outpatient care provider that will provide care to the proposed patient.
(c)
The terms and conditions of the treatment plan shall be established by an examiner in consultation with any
gatekeeper
treatment coordinator
designated by the department and approved by the court. In preparing the
plan, the examiner shall consult with the county attorney, treating health care providers and the patient or the person responsible for the care and custody of the patient, if known.
(d)
The treatment plan may require:
(i)
Periodic reporting
, including reporting required under subsection (k) of this section
;
(f)
The treatment center or treatment provider or any other person identified in the treatment plan shall report to the county attorney and any
gatekeeper
treatment coordinator
designated by the department any material noncompliance by the patient with the treatment plan.
(k)
Not less than once every six (6) months, the treatment coordinator shall provide a written report to the county attorney for any patient committed to directed outpatient treatment under this section, including any revisions to the patient's treatment plan.
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112.
Liability for costs of emergency custody, involuntary hospitalization and proceedings therefor; cost sharing.
(a)
Subject to the provisions of subsections (d)
,
and
(e)
and (k)
of this section, the county in which a person is
detained
placed in emergency custody
or in which involuntary hospitalization proceedings are brought shall pay the costs of:
(i)
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, pursuant to W.S. 25
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109, including costs of medical treatment for those conditions:
(A)
That resulted in the emergency
detention
custody
of the person; or
(b)
Subject to the provisions of subsection (d) of this section, when a
detained
person
placed in emergency custody
or proposed patient is not a resident of Wyoming,
the department shall pay the costs listed in paragraphs (a)(i) through (iii) of this section.
(c)
The county shall pay for the first seventy
‑
two (72) hours as provided in subsection (a) of this section even if the patient waives the hearing required under W.S. 25
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109 and proceeds to voluntary outpatient treatment, directed outpatient commitment or involuntary hospitalization proceedings. Subject to the provisions of subsections (d) and (e) of this section, if continued emergency
detention
custody
is ordered pursuant to W.S. 25
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109(k)(iii), the county's liability for any costs of
detention
emergency custody
, treatment or transportation shall terminate after the first seventy
‑
two (72) hours of
detention
emergency custody
, 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. All costs of treatment, transportation and continued emergency
detention
custody
incurred after the first seventy
‑
two (72) hours of
detention
emergency custody
, in addition to any Saturday, Sunday or legal holiday, shall be paid by:
(e)
When a person is
detained
placed in emergency custody
under W.S. 25
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109, the county in which the person resided shall be liable for costs of treatment for the first seventy
‑
two (72) hours of
detention
emergency custody
, in addition to any Saturday, Sunday or legal holiday that falls within the seventy
‑
two (72) hours. If the person remains in
detention
emergency custody
after the hearing pursuant to W.S. 25
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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
emergency custody
or involuntary commitment is ordered, subject to payment of costs as provided in this subsection or subsection (c) of this section.
(g)
The department in consultation with each board of county commissioners may establish a single point of responsibility or
gatekeeper
treatment coordinator
.
Gatekeeper
Treatment coordinator
duties shall include, but are not limited to, providing guidance on issues of
detention
emergency custody
and involuntary treatment
, appearing at hearings and providing recommendations to the court regarding the custody and treatment of patients
and monitoring and coordinating timely, efficient and effective patient treatment prior to, during and after any emergency
detention
custody
or involuntary treatment under this act. No
gatekeeper
treatment coordinator
designated under this subsection shall provide inpatient psychiatric treatment to patients under this act, unless the
gatekeeper
treatment coordinator
has been approved by the department of health to provide these services.
(h)
The county attorney shall notify the department and any
gatekeeper
treatment coordinator
of any
detention
emergency custody placement
, continued emergency
detention
custody
order, directed outpatient commitment or involuntary hospitalization order within twenty
‑
four (24) hours.
(j)
The department, boards of county commissioners, designated hospitals,
gatekeepers
treatment coordinators
and other treatment providers may, upon contract or
agreement, coordinate and monitor the services and payments required for the treatment of persons with mental illness as provided under this
section
act
. Pursuant to contract or agreement, the department may assume any part of the expenses associated with a
gatekeeper
treatment coordinator
which expenses would otherwise be the responsibility of a county under this act, including expenses for the transportation of patients to appropriate care settings.
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120.
Rights of patients; commitment and treatment of persons being treated by prayer.
(d)
No person who is being treated in good faith by spiritual means alone, through prayer, by a duly accredited practitioner in accordance with the tenets and practices of a recognized church or religious denomination may be
detained
placed in emergency custody
, hospitalized or ordered to receive treatment under this act unless:
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125.
Clothing and transportation upon discharge.
(b)
The county responsible for payment of costs pursuant to W.S. 25
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112(a) shall ensure that a patient discharged from emergency
detention
custody
within seventy
‑
two (72) hours, or upon expiration of emergency
detention
custody
after seventy
‑
two (72) hours without a court order for hospitalization under W.S. 25
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110, possesses suitable clothing and adequate means to ensure 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.
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127.
Convalescent status; discharge; readmittance.
(a)
After providing notice to the court, the county attorney who initiated involuntary hospitalization procedures, any
gatekeeper
treatment coordinator
designated by the department and all interested parties, the hospital may release an improved patient on convalescent leave subject to the following:
(iii)
Release on convalescent leave shall include a plan of treatment on an outpatient or nonhospital basis and other provisions for continuing responsibility of the patient by the hospital. Prior to the end of one (1) year on convalescent leave, and not less than annually thereafter, the hospital shall reexamine the facts relating to the hospitalization of the patient on convalescent 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, to any
gatekeeper
treatment coordinator
designated by the department and to the county attorney who initiated procedures for the involuntary hospitalization.
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128.
Access to patient information.
Any disclosure of patient information required by this article shall be subject to limitations imposed by state and federal law. The department shall promulgate rules facilitating the exchange of information required by this article to the maximum extent allowed by state and federal law. At the discretion of the court considering a matter
under this article, the court may order the disclosure of information required by this article. The court also may designate and direct the actions of a
gatekeeper
treatment coordinator
otherwise designated by the department under W.S. 25
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112(g) for the purpose of allowing the gatekeeper access to patient information.
Section 2.
W.S. 25
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101(a)(xvi) is repealed.
Section 3
.
The department of health shall promulgate all rules necessary to implement the provisions of this act.
Section 4
.
(a) Except as provided in subsection (b) of this section, t
his act is effective July 1, 2021
.
(b) Sections 3 and 4 of this act are 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.
(END)
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SF0031