5082-S.E AMC CONF H3324.1
ESSB 5082 - CONF REPT
By Conference Committee
ADOPTED 4/26/97
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1. The legislature finds it is often necessary for parents to obtain mental health or chemical dependency treatment for their minor children prior to the time the child's condition presents a likelihood of serious harm or the child becomes gravely disabled. The legislature finds that treatment of such conditions is not the equivalent of incarceration or detention, but is a legitimate act of parental discretion, when supported by decisions of credentialed professionals. The legislature finds that, consistent with Parham v. J.R., 442 U.S. 584 (1979), state action is not involved in the determination of a parent and professional person to admit a minor child to treatment and finds this act provides sufficient independent review by the department of social and health services, as a neutral fact-finder, to protect the interests of all parties. The legislature finds it is necessary to provide parents a statutory process, other than the petition process provided in chapters 70.96A and 71.34 RCW, to obtain treatment for their minor children without the consent of the children.
The legislature finds that differing standards of admission and review in parent-initiated mental health and chemical dependency treatment for their minor children are necessary and the admission standards and procedures under state involuntary treatment procedures are not adequate to provide safeguards for the safety and well-being of all children. The legislature finds the timeline for admission and reviews under existing law do not provide sufficient opportunities for assessment of the mental health and chemically dependent status of every minor child and that additional time and different standards will facilitate the likelihood of successful treatment of children who are in need of assistance but unwilling to obtain it voluntarily. The legislature finds there are children whose behavior presents a clear need of medical treatment but is not so extreme as to require immediate state intervention under the state involuntary treatment procedures.
MENTAL HEALTH
Sec. 2. RCW 71.34.010 and 1992 c 205 s 302 are each amended to read as follows:
It
is the purpose of this chapter to ((ensure)) assure that minors
in need of mental health care and treatment receive an appropriate continuum of
culturally relevant care and treatment, ((from)) including
prevention and early intervention ((to)), self-directed care,
parent-directed care, and involuntary treatment. To facilitate the
continuum of care and treatment to minors in out-of-home placements, all
divisions of the department that provide mental health services to minors shall
jointly plan and deliver those services.
It
is also the purpose of this chapter to protect the rights of minors against
needless hospitalization and deprivations of liberty and to enable treatment
decisions to be made in response to clinical needs in accordance with sound
professional judgment. The mental health care and treatment providers shall
encourage the use of voluntary services and, whenever clinically appropriate,
the providers shall offer less restrictive alternatives to inpatient
treatment. Additionally, all mental health care and treatment providers shall
((ensure)) assure that minors' parents are given an opportunity
to participate in the treatment decisions for their minor children. The mental
health care and treatment providers shall, to the extent possible, offer
services that involve minors' parents or family.
It is also the purpose of this chapter to assure the ability of parents to exercise reasonable, compassionate care and control of their minor children when there is a medical necessity for treatment and without the requirement of filing a petition under this chapter.
Sec. 3. RCW 71.34.020 and 1985 c 354 s 2 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Child psychiatrist" means a person having a license as a physician and surgeon in this state, who has had graduate training in child psychiatry in a program approved by the American Medical Association or the American Osteopathic Association, and who is board eligible or board certified in child psychiatry.
(2) "Children's mental health specialist" means:
(a) A mental health professional who has completed a minimum of one hundred actual hours, not quarter or semester hours, of specialized training devoted to the study of child development and the treatment of children; and
(b) A mental health professional who has the equivalent of one year of full-time experience in the treatment of children under the supervision of a children's mental health specialist.
(3) "Commitment" means a determination by a judge or court commissioner, made after a commitment hearing, that the minor is in need of inpatient diagnosis, evaluation, or treatment or that the minor is in need of less restrictive alternative treatment.
(4) "County-designated mental health professional" means a mental health professional designated by one or more counties to perform the functions of a county-designated mental health professional described in this chapter.
(5) "Department" means the department of social and health services.
(6) "Evaluation and treatment facility" means a public or private facility or unit that is certified by the department to provide emergency, inpatient, residential, or outpatient mental health evaluation and treatment services for minors. A physically separate and separately-operated portion of a state hospital may be designated as an evaluation and treatment facility for minors. A facility which is part of or operated by the department or federal agency does not require certification. No correctional institution or facility, juvenile court detention facility, or jail may be an evaluation and treatment facility within the meaning of this chapter.
(7) "Evaluation and treatment program" means the total system of services and facilities coordinated and approved by a county or combination of counties for the evaluation and treatment of minors under this chapter.
(8) "Gravely disabled minor" means a minor who, as a result of a mental disorder, is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety, or manifests severe deterioration in routine functioning evidenced by repeated and escalating loss of cognitive or volitional control over his or her actions and is not receiving such care as is essential for his or her health or safety.
(9) "Inpatient treatment" means twenty-four-hour-per-day mental health care provided within a general hospital, psychiatric hospital, or residential treatment facility certified by the department as an evaluation and treatment facility for minors.
(10) "Less restrictive alternative" or "less restrictive setting" means outpatient treatment provided to a minor who is not residing in a facility providing inpatient treatment as defined in this chapter.
(11) "Likelihood of serious harm" means either: (a) A substantial risk that physical harm will be inflicted by an individual upon his or her own person, as evidenced by threats or attempts to commit suicide or inflict physical harm on oneself; (b) a substantial risk that physical harm will be inflicted by an individual upon another, as evidenced by behavior which has caused such harm or which places another person or persons in reasonable fear of sustaining such harm; or (c) a substantial risk that physical harm will be inflicted by an individual upon the property of others, as evidenced by behavior which has caused substantial loss or damage to the property of others.
(12) "Medical necessity" for inpatient care means a requested service which is reasonably calculated to: (a) Diagnose, correct, cure, or alleviate a mental disorder; or (b) prevent the worsening of mental conditions that endanger life or cause suffering and pain, or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no adequate less restrictive alternative available.
(13) "Medically appropriate" means that a minor admitted to inpatient treatment, under section 13 of this act, has not sufficiently improved his or her condition to be released to a less restrictive setting.
(14) "Mental disorder" means any organic, mental, or emotional impairment that has substantial adverse effects on an individual's cognitive or volitional functions. The presence of alcohol abuse, drug abuse, juvenile criminal history, antisocial behavior, or mental retardation alone is insufficient to justify a finding of "mental disorder" within the meaning of this section.
(((13)))
(15) "Mental health professional" means a psychiatrist,
psychologist, psychiatric nurse, or social worker, and such other mental health
professionals as may be defined by rules adopted by the secretary under this
chapter.
(((14)))
(16) "Minor" means any person under the age of eighteen years.
(((15)))
(17) "Outpatient treatment" means any of the nonresidential
services mandated under chapter 71.24 RCW and provided by licensed services
providers as identified by RCW 71.24.025(3).
(((16)))
(18) "Parent" means:
(a) A biological or adoptive parent who has legal custody of the child, including either parent if custody is shared under a joint custody agreement; or
(b) A person or agency judicially appointed as legal guardian or custodian of the child.
(((17)))
(19) "Professional person in charge" or "professional
person" means a physician or other mental health professional
empowered by an evaluation and treatment facility with authority to make
admission and discharge decisions on behalf of that facility.
(((18)))
(20) "Psychiatric nurse" means a registered nurse who has a
bachelor's degree from an accredited college or university, and who has had, in
addition, at least two years' experience in the direct treatment of mentally
ill or emotionally disturbed persons, such experience gained under the
supervision of a mental health professional. "Psychiatric nurse"
shall also mean any other registered nurse who has three years of such
experience.
(((19)))
(21) "Psychiatrist" means a person having a license as a
physician in this state who has completed residency training in psychiatry in a
program approved by the American Medical Association or the American
Osteopathic Association, and is board eligible or board certified in
psychiatry.
(((20)))
(22) "Psychologist" means a person licensed as a psychologist
under chapter 18.83 RCW.
(((21)))
(23) "Responsible other" means the minor, the minor's parent
or estate, or any other person legally responsible for support of the minor.
(((22)))
(24) "Secretary" means the secretary of the department or
secretary's designee.
(((23)))
(25) "Start of initial detention" means the time of arrival of
the minor at the first evaluation and treatment facility offering inpatient
treatment if the minor is being involuntarily detained at the time. With
regard to voluntary patients, "start of initial detention" means the
time at which the minor gives notice of intent to leave under the provisions of
this chapter.
Sec. 4. RCW 71.34.025 and 1995 c 312 s 56 are each amended to read as follows:
(1)
((The admission of any child under RCW 71.34.030 may be reviewed by the
county-designated mental health professional between fifteen and thirty days
following admission. The county-designated mental health professional may
undertake the review on his or her own initiative and may seek reimbursement
from the parents, their insurance, or medicaid for the expense of the review.
(2))) The
department shall ((ensure)) assure that, for any minor admitted to
inpatient treatment under section 13 of this act, a review is conducted by
a physician or other mental health professional who is employed by the
department, or an agency under contract with the department, and who neither
has a financial interest in continued inpatient treatment of the minor nor is
affiliated with the facility providing the treatment. The physician or other
mental health professional shall conduct the review no sooner than five days
and no later than ((sixty)) ten days, excluding Saturdays,
Sundays, and holidays, following admission to determine whether it is
medically appropriate to continue the ((child's)) minor's
treatment on an inpatient basis. ((The department may, subject to available
funds, contract with a county for the conduct of the review conducted under
this subsection and may seek reimbursement from the parents, their insurance,
or medicaid for the expense of any review conducted by an agency under
contract.
If
the county-designated mental health professional determines that continued
inpatient treatment of the child is no longer medically appropriate, the
professional shall notify the facility, the child, the child's parents, and the
department of the finding within twenty-four hours of the determination.
(3)
For purposes of eligibility for medical assistance under chapter 74.09 RCW,
children in inpatient mental health or chemical dependency treatment shall be
considered to be part of their parent's or legal guardian's household, unless
the child has been assessed by the department of social and health services or
its designee as likely to require such treatment for at least ninety
consecutive days, or is in out-of-home care in accordance with chapter 13.34
RCW, or the child's parents are found to not be exercising responsibility for
care and control of the child. Payment for such care by the department of
social and health services shall be made only in accordance with rules,
guidelines, and clinical criteria applicable to inpatient treatment of minors
established by the department.))
(2) The department shall, at thirty-day intervals following the review conducted under subsection (1) of this section, conduct three reviews of the treatment status of each minor admitted to inpatient treatment, under section 13 of this act, to determine whether it is medically appropriate to continue the minor's treatment under inpatient status. The reviews shall be conducted by a physician or other mental health professional who is employed by the department, or an agency under contract with the department, and who neither has a financial interest in continued inpatient treatment of the minor nor is affiliated with the facility providing the treatment.
(3) In making a determination under subsection (1) or (2) of this section, the department shall consider the opinion of the treatment provider, the safety of the minor, and the likelihood the minor's mental health will deteriorate if released from inpatient treatment. The department shall consult with the parent in advance of making its determination.
(4) If the department determines it is no longer medically appropriate for a minor to receive inpatient treatment, the department shall immediately notify the parents and the facility. The facility shall release the minor to the parents within twenty-four hours of receiving notice. If the professional person in charge and the parent believe that it is medically appropriate for the minor to remain in inpatient treatment, the minor shall be released to the parent on the second judicial day following the department's determination in order to allow the parent time to file an at-risk youth petition under chapter 13.32A RCW. If the department determines it is medically appropriate for the minor to receive outpatient treatment and the minor declines to obtain such treatment, such refusal shall be grounds for the parent to file an at-risk youth petition.
(5) If after the third department review under subsection (2) of this section, the department determines that it is medically appropriate to continue the minor's inpatient treatment, the department, or the department's designee, shall file a petition under RCW 71.34.070 within seven days of the department's determination. For the purposes of this section, it is not necessary to file a petition for initial detention.
(6) If the evaluation conducted under section 13 of this act is done by the department, the reviews required by subsections (1) and (2) of this section shall be done by contract with an independent agency.
(7) The department may, subject to available funds, contract with other governmental agencies to conduct the reviews under this section. The department may seek reimbursement from the parents, their insurance, or medicaid for the expense of any review conducted by an agency under contract.
NEW SECTION. Sec. 5. A new section is added to chapter 71.34 RCW to read as follows:
For purposes of eligibility for medical assistance under chapter 74.09 RCW, minors in inpatient mental health treatment shall be considered to be part of their parent's or legal guardian's household, unless the minor has been assessed by the department or its designee as likely to require such treatment for at least ninety consecutive days, or is in out-of-home care in accordance with chapter 13.34 RCW, or the parents are found to not be exercising responsibility for care and control of the minor. Payment for such care by the department shall be made only in accordance with rules, guidelines, and clinical criteria applicable to inpatient treatment of minors established by the department.
VOLUNTARY MENTAL HEALTH OUTPATIENT TREATMENT
Sec. 6. RCW 71.34.030 and 1995 c 312 s 52 are each amended to read as follows:
(((1)))
Any minor thirteen years or older may request and receive outpatient treatment
without the consent of the minor's parent. Parental authorization is required
for outpatient treatment of a minor under the age of thirteen.
(((2)
When in the judgment of the professional person in charge of an evaluation and
treatment facility there is reason to believe that a minor is in need of
inpatient treatment because of a mental disorder, and the facility provides the
type of evaluation and treatment needed by the minor, and it is not feasible to
treat the minor in any less restrictive setting or the minor's home, the minor
may be admitted to an evaluation and treatment facility in accordance with the
following requirements:
(a)
A minor may be voluntarily admitted by application of the parent. The consent
of the minor is not required for the minor to be evaluated and admitted as
appropriate.
(b)
A minor thirteen years or older may, with the concurrence of the professional
person in charge of an evaluation and treatment facility, admit himself or
herself without parental consent to the evaluation and treatment facility,
provided that notice is given by the facility to the minor's parent in
accordance with the following requirements:
(i)
Notice of the minor's admission shall be in the form most likely to reach the
parent within twenty-four hours of the minor's voluntary admission and shall
advise the parent that the minor has been admitted to inpatient treatment; the
location and telephone number of the facility providing such treatment; and the
name of a professional person on the staff of the facility providing treatment
who is designated to discuss the minor's need for inpatient treatment with the
parent.
(ii)
The minor shall be released to the parent at the parent's request for release
unless the facility files a petition with the superior court of the county in
which treatment is being provided setting forth the basis for the facility's
belief that the minor is in need of inpatient treatment and that release would
constitute a threat to the minor's health or safety.
(iii)
The petition shall be signed by the professional person in charge of the
facility or that person's designee.
(iv)
The parent may apply to the court for separate counsel to represent the parent
if the parent cannot afford counsel.
(v)
There shall be a hearing on the petition, which shall be held within three
judicial days from the filing of the petition.
(vi)
The hearing shall be conducted by a judge, court commissioner, or licensed
attorney designated by the superior court as a hearing officer for such
hearing. The hearing may be held at the treatment facility.
(vii)
At such hearing, the facility must demonstrate by a preponderance of the
evidence presented at the hearing that the minor is in need of inpatient
treatment and that release would constitute a threat to the minor's health or
safety. The hearing shall not be conducted using the rules of evidence, and
the admission or exclusion of evidence sought to be presented shall be within
the exercise of sound discretion by the judicial officer conducting the
hearing.
(c)
Written renewal of voluntary consent must be obtained from the applicant no
less than once every twelve months.
(d)
The minor's need for continued inpatient treatments shall be reviewed and
documented no less than every one hundred eighty days.
(3)
A notice of intent to leave shall result in the following:
(a)
Any minor under the age of thirteen must be discharged immediately upon written
request of the parent.
(b)
Any minor thirteen years or older voluntarily admitted may give notice of
intent to leave at any time. The notice need not follow any specific form so
long as it is written and the intent of the minor can be discerned.
(c)
The staff member receiving the notice shall date it immediately, record its existence
in the minor's clinical record, and send copies of it to the minor's attorney,
if any, the county-designated mental health professional, and the parent.
(d)
The professional person in charge of the evaluation and treatment facility
shall discharge the minor, thirteen years or older, from the facility within
twenty-four hours after receipt of the minor's notice of intent to leave,
unless the county-designated mental health professional or a parent or legal
guardian files a petition or an application for initial detention within the
time prescribed by this chapter.
(4)
The ability of a parent to apply to a certified evaluation and treatment
program for the involuntary admission of his or her minor child does not create
a right to obtain or benefit from any funds or resources of the state.
However, the state may provide services for indigent minors to the extent that
funds are available therefor.))
NEW SECTION. Sec. 7. For the purpose of gathering information related to parental notification of outpatient mental health treatment of minors, the department of health shall conduct a survey of providers of outpatient treatment, as defined in chapter 71.34 RCW. The survey shall gather information from a statistically valid sample of providers. In accordance with confidentiality statutes and the physician-patient privilege, the survey shall secure information from the providers related to:
(1) The number of minors receiving outpatient treatment;
(2) The number of parents of minors in treatment notified of the minor's treatment;
(3) The average number of outpatient visits prior to parental notification;
(4) The average number of treatments with parental notification;
(5) The average number of treatments without parental notification;
(6) The percentage of minors in treatment who are prescribed medication;
(7) The medication prescribed;
(8) The number of patients terminating treatment due to parental notification; and
(9) Any other pertinent information.
The department shall submit the survey results to the governor and the appropriate committees of the legislature by December 1, 1997.
This section expires June 1, 1998.
VOLUNTARY MENTAL HEALTH INPATIENT TREATMENT
NEW SECTION. Sec. 8. A new section is added to chapter 71.34 RCW to read as follows:
(1) A minor thirteen years or older may admit himself or herself to an evaluation and treatment facility for inpatient mental treatment, without parental consent. The admission shall occur only if the professional person in charge of the facility concurs with the need for inpatient treatment.
(2) When, in the judgment of the professional person in charge of an evaluation and treatment facility, there is reason to believe that a minor is in need of inpatient treatment because of a mental disorder, and the facility provides the type of evaluation and treatment needed by the minor, and it is not feasible to treat the minor in any less restrictive setting or the minor's home, the minor may be admitted to an evaluation and treatment facility.
(3) Written renewal of voluntary consent must be obtained from the applicant no less than once every twelve months. The minor's need for continued inpatient treatments shall be reviewed and documented no less than every one hundred eighty days.
NEW SECTION. Sec. 9. A new section is added to chapter 71.34 RCW to read as follows:
The administrator of the treatment facility shall provide notice to the parents of a minor when the minor is voluntarily admitted to inpatient treatment under section 8 of this act. The notice shall be in the form most likely to reach the parent within twenty-four hours of the minor's voluntary admission and shall advise the parent: (1) That the minor has been admitted to inpatient treatment; (2) of the location and telephone number of the facility providing such treatment; (3) of the name of a professional person on the staff of the facility providing treatment who is designated to discuss the minor's need for inpatient treatment with the parent; and (4) of the medical necessity for admission.
NEW SECTION. Sec. 10. A new section is added to chapter 71.34 RCW to read as follows:
(1) Any minor thirteen years or older who has voluntarily admitted himself or herself to inpatient treatment shall be released to the parent upon the parent's written request for release unless the professional person in charge of the facility exercises his or her option to file a petition for commitment of a minor.
(2)(a) The petition shall be filed with the superior court of the county in which treatment is being provided setting forth the basis for the facility's belief that the minor is in need of inpatient treatment and that release would constitute a threat to the minor's health or safety.
(b) The petition shall be signed by the minor and the professional person in charge of the facility or that person's designee.
(c) The parent may apply to the court for separate counsel to represent the parent if the parent cannot afford counsel.
(d) There shall be a hearing on the petition, which shall be held within seventy-two hours from the filing of the petition.
(3) The commitment hearing shall be conducted at the superior court or an appropriate place at the treatment facility.
(4) The professional person must demonstrate, by a preponderance of the evidence, that the minor is in need of inpatient treatment and that the release would constitute a threat to the minor's health or safety. The rules of evidence shall not apply at the hearing.
NEW SECTION. Sec. 11. A new section is added to chapter 71.34 RCW to read as follows:
(1) Any minor thirteen years or older voluntarily admitted to an evaluation and treatment facility under section 8 of this act may give notice of intent to leave at any time. The notice need not follow any specific form so long as it is written and the intent of the minor can be discerned.
(2) The staff member receiving the notice shall date it immediately, record its existence in the minor's clinical record, and send copies of it to the minor's attorney, if any, the county-designated mental health professional, and the parent.
(3) The professional person shall discharge the minor, thirteen years or older, from the facility within twenty-four hours after receipt of the minor's notice of intent to leave, unless the county-designated mental health professional commences an initial detention proceeding under the provisions of this chapter.
NEW SECTION. Sec. 12. A new section is added to chapter 71.34 RCW to read as follows:
Any minor admitted to inpatient treatment under section 8 or 13 of this act shall be discharged immediately from inpatient treatment upon written request of the parent.
PARENT-INITIATED MENTAL HEALTH TREATMENT
NEW SECTION. Sec. 13. A new section is added to chapter 71.34 RCW to read as follows:
(1) A parent may bring, or authorize the bringing of, his or her minor child to an evaluation and treatment facility and request that the professional person examine the minor to determine whether the minor has a mental disorder and is in need of inpatient treatment.
(2) The consent of the minor is not required for admission, evaluation, and treatment if the parent brings the minor to the facility.
(3) An appropriately trained professional person may evaluate whether the minor has a mental disorder. The evaluation shall be completed within twenty-four hours of the time the minor was brought to the facility, unless the professional person determines that the condition of the minor necessitates additional time for evaluation. In no event shall a minor be held longer than seventy-two hours for evaluation without being admitted or released. If, in the judgment of the professional person, it is determined it is a medical necessity for the minor to receive inpatient treatment, the minor may be admitted. Prior to admission, the facility shall limit treatment to that which the professional person determines is medically necessary to stabilize the minor's condition. Within twenty-four hours of the admission, the professional person shall notify the department of the admission.
(4) No provider is obligated to provide treatment to a minor under the provisions of this section. No provider may admit a minor to treatment under this section unless it is medically necessary.
(5) No minor receiving inpatient treatment under this section may be discharged from the facility based solely on his or her request.
(6) For the purposes of this section "professional person" does not include a social worker, unless the social worker is certified under RCW 18.19.110 and appropriately trained and qualified by education and experience, as defined by the department, in psychiatric social work.
NEW SECTION. Sec. 14. A new section is added to chapter 71.34 RCW to read as follows:
(1) A parent may bring, or authorize the bringing of, his or her minor child to a provider of outpatient mental health treatment and request that an appropriately trained professional person examine the minor to determine whether the minor has a mental disorder and is in need of outpatient treatment.
(2) The consent of the minor is not required for evaluation if the parent brings the minor to the provider.
(3) The professional person may evaluate whether the minor has a mental disorder and is in need of outpatient treatment.
NEW SECTION. Sec. 15. A new section is added to chapter 71.34 RCW to read as follows:
The ability of a parent to apply to a certified evaluation and treatment program for the admission of his or her minor does not create a right to obtain or benefit from any funds or resources of the state. The state may provide services for indigent minors to the extent that funds are available.
CHEMICAL DEPENDENCY
Sec. 16. RCW 70.96A.020 and 1996 c 178 s 23 and 1996 c 133 s 33 are each reenacted and amended to read as follows:
For the purposes of this chapter the following words and phrases shall have the following meanings unless the context clearly requires otherwise:
(1) "Alcoholic" means a person who suffers from the disease of alcoholism.
(2) "Alcoholism" means a disease, characterized by a dependency on alcoholic beverages, loss of control over the amount and circumstances of use, symptoms of tolerance, physiological or psychological withdrawal, or both, if use is reduced or discontinued, and impairment of health or disruption of social or economic functioning.
(3) "Approved treatment program" means a discrete program of chemical dependency treatment provided by a treatment program certified by the department of social and health services as meeting standards adopted under this chapter.
(4) "Chemical dependency" means alcoholism or drug addiction, or dependence on alcohol and one or more other psychoactive chemicals, as the context requires.
(5) "Chemical dependency program" means expenditures and activities of the department designed and conducted to prevent or treat alcoholism and other drug addiction, including reasonable administration and overhead.
(6) "Department" means the department of social and health services.
(7) "Designated chemical dependency specialist" means a person designated by the county alcoholism and other drug addiction program coordinator designated under RCW 70.96A.310 to perform the commitment duties described in RCW 70.96A.140 and qualified to do so by meeting standards adopted by the department.
(8) "Director" means the person administering the chemical dependency program within the department.
(9) "Drug addict" means a person who suffers from the disease of drug addiction.
(10) "Drug addiction" means a disease characterized by a dependency on psychoactive chemicals, loss of control over the amount and circumstances of use, symptoms of tolerance, physiological or psychological withdrawal, or both, if use is reduced or discontinued, and impairment of health or disruption of social or economic functioning.
(11) "Emergency service patrol" means a patrol established under RCW 70.96A.170.
(12) "Gravely disabled by alcohol or other drugs" means that a person, as a result of the use of alcohol or other drugs: (a) Is in danger of serious physical harm resulting from a failure to provide for his or her essential human needs of health or safety; or (b) manifests severe deterioration in routine functioning evidenced by a repeated and escalating loss of cognition or volitional control over his or her actions and is not receiving care as essential for his or her health or safety.
(13) "Incapacitated by alcohol or other psychoactive chemicals" means that a person, as a result of the use of alcohol or other psychoactive chemicals, has his or her judgment so impaired that he or she is incapable of realizing and making a rational decision with respect to his or her need for treatment and presents a likelihood of serious harm to himself or herself, to any other person, or to property.
(14) "Incompetent person" means a person who has been adjudged incompetent by the superior court.
(15) "Intoxicated person" means a person whose mental or physical functioning is substantially impaired as a result of the use of alcohol or other psychoactive chemicals.
(16) "Licensed physician" means a person licensed to practice medicine or osteopathic medicine and surgery in the state of Washington.
(17) "Likelihood of serious harm" means either: (a) A substantial risk that physical harm will be inflicted by an individual upon his or her own person, as evidenced by threats or attempts to commit suicide or inflict physical harm on one's self; (b) a substantial risk that physical harm will be inflicted by an individual upon another, as evidenced by behavior that has caused the harm or that places another person or persons in reasonable fear of sustaining the harm; or (c) a substantial risk that physical harm will be inflicted by an individual upon the property of others, as evidenced by behavior that has caused substantial loss or damage to the property of others.
(18) "Medical necessity" for inpatient care of a minor means a requested certified inpatient service that is reasonably calculated to: (a) Diagnose, arrest, or alleviate a chemical dependency; or (b) prevent the worsening of chemical dependency conditions that endanger life or cause suffering and pain, or result in illness or infirmity or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no adequate less restrictive alternative available.
(19) "Medically appropriate" means a minor admitted by his or her parents to inpatient treatment under section 21 of this act has not sufficiently improved his or her condition to be released to a less restrictive setting.
(20) "Minor" means a person less than eighteen years of age.
(((19)))
(21) "Parent" means the parent or parents who have the legal
right to custody of the child. Parent includes custodian or guardian.
(((20)))
(22) "Peace officer" means a law enforcement official of a
public agency or governmental unit, and includes persons specifically given
peace officer powers by any state law, local ordinance, or judicial order of
appointment.
(((21)))
(23) "Person" means an individual, including a minor.
(((22)))
(24) "Professional person in charge" or "professional
person" means a physician or chemical dependency counselor as defined in
rule by the department, who is empowered by a certified treatment program with
authority to make assessment, admission, continuing care, and discharge
decisions on behalf of the certified program.
(25) "Secretary" means the secretary of the department of social and health services.
(((23)))
(26) "Treatment" means the broad range of emergency,
detoxification, residential, and outpatient services and care, including
diagnostic evaluation, chemical dependency education and counseling, medical,
psychiatric, psychological, and social service care, vocational rehabilitation
and career counseling, which may be extended to alcoholics and other drug
addicts and their families, persons incapacitated by alcohol or other
psychoactive chemicals, and intoxicated persons.
(((24)))
(27) "Treatment program" means an organization, institution,
or corporation, public or private, engaged in the care, treatment, or
rehabilitation of alcoholics or other drug addicts.
VOLUNTARY CHEMICAL DEPENDENCY OUTPATIENT TREATMENT
Sec. 17. RCW 70.96A.095 and 1996 c 133 s 34 are each amended to read as follows:
(((1)))
Any person thirteen years of age or older may give consent for himself or
herself to the furnishing of outpatient treatment by a chemical dependency
treatment program certified by the department. ((Consent of the parent of a
person less than eighteen years of age for inpatient treatment is necessary to
authorize the care unless the child meets the definition of a child in need of
services in RCW 13.32A.030(4)(c), as determined by the department.))
Parental authorization is required for any treatment of a minor under the age
of thirteen. ((The parent of a minor is not liable for payment of care for
such persons pursuant to this chapter, unless they have joined in the consent
to the treatment.
(2)
The parent of any minor child may apply to a certified treatment program for
the admission of his or her minor child for purposes authorized in this
chapter. The consent of the minor child shall not be required for the
application or admission. The certified treatment program shall accept the
application and evaluate the child for admission. The ability of a parent to
apply to a certified treatment program for the admission of his or her minor
child does not create a right to obtain or benefit from any funds or resources
of the state. However, the state may provide services for indigent minors to
the extent that funds are available therefor.
(3)
Any provider of outpatient treatment who provides outpatient treatment to a
minor thirteen years of age or older shall provide notice of the minor's
request for treatment to the minor's parents if: (a) The minor signs a written
consent authorizing the disclosure; or (b) the treatment program director
determines that the minor lacks capacity to make a rational choice regarding
consenting to disclosure. The notice shall be made within seven days of the
request for treatment, excluding Saturdays, Sundays, and holidays, and shall
contain the name, location, and telephone number of the facility providing
treatment, and the name of a professional person on the staff of the facility
providing treatment who is designated to discuss the minor's need for treatment
with the parent.))
NEW SECTION. Sec. 18. A new section is added to chapter 70.96A RCW to read as follows:
Any provider of outpatient treatment who provides outpatient treatment to a minor thirteen years of age or older shall provide notice of the minor's request for treatment to the minor's parents if: (1) The minor signs a written consent authorizing the disclosure; or (2) the treatment program director determines that the minor lacks capacity to make a rational choice regarding consenting to disclosure. The notice shall be made within seven days of the request for treatment, excluding Saturdays, Sundays, and holidays, and shall contain the name, location, and telephone number of the facility providing treatment, and the name of a professional person on the staff of the facility providing treatment who is designated to discuss the minor's need for treatment with the parent.
VOLUNTARY CHEMICAL DEPENDENCY INPATIENT TREATMENT
NEW SECTION. Sec. 19. A new section is added to chapter 70.96A RCW to read as follows:
Parental consent is required for inpatient chemical dependency treatment of a minor, unless the child meets the definition of a child in need of services in RCW 13.32A.030(4)(c) as determined by the department: PROVIDED, That parental consent is required for any treatment of a minor under the age of thirteen.
This section does not apply to petitions filed under this chapter.
NEW SECTION. Sec. 20. A new section is added to chapter 70.96A RCW to read as follows:
(1) The parent of a minor is not liable for payment of inpatient or outpatient chemical dependency treatment unless the parent has joined in the consent to the treatment.
(2) The ability of a parent to apply to a certified treatment program for the admission of his or her minor child does not create a right to obtain or benefit from any funds or resources of the state. However, the state may provide services for indigent minors to the extent that funds are available therefor.
PARENT-INITIATED CHEMICAL DEPENDENCY TREATMENT
NEW SECTION. Sec. 21. A new section is added to chapter 70.96A RCW to read as follows:
(1) A parent may bring, or authorize the bringing of, his or her minor child to a certified treatment program and request that a chemical dependency assessment be conducted by a professional person to determine whether the minor is chemically dependent and in need of inpatient treatment.
(2) The consent of the minor is not required for admission, evaluation, and treatment if the parent brings the minor to the program.
(3) An appropriately trained professional person may evaluate whether the minor is chemically dependent. The evaluation shall be completed within twenty-four hours of the time the minor was brought to the program, unless the professional person determines that the condition of the minor necessitates additional time for evaluation. In no event shall a minor be held longer than seventy-two hours for evaluation without being admitted or released. If, in the judgment of the professional person, it is determined it is a medical necessity for the minor to receive inpatient treatment, the minor may be admitted. Prior to admission, the facility shall limit treatment to that which the professional person determines is medically necessary to stabilize the minor's condition. Within twenty-four hours of the admission the professional person shall notify the department of the admission.
(4) No provider is obligated to provide treatment to a minor under the provisions of this section. No provider may admit a minor to treatment under this section unless it is medically necessary.
(5) No minor receiving inpatient treatment under this section may be discharged from the program based solely on his or her request.
(6) Any minor admitted to inpatient treatment under this section shall be discharged immediately from inpatient treatment upon written request of the parent.
Sec. 22. RCW 70.96A.097 and 1995 c 312 s 48 are each amended to read as follows:
(1)
((The admission of any child under RCW 70.96A.095 may be reviewed by the
county-designated chemical dependency specialist between fifteen and thirty
days following admission. The county-designated chemical dependency specialist
may undertake the review on his or her own initiative and may seek
reimbursement from the parents, their insurance, or medicaid for the expense of
the review.
(2))) The
department shall ensure that, for any minor admitted to inpatient treatment
under section 21 of this act, a review is conducted by a physician or
chemical dependency counselor, as defined in rule by the department, who is
employed by the department or an agency under contract with the department and
who neither has a financial interest in continued inpatient treatment of the
minor nor is affiliated with the program providing the treatment. The
physician or chemical dependency counselor shall conduct the review no sooner
than five days and no later than ((sixty)) ten days,
excluding Saturdays, Sundays, and holidays, following admission to
determine whether it is medically appropriate to continue the ((child's))
minor's treatment on an inpatient basis. ((The department may,
subject to available funds, contract with a county for the conduct of the
review conducted under this subsection and may seek reimbursement from the
parents, their insurance, or medicaid for the expense of any review conducted
by an agency under contract.
If
the county-designated chemical dependency specialist determines that continued
inpatient treatment of the child is no longer medically appropriate, the
specialist shall notify the facility, the child, the child's parents, and the
department of the finding within twenty-four hours of the determination.
(3)
For purposes of eligibility for medical assistance under chapter 74.09 RCW,
children in inpatient mental health or chemical dependency treatment shall be
considered to be part of their parent's or legal guardian's household, unless
the child has been assessed by the department of social and health services or
its designee as likely to require such treatment for at least ninety
consecutive days, or is in out-of-home care in accordance with chapter 13.34
RCW, or the child's parents are found to not be exercising responsibility for
care and control of the child. Payment for such care by the department of social
and health services shall be made only in accordance with rules, guidelines,
and clinical criteria applicable to inpatient treatment of minors established
by the department.))
(2) The department shall, at thirty-day intervals following the review conducted under subsection (1) of this section, conduct reviews of the treatment status of each minor admitted to inpatient treatment, under section 21 of this act, to determine whether it is medically appropriate to continue the minor's treatment under inpatient status. The reviews shall be conducted by a physician or chemical dependency counselor, as defined in rule by the department, who is employed by the department, or an agency under contract with the department, and who neither has a financial interest in continued inpatient treatment of the minor nor is affiliated with the program providing the treatment.
(3) In making a determination under subsection (1) or (2) of this section whether it is medically appropriate to release the minor from inpatient treatment, the department shall consider the opinion of the treatment provider, the safety of the minor, the likelihood the minor's chemical dependency recovery will deteriorate if released from inpatient treatment, and the wishes of the parent.
(4) If the department determines it is no longer medically appropriate for a minor to receive inpatient treatment, the department shall immediately notify the parents and the professional person in charge. The professional person in charge shall release the minor to the parents within twenty-four hours of receiving notice. If the professional person in charge and the parent believe that it is medically appropriate for the minor to remain in inpatient treatment, the minor shall be released to the parent on the second judicial day following the department's determination in order to allow the parent time to file an at-risk youth petition under chapter 13.32A RCW. If the department determines it is medically appropriate for the minor to receive outpatient treatment and the minor declines to obtain such treatment, such refusal shall be grounds for the parent to file an at-risk youth petition.
(5) The department may, subject to available funds, contract with other governmental agencies for the conduct of the reviews conducted under this section and may seek reimbursement from the parents, their insurance, or medicaid for the expense of any review conducted by an agency under contract.
NEW SECTION. Sec. 23. A new section is added to chapter 70.96A RCW to read as follows:
(1) A parent may bring, or authorize the bringing of, his or her minor child to a provider of outpatient chemical dependency treatment and request that an appropriately trained professional person examine the minor to determine whether the minor has a chemical dependency and is in need of outpatient treatment.
(2) The consent of the minor is not required for evaluation if the parent brings the minor to the provider.
(3) The professional person in charge of the program may evaluate whether the minor has a chemical dependency and is in need of outpatient treatment.
NEW SECTION. Sec. 24. A new section is added to chapter 70.96A RCW to read as follows:
For purposes of eligibility for medical assistance under chapter 74.09 RCW, minors in inpatient chemical dependency treatment shall be considered to be part of their parent's or legal guardian's household, unless the minor has been assessed by the department or its designee as likely to require such treatment for at least ninety consecutive days, or is in out-of-home care in accordance with chapter 13.34 RCW, or the parents are found to not be exercising responsibility for care and control of the minor. Payment for such care by the department shall be made only in accordance with rules, guidelines, and clinical criteria applicable to inpatient treatment of minors established by the department.
NEW SECTION. Sec. 25. It is the purpose of sections 21 and 23 of this act to assure the ability of parents to exercise reasonable, compassionate care and control of their minor children when there is a medical necessity for treatment and without the requirement of filing a petition under chapter 70.96A RCW.
NEW SECTION. Sec. 26. Part headings used in this act do not constitute any part of the law.
NEW SECTION. Sec. 27. The department of social and health services shall adopt rules defining "appropriately trained professional person" for the purposes of conducting mental health and chemical dependency evaluations under sections 13(3), 14(1), 21(3), and 23(1) of this act."
ESSB 5082 - CONF REPT
By Conference Committee
On page 1, line 2 of the title, after "minors;" strike the remainder of the title and insert "amending RCW 71.34.010, 71.34.020, 71.34.025, 71.34.030, 70.96A.095, and 70.96A.097; reenacting and amending RCW 70.96A.020; adding new sections to chapter 71.34 RCW; adding new sections to chapter 70.96A RCW; creating new sections; and providing an expiration date."
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