Revisions to Involuntary Commitment Laws

nc-stampHB 564 – Revise IVC Laws to Improve Behavioral Health

Primary Sponsors: Rep. Josh Dobson (R – Avery),  Rep. Susan Martin (R – Pitt), Rep. Donny Lambeth (R – Forsyth), Rep. Chris Malone (R – Wake)

SB 630 – Revise IVC Laws to Improve Behavioral Health 

Primary Sponsors: Sen. Ralph Hise (R – Madison), Sen. Joyce Kraweic (R – Guilford), Sen. Shirley Randleman (R – Stokes)

This bill seeks to revise laws pertaining to involuntary commitment in order to improve the delivery of behavioral health services in NC.

Definitions

This bill defines a “commitment” examiner as a physician, eligible psychologist or any health professional who is certified to perform the first examination for involuntary commitment.

The bill defines “incapable” as someone who lacks sufficient understanding to make and communicate mental health treatment decisions, according to a physician or eligible psychologist.

Section 3 Client Exceptions

The bill would allow facilities to disclose the time and location of admission or discharge to the client’s next of kin.

Section 4 Exceptions and Court Proceedings

This bill would allow the client’s counsel to have access to any medical and court records that the counsel deems relevant to the court proceeding and would not be required to obtain the client’s consent in order to access these records.

Section 8 LME/MCO Community Crisis Service Plan

This bill would require every LME/MCO to adopt a community crisis service plan that encompasses separate “local area crisis service plans” for all of the regions within the LME/MCO. All plans must:

  • Identify one or more facilities where a respondent must be taken for a first examination by a commitment examiner.
  • Identify persons designated to be responsible for transportation.
  • Identify training for law enforcement personnel who provide custody of involuntary commitment respondents.

Section 9 Transfer of Clients Between 24-hour Facilities or to an Acute Care Hospital

The bill states that if a respondent is a minor, an incompetent adult or an individual with the health care power of attorney who is deemed incapable, then within 24 hours after the transfer, the individual’s legally responsible person must know the location of the transfer and if the transfer is complete.

When a client is transferred from a 24-hour facility to an acute care hospital for medical reasons, the hospital shall return the client to the original facility as soon as space becomes available.

Section 14 Voluntary Admission

This portion of the bill states that when an individual makes advance instruction for treatment, physicians would be required to act in accordance with advance instruction.

The bill states that for discharge of an individual determined to be incapable, if the physician or eligible psychologist believes that an individual has regained capacity to make treatment decisions, and the individual refuses to sign an authorization for continued treatment within 72 hours after regaining capacity, the facility shall discharge the individual.

Section 19 Custody and Transportation

The bill states limitations and conditions on force and restraint outlined in this bill do not apply to acute care hospitals or general hospitals.

Section 22 Custody Order

This section changes all of the language of physician or eligible psychologist to “commitment examiner”.

Section 23 Special Emergency

This section changes all of the language of physician or eligible psychologist to “commitment examiner”.

Section 24 First Examination

This section would allow the area facility to determine who is qualified to perform the medical screening for the first examination.

This section states when outpatient commitment is recommended by a commitment examiner who is different than the proposed outpatient treatment physician or center, the  commitment examiner would be required to contact the LME/MCO that serves the county where the respondent resides to inform them of the outpatient commitment recommendation. The LME/MCO shall determine whether the respondent is a client of the LME/MCO or eligible for its services and, if so, shall identify and schedule an appointment with a proposed outpatient treatment physician or center.

Section 25 Secretary Authority

This bill would allow other health professionals whose scope of practice includes diagnosing and documenting psychiatric or substance abuse disorders to determine capacity to give informed consent as follows:

  • To certify a nurse practitioner, a licensed professional counselor or a physician assistant to conduct the first examinations;
  • To certify licensed clinical addictions specialists to conduct the first examinations.

The bill states this could not be construed as a scope of practice expansion.

The bill would also require the NC Department of Health and Human Services (DHHS) to submit a list of first commitment examiners to the Chief District Court Judge of each judicial district.

Section 27 Outpatient Commitment

Under this section of the bill, physicians would be required to contact the LME/MCO that serves the County in which the respondent resides if the patient is being recommended for outpatient commitment.

Section 31 Disposition

Before ordering any outpatient commitment, the court must find availability of outpatient treatment from a physician or center that has agreed to accept the respondent. The bill would also require that the patient have an outpatient appointment no later than 7 days after the respondent’s discharge from the 24-hour facility.

Section 37 Commitment; Second Examination

This portion of the bill requires that a patient be examined by a physician if the initial commitment evaluation was not performed by a physician. The bill would also require that the findings be made in writing in all cases and that a copy of the written findings shall be sent to the clerk of superior court.

This bill was placed on the Senate Judiciary Committee for April 24, 2017.

If it is found favorable there it will move to the Senate Health Care Committee, and the Senate Rules and Operations Committee.

 
 

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