Connecticut Seal

General Assembly

Amendment

 

February Session, 2018

LCO No. 5803

   
 

*SB0038405803HRO*

Offered by:

 

REP. CANDELORA, 86th Dist.

 

To: Subst. Senate Bill No. 384

File No. 338

Cal. No. 545

(As Amended by Senate Amendment Schedule "A")

"AN ACT CONCERNING MENTAL HEALTH PARITY, DATA REPORTED BY MANAGED CARE ORGANIZATIONS AND THE ALL-PAYER CLAIMS DATABASE."

After the last section, add the following and renumber sections and internal references accordingly:

"Sec. 501. (NEW) (Effective October 1, 2018) (a) As used in this section:

(1) "Facility" means any inpatient or outpatient hospital, clinic, skilled nursing facility or other facility for the diagnosis, observation or treatment of persons with psychiatric disabilities;

(2) "Patient" means any person being treated in a facility;

(3) "Head of the facility" means the superintendent or medical director of a facility, or such superintendent's or medical director's designated delegate;

(4) "Informed consent" means permission given competently and voluntarily after a patient has been informed of the reason for treatment, the nature of the proposed treatment, the advantages or disadvantages of the treatment, medically acceptable alternative treatment, the risks associated with receiving the proposed treatment and the risk of no treatment; and

(5) "Direct threat of harm" means the patient's clinical history demonstrates a pattern of serious physical injury or life-threatening injury to self or to others that is caused by the psychiatric disabilities with which the patient has been diagnosed and is documented by objective medical and other factual evidence. Such evidence of past pattern of dangerous behavior shall be manifested in the patient's medical history and there shall exist a high probability that the patient will inflict substantial harm on such patient or others.

(b) Prior to discharging a patient from a facility, if it is determined by the head of the facility and two qualified physicians that (1) (A) a patient who is to be discharged from the facility is capable of giving informed consent but refuses to consent to take medication for treatment of the patient's psychiatric disabilities, or (B) a patient has a demonstrated history of failure to take medications prescribed for the treatment of the patient's psychiatric disabilities, (2) there is no less intrusive beneficial treatment, and (3) without medication, the psychiatric disabilities with which the patient has been diagnosed will continue unabated and place the patient or others in direct threat of harm, the head of the facility may apply to the Probate Court for appointment of a conservator of the person with specific authority to consent to the administration of medication after discharge from the facility or, in a case where a conservator of the person has previously been appointed under section 45a-650 of the general statutes, the head of the facility or the conservator may petition the Probate Court to grant such specific authority to the conservator. Pursuant to this subsection, the Probate Court may appoint a conservator with such specific authority if the court finds by clear and convincing evidence that the patient refuses to consent to medication for the treatment of the patient's psychiatric disability or has a demonstrated history of failure to take medications prescribed for the treatment of the patient's psychiatric disabilities and such medication is necessary for the patient's treatment. The authority of a conservator to consent to the administration of medication under this subsection shall be effective for not more than one hundred twenty days following the date of the patient's discharge from the facility.

(c) If, after being discharged from a facility, a patient fails or refuses to take medication ordered by a prescribing practitioner and such patient has a conservator of the person vested with the authority to consent to the administration of medication pursuant to subsection (b) of this section, such conservator may consent on behalf of the patient to the administration of such medication and the patient may be medicated over the patient's objection. Such medication shall be administered in a manner and place that, in the best judgment of the prescribing practitioner, is clinically appropriate, safe and consistent with the dignity and privacy of the patient. A conservator of the person appointed pursuant to subsection (b) of this section may request that state or local police or a licensed or certified ambulance service assist in transporting the patient to a designated location for the purpose of administering the medication.

Sec. 502. Subsections (c) to (g), inclusive, of section 17a-498 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(c) (1) The court shall require the [ certificates] certificate, signed under penalty of false statement, of [ at least two impartial physicians selected by the court, one of whom shall be a practicing psychiatrist, and each of whom shall be licensed to practice medicine in the state of Connecticut and shall have] an impartial physician selected by the court, who shall be a practicing psychiatrist, licensed to practice medicine in the state of Connecticut, who has been a practitioner of medicine for at least one year and who shall not be connected with the hospital for psychiatric disabilities to which the application is being made, or related by blood or marriage to the applicant, or to the respondent. Such [ certificates] certificate shall indicate that the [ physicians have] physician has personally examined the respondent not more than ten days prior to such hearing. The court shall appoint such [ physicians] physician from a list of physicians and psychiatrists provided by the Commissioner of Mental Health and Addiction Services and such [ appointments] appointment shall be made in accordance with regulations promulgated by the Probate Court Administrator in accordance with section 45a-77. [ Each such] The physician shall make a report on a separate form provided for that purpose by the Probate Court Administrator and shall answer such questions as may be set forth on such form as fully and completely as reasonably possible. Such form shall include, but not be limited to, questions relating to the specific psychiatric disabilities alleged, whether or not the respondent is dangerous to himself or herself or others, whether or not such illness has resulted or will result in serious disruption of the respondent's mental and behavioral functioning, whether or not hospital treatment is both necessary and available, whether or not less restrictive placement is recommended and available and whether or not the respondent is incapable of understanding the need to accept the recommended treatment on a voluntary basis. [ Each such] The physician shall state upon the form the reasons for his or her opinions. Such respondent or his or her counsel shall have the right to present evidence and cross-examine witnesses who testify at any hearing on the application. If such respondent notifies the court not less than three days before the hearing that he or she wishes to cross-examine the examining [ physicians] physician, the court shall order such [ physicians] physician to appear.

(2) The court shall cause a recording of the testimony of such hearing to be made, to be transcribed only in the event of an appeal from the decree rendered under this section. A copy of such transcript shall be furnished without charge to any appellant whom the Probate Court finds unable to pay for such copy. The cost of such transcript shall be paid from funds appropriated to the Judicial Department.

(3) If the court finds by clear and convincing evidence that the respondent has psychiatric disabilities and is dangerous to himself or herself or others or gravely disabled, the court shall make an order for his or her commitment, considering whether or not a less restrictive placement is available, to a hospital for psychiatric disabilities to be named in such order, there to be confined for the period of the duration of such psychiatric disabilities or until he or she is discharged or converted to voluntary status pursuant to section 17a-506, as amended by this act, in due course of law. Such court order shall further command some suitable person to convey such person to such hospital for psychiatric disabilities and deliver him or her, with a copy of such order and of such [ certificates] certificate, to the keeper thereof. In appointing a person to execute such order, the court shall give preference to a near relative or friend of the person with psychiatric disabilities, so far as the court deems it practicable and judicious. Notice of any action taken by the court shall be given to the respondent and his or her attorney, if any, in such manner as the court concludes would be appropriate under the circumstances.

(d) If the respondent refuses to be examined by the court-appointed [ physicians] physician as provided in subsection (c) of this section, the court may issue a warrant for the apprehension of the respondent and a police officer for the town in which such court is located or if there is no such police officer then the state police shall deliver the respondent to a general hospital where the respondent shall be examined by [ two physicians, one of whom] an impartial physician, who shall be a practicing psychiatrist, in accordance with subsection (c) of this section. If as a result of such examination, the respondent is committed under section 17a-502, transportation of the respondent to any such hospital, if such respondent is a female, shall be in accordance with the provisions of section 17a-505. If the respondent is not committed under section 17a-502, the respondent shall be released and the [ reports] report of such [ physicians] physician shall be sent to the Probate Court to satisfy the requirement of examination by [ two physicians] a physician under subsection (c) of this section.

(e) The respondent shall be given the opportunity to elect voluntary status under section 17a-506, as amended by this act, at any time prior to adjudication of the application, subject to the following provisions: (1) In the event that a patient is in the hospital, the patient shall be informed by a member of the hospital staff within twenty-four hours prior to the time an application is filed with the court, that he or she may continue in the hospital on a voluntary basis under the provisions of section 17a-506, as amended by this act, and any application for involuntary commitment by the hospital shall include a statement that such voluntary status has been offered to the respondent and refused, and (2) in the event that a respondent is not hospitalized, the notice of hearing shall inform the respondent that the respondent has the right to enter the hospital on a voluntary basis under the provisions of section 17a-506, as amended by this act, and, if the respondent enters the hospital under section 17a-506, as amended by this act, the application for involuntary commitment shall be withdrawn. When any patient who has elected voluntary status following the filing of an application but prior to adjudication in any proceeding for involuntary commitment thereafter notifies the hospital that he or she wants to be released, a new application for involuntary commitment may be filed. If such new application is filed not later than forty-five days after the patient's election of voluntary status on a prior application, the application for involuntary commitment may, at the discretion of the judge, be heard on the merits, notwithstanding the patient's subsequent request to remain a voluntary patient under the provisions of section 17a-506, as amended by this act. Notwithstanding the provisions of sections 17a-29, 17a-540, as amended by this act, 17a-543, 17a-544, subsection (f) of section 17a-547 and section 17a-548, if a patient under section 17a-506, as amended by this act, refuses to accept medication or treatment in accordance with the treatment plan prescribed by the attending physician and such patient is imminently dangerous to himself or others, an application for involuntary commitment may be filed for such patient in accordance with the provisions of this section.

(f) The respondent shall be present at any hearing for his or her commitment under this section. If the respondent is medicated at that time, the hospital shall provide written notice to the court of such fact and of the common effects of such medication.

(g) The hospital shall notify each patient at least annually that such patient has a right to a further hearing pursuant to this section. If the patient requests such hearing, it shall be held by the Probate Court for the district in which the hospital is located. Any such request shall be immediately filed with the appropriate court by the hospital. After such request is filed with the Probate Court, it shall proceed in the manner provided in subsections (a), (b), (c) and (f) of this section. In addition, the hospital shall furnish the Probate Court for the district in which the hospital is located on a monthly basis with a list of all patients confined in the hospital involuntarily without release for one year since the last annual review under this section of the patient's commitment or since the original commitment. The hospital shall include in such notification the type of review the patient last received. If the patient's last annual review had a hearing, the Probate Court shall, within fifteen business days thereafter, appoint an impartial physician who is a psychiatrist from the list provided by the Commissioner of Mental Health and Addiction Services as set forth in subsection (c) of this section and not connected with the hospital in which the patient is confined or related by blood or marriage to the original applicant or to the respondent, which physician shall see and examine each such patient within fifteen business days after such physician's appointment and make a report forthwith to such court of the condition of the patient on forms provided by the Probate Court Administrator. If the Probate Court concludes that the confinement of any such patient should be reviewed by such court for possible release of the patient, the court, on its own motion, shall proceed in the manner provided in subsections (a), (b), (c) and (f) of this section, except that the examining physician shall be considered [ one of] the [ physicians] physician required by subsection (c) of this section. If the patient's last annual review did not result in a hearing, and in any event at least every two years, the Probate Court shall, within fifteen business days, proceed with a hearing in the manner provided in subsections (a), (b), (c) and (f) of this section. All costs and expenses, including Probate Court entry fees provided by statute, in conjunction with the annual psychiatric review and the judicial review under this subsection, except costs for physicians appointed pursuant to this subsection, shall be established by, and paid from funds appropriated to, the Judicial Department, except that if funds have not been included in the budget of the Judicial Department for such costs and expenses, such payment shall be made from the Probate Court Administration Fund. Compensation of any physician appointed to conduct the annual psychiatric review, to examine a patient for any hearing held as a result of such annual review or for any other biennial hearing required pursuant to sections 17a-75 to 17a-83, inclusive, 17a-450 to 17a-484, inclusive, 17a-495 to 17a-528, inclusive, 17a-540 to 17a-550, inclusive, as amended by this act, 17a-560 to 17a-576, inclusive, and 17a-615 to 17a-618, inclusive, shall be paid by the state from funds appropriated to the Department of Mental Health and Addiction Services in accordance with rates established by the Department of Mental Health and Addiction Services.

Sec. 503. Subsection (c) of section 17a-506 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(c) Any person for whom a conservator of the person has been appointed in accordance with sections 45a-644 to 45a-662, inclusive, may request admission to a hospital for psychiatric disabilities and such hospital may admit such person. The hospital shall notify the conservator and the probate court which appointed the conservator of the admission not later than five business days after such admission. The probate court shall, not later than ten business days after such notice, appoint a physician who is a psychiatrist from the list provided by the Commissioner of Mental Health and Addiction Services as set forth in subsection (c) of section 17a-498, as amended by this act. The physician shall examine the patient [ within ten business days of his] not later than ten business days after the date of his or her appointment to determine if the patient has given informed consent to his or her hospitalization. The physician shall make a report forthwith to the court. If the court concludes that the patient did not give informed consent to the hospitalization, the court, on its own motion, may proceed in the manner provided in subsections (a), (b), (c) and (f) of section 17a-498, as amended by this act. All costs and expenses, including Probate Court entry fees, shall be paid [ by the patient or, if he has a conservator of the estate, by such conservator] from funds appropriated to the Judicial Department.

Sec. 504. Section 17a-542 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

Every patient treated in any facility for treatment of persons with psychiatric disabilities shall receive humane and dignified treatment at all times, with full respect for his personal dignity and right to privacy. Each patient shall be treated in accordance with a specialized treatment plan suited to his disorder. Such treatment plan shall include a discharge plan which shall include, but not be limited to, (1) reasonable notice to the patient of his impending discharge, (2) active participation by the patient in planning for his discharge and (3) planning for appropriate aftercare to the patient upon his discharge. Subject to the privacy protections afforded a patient under federal law, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended from time to time, the head of a facility may direct that any person involved in the formulation of the patient's treatment plan or discharge plan communicate with, and obtain medical records from inpatient and outpatient health care providers who have previously treated the patient. In addition, when formulating such treatment plan or discharge plan, persons involved in the formulation of such plans may also communicate with any person with whom the patient has resided in the twelve-month period prior to being admitted to the facility and with the patient's spouse, parents, siblings or children in order to better understand the patient's medical needs.

Sec. 505. Subdivision (1) of section 17a-540 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2018):

(1) "Facility" means any inpatient or outpatient hospital, clinic, skilled nursing facility or other facility for the diagnosis, observation or treatment of persons with psychiatric disabilities;"

This act shall take effect as follows and shall amend the following sections:

Sec. 501

October 1, 2018

New section

Sec. 502

October 1, 2018

17a-498(c) to (g)

Sec. 503

October 1, 2018

17a-506(c)

Sec. 504

October 1, 2018

17a-542

Sec. 505

October 1, 2018

17a-540(1)