BILL REQ. #:  H-4986.3 

READ FIRST TIME 02/05/08.   

     AN ACT Relating to parental consent to mental health treatment for minors; amending RCW 71.34.020, 71.34.530, and 71.34.500; adding a new section to chapter 71.34 RCW; creating new sections; repealing RCW 71.34.600, 71.34.610, 71.34.620, 71.34.630, 71.34.640, 71.34.650, and 71.34.660; and providing an effective date.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1   RCW 71.34.020 and 2006 c 93 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) "Designated mental health professional" means a mental health professional designated by one or more counties to perform the functions of a 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, including medication and medication supervision, 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) "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.
     (14) "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.
     (15) "Minor" means any person under the age of eighteen years.
     (16) "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)) mental health services provided in a nonresidential setting that include, but are not limited to, assessment, diagnosis, psychiatric treatment, medication, medication supervision, counseling, psychotherapy, and assuring transfer of relevant patient information between service providers.
     (17) "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.
     (18) "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.
     (19) "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.
     (20) "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.
     (21) "Psychologist" means a person licensed as a psychologist under chapter 18.83 RCW.
     (22) "Responsible other" means the minor, the minor's parent or estate, or any other person legally responsible for support of the minor.
     (23) "Secretary" means the secretary of the department or secretary's designee.
     (24) "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. 2   RCW 71.34.530 and 2006 c 93 s 4 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, or authorization from a person who may consent on behalf of the minor pursuant to RCW 7.70.065, is required for outpatient treatment of a minor under the age of thirteen.
     (2)(a) The parent or legal guardian of a minor may consent to voluntary outpatient treatment on behalf of the minor on the recommendation of a psychiatrist, psychologist, or other licensed mental health professional, as defined in RCW 71.34.020, who has significant experience in the treatment of children with mental disorders and has examined the minor. The minor's consent is not necessary.
     (b) At the beginning of outpatient treatment under (a) of this subsection, the treatment provider or the treatment provider's designee shall provide the minor with an explanation of the nature of the mental health treatment in which the minor may be involved together with a statement of the minor's rights, including the right to object to treatment by filing a petition with the superior court of the county in which the treatment provider is located.
     (c) Within twenty-four hours of initiating outpatient treatment of the minor under (a) of this subsection, the treatment provider or the treatment provider's designee shall notify the superior court of the county in which the treatment provider's office is located that treatment has been initiated under this section. The county superior court shall provide the treatment provider or his or her designee with the name and telephone number of an attorney who is employed by or under contract with the county to represent individuals subject to involuntary commitment under chapter 71.05 RCW. The treatment provider or his or her designee shall immediately contact that attorney on behalf of the minor. Within three business days of being contacted by the treatment provider or his or her designee, the attorney must meet with the minor to determine whether he or she wants to exercise his or her right to object to the outpatient treatment. If the minor wants to object to the treatment, the attorney must file a petition challenging the treatment with the superior court within two business days of the meeting. The superior court shall waive any filing fee associated with a petition filed under this subsection.
     (d) Prior to initiating outpatient treatment of a minor under this subsection (2), a psychiatrist or psychologist with significant experience in the treatment of minors with mental disorders must conduct a complete assessment of the minor and the minor's family, which shall become a part of the minor's treatment record and be made available to the court if the minor petitions for withdrawal or modification of treatment under (e) of this subsection. The assessment shall include an assessment of whether the minor has a mental disorder for which outpatient treatment is a medical necessity, the relationship between the minor and his or her parents, and any other factors relevant to the ability to meet the minor's need for treatment.
     (e) Upon receipt of a petition filed under (c) of this subsection, the court shall schedule a hearing to be held within seventy-two hours following the filing of the petition, unless continued upon the request of the attorney for the minor. The hearing shall be conducted by a judicial officer who shall determine whether or not the outpatient mental health treatment is a medical necessity. For outpatient treatment to continue against the minor's wishes, the court must find all of the following by a preponderance of the evidence:
     (i) That the minor has a diagnosed mental disorder or is in need of an evaluation to determine whether the minor has a mental disorder;
     (ii) That it is a medical necessity that the minor receive outpatient mental health treatment; and
     (iii) That the disorder can be adequately treated by the proposed treatment provider.
     (f) A minor ordered to undergo treatment due to a determination under (e) of this subsection shall receive outpatient treatment at the treatment setting designated by the court for a period of up to three months. The minor shall be discharged from treatment whenever the minor's treatment provider determines that the minor no longer is in need of outpatient treatment, consent to treatment has been revoked under subsection (4)(a) of this section, or at the end of the time period of the order, whichever occurs first. If the minor's treatment provider determines continued outpatient treatment will be necessary at the end of the time period of the order and the minor does not consent to continued outpatient treatment prior to the end of the time period of the order, the court shall conduct a review hearing in accordance with this subsection to determine whether to:
     (i) Release the minor; or
     (ii) Make a subsequent order for outpatient mental health treatment for a period not to exceed three months subject to discharge of the minor whenever the minor's treatment provider determines that the minor no longer is in need of treatment, or if consent has been revoked under subsection (4)(a) of this section.
     (g) The total period of outpatient treatment ordered under this section may not exceed six months from the date outpatient treatment was initiated.
     (h) A person who has legal custody or court-ordered residential time with a minor may object to the consent for outpatient treatment of the minor given by a parent who does not have legal custody by filing a petition with the court. However, a parent may not file a petition objecting to the consent for outpatient treatment of the minor under this section if the person consenting to the outpatient treatment has been given sole authority to consent to all medical decisions for the minor under a court order.
     (i) Nothing in this section shall be construed as restricting or altering a minor's existing rights to consent to voluntary outpatient mental health treatment on his or her own behalf at thirteen years of age or older, or a parent's ability to consent to outpatient mental health treatment on behalf of a minor who is younger than thirteen years of age.
     (3) A minor may not abrogate consent provided by a parent or legal guardian on the minor's behalf, nor may a parent or legal guardian abrogate consent given by the minor on his or her own behalf.
     (4)(a) A parent or legal guardian who has provided consent to outpatient treatment under subsection (2) of this section may revoke that consent. The parental revocation shall be effective unless the minor who is thirteen years of age or older has provided consent for continued outpatient treatment.
     (b) A minor who is thirteen years of age or older who has provided consent to outpatient treatment may revoke that consent. The minor's revocation shall be effective unless the parent or legal guardian to the minor has provided for continued treatment under subsection (2) of this section.
     (5) For purposes of this section, "parent" does not include the department or other supervision agency when a minor has been placed in out-of-home care under chapter 13.34 RCW.

Sec. 3   RCW 71.34.500 and 2006 c 93 s 3 are each amended to read as follows:
     (1)(a) 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. Parental authorization, or authorization from a person who may consent on behalf of the minor pursuant to RCW 7.70.065, is required for inpatient treatment of a minor under the age of thirteen.
     (((2))) (b) 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))) (c) 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.
     (2)(a) The parent or legal guardian of a minor who is thirteen years of age or older may consent to voluntary inpatient treatment on behalf of the minor on the recommendation of a psychiatrist, psychologist, or other licensed mental health professional, as defined in RCW 71.34.020, who has significant experience in the treatment of children with mental disorders and has examined the minor. The minor's consent is not necessary.
     (b) At the time of admission under (a) of this subsection, the professional person in charge of the facility or the professional person's designee shall provide the minor with an explanation of the nature of the mental health treatment in which the minor may be involved together with a statement of the minor's rights, including the right to object to treatment by filing a petition with the superior court of the county in which the facility is located.
     (c) Within twenty-four hours of admission of the minor under (a) of this subsection, the professional person in charge of the facility or the professional person's designee shall notify the superior court of the county in which the facility is located that a youth has been admitted for treatment under this section. The county superior court shall provide the professional person or his or her designee with the name and telephone number of an attorney who is employed by or under contract with the county to represent individuals subject to involuntary commitment under chapter 71.05 RCW. The professional person or his or her designee shall immediately contact that attorney on behalf of the minor. Within twenty-four hours of being contacted by the professional person or his or her designee, the attorney must meet with the minor to determine whether he or she wants to exercise his or her right to object to the inpatient treatment. If the minor wants to object to the treatment, the attorney must file a petition challenging the treatment with the superior court within two business days of the meeting. The superior court shall waive any filing fee associated with a petition filed under this subsection.
     (d) Within forty-eight hours of admission of a minor under this subsection (2), a psychiatrist or psychologist with significant experience in the treatment of minors with mental disorders must conduct a complete assessment of the minor and the minor's family, which shall become a part of the minor's treatment record and be made available to the court if the minor petitions for withdrawal or modification of treatment under (e) of this subsection. The assessment shall include an assessment of whether the minor has a mental disorder for which inpatient treatment is a medical necessity, whether treatment can be appropriately provided in a less restrictive outpatient environment, the relationship between the minor and his or her parents, and any other factors relevant to the ability to meet the minor's need for treatment.
     (e) Upon receipt of a petition filed under (c) of this subsection, the court shall schedule a hearing to be held within seventy-two hours following the filing of the petition, unless continued upon the request of the attorney for the minor. A request for a continuance by the minor's attorney may not exceed an additional seventy-two hours. The hearing shall be conducted by a judicial officer who shall determine whether or not the inpatient mental health treatment is a medical necessity. For inpatient treatment to continue against the minor's wishes, the court must find all of the following by a preponderance of the evidence:
     (i) That the minor has a diagnosed mental disorder or is in need of an evaluation to determine whether the minor has a mental disorder;
     (ii) That it is a medical necessity that the minor receive inpatient mental health treatment; and
     (iii) That the disorder can be treated in the particular facility where the treatment is taking place.
     (f) A minor ordered to undergo treatment due to a determination under (e) of this subsection shall remain and receive inpatient treatment at the treatment setting designated by the court for a period of up to thirty days. The minor shall be discharged whenever the attending physician determines that the minor no longer is in need of inpatient treatment, consent to treatment has been revoked under subsection (4)(a) of this section, or at the end of the time period of the order, whichever occurs first. If the attending physician determines continued inpatient treatment will be necessary at the end of the time period of the order and the minor does not consent to continued inpatient treatment prior to the end of the time period of the order, the court shall conduct a review hearing in accordance with this subsection to determine whether to:
     (i) Release the minor; or
     (ii) Make a subsequent order for inpatient mental health treatment for a period not to exceed sixty days subject to discharge of the minor whenever the attending physician determines that the minor no longer is in need of treatment, or if consent has been revoked under subsection (4)(a) of this section.
     (g) The total period of inpatient treatment ordered under this section shall not exceed ninety days from the date of the minor's admission to the facility. The professional person in charge or his or her designee shall ensure that a discharge plan is provided for each minor discharged from the facility. The discharge plan shall address the minor's continued need for treatment, referrals to appropriate services for the minor and his or her parents, and services needed to facilitate the minor's successful transition back into school, family life, and other activities.
     (h) A person who has legal custody or court-ordered residential time with a minor may object to the consent for inpatient treatment of the minor given by a parent who does not have legal custody by filing a petition with the court. However, a parent may not file a petition objecting to the consent for inpatient treatment of the minor under this section if the person consenting to the inpatient treatment has been given sole authority to consent to all medical decisions for the child under a court order.
     (i) Nothing in this section shall be construed as restricting or altering a minor's existing rights to consent to voluntary inpatient mental health treatment on his or her own behalf at thirteen years of age or older, or a parent's ability to consent to inpatient mental health treatment on behalf of a minor who is younger than thirteen years of age.
     (3) A minor may not abrogate consent provided by a parent or legal guardian on the minor's behalf, nor may a parent or legal guardian abrogate consent given by the minor on his or her own behalf.
     (4)(a) A parent or legal guardian who has provided consent to inpatient treatment under subsection (2) of this section may revoke that consent. The parental revocation shall be effective unless the minor who is thirteen years of age or older has provided consent for continued inpatient treatment.
     (b) A minor who is thirteen years of age or older who has provided consent to inpatient treatment may revoke that consent. The minor's revocation shall be effective unless the parent or legal guardian to the minor has provided for continued treatment under subsection (2) of this section.
     (5) For purposes of this section, "parent" does not include the department or other supervision agency when a minor has been placed in out-of-home care under chapter 13.34 RCW.

NEW SECTION.  Sec. 4   A new section is added to chapter 71.34 RCW to read as follows:
     Attorneys appointed for persons pursuant to this chapter shall be compensated for their services as follows: (1) The person for whom an attorney is appointed shall, if he or she is financially able pursuant to standards as to financial capability and indigency set by the superior court of the county in which the proceeding is held, bear the costs of such legal services; (2) if such person is indigent pursuant to such standards, the costs of such services shall be borne by the county in which the proceeding is held.

NEW SECTION.  Sec. 5   The administrative office of the courts, in consultation with the department of social and health services and other interested organizations, shall develop standard forms for the statement of the minor's rights and the petition to request withdrawal from or modification of mental health treatment provided to minors under RCW 71.34.530 and 71.34.500. The statement and forms shall be designed to be readily understood and completed by a minor thirteen to seventeen years of age.

NEW SECTION.  Sec. 6   This act takes effect January 1, 2010.

NEW SECTION.  Sec. 7   The following acts or parts of acts are each repealed:
     (1) RCW 71.34.600 (Parent may request determination whether minor has mental disorder requiring inpatient treatment -- Minor consent not required -- Duties and obligations of professional person and facility) and 2007 c 375 s 11, 2005 c 371 s 4, & 1998 c 296 s 17;
     (2) RCW 71.34.610 (Review of admission and inpatient treatment of minors -- Determination of medical necessity -- Department review -- Minor declines necessary treatment -- At-risk youth petition -- Costs -- Public funds) and 1998 c 296 s 9 & 1995 c 312 s 56;
     (3) RCW 71.34.620 (Minor may petition court for release from facility) and 1998 c 296 s 19;
     (4) RCW 71.34.630 (Minor not released by petition under RCW 71.34.620 -- Release within thirty days -- Professional may initiate proceedings to stop release) and 1998 c 296 s 20;
     (5) RCW 71.34.640 (Evaluation of treatment of minors) and 1996 c 133 s 36 & 1995 c 312 s 58;
     (6) RCW 71.34.650 (Parent may request determination whether minor has mental disorder requiring outpatient treatment -- Consent of minor not required -- Discharge of minor) and 1998 c 296 s 18; and
     (7) RCW 71.34.660 (Limitation on liability for admitting or accepting minor child) and 2005 c 371 s 3.

NEW SECTION.  Sec. 8   The code reviser shall replace the subheading of "Minor-Initiated Treatment" with "Voluntary Treatment" in chapter 71.34 RCW and shall remove the subheading "Parent-Initiated Treatment" in chapter 71.34 RCW.