SB 6739 -
By Committee on Health Care & Wellness
ADOPTED 03/04/2008
Strike everything after the enacting clause and insert the following:
"Sec. 1 RCW 71.05.020 and 2007 c 375 s 6 and 2007 c 191 s 2 are
each reenacted and amended to read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Admission" or "admit" means a decision by a physician or
psychiatric advanced registered nurse practitioner that a person should
be examined or treated as a patient in a hospital;
(2) "Antipsychotic medications" means that class of drugs primarily
used to treat serious manifestations of mental illness associated with
thought disorders, which includes, but is not limited to atypical
antipsychotic medications;
(3) "Attending staff" means any person on the staff of a public or
private agency having responsibility for the care and treatment of a
patient;
(4) "Commitment" means the determination by a court that a person
should be detained for a period of either evaluation or treatment, or
both, in an inpatient or a less restrictive setting;
(5) "Conditional release" means a revocable modification of a
commitment, which may be revoked upon violation of any of its terms;
(6) "Crisis stabilization unit" means a short-term facility or a
portion of a facility licensed by the department of health and
certified by the department of social and health services under RCW
71.24.035, such as an evaluation and treatment facility or a hospital,
which has been designed to assess, diagnose, and treat individuals
experiencing an acute crisis without the use of long-term
hospitalization;
(7) "Custody" means involuntary detention under the provisions of
this chapter or chapter 10.77 RCW, uninterrupted by any period of
unconditional release from commitment from a facility providing
involuntary care and treatment;
(8) "Department" means the department of social and health
services;
(9) "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 chapters 70.96A and 70.96B RCW;
(10) "Designated crisis responder" means a mental health
professional appointed by the county or the regional support network to
perform the duties specified in this chapter;
(11) "Designated mental health professional" means a mental health
professional designated by the county or other authority authorized in
rule to perform the duties specified in this chapter;
(12) "Detention" or "detain" means the lawful confinement of a
person, under the provisions of this chapter;
(13) "Developmental disabilities professional" means a person who
has specialized training and three years of experience in directly
treating or working with persons with developmental disabilities and is
a psychiatrist, psychologist, psychiatric advanced registered nurse
practitioner, or social worker, and such other developmental
disabilities professionals as may be defined by rules adopted by the
secretary;
(14) "Developmental disability" means that condition defined in RCW
71A.10.020(3);
(15) "Discharge" means the termination of hospital medical
authority. The commitment may remain in place, be terminated, or be
amended by court order;
(16) "Evaluation and treatment facility" means any facility which
can provide directly, or by direct arrangement with other public or
private agencies, emergency evaluation and treatment, outpatient care,
and timely and appropriate inpatient care to persons suffering from a
mental disorder, and which is certified as such by the department. A
physically separate and separately operated portion of a state hospital
may be designated as an evaluation and treatment facility. A facility
which is part of, or operated by, the department or any federal agency
will not require certification. No correctional institution or
facility, or jail, shall be an evaluation and treatment facility within
the meaning of this chapter;
(17) "Gravely disabled" means a condition in which a person, as a
result of a mental disorder: (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 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;
(18) "Habilitative services" means those services provided by
program personnel to assist persons in acquiring and maintaining life
skills and in raising their levels of physical, mental, social, and
vocational functioning. Habilitative services include education,
training for employment, and therapy. The habilitative process shall
be undertaken with recognition of the risk to the public safety
presented by the person being assisted as manifested by prior charged
criminal conduct;
(19) "History of one or more violent acts" refers to the period of
time ten years prior to the filing of a petition under this chapter,
excluding any time spent, but not any violent acts committed, in a
mental health facility or in confinement as a result of a criminal
conviction;
(20) "Imminent" means the state or condition of being likely to
occur at any moment or near at hand, rather than distant or remote;
(21) "Individualized service plan" means a plan prepared by a
developmental disabilities professional with other professionals as a
team, for a person with developmental disabilities, which shall state:
(a) The nature of the person's specific problems, prior charged
criminal behavior, and habilitation needs;
(b) The conditions and strategies necessary to achieve the purposes
of habilitation;
(c) The intermediate and long-range goals of the habilitation
program, with a projected timetable for the attainment;
(d) The rationale for using this plan of habilitation to achieve
those intermediate and long-range goals;
(e) The staff responsible for carrying out the plan;
(f) Where relevant in light of past criminal behavior and due
consideration for public safety, the criteria for proposed movement to
less-restrictive settings, criteria for proposed eventual discharge or
release, and a projected possible date for discharge or release; and
(g) The type of residence immediately anticipated for the person
and possible future types of residences;
(22) "Judicial commitment" means a commitment by a court pursuant
to the provisions of this chapter;
(23) "Likelihood of serious harm" means:
(a) A substantial risk that: (i) Physical harm will be inflicted
by a person upon his or her own person, as evidenced by threats or
attempts to commit suicide or inflict physical harm on oneself; (ii)
physical harm will be inflicted by a person 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 (iii)
physical harm will be inflicted by a person upon the property of
others, as evidenced by behavior which has caused substantial loss or
damage to the property of others; or
(b) The person has threatened the physical safety of another and
has a history of one or more violent acts;
(24) "Mental disorder" means any organic, mental, or emotional
impairment which has substantial adverse effects on a person's
cognitive or volitional functions;
(25) "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 pursuant to the provisions of this chapter;
(26) "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;
(27) "Private agency" means any person, partnership, corporation,
or association that is not a public agency, whether or not financed in
whole or in part by public funds, which constitutes an evaluation and
treatment facility or private institution, or hospital, which is
conducted for, or includes a department or ward conducted for, the care
and treatment of persons who are mentally ill;
(28) "Professional person" means a mental health professional and
shall also mean a physician, psychiatric advanced registered nurse
practitioner, registered nurse, and such others as may be defined by
rules adopted by the secretary pursuant to the provisions of this
chapter;
(29) "Psychiatric advanced registered nurse practitioner" means a
person who is licensed as an advanced registered nurse practitioner
pursuant to chapter 18.79 RCW; and who is board certified in advanced
practice psychiatric and mental health nursing.
(30) "Psychiatrist" means a person having a license as a physician
and surgeon in this state who has in addition completed three years of
graduate training in psychiatry in a program approved by the American
medical association or the American osteopathic association and is
certified or eligible to be certified by the American board of
psychiatry and neurology;
(((30))) (31) "Psychologist" means a person who has been licensed
as a psychologist pursuant to chapter 18.83 RCW;
(((31))) (32) "Public agency" means any evaluation and treatment
facility or institution, or hospital which is conducted for, or
includes a department or ward conducted for, the care and treatment of
persons with mental illness, if the agency is operated directly by,
federal, state, county, or municipal government, or a combination of
such governments;
(((32))) (33) "Registration records" include all the records of the
department, regional support networks, treatment facilities, and other
persons providing services to the department, county departments, or
facilities which identify persons who are receiving or who at any time
have received services for mental illness;
(((33))) (34) "Release" means legal termination of the commitment
under the provisions of this chapter;
(((34))) (35) "Resource management services" has the meaning given
in chapter 71.24 RCW;
(((35))) (36) "Secretary" means the secretary of the department of
social and health services, or his or her designee;
(((36))) (37) "Social worker" means a person with a master's or
further advanced degree from an accredited school of social work or a
degree deemed equivalent under rules adopted by the secretary;
(((37))) (38) "Treatment records" include registration and all
other records concerning persons who are receiving or who at any time
have received services for mental illness, which are maintained by the
department, by regional support networks and their staffs, and by
treatment facilities. Treatment records include mental health
information contained in a medical bill including but not limited to
mental health drugs, a mental health diagnosis, provider name, and
dates of service stemming from a medical service. Treatment records do
not include notes or records maintained for personal use by a person
providing treatment services for the department, regional support
networks, or a treatment facility if the notes or records are not
available to others;
(((38))) (39) "Violent act" means behavior that resulted in
homicide, attempted suicide, nonfatal injuries, or substantial damage
to property.
Sec. 2 RCW 71.05.215 and 1997 c 112 s 16 are each amended to read
as follows:
(1) A person found to be gravely disabled or presents a likelihood
of serious harm as a result of a mental disorder has a right to refuse
antipsychotic medication unless it is determined that the failure to
medicate may result in a likelihood of serious harm or substantial
deterioration or substantially prolong the length of involuntary
commitment and there is no less intrusive course of treatment than
medication in the best interest of that person.
(2) The department shall adopt rules to carry out the purposes of
this chapter. These rules shall include:
(a) An attempt to obtain the informed consent of the person prior
to administration of antipsychotic medication.
(b) For short-term treatment up to thirty days, the right to refuse
antipsychotic medications unless there is an additional concurring
medical opinion approving medication by a psychiatrist, psychiatric
advanced registered nurse practitioner, or physician in consultation
with a mental health professional with prescriptive authority.
(c) For continued treatment beyond thirty days through the hearing
on any petition filed under RCW ((71.05.370(7))) 71.05.217, the right
to periodic review of the decision to medicate by the medical director
or designee.
(d) Administration of antipsychotic medication in an emergency and
review of this decision within twenty-four hours. An emergency exists
if the person presents an imminent likelihood of serious harm, and
medically acceptable alternatives to administration of antipsychotic
medications are not available or are unlikely to be successful; and in
the opinion of the physician or psychiatric advanced registered nurse
practitioner, the person's condition constitutes an emergency requiring
the treatment be instituted prior to obtaining a second medical
opinion.
(e) Documentation in the medical record of the ((physician's))
attempt by the physician or psychiatric advanced registered nurse
practitioner to obtain informed consent and the reasons why
antipsychotic medication is being administered over the person's
objection or lack of consent.
Sec. 3 RCW 71.05.217 and 1997 c 112 s 31 are each amended to read
as follows:
Insofar as danger to the individual or others is not created, each
person involuntarily detained, treated in a less restrictive
alternative course of treatment, or committed for treatment and
evaluation pursuant to this chapter shall have, in addition to other
rights not specifically withheld by law, the following rights, a list
of which shall be prominently posted in all facilities, institutions,
and hospitals providing such services:
(1) To wear his or her own clothes and to keep and use his or her
own personal possessions, except when deprivation of same is essential
to protect the safety of the resident or other persons;
(2) To keep and be allowed to spend a reasonable sum of his or her
own money for canteen expenses and small purchases;
(3) To have access to individual storage space for his or her
private use;
(4) To have visitors at reasonable times;
(5) To have reasonable access to a telephone, both to make and
receive confidential calls;
(6) To have ready access to letter writing materials, including
stamps, and to send and receive uncensored correspondence through the
mails;
(7) Not to consent to the administration of antipsychotic
medications beyond the hearing conducted pursuant to RCW
71.05.320(((2))) (3) or the performance of electroconvulsant therapy or
surgery, except emergency life-saving surgery, unless ordered by a
court of competent jurisdiction pursuant to the following standards and
procedures:
(a) The administration of antipsychotic medication or
electroconvulsant therapy shall not be ordered unless the petitioning
party proves by clear, cogent, and convincing evidence that there
exists a compelling state interest that justifies overriding the
patient's lack of consent to the administration of antipsychotic
medications or electroconvulsant therapy, that the proposed treatment
is necessary and effective, and that medically acceptable alternative
forms of treatment are not available, have not been successful, or are
not likely to be effective.
(b) The court shall make specific findings of fact concerning: (i)
The existence of one or more compelling state interests; (ii) the
necessity and effectiveness of the treatment; and (iii) the person's
desires regarding the proposed treatment. If the patient is unable to
make a rational and informed decision about consenting to or refusing
the proposed treatment, the court shall make a substituted judgment for
the patient as if he or she were competent to make such a
determination.
(c) The person shall be present at any hearing on a request to
administer antipsychotic medication or electroconvulsant therapy filed
pursuant to this subsection. The person has the right: (i) To be
represented by an attorney; (ii) to present evidence; (iii) to cross-examine witnesses; (iv) to have the rules of evidence enforced; (v) to
remain silent; (vi) to view and copy all petitions and reports in the
court file; and (vii) to be given reasonable notice and an opportunity
to prepare for the hearing. The court may appoint a psychiatrist,
psychiatric advanced registered nurse practitioner, psychologist within
their scope of practice, or physician to examine and testify on behalf
of such person. The court shall appoint a psychiatrist, psychiatric
advanced registered nurse practitioner, psychologist within their scope
of practice, or physician designated by such person or the person's
counsel to testify on behalf of the person in cases where an order for
electroconvulsant therapy is sought.
(d) An order for the administration of antipsychotic medications
entered following a hearing conducted pursuant to this section shall be
effective for the period of the current involuntary treatment order,
and any interim period during which the person is awaiting trial or
hearing on a new petition for involuntary treatment or involuntary
medication.
(e) Any person detained pursuant to RCW 71.05.320(((2))) (3), who
subsequently refuses antipsychotic medication, shall be entitled to the
procedures set forth in ((RCW 71.05.217(7))) this subsection.
(f) Antipsychotic medication may be administered to a nonconsenting
person detained or committed pursuant to this chapter without a court
order pursuant to RCW 71.05.215(2) or under the following
circumstances:
(i) A person presents an imminent likelihood of serious harm;
(ii) Medically acceptable alternatives to administration of
antipsychotic medications are not available, have not been successful,
or are not likely to be effective; and
(iii) In the opinion of the physician or psychiatric advanced
registered nurse practitioner with responsibility for treatment of the
person, or his or her designee, the person's condition constitutes an
emergency requiring the treatment be instituted before a judicial
hearing as authorized pursuant to this section can be held.
If antipsychotic medications are administered over a person's lack
of consent pursuant to this subsection, a petition for an order
authorizing the administration of antipsychotic medications shall be
filed on the next judicial day. The hearing shall be held within two
judicial days. If deemed necessary by the physician or psychiatric
advanced registered nurse practitioner with responsibility for the
treatment of the person, administration of antipsychotic medications
may continue until the hearing is held;
(8) To dispose of property and sign contracts unless such person
has been adjudicated an incompetent in a court proceeding directed to
that particular issue;
(9) Not to have psychosurgery performed on him or her under any
circumstances."
Correct the title.
EFFECT: Changes a reference to "advanced nurse practitioners" to "psychiatric advanced registered nurse practitioners" to be consistent with terminology in the rest of the bill.