BILL REQ. #: H-1145.1
State of Washington | 61st Legislature | 2009 Regular Session |
READ FIRST TIME 02/03/09.
AN ACT Relating to advanced registered nurse practitioners; and amending RCW 71.05.210, 71.05.230, 71.05.290, 71.05.300, 71.05.360, 71.05.390, 71.05.420, 71.05.630, 71.05.660, 71.06.040, 71.12.540, 71.32.140, 71.32.250, 71.32.260, 71.34.355, 71.34.720, 71.34.730, 71.34.750, 71.34.770, and 71.05.020.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 71.05.210 and 2000 c 94 s 6 are each amended to read
as follows:
Each person involuntarily detained and accepted or admitted at an
evaluation and treatment facility (1) shall, within twenty-four hours
of his or her admission or acceptance at the facility, be examined and
evaluated by (a) a licensed physician who may be assisted by a
physician assistant according to chapter 18.71A RCW or a mental health
professional, (b) an advanced registered nurse practitioner according
to chapter 18.79 RCW and a mental health professional, or (c) a
licensed physician and an advanced registered nurse practitioner and
(2) shall receive such treatment and care as his or her condition
requires including treatment on an outpatient basis for the period that
he or she is detained, except that, beginning twenty-four hours prior
to a trial or hearing pursuant to RCW 71.05.215, 71.05.240, 71.05.310,
71.05.320, 71.05.340, or ((71.05.370)) 71.05.217, the individual may
refuse psychiatric medications, but may not refuse: (((1))) (a) Any
other medication previously prescribed by a person licensed under Title
18 RCW; or (((2))) (b) emergency lifesaving treatment, and the
individual shall be informed at an appropriate time of his or her right
of such refusal. The person shall be detained up to seventy-two hours,
if, in the opinion of the professional person in charge of the
facility, or his or her professional designee, the person presents a
likelihood of serious harm, or is gravely disabled. A person who has
been detained for seventy-two hours shall no later than the end of such
period be released, unless referred for further care on a voluntary
basis, or detained pursuant to court order for further treatment as
provided in this chapter.
If, after examination and evaluation, the mental health
professional and licensed physician ((and mental health professional))
or advanced registered nurse practitioner determine that the initial
needs of the person would be better served by placement in a chemical
dependency treatment facility, then the person shall be referred to an
approved treatment program defined under RCW 70.96A.020.
An evaluation and treatment center admitting or accepting any
person pursuant to this chapter whose physical condition reveals the
need for hospitalization shall assure that such person is transferred
to an appropriate hospital for evaluation or admission for treatment.
Notice of such fact shall be given to the court, the designated
attorney, and the ((county)) designated mental health professional and
the court shall order such continuance in proceedings under this
chapter as may be necessary, but in no event may this continuance be
more than fourteen days.
Sec. 2 RCW 71.05.230 and 2006 c 333 s 302 are each amended to
read as follows:
A person detained for seventy-two hour evaluation and treatment may
be detained for not more than fourteen additional days of involuntary
intensive treatment or ninety additional days of a less restrictive
alternative to involuntary intensive treatment. There shall be no fee
for filing petitions for fourteen days of involuntary intensive
treatment. A petition may only be filed if the following conditions
are met:
(1) The professional staff of the agency or facility providing
evaluation services has analyzed the person's condition and finds that
the condition is caused by mental disorder and either results in a
likelihood of serious harm, or results in the detained person being
gravely disabled and are prepared to testify those conditions are met;
and
(2) The person has been advised of the need for voluntary treatment
and the professional staff of the facility has evidence that he or she
has not in good faith volunteered; and
(3) The facility providing intensive treatment is certified to
provide such treatment by the department; and
(4) The professional staff of the agency or facility or the
designated mental health professional has filed a petition for fourteen
day involuntary detention or a ninety day less restrictive alternative
with the court. The petition must be signed either by:
(a) Two physicians ((or by));
(b) One physician and a mental health professional((who));
(c) Two psychiatric advanced registered nurse practitioners;
(d) One psychiatric advanced registered nurse practitioner and a
mental health professional; or
(e) A physician and an advanced registered nurse practitioner. The
persons signing the petition must have examined the person. If
involuntary detention is sought the petition shall state facts that
support the finding that such person, as a result of mental disorder,
presents a likelihood of serious harm, or is gravely disabled and that
there are no less restrictive alternatives to detention in the best
interest of such person or others. The petition shall state
specifically that less restrictive alternative treatment was considered
and specify why treatment less restrictive than detention is not
appropriate. If an involuntary less restrictive alternative is sought,
the petition shall state facts that support the finding that such
person, as a result of mental disorder, presents a likelihood of
serious harm, or is gravely disabled and shall set forth the less
restrictive alternative proposed by the facility; and
(5) A copy of the petition has been served on the detained person,
his or her attorney and his or her guardian or conservator, if any,
prior to the probable cause hearing; and
(6) The court at the time the petition was filed and before the
probable cause hearing has appointed counsel to represent such person
if no other counsel has appeared; and
(7) The court has ordered a fourteen day involuntary intensive
treatment or a ninety day less restrictive alternative treatment after
a probable cause hearing has been held pursuant to RCW 71.05.240; and
(8) At the conclusion of the initial commitment period, the
professional staff of the agency or facility or the designated mental
health professional may petition for an additional period of either
ninety days of less restrictive alternative treatment or ninety days of
involuntary intensive treatment as provided in RCW 71.05.290; and
(9) If the hospital or facility designated to provide outpatient
treatment is other than the facility providing involuntary treatment,
the outpatient facility so designated has agreed to assume such
responsibility.
Sec. 3 RCW 71.05.290 and 2008 c 213 s 7 are each amended to read
as follows:
(1) At any time during a person's fourteen day intensive treatment
period, the professional person in charge of a treatment facility or
his or her professional designee or the designated mental health
professional may petition the superior court for an order requiring
such person to undergo an additional period of treatment. Such
petition must be based on one or more of the grounds set forth in RCW
71.05.280.
(2) The petition shall summarize the facts which support the need
for further confinement and shall be supported by affidavits signed by:
(a) Two examining physicians((, or by));
(b) One examining physician and examining mental health
professional;
(c) Two psychiatric advanced registered nurse practitioners;
(d) One psychiatric advanced registered nurse practitioner and a
mental health professional; or
(e) An examining physician and an examining advanced registered
nurse practitioner. The affidavits shall describe in detail the
behavior of the detained person which supports the petition and shall
explain what, if any, less restrictive treatments which are
alternatives to detention are available to such person, and shall state
the willingness of the affiant to testify to such facts in subsequent
judicial proceedings under this chapter.
(3) If a person has been determined to be incompetent pursuant to
RCW 10.77.086(4), then the professional person in charge of the
treatment facility or his or her professional designee or the
designated mental health professional may directly file a petition for
one hundred eighty day treatment under RCW 71.05.280(3). No petition
for initial detention or fourteen day detention is required before such
a petition may be filed.
Sec. 4 RCW 71.05.300 and 2008 c 213 s 8 are each amended to read
as follows:
(1) The petition for ninety day treatment shall be filed with the
clerk of the superior court at least three days before expiration of
the fourteen-day period of intensive treatment. At the time of filing
such petition, the clerk shall set a time for the person to come before
the court on the next judicial day after the day of filing unless such
appearance is waived by the person's attorney, and the clerk shall
notify the designated mental health professional. The designated
mental health professional shall immediately notify the person
detained, his or her attorney, if any, and his or her guardian or
conservator, if any, the prosecuting attorney, and the regional support
network administrator, and provide a copy of the petition to such
persons as soon as possible. The regional support network
administrator or designee may review the petition and may appear and
testify at the full hearing on the petition.
(2) At the time set for appearance the detained person shall be
brought before the court, unless such appearance has been waived and
the court shall advise him or her of his or her right to be represented
by an attorney and of his or her right to a jury trial. If the
detained person is not represented by an attorney, or is indigent or is
unwilling to retain an attorney, the court shall immediately appoint an
attorney to represent him or her. The court shall, if requested,
appoint a reasonably available licensed physician, advanced registered
nurse practitioner, psychologist, or psychiatrist, designated by the
detained person to examine and testify on behalf of the detained
person.
(3) The court may, if requested, also appoint a professional person
as defined in RCW 71.05.020 to seek less restrictive alternative
courses of treatment and to testify on behalf of the detained person.
In the case of a person with a developmental disability who has been
determined to be incompetent pursuant to RCW 10.77.086(4), then the
appointed professional person under this section shall be a
developmental disabilities professional.
(4) The court shall also set a date for a full hearing on the
petition as provided in RCW 71.05.310.
Sec. 5 RCW 71.05.360 and 2007 c 375 s 14 are each amended to read
as follows:
(1)(a) Every person involuntarily detained or committed under the
provisions of this chapter shall be entitled to all the rights set
forth in this chapter, which shall be prominently posted in the
facility, and shall retain all rights not denied him or her under this
chapter except as chapter 9.41 RCW may limit the right of a person to
purchase or possess a firearm or to qualify for a concealed pistol
license.
(b) No person shall be presumed incompetent as a consequence of
receiving an evaluation or voluntary or involuntary treatment for a
mental disorder, under this chapter or any prior laws of this state
dealing with mental illness. Competency shall not be determined or
withdrawn except under the provisions of chapter 10.77 or 11.88 RCW.
(c) Any person who leaves a public or private agency following
evaluation or treatment for mental disorder shall be given a written
statement setting forth the substance of this section.
(2) Each person involuntarily detained or committed pursuant to
this chapter shall have the right to adequate care and individualized
treatment.
(3) The provisions of this chapter shall not be construed to deny
to any person treatment by spiritual means through prayer in accordance
with the tenets and practices of a church or religious denomination.
(4) Persons receiving evaluation or treatment under this chapter
shall be given a reasonable choice of an available physician, advanced
registered nurse practitioner, or other professional person qualified
to provide such services.
(5) Whenever any person is detained for evaluation and treatment
pursuant to this chapter, both the person and, if possible, a
responsible member of his or her immediate family, personal
representative, guardian, or conservator, if any, shall be advised as
soon as possible in writing or orally, by the officer or person taking
him or her into custody or by personnel of the evaluation and treatment
facility where the person is detained that unless the person is
released or voluntarily admits himself or herself for treatment within
seventy-two hours of the initial detention:
(a) A judicial hearing in a superior court, either by a judge or
court commissioner thereof, shall be held not more than seventy-two
hours after the initial detention to determine whether there is
probable cause to detain the person after the seventy-two hours have
expired for up to an additional fourteen days without further automatic
hearing for the reason that the person is a person whose mental
disorder presents a likelihood of serious harm or that the person is
gravely disabled;
(b) The person has a right to communicate immediately with an
attorney; has a right to have an attorney appointed to represent him or
her before and at the probable cause hearing if he or she is indigent;
and has the right to be told the name and address of the attorney that
the mental health professional has designated pursuant to this chapter;
(c) The person has the right to remain silent and that any
statement he or she makes may be used against him or her;
(d) The person has the right to present evidence and to cross-examine witnesses who testify against him or her at the probable cause
hearing; and
(e) The person has the right to refuse psychiatric medications,
including antipsychotic medication beginning twenty-four hours prior to
the probable cause hearing.
(6) When proceedings are initiated under RCW 71.05.153, no later
than twelve hours after such person is admitted to the evaluation and
treatment facility the personnel of the evaluation and treatment
facility or the designated mental health professional shall serve on
such person a copy of the petition for initial detention and the name,
business address, and phone number of the designated attorney and shall
forthwith commence service of a copy of the petition for initial
detention on the designated attorney.
(7) The judicial hearing described in subsection (5) of this
section is hereby authorized, and shall be held according to the
provisions of subsection (5) of this section and rules promulgated by
the supreme court.
(8) At the probable cause hearing the detained person shall have
the following rights in addition to the rights previously specified:
(a) To present evidence on his or her behalf;
(b) To cross-examine witnesses who testify against him or her;
(c) To be proceeded against by the rules of evidence;
(d) To remain silent;
(e) To view and copy all petitions and reports in the court file.
(9) ((The physician-patient privilege or the psychologist-client
privilege shall be)) Privileges between patients and physicians,
psychologists, or nursing staff are deemed waived in proceedings under
this chapter relating to the administration of antipsychotic
medications. As to other proceedings under this chapter, the
privileges shall be waived when a court of competent jurisdiction in
its discretion determines that such waiver is necessary to protect
either the detained person or the public.
The waiver of a privilege under this section is limited to records
or testimony relevant to evaluation of the detained person for purposes
of a proceeding under this chapter. Upon motion by the detained person
or on its own motion, the court shall examine a record or testimony
sought by a petitioner to determine whether it is within the scope of
the waiver.
The record maker shall not be required to testify in order to
introduce medical or psychological records of the detained person so
long as the requirements of RCW 5.45.020 are met except that portions
of the record which contain opinions as to the detained person's mental
state must be deleted from such records unless the person making such
conclusions is available for cross-examination.
(10) Insofar as danger to the person 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) 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;
(b) To keep and be allowed to spend a reasonable sum of his or her
own money for canteen expenses and small purchases;
(c) To have access to individual storage space for his or her
private use;
(d) To have visitors at reasonable times;
(e) To have reasonable access to a telephone, both to make and
receive confidential calls, consistent with an effective treatment
program;
(f) To have ready access to letter writing materials, including
stamps, and to send and receive uncensored correspondence through the
mails;
(g) To discuss treatment plans and decisions with professional
persons;
(h) Not to consent to the administration of antipsychotic
medications and not to thereafter be administered antipsychotic
medications unless ordered by a court under RCW 71.05.217 or pursuant
to an administrative hearing under RCW 71.05.215;
(i) Not to consent to the performance of electroconvulsant therapy
or surgery, except emergency life-saving surgery, unless ordered by a
court under RCW 71.05.217;
(j) Not to have psychosurgery performed on him or her under any
circumstances;
(k) To dispose of property and sign contracts unless such person
has been adjudicated an incompetent in a court proceeding directed to
that particular issue.
(11) Every person involuntarily detained shall immediately be
informed of his or her right to a hearing to review the legality of his
or her detention and of his or her right to counsel, by the
professional person in charge of the facility providing evaluation and
treatment, or his or her designee, and, when appropriate, by the court.
If the person so elects, the court shall immediately appoint an
attorney to assist him or her.
(12) A person challenging his or her detention or his or her
attorney shall have the right to designate and have the court appoint
a reasonably available independent physician, advanced registered nurse
practitioner, or licensed mental health professional to examine the
person detained, the results of which examination may be used in the
proceeding. The person shall, if he or she is financially able, bear
the cost of such expert examination, otherwise such expert examination
shall be at public expense.
(13) Nothing contained in this chapter shall prohibit the patient
from petitioning by writ of habeas corpus for release.
(14) Nothing in this chapter shall prohibit a person committed on
or prior to January 1, 1974, from exercising a right available to him
or her at or prior to January 1, 1974, for obtaining release from
confinement.
(15) Nothing in this section permits any person to knowingly
violate a no-contact order or a condition of an active judgment and
sentence or an active condition of supervision by the department of
corrections.
Sec. 6 RCW 71.05.390 and 2007 c 375 s 15 are each amended to read
as follows:
Except as provided in this section, RCW 71.05.445, 71.05.630,
70.96A.150, or pursuant to a valid release under RCW 70.02.030, the
fact of admission and all information and records compiled, obtained,
or maintained in the course of providing services to either voluntary
or involuntary recipients of services at public or private agencies
shall be confidential.
Information and records may be disclosed only:
(1) In communications between qualified professional persons to
meet the requirements of this chapter, in the provision of services or
appropriate referrals, or in the course of guardianship proceedings.
The consent of the person, or his or her personal representative or
guardian, shall be obtained before information or records may be
disclosed by a professional person employed by a facility unless
provided to a professional person:
(a) Employed by the facility;
(b) Who has medical responsibility for the patient's care;
(c) Who is a designated mental health professional;
(d) Who is providing services under chapter 71.24 RCW;
(e) Who is employed by a state or local correctional facility where
the person is confined or supervised; or
(f) Who is providing evaluation, treatment, or follow-up services
under chapter 10.77 RCW.
(2) When the communications regard the special needs of a patient
and the necessary circumstances giving rise to such needs and the
disclosure is made by a facility providing services to the operator of
a facility in which the patient resides or will reside.
(3)(a) When the person receiving services, or his or her guardian,
designates persons to whom information or records may be released, or
if the person is a minor, when his or her parents make such
designation.
(b) A public or private agency shall release to a person's next of
kin, attorney, personal representative, guardian, or conservator, if
any:
(i) The information that the person is presently a patient in the
facility or that the person is seriously physically ill;
(ii) A statement evaluating the mental and physical condition of
the patient, and a statement of the probable duration of the patient's
confinement, if such information is requested by the next of kin,
attorney, personal representative, guardian, or conservator; and
(iii) Such other information requested by the next of kin or
attorney as may be necessary to decide whether or not proceedings
should be instituted to appoint a guardian or conservator.
(4) To the extent necessary for a recipient to make a claim, or for
a claim to be made on behalf of a recipient for aid, insurance, or
medical assistance to which he or she may be entitled.
(5)(a) For either program evaluation or research, or both:
PROVIDED, That the secretary adopts rules for the conduct of the
evaluation or research, or both. Such rules shall include, but need
not be limited to, the requirement that all evaluators and researchers
must sign an oath of confidentiality substantially as follows:
"As a condition of conducting evaluation or research concerning
persons who have received services from (fill in the facility, agency,
or person) I, . . . . . . . . ., agree not to divulge, publish, or
otherwise make known to unauthorized persons or the public any
information obtained in the course of such evaluation or research
regarding persons who have received services such that the person who
received such services is identifiable.
I recognize that unauthorized release of confidential information
may subject me to civil liability under the provisions of state law.
/s/ . . . . . . . . . . . . " |
Sec. 7 RCW 71.05.420 and 2005 c 504 s 110 are each amended to
read as follows:
Except as provided in RCW 71.05.425, when any disclosure of
information or records is made as authorized by RCW 71.05.390, the
physician or advanced registered nurse practitioner in charge of the
patient or the professional person in charge of the facility shall
promptly cause to be entered into the patient's medical record the date
and circumstances under which said disclosure was made, the names and
relationships to the patient, if any, of the persons or agencies to
whom such disclosure was made, and the information disclosed.
Sec. 8 RCW 71.05.630 and 2007 c 191 s 1 are each amended to read
as follows:
(1) Except as otherwise provided by law, all treatment records
shall remain confidential and may be released only to the persons
designated in this section, or to other persons designated in an
informed written consent of the patient.
(2) Treatment records of a person may be released without informed
written consent in the following circumstances:
(a) To a person, organization, or agency as necessary for
management or financial audits, or program monitoring and evaluation.
Information obtained under this subsection shall remain confidential
and may not be used in a manner that discloses the name or other
identifying information about the person whose records are being
released.
(b) To the department, the director of regional support networks,
or a qualified staff member designated by the director only when
necessary to be used for billing or collection purposes. The
information shall remain confidential.
(c) For purposes of research as permitted in chapter 42.48 RCW.
(d) Pursuant to lawful order of a court.
(e) To qualified staff members of the department, to the director
of regional support networks, to resource management services
responsible for serving a patient, or to service providers designated
by resource management services as necessary to determine the progress
and adequacy of treatment and to determine whether the person should be
transferred to a less restrictive or more appropriate treatment
modality or facility. The information shall remain confidential.
(f) Within the treatment facility where the patient is receiving
treatment, confidential information may be disclosed to persons
employed, serving in bona fide training programs, or participating in
supervised volunteer programs, at the facility when it is necessary to
perform their duties.
(g) Within the department as necessary to coordinate treatment for
mental illness, developmental disabilities, alcoholism, or drug abuse
of persons who are under the supervision of the department.
(h) To a licensed physician or advanced registered nurse
practitioner who has determined that the life or health of the person
is in danger and that treatment without the information contained in
the treatment records could be injurious to the patient's health.
Disclosure shall be limited to the portions of the records necessary to
meet the medical emergency.
(i) To a facility that is to receive a person who is involuntarily
committed under chapter 71.05 RCW, or upon transfer of the person from
one treatment facility to another. The release of records under this
subsection shall be limited to the treatment records required by law,
a record or summary of all somatic treatments, and a discharge summary.
The discharge summary may include a statement of the patient's problem,
the treatment goals, the type of treatment which has been provided, and
recommendation for future treatment, but may not include the patient's
complete treatment record.
(j) Notwithstanding the provisions of RCW 71.05.390(7), to a
correctional facility or a corrections officer who is responsible for
the supervision of a person who is receiving inpatient or outpatient
evaluation or treatment. Except as provided in RCW 71.05.445 and
71.34.345, release of records under this section is limited to:
(i) An evaluation report provided pursuant to a written supervision
plan.
(ii) The discharge summary, including a record or summary of all
somatic treatments, at the termination of any treatment provided as
part of the supervision plan.
(iii) When a person is returned from a treatment facility to a
correctional facility, the information provided under (j)(iv) of this
subsection.
(iv) Any information necessary to establish or implement changes in
the person's treatment plan or the level or kind of supervision as
determined by resource management services. In cases involving a
person transferred back to a correctional facility, disclosure shall be
made to clinical staff only.
(k) To the person's counsel or guardian ad litem, without
modification, at any time in order to prepare for involuntary
commitment or recommitment proceedings, reexaminations, appeals, or
other actions relating to detention, admission, commitment, or
patient's rights under chapter 71.05 RCW.
(l) To staff members of the protection and advocacy agency or to
staff members of a private, nonprofit corporation for the purpose of
protecting and advocating the rights of persons with mental disorders
or developmental disabilities. Resource management services may limit
the release of information to the name, birthdate, and county of
residence of the patient, information regarding whether the patient was
voluntarily admitted, or involuntarily committed, the date and place of
admission, placement, or commitment, the name and address of a guardian
of the patient, and the date and place of the guardian's appointment.
Any staff member who wishes to obtain additional information shall
notify the patient's resource management services in writing of the
request and of the resource management services' right to object. The
staff member shall send the notice by mail to the guardian's address.
If the guardian does not object in writing within fifteen days after
the notice is mailed, the staff member may obtain the additional
information. If the guardian objects in writing within fifteen days
after the notice is mailed, the staff member may not obtain the
additional information.
(m) For purposes of coordinating health care, the department may
release without informed written consent of the patient, information
acquired for billing and collection purposes as described in (b) of
this subsection to all current treating providers of the patient with
prescriptive authority who have written a prescription for the patient
within the last twelve months. The department shall notify the patient
that billing and collection information has been released to named
providers, and provide the substance of the information released and
the dates of such release. The department shall not release
counseling, inpatient psychiatric hospitalization, or drug and alcohol
treatment information without a signed written release from the client.
(3) Whenever federal law or federal regulations restrict the
release of information contained in the treatment records of any
patient who receives treatment for chemical dependency, the department
may restrict the release of the information as necessary to comply with
federal law and regulations.
Sec. 9 RCW 71.05.660 and 2005 c 504 s 114 are each amended to
read as follows:
Nothing in this chapter or chapter 70.96A, 71.05, 71.34, or 70.96B
RCW shall be construed to interfere with communications between
physicians, advanced registered nurse practitioners, or psychologists
and patients and attorneys and clients.
Sec. 10 RCW 71.06.040 and 1959 c 25 s 71.06.040 are each amended
to read as follows:
At a preliminary hearing upon the charge of sexual psychopathy, the
court may require the testimony of two duly licensed physicians or
advanced registered nurse practitioners who have examined the
defendant. If the court finds that there are reasonable grounds to
believe the defendant is a sexual psychopath, the court shall order
said defendant confined at the nearest state hospital for observation
as to the existence of sexual psychopathy. Such observation shall be
for a period of not to exceed ninety days. The defendant shall be
detained in the county jail or other county facilities pending
execution of such observation order by the department.
Sec. 11 RCW 71.12.540 and 1989 1st ex.s. c 9 s 233 are each
amended to read as follows:
The authorities of each establishment as defined in this chapter
shall place on file in the office of the establishment the
recommendations made by the department of health as a result of such
visits, for the purpose of consultation by such authorities, and for
reference by the department representatives upon their visits. Every
such establishment shall keep records of every person admitted thereto
as follows and shall furnish to the department, when required, the
following data: Name, age, sex, marital status, date of admission,
voluntary or other commitment, name of physician or advanced registered
nurse practitioner, diagnosis, and date of discharge.
Sec. 12 RCW 71.32.140 and 2004 c 39 s 2 are each amended to read
as follows:
(1) A principal who:
(a) Chose not to be able to revoke his or her directive during any
period of incapacity;
(b) Consented to voluntary admission to inpatient mental health
treatment, or authorized an agent to consent on the principal's behalf;
and
(c) At the time of admission to inpatient treatment, refuses to be
admitted,
may only be admitted into inpatient mental health treatment under
subsection (2) of this section.
(2) A principal may only be admitted to inpatient mental health
treatment under his or her directive if, prior to admission, a
((physician)) member of the treating facility's professional staff who
is a physician or advanced registered nurse practitioner:
(a) Evaluates the principal's mental condition, including a review
of reasonably available psychiatric and psychological history,
diagnosis, and treatment needs, and determines, in conjunction with
another health care provider or mental health professional, that the
principal is incapacitated;
(b) Obtains the informed consent of the agent, if any, designated
in the directive;
(c) Makes a written determination that the principal needs an
inpatient evaluation or is in need of inpatient treatment and that the
evaluation or treatment cannot be accomplished in a less restrictive
setting; and
(d) Documents in the principal's medical record a summary of the
physician's or advanced registered nurse practitioner's findings and
recommendations for treatment or evaluation.
(3) In the event the admitting physician is not a psychiatrist, or
the advanced registered nurse practitioner is not a psychiatric
advanced registered nurse practitioner, the principal shall receive a
complete psychological assessment by a mental health professional
within twenty-four hours of admission to determine the continued need
for inpatient evaluation or treatment.
(4)(a) If it is determined that the principal has capacity, then
the principal may only be admitted to, or remain in, inpatient
treatment if he or she consents at the time or is detained under the
involuntary treatment provisions of chapter 70.96A, 71.05, or 71.34
RCW.
(b) If a principal who is determined by two health care providers
or one mental health professional and one health care provider to be
incapacitated continues to refuse inpatient treatment, the principal
may immediately seek injunctive relief for release from the facility.
(5) If, at the end of the period of time that the principal or the
principal's agent, if any, has consented to voluntary inpatient
treatment, but no more than fourteen days after admission, the
principal has not regained capacity or has regained capacity but
refuses to consent to remain for additional treatment, the principal
must be released during reasonable daylight hours, unless detained
under chapter 70.96A, 71.05, or 71.34 RCW.
(6)(a) Except as provided in (b) of this subsection, any principal
who is voluntarily admitted to inpatient mental health treatment under
this chapter shall have all the rights provided to individuals who are
voluntarily admitted to inpatient treatment under chapter 71.05, 71.34,
or 72.23 RCW.
(b) Notwithstanding RCW 71.05.050 regarding consent to inpatient
treatment for a specified length of time, the choices an incapacitated
principal expressed in his or her directive shall control, provided,
however, that a principal who takes action demonstrating a desire to be
discharged, in addition to making statements requesting to be
discharged, shall be discharged, and no principal shall be restrained
in any way in order to prevent his or her discharge. Nothing in this
subsection shall be construed to prevent detention and evaluation for
civil commitment under chapter 71.05 RCW.
(7) Consent to inpatient admission in a directive is effective only
while the professional person, health care provider, and health care
facility are in substantial compliance with the material provisions of
the directive related to inpatient treatment.
Sec. 13 RCW 71.32.250 and 2003 c 283 s 25 are each amended to
read as follows:
(1) If a principal who is a resident of a long-term care facility
is admitted to inpatient mental health treatment pursuant to his or her
directive, the principal shall be allowed to be readmitted to the same
long-term care facility as if his or her inpatient admission had been
for a physical condition on the same basis that the principal would be
readmitted under state or federal statute or rule when:
(a) The treating facility's professional staff determine that
inpatient mental health treatment is no longer medically necessary for
the resident. The determination shall be made in writing by a
psychiatrist, psychiatric advanced registered nurse practitioner, or
((by)) a mental health professional and either (i) a physician or (ii)
advanced registered nurse practitioner; or
(b) The person's consent to admission in his or her directive has
expired.
(2)(a) If the long-term care facility does not have a bed available
at the time of discharge, the treating facility may discharge the
resident, in consultation with the resident and agent if any, and in
accordance with a medically appropriate discharge plan, to another
long-term care facility.
(b) This section shall apply to inpatient mental health treatment
admission of long-term care facility residents, regardless of whether
the admission is directly from a facility, hospital emergency room, or
other location.
(c) This section does not restrict the right of the resident to an
earlier release from the inpatient treatment facility. This section
does not restrict the right of a long-term care facility to initiate
transfer or discharge of a resident who is readmitted pursuant to this
section, provided that the facility has complied with the laws
governing the transfer or discharge of a resident.
(3) The joint legislative audit and review committee shall conduct
an evaluation of the operation and impact of this section. The
committee shall report its findings to the appropriate committees of
the legislature by December 1, 2004.
Sec. 14 RCW 71.32.260 and 2003 c 283 s 26 are each amended to
read as follows:
The directive shall be in substantially the following form:
Mental Health Advance Directive | |
NOTICE TO PERSONS CREATING A MENTAL HEALTH ADVANCE DIRECTIVE | |
This is an important legal document. It creates an advance directive for mental health treatment. Before signing this document you should know these important facts: | |
YOU DO NOT HAVE TO FILL OUT OR SIGN THIS FORM. IF YOU DO NOT SIGN THIS FORM, IT WILL NOT TAKE EFFECT. | |
If you choose to complete and sign this document, you may still decide to leave some items blank. | |
YOU MAY NOT REVOKE THIS DIRECTIVE WHEN YOU HAVE BEEN FOUND TO BE INCAPACITATED UNLESS YOU HAVE SPECIFICALLY STATED IN THIS DIRECTIVE THAT YOU WANT IT TO BE REVOCABLE WHEN YOU ARE INCAPACITATED. | |
PART I. STATEMENT OF INTENT TO CREATE A MENTAL HEALTH ADVANCE DIRECTIVE | |
I, . . . . . . . . . . being a person with capacity, willfully and voluntarily execute this mental health advance directive so that my choices regarding my mental health care will be carried out in circumstances when I am unable to express my instructions and preferences regarding my mental health care. If a guardian is appointed by a court to make mental health decisions for me, I intend this document to take precedence over all other means of ascertaining my intent. | |
The fact that I may have left blanks in this directive does not affect its validity in any way. I intend that all completed sections be followed. If I have not expressed a choice, my agent should make the decision that he or she determines is in my best interest. I intend this directive to take precedence over any other directives I have previously executed, to the extent that they are inconsistent with this document, or unless I expressly state otherwise in either document. | |
I understand that I may revoke this directive in whole or in part if I am a person with capacity. I understand that I cannot revoke this directive if a court, two health care providers, or one mental health professional and one health care provider find that I am an incapacitated person, unless, when I executed this directive, I chose to be able to revoke this directive while incapacitated. | |
I understand that, except as otherwise provided in law, revocation must be in writing. I understand that nothing in this directive, or in my refusal of treatment to which I consent in this directive, authorizes any health care provider, professional person, health care facility, or agent appointed in this directive to use or threaten to use abuse, neglect, financial exploitation, or abandonment to carry out my directive. | |
I understand that there are some circumstances where my provider may not have to follow my directive. | |
PART II. WHEN THIS DIRECTIVE IS EFFECTIVE | |
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID. | |
I intend that this directive become effective (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Immediately upon my signing of this directive. | |
. . . . . . If I become incapacitated. | |
. . . . . . When the following circumstances, symptoms, or behaviors occur: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
PART III. DURATION OF THIS DIRECTIVE | |
YOU MUST COMPLETE THIS PART FOR YOUR DIRECTIVE TO BE VALID. | |
I want this directive to (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Remain valid and in effect for an indefinite period of time. | |
. . . . . . Automatically expire . . . . . . years from the date it was created. | |
PART IV. WHEN I MAY REVOKE THIS DIRECTIVE | |
YOU MUST COMPLETE THIS PART FOR THIS DIRECTIVE TO BE VALID. | |
I intend that I be able to revoke this directive (YOU MUST CHOOSE ONLY ONE): | |
. . . . . . Only when I have capacity. | |
. . . . . . Even if I am incapacitated. | |
PART V. PREFERENCES AND INSTRUCTIONS ABOUT TREATMENT, FACILITIES, AND PHYSICIANS OR ADVANCED REGISTERED NURSE PRACTITIONERS | |
A. Preferences and Instructions About Physician(s) or Advanced Registered Nurse Practitioner(s) to be Involved in My Treatment | |
I would like the physician(s) or advanced registered nurse practitioner(s) named below to be involved in my treatment
decisions: Dr. or ARNP . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . . Dr. or ARNP . . . . . . . . . . . . . . . . Contact information: . . . . . . . . . . . . | |
I do not wish to be treated by Dr. or ARNP . . . . . . . . . . . . | |
B. Preferences and Instructions About Other Providers | |
I am receiving other treatment or care from providers who I feel have an impact on my mental health care. I would like the following treatment provider(s) to be contacted when this directive is effective: | |
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . . | |
Name . . . . . . . . . . . . . . . . . . . . Profession . . . . . . . . . . . . . . . . . . . . Contact information . . . . . . . . . . . . | |
C. Preferences and Instructions About Medications for Psychiatric Treatment (initial and complete all that apply) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the following medications: . . . . . . . . . . . . | |
. . . . . . I do not consent, and I do not authorize my agent (if appointed) to consent, to the administration of the following medications: . . . . . . . . . . . . | |
. . . . . . I am willing to take the medications excluded above if my only reason for excluding them is the side effects
which include . . . . . . . . . . . . and these side effects can be eliminated by dosage adjustment or other means | |
. . . . . . I am willing to try any other medication the hospital doctor or advanced registered nurse practitioner recommends | |
. . . . . . I am willing to try any other medications my outpatient doctor or advanced registered nurse practitioner recommends | |
. . . . . . I do not want to try any other medications. | |
Medication Allergies | |
I have allergies to, or severe side effects from, the following: . . . . . . . . . . . . . . . . . . . . . . . . | |
Other Medication Preferences or Instructions | |
. . . . . . I have the following other preferences or instructions about medications . . . . . . . . . . . . . . . . . . . . . . . . | |
D. Preferences and Instructions About Hospitalization and Alternatives (initial all that apply and, if desired, rank "1" for first choice, "2" for second choice, and so on) | |
. . . . . . In the event my psychiatric condition is serious enough to require 24-hour care and I have no physical conditions that require immediate access to emergency medical care, I prefer to receive this care in programs/facilities designed as alternatives to psychiatric hospitalizations. | |
. . . . . . I would also like the interventions below to be tried before hospitalization is considered: | |
. . . . . . Calling someone or having someone call me when needed. | |
Name: . . . . . . . . . . . . | Telephone: . . . . . . . . . . . . |
. . . . . . Staying overnight with someone | |
Name: . . . . . . . . . . . . | Telephone: . . . . . . . . . . . . |
. . . . . . Having a mental health service provider come to see me | |
. . . . . . Going to a crisis triage center or emergency room | |
. . . . . . Staying overnight at a crisis respite (temporary) bed | |
. . . . . . Seeing a service provider for help with psychiatric medications | |
. . . . . . Other, specify: . . . . . . . . . . . . | |
Authority to Consent to Inpatient Treatment | |
I consent, and authorize my agent (if appointed) to consent, to voluntary admission to inpatient mental health treatment for . . . . . . days (not to exceed 14 days) | |
(Sign one): | |
. . . . . . If deemed appropriate by my agent (if appointed) and treating physician or advanced registered nurse practitioner | |
. . . . . . . . . . . . (Signature) | |
or | |
. . . . . . Under the following circumstances (specify symptoms, behaviors, or circumstances that indicate the need for hospitalization) . . . . . . . . . . . . | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I do not consent, or authorize my agent (if appointed) to consent, to inpatient treatment | |
. . . . . . . . . . . . (Signature) | |
Hospital Preferences and Instructions | |
If hospitalization is required, I prefer the following hospitals: . . . . . . . . . . . . | |
I do not consent to be admitted to the following hospitals: . . . . . . . . . . . . | |
E. Preferences and Instructions About Preemergency | |
I would like the interventions below to be tried before use of seclusion or restraint is considered (initial all that apply): | |
. . . . . . "Talk me down" one-on-one | |
. . . . . . More medication | |
. . . . . . Time out/privacy | |
. . . . . . Show of authority/force | |
. . . . . . Shift my attention to something else | |
. . . . . . Set firm limits on my behavior | |
. . . . . . Help me to discuss/vent feelings | |
. . . . . . Decrease stimulation | |
. . . . . . Offer to have neutral person settle dispute | |
. . . . . . Other, specify . . . . . . . . . . . . | |
F. Preferences and Instructions About Seclusion, Restraint, and Emergency Medications | |
If it is determined that I am engaging in behavior that requires seclusion, physical restraint, and/or emergency use of medication, I prefer these interventions in the order I have chosen (choose "1" for first choice, "2" for second choice, and so on): | |
. . . . . . Seclusion | |
. . . . . . Seclusion and physical restraint (combined) | |
. . . . . . Medication by injection | |
. . . . . . Medication in pill or liquid form | |
In the event that my attending physician or advanced registered nurse practitioner decides to use medication in response to an emergency situation after due consideration of my preferences and instructions for emergency treatments stated above, I expect the choice of medication to reflect any preferences and instructions I have expressed in Part III C of this form. The preferences and instructions I express in this section regarding medication in emergency situations do not constitute consent to use of the medication for nonemergency treatment. | |
G. Preferences and Instructions About Electroconvulsive Therapy (ECT or Shock Therapy) | |
My wishes regarding electroconvulsive therapy are (sign one): | |
. . . . . . I do not consent, nor authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy | |
. . . . . . . . . . . . (Signature) | |
. . . . . . I consent, and authorize my agent (if appointed) to consent, to the administration of electroconvulsive therapy, but only under the following conditions: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . (Signature) | |
H. Preferences and Instructions About Who is Permitted to Visit | |
If I have been admitted to a mental health treatment facility, the following people are not permitted to visit me there: | |
Name: . . . . . . . . . . . . | |
Name: . . . . . . . . . . . . | |
Name: . . . . . . . . . . . . | |
I understand that persons not listed above may be permitted to visit me. | |
I. Additional Instructions About My Mental Health Care | |
Other instructions about my mental health care: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
In case of emergency, please contact: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Physician or Advanced Registered Nurse Practitioner: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Telephone: . . . . . . . . . . . . | |
The following may help me to avoid a hospitalization: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
I generally react to being hospitalized as follows: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
Staff of the hospital or crisis unit can help me by doing the following: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
J. Refusal of Treatment | |
I do not consent to any mental health treatment. | |
. . . . . . . . . . . . (Signature) | |
PART VI. DURABLE POWER OF ATTORNEY (APPOINTMENT OF MY AGENT) | |
(Fill out this part only if you wish to appoint an agent or nominate a guardian.) | |
I authorize an agent to make mental health treatment decisions on my behalf. The authority granted to my agent includes the right to consent, refuse consent, or withdraw consent to any mental health care, treatment, service, or procedure, consistent with any instructions and/or limitations I have set forth in this directive. I intend that those decisions should be made in accordance with my expressed wishes as set forth in this document. If I have not expressed a choice in this document and my agent does not otherwise know my wishes, I authorize my agent to make the decision that my agent determines is in my best interest. This agency shall not be affected by my incapacity. Unless I state otherwise in this durable power of attorney, I may revoke it unless prohibited by other state law. | |
A. Designation of an Agent | |
I appoint the following person as my agent to make mental health treatment decisions for me as authorized in this document and request that this person be notified immediately when this directive becomes effective: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
B. Designation of Alternate Agent | |
If the person named above is unavailable, unable, or refuses to serve as my agent, or I revoke that person's authority to serve as my agent, I hereby appoint the following person as my alternate agent and request that this person be notified immediately when this directive becomes effective or when my original agent is no longer my agent: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
C. When My Spouse is My Agent (initial if desired) | |
. . . . . . If my spouse is my agent, that person shall remain my agent even if we become legally separated or our marriage is dissolved, unless there is a court order to the contrary or I have remarried. | |
D. Limitations on My Agent's Authority | |
I do not grant my agent the authority to consent on my behalf to the following: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
E. Limitations on My Ability to Revoke this Durable Power of Attorney | |
I choose to limit my ability to revoke this durable power of attorney as follows: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
F. Preference as to Court-Appointed Guardian | |
In the event a court appoints a guardian who will make decisions regarding my mental health treatment, I nominate the following person as my guardian: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Work telephone: . . . . . . . . . . . . | Home telephone: . . . . . . . . . . . . |
Relationship: . . . . . . . . . . . . | |
The appointment of a guardian of my estate or my person or any other decision maker shall not give the guardian or decision maker the power to revoke, suspend, or terminate this directive or the powers of my agent, except as authorized by law. | |
. . . . . . . . . . . . (Signature required if nomination is made) | |
PART VII. OTHER DOCUMENTS | |
(Initial all that apply) | |
I have executed the following documents that include the power to make decisions regarding health care services for myself: | |
. . . . . . Health care power of attorney (chapter 11.94 RCW) | |
. . . . . . "Living will" (Health care directive; chapter 70.122 RCW) | |
. . . . . . I have appointed more than one agent. I understand that the most recently appointed agent controls except as stated below: | |
. . . . . . . . . . . . | |
PART VIII. NOTIFICATION OF OTHERS AND CARE OF PERSONAL AFFAIRS | |
(Fill out this part only if you wish to provide nontreatment instructions.) | |
I understand the preferences and instructions in this part are NOT the responsibility of my treatment provider and that no treatment provider is required to act on them. | |
A. Who Should Be Notified | |
I desire my agent to notify the following individuals as soon as possible when this directive becomes effective: | |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Day telephone: . . . . . . . . . . . . | Evening telephone: . . . . . . . . . . . . |
Name: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Day telephone: . . . . . . . . . . . . | Evening telephone: . . . . . . . . . . . . |
B. Preferences or Instructions About Personal Affairs | |
I have the following preferences or instructions about my personal affairs (e.g., care of dependents, pets, household) if I am admitted to a mental health treatment facility: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
C. Additional Preferences and Instructions: | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . . . . . . . | |
PART IX. SIGNATURE | |
By signing here, I indicate that I understand the purpose and effect of this document and that I am giving my informed consent to the treatments and/or admission to which I have consented or authorized my agent to consent in this directive. I intend that my consent in this directive be construed as being consistent with the elements of informed consent under chapter 7.70 RCW. | |
Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
This directive was signed and declared by the "Principal," to be his or her directive, in our presence who, at his or her request, have signed our names below as witnesses. We declare that, at the time of the creation of this instrument, the Principal is personally known to us, and, according to our best knowledge and belief, has capacity at this time and does not appear to be acting under duress, undue influence, or fraud. We further declare that none of us is: | |
(A) A person designated to make medical decisions on the principal's behalf; | |
(B) A health care provider or professional person directly involved with the provision of care to the principal at the time the directive is executed; | |
(C) An owner, operator, employee, or relative of an owner or operator of a health care facility or long-term care facility in which the principal is a patient or resident; | |
(D) A person who is related by blood, marriage, or adoption to the person, or with whom the principal has a dating relationship as defined in RCW 26.50.010; | |
(E) An incapacitated person; | |
(F) A person who would benefit financially if the principal undergoes mental health treatment; or | |
(G) A minor. | |
Witness 1: Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
Telephone: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
Witness 2: Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
Telephone: . . . . . . . . . . . . | Address: . . . . . . . . . . . . |
PART X. RECORD OF DIRECTIVE | |
I have given a copy of this directive to the following persons: . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
DO NOT FILL OUT PART XI UNLESS YOU INTEND TO REVOKE THIS DIRECTIVE IN PART OR IN WHOLE | |
PART XI. REVOCATION OF THIS DIRECTIVE | |
(Initial any that apply): | |
. . . . . . I am revoking the following part(s) of this directive (specify): . . . . . . . . . . . . | |
. . . . . . . . . . . . | |
. . . . . . I am revoking all of this directive. | |
By signing here, I indicate that I understand the purpose and effect of my revocation and that no person is bound by any revoked provision(s). I intend this revocation to be interpreted as if I had never completed the revoked provision(s). | |
Signature: . . . . . . . . . . . . | Date: . . . . . . . . . . . . |
Printed Name: . . . . . . . . . . . . | |
DO NOT SIGN THIS PART UNLESS YOU INTEND TO REVOKE THIS DIRECTIVE IN PART OR IN WHOLE |
Sec. 15 RCW 71.34.355 and 1985 c 354 s 16 are each amended to
read as follows:
Absent a risk to self or others, minors treated under this chapter
have the following rights, which shall be prominently posted in the
evaluation and treatment facility:
(1) To wear their own clothes and to keep and use personal
possessions;
(2) To keep and be allowed to spend a reasonable sum of their own
money for canteen expenses and small purchases;
(3) To have individual storage space for 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) To discuss treatment plans and decisions with mental health
professionals;
(8) To have the right to adequate care and individualized
treatment;
(9) Not to consent to the performance of electro-convulsive
treatment or surgery, except emergency life-saving surgery, upon him or
her, and not to have electro-convulsive treatment or nonemergency
surgery in such circumstance unless ordered by a court pursuant to a
judicial hearing in which the minor is present and represented by
counsel, and the court shall appoint a psychiatrist, psychologist,
advanced registered nurse practitioner, or physician designated by the
minor or the minor's counsel to testify on behalf of the minor. The
minor's parent may exercise this right on the minor's behalf, and must
be informed of any impending treatment;
(10) Not to have psychosurgery performed on him or her under any
circumstances.
Sec. 16 RCW 71.34.720 and 1991 c 364 s 12 are each amended to
read as follows:
(1) Each minor approved by the facility for inpatient admission
shall be examined and evaluated by a children's mental health
specialist as to the child's mental condition and by a physician or
advanced registered nurse practitioner as to the child's physical
condition within twenty-four hours of admission. Reasonable measures
shall be taken to ensure medical treatment is provided for any
condition requiring immediate medical attention.
(2) If, after examination and evaluation, the children's mental
health specialist and the physician or advanced registered nurse
practitioner determine that the initial needs of the minor would be
better served by placement in a chemical dependency treatment facility,
then the minor shall be referred to an approved treatment program
defined under RCW 70.96A.020.
(3) The admitting facility shall take reasonable steps to notify
immediately the minor's parent of the admission.
(4) During the initial seventy-two hour treatment period, the minor
has a right to associate or receive communications from parents or
others unless the professional person in charge determines that such
communication would be seriously detrimental to the minor's condition
or treatment and so indicates in the minor's clinical record, and
notifies the minor's parents of this determination. In no event may
the minor be denied the opportunity to consult an attorney.
(5) If the evaluation and treatment facility admits the minor, it
may detain the minor for evaluation and treatment for a period not to
exceed seventy-two hours from the time of provisional acceptance. The
computation of such seventy-two hour period shall exclude Saturdays,
Sundays, and holidays. This initial treatment period shall not exceed
seventy-two hours except when an application for voluntary inpatient
treatment is received or a petition for fourteen-day commitment is
filed.
(6) Within twelve hours of the admission, the facility shall advise
the minor of his or her rights as set forth in this chapter.
Sec. 17 RCW 71.34.730 and 1995 c 312 s 54 are each amended to
read as follows:
(1) The professional person in charge of an evaluation and
treatment facility where a minor has been admitted involuntarily for
the initial seventy-two hour treatment period under this chapter may
petition to have a minor committed to an evaluation and treatment
facility for fourteen-day diagnosis, evaluation, and treatment.
If the professional person in charge of the treatment and
evaluation facility does not petition to have the minor committed, the
parent who has custody of the minor may seek review of that decision in
court. The parent shall file notice with the court and provide a copy
of the treatment and evaluation facility's report.
(2) A petition for commitment of a minor under this section shall
be filed with the superior court in the county where the minor is
residing or being detained.
(a) A petition for a fourteen-day commitment shall be signed
((either)) by (i) two physicians ((or by one physician and)), (ii) two
advanced registered nurse practitioners, (iii) a mental health
professional ((who)) and either a physician or an advanced registered
nurse practitioner, or (iv) a physician and advanced registered nurse
practitioner. The person signing the petition must have examined the
minor, and ((shall)) the petition must contain the following:
(((i))) (A) The name and address of the petitioner;
(((ii))) (B) The name of the minor alleged to meet the criteria for
fourteen-day commitment;
(((iii))) (C) The name, telephone number, and address if known of
every person believed by the petitioner to be legally responsible for
the minor;
(((iv))) (D) A statement that the petitioner has examined the minor
and finds that the minor's condition meets required criteria for
fourteen-day commitment and the supporting facts therefor;
(((v))) (E) A statement that the minor has been advised of the need
for voluntary treatment but has been unwilling or unable to consent to
necessary treatment;
(((vi))) (F) A statement recommending the appropriate facility or
facilities to provide the necessary treatment; and
(((vii))) (G) A statement concerning whether a less restrictive
alternative to inpatient treatment is in the best interests of the
minor.
(b) A copy of the petition shall be personally delivered to the
minor by the petitioner or petitioner's designee. A copy of the
petition shall be sent to the minor's attorney and the minor's parent.
Sec. 18 RCW 71.34.750 and 1985 c 354 s 9 are each amended to read
as follows:
(1) At any time during the minor's period of fourteen-day
commitment, the professional person in charge may petition the court
for an order requiring the minor to undergo an additional one hundred
eighty-day period of treatment. The evidence in support of the
petition shall be presented by the county prosecutor unless the
petition is filed by the professional person in charge of a state-operated facility in which case the evidence shall be presented by the
attorney general.
(2) The petition for one hundred eighty-day commitment shall
contain the following:
(a) The name and address of the petitioner or petitioners;
(b) The name of the minor alleged to meet the criteria for one
hundred eighty-day commitment;
(c) A statement that the petitioner is the professional person in
charge of the evaluation and treatment facility responsible for the
treatment of the minor;
(d) The date of the fourteen-day commitment order; and
(e) A summary of the facts supporting the petition.
(3) The petition shall be supported by accompanying affidavits
signed by (a) two examining physicians, one of whom shall be a child
psychiatrist, ((or by one examining physician and)) or two advanced
registered nurse practitioners, one of whom shall be a child and
adolescent or family psychiatric advanced registered nurse
practitioner, (b) one children's mental health specialist and either an
examining physician or an advanced registered nurse practitioner, or
(c) an examining physician and advanced registered nurse practitioner,
one of which needs to be a child psychiatrist or a child and adolescent
psychiatric nurse practitioner. The affidavits shall describe in
detail the behavior of the detained minor which supports the petition
and shall state whether a less restrictive alternative to inpatient
treatment is in the best interests of the minor.
(4) The petition for one hundred eighty-day commitment shall be
filed with the clerk of the court at least three days before the
expiration of the fourteen-day commitment period. The petitioner or
the petitioner's designee shall within twenty-four hours of filing
serve a copy of the petition on the minor and notify the minor's
attorney and the minor's parent. A copy of the petition shall be
provided to such persons at least twenty-four hours prior to the
hearing.
(5) At the time of filing, the court shall set a date within seven
days for the hearing on the petition. The court may continue the
hearing upon the written request of the minor or the minor's attorney
for not more than ten days. The minor or the parents shall be afforded
the same rights as in a fourteen-day commitment hearing. Treatment of
the minor shall continue pending the proceeding.
(6) For one hundred eighty-day commitment, the court must find by
clear, cogent, and convincing evidence that the minor:
(a) Is suffering from a mental disorder;
(b) Presents a likelihood of serious harm or is gravely disabled;
and
(c) Is in need of further treatment that only can be provided in a
one hundred eighty-day commitment.
(7) If the court finds that the criteria for commitment are met and
that less restrictive treatment in a community setting is not
appropriate or available, the court shall order the minor committed for
further inpatient treatment to the custody of the secretary or to a
private treatment and evaluation facility if the minor's parents have
assumed responsibility for payment for the treatment. If the court
finds that a less restrictive alternative is in the best interest of
the minor, the court shall order less restrictive alternative treatment
upon such conditions as necessary.
If the court determines that the minor does not meet the criteria
for one hundred eighty-day commitment, the minor shall be released.
(8) Successive one hundred eighty-day commitments are permissible
on the same grounds and under the same procedures as the original one
hundred eighty-day commitment. Such petitions shall be filed at least
five days prior to the expiration of the previous one hundred eighty-day commitment order.
Sec. 19 RCW 71.34.770 and 1985 c 354 s 12 are each amended to
read as follows:
(1) The professional person in charge of the inpatient treatment
facility may authorize release for the minor under such conditions as
appropriate. Conditional release may be revoked pursuant to RCW
71.34.780 if leave conditions are not met or the minor's functioning
substantially deteriorates.
(2) Minors may be discharged prior to expiration of the commitment
period if the treating physician, advanced registered nurse
practitioner, or professional person in charge concludes that the minor
no longer meets commitment criteria.
Sec. 20 RCW 71.05.020 and 2008 c 156 s 1 are each 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 advanced registered nurse practitioner,
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;
(31) "Psychologist" means a person who has been licensed as a
psychologist pursuant to chapter 18.83 RCW;
(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;
(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;
(34) "Release" means legal termination of the commitment under the
provisions of this chapter;
(35) "Resource management services" has the meaning given in
chapter 71.24 RCW;
(36) "Secretary" means the secretary of the department of social
and health services, or his or her designee;
(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;
(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;
(39) "Violent act" means behavior that resulted in homicide,
attempted suicide, nonfatal injuries, or substantial damage to
property.