REPORT TITLE:
Health


DESCRIPTION:
Appropriates $2 for soil testing in Village Park and West Loch
Fairways.  Requires DOH to establish process allowing the
involuntary medication of institutionalized psychiatric patients.
Requires insurers, mutual benefit societies, and health
maintenance organizations to pay all rural health care facilities
directly.  (HB1663 SD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        1663
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                S.D. 2
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH.



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

 1                              Part I
 
 2      SECTION 1.  The legislature finds that, as the population of
 
 3 the State grows, housing developments and residential areas are
 
 4 being constructed on former agricultural lands or on locations
 
 5 formerly used by the military.  This situation is certain to
 
 6 increase as agriculture declines and additional lands become
 
 7 available for residential development.  Environmental health
 
 8 hazards in the soil as residue from pesticides can remain
 
 9 undetected until significant clusters of disease or illness are
 
10 identified.  Secret underground military facilities, such as
 
11 tunnels or bunkers, in which were stored arms or chemicals, are
 
12 also capable of causing environmental health hazards.
 
13      The legislature finds that significant clusters of illness
 
14 or disease are not readily identifiable until some commonality
 
15 occurs, such as proximate neighbors comparing notes or children
 
16 of the same age level entering a single neighborhood school being
 
17 enrolled in special education classes.
 
18      The legislature further finds that when a significant
 
19 cluster or increase of illness or disease occurs in a school and
 

 
Page 2                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1 is identified by the faculty, it should be the responsibility of
 
 2 the principal and faculty to report their suspicions to the
 
 3 department of health.  The department of health, working in
 
 4 cooperation with the department of education, should be
 
 5 responsible for the related health services.
 
 6      Of particular concern to the legislature is the Village Park
 
 7 and West Loch Fairways communities.  Village Park is a
 
 8 subdivision of approximately 2,000 families, and West Loch
 
 9 Fairways is a subdivision of approximately 720 families, who
 
10 share a common health phenomenon.  Many of the Village Park and
 
11 West Loch Fairway families and children have varying degrees of
 
12 disabilities and illnesses that are more than coincidence.  One
 
13 out of ten children has some physical or learning disability, or
 
14 both, that requires special needs education.  Physical
 
15 disabilities include Downs Syndrome, trisomy 8 and trisomy 18,
 
16 spina bifida, heart abnormalities, leukemia, and respiratory
 
17 ailments.  Learning disabilities include mental retardation,
 
18 hearing, emotional, visual, speech and language, attention
 
19 deficit disorder, hyperactivity, oppositional defiant disorder,
 
20 multiple handicaps, and autism.
 
21      The purpose of this part is to appropriate funds to the
 
22 department of health to conduct soil testing for Village Park and
 
23 West Loch Fairways.
 

 
Page 3                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1      SECTION 2.  There is appropriated out of the environmental
 
 2 response revolving fund under section 128D-2, Hawaii Revised
 
 3 Statutes, the sum of $2, or so much thereof as may be necessary,
 
 4 for fiscal year 1999-2000, for the department of health to
 
 5 conduct soil testing at Village Park and West Loch Fairways to
 
 6 determine if the soil is a cause of the illnesses, and the
 
 7 physical and learning disabilities of children and families
 
 8 living in Village Park and West Loch Fairways.  The testing shall
 
 9 be completed by December 15, 1999.
 
10      SECTION 3.  The sum appropriated shall be expended by the
 
11 department of health.
 
12      SECTION 4.  The department of health, with the assistance of
 
13 the department of agriculture, Citizens for a Safe Environment,
 
14 and Life of the Land, shall report its findings and
 
15 recommendations to the legislature no later than twenty days
 
16 prior to the convening of the regular session of 2000.
 
17                              Part II
 
18      SECTION 5.  The purpose of this part is to require the
 
19 director of health to adopt rules to establish an administrative
 
20 process allowing the involuntary medication of psychiatric
 
21 patients institutionalized at in-patient psychiatric facilities
 
22 or the Hawaii state hospital in order to alleviate mental illness
 
23 and restore competency while protecting the rights of patients.
 

 
Page 4                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1      SECTION 6.  Chapter 334, Hawaii Revised Statutes, is amended
 
 2 by adding a new section to part III to be appropriately
 
 3 designated and to read as follows:
 
 4      "§334-     Involuntary treatment with psychiatric
 
 5 medication.  (a)  The director shall adopt rules pursuant to
 
 6 chapter 91 to enable interdisciplinary clinical review panels to
 
 7 authorize the involuntary administration of psychotropic
 
 8 medication for appropriate patients committed to in-patient
 
 9 psychiatric facilities or the state hospital established under
 
10 section 334-31 for purposes of:
 
11      (1)  Involuntary hospitalization under section 334-60.2;
 
12      (2)  Examination with respect to physical or mental illness,
 
13           disease, or defect under section 704-404; or
 
14      (3)  Placement in the custody of the director and placement
 
15           in an appropriate institution under section 704-406,
 
16           704-411, or 704-413(3).
 
17      (b)  The rules shall:
 
18      (1)  Permit the involuntary administration of psychotropic
 
19           medication only when medically appropriate and,
 
20           considering less intrusive alternatives, essential for
 
21           the sake of the individual or the safety of others, or
 
22           both, or when treatment is necessary to obtain an
 
23           adjudication of the individual's guilt or innocence for
 

 
Page 5                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1           defendants committed under section 704-404 or 704-406,
 
 2           when treatment is necessary to obtain an adjudication
 
 3           of the individual's guilt or innocence; and
 
 4      (2)  Include an appeals process to a separate panel,
 
 5           appointed by the director, whose decision shall be
 
 6           deemed the final administrative decision, which may be
 
 7           appealed to the circuit court within fourteen days.
 
 8 The administrative process established under the rules shall not
 
 9 be construed as a contested case under chapter 91."
 
10      SECTION 7.  Section 334E-2, Hawaii Revised Statutes, is
 
11 amended by amending subsection (a) to read as follows:
 
12      "(a)  Any patient in a psychiatric facility shall be
 
13 afforded rights; and any psychiatric facility shall provide the
 
14 rights to all patients; provided that when a patient is not able
 
15 to exercise the patient's rights, the patient's legal guardian or
 
16 legal representative shall have the authority to exercise the
 
17 [same] rights on behalf of the patient.  The rights shall
 
18 include, but not be limited to, the following:
 
19      (1)  Access to written rules and regulations with which the
 
20           patient is expected to comply;
 
21      (2)  Access to the facility's grievance procedure or to the
 
22           department of health as provided in section 334-3;
 
23      (3)  Freedom from reprisal;
 

 
Page 6                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1      (4)  Privacy, respect, and personal dignity;
 
 2      (5)  A humane environment;
 
 3      (6)  Freedom from discriminatory treatment based on race,
 
 4           color, creed, national origin, age, and sex;
 
 5      (7)  A written treatment plan based on the individual
 
 6           patient;
 
 7      (8)  Participation in the planning of the patient's
 
 8           treatment plan;
 
 9      (9)  Refusal of treatment except in emergency situations or
 
10           where a court order or administrative authorization
 
11           pursuant to section 334-    exists;
 
12     (10)  Refusal to participate in experimentation;
 
13     (11)  The choice of physician if the physician chosen agrees;
 
14     (12)  A qualified, competent staff;
 
15     (13)  A medical examination before initiation of non-
 
16           emergency treatment;
 
17     (14)  Confidentiality of the patient's records;
 
18     (15)  Access to the patient's records;
 
19     (16)  Knowledge of rights withheld or removed by a court or
 
20           by law;
 
21     (17)  Physical exercise and recreation;
 
22     (18)  Adequate diet;
 
23     (19)  Knowledge of the names and titles of staff members with
 

 
Page 7                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1           whom the patient has frequent contact;
 
 2     (20)  The right to work at the facility and fair compensation
 
 3           for work done; provided that work is available and is
 
 4           part of the patient's treatment plan;
 
 5     (21)  Visitation rights, unless the patient poses a danger to
 
 6           self or others; provided that [where] if visitation is
 
 7           prohibited, the legal guardian or legal representative
 
 8           shall be allowed to visit the patient upon request;
 
 9     (22)  Uncensored communication;
 
10     (23)  Notice of and reasons for an impending transfer;
 
11     (24)  Freedom from seclusion or restraint, except:
 
12           (A)  When necessary to prevent injury to self or
 
13                others; or
 
14           (B)  When part of the treatment plan; or
 
15           (C)  When necessary to preserve the rights of other
 
16                patients or staff;
 
17     (25)  Disclosure to a court, at an involuntary civil
 
18           commitment hearing, of all treatment procedures which
 
19           have been administered prior to the hearing; and
 
20     (26)  Receipt by the patient and the patient's guardian or
 
21           legal guardian, if the patient has one, of this
 
22           enunciation of rights at the time of admission."
 
23      SECTION 8.  Section 334-60.2, Hawaii Revised Statutes, is
 

 
Page 8                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1 amended to read as follows:
 
 2      "§334-60.2  Involuntary hospitalization criteria[.]; right
 
 3 to counsel.  (a)  A person may be committed to a psychiatric
 
 4 facility for involuntary hospitalization, if the court finds:
 
 5      (1)  That the person is mentally ill or suffering from
 
 6           substance abuse;
 
 7      (2)  That the person is imminently dangerous to self or
 
 8           others, is gravely disabled or is obviously ill; and
 
 9      (3)  That the person is in need of care or treatment, or
 
10           both, and there is no suitable alternative available
 
11           through existing facilities and programs which would be
 
12           less restrictive than hospitalization.
 
13      (b)  A person under subsection (a) shall have the right to
 
14 counsel paid for by the State, if the person has no counsel for
 
15 any reason, for proceedings for involuntary hospitalization."
 
16      SECTION 9.  The department of health shall report to the
 
17 legislature prior to the convening of the regular session of
 
18 2000, 2001, and 2002, on the effect of section 6 of this part on
 
19 committed patients and institutional staff.  The first report for
 
20 the 2000 regular session shall include a draft of administrative
 
21 rules required to be adopted under section 6 of this part and
 
22 recommendations for statutory amendments, if any.
 
23                             Part III
 

 
Page 9                                                     1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1      SECTION 10.  Chapter 431, Hawaii Revised Statutes, is
 
 2 amended by adding a new section to article 10A to be
 
 3 appropriately designated and to read as follows:
 
 4      "§431:10A-    Direct payment to rural health care
 
 5 facilities.  (a)  An insurer, after receiving a claim for payment
 
 6 of benefits under this article, shall pay the indemnity or
 
 7 reimbursement directly to the rural health care facility that
 
 8 provided the services, regardless of the rural health care
 
 9 facility's participatory status with the insurer's plan.
 
10      (b)  If the insurer makes payment to the covered person, the
 
11 insurer shall remain liable for payment to the rural health care
 
12 facility.  This subsection does not prohibit the insurer from
 
13 recovering any amount mistakenly paid to the covered person.
 
14      (c)  For purposes of this section, "rural health care
 
15 facility" is defined by regulations of the United States
 
16 Department of Health and Human Services."
 
17      SECTION 11.  Chapter 432, Hawaii Revised Statutes, is
 
18 amended by adding a new section to article 1 to be appropriately
 
19 designated and to read as follows:
 
20      "§432:1-    Direct payment to rural health care facilities.
 
21 (a)  A mutual benefit society, after receiving a claim for
 
22 payment of benefits under this chapter, shall pay the indemnity
 
23 or reimbursement directly to the rural health care facility that
 

 
Page 10                                                    1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1 provided the services, regardless of the rural health care
 
 2 facility's participatory status with the society's health care
 
 3 plan.
 
 4      (b)  If the society makes payment to the covered person, the
 
 5 society shall remain liable for payment to the rural health care
 
 6 facility.  This subsection does not prohibit the society from
 
 7 recovering any amount mistakenly paid to the covered person.
 
 8      (c)  For purposes of this section, "rural health care
 
 9 facility" is defined by regulations of the United States
 
10 Department of Health and Human Services."
 
11      SECTION 12.  Chapter 432D, Hawaii Revised Status, is amended
 
12 by adding a new section to be appropriately designated and to
 
13 read as follows:
 
14      "§432D-    Direct payment to rural health care facilities.
 
15 (a)  A health maintenance organization, after receiving a claim
 
16 for payment of benefits under this chapter, shall pay the
 
17 indemnity or reimbursement directly to the rural health care
 
18 facility that provided the health care services, regardless of
 
19 the rural health care facility's participatory status with the
 
20 health maintenance organization's plan.
 
21      (b)  If the health maintenance organization makes payment to
 
22 the covered person, the health maintenance organization shall
 
23 remain liable for payment to the rural health care facility.
 

 
Page 11                                                    1663
                                     H.B. NO.           H.D. 2
                                                        S.D. 2
                                                        


 1 This subsection does not prohibit the health maintenance
 
 2 organization from recovering any amount mistakenly paid to the
 
 3 covered person.
 
 4      (c)  For purposes of this section, "rural health care
 
 5 facility" is defined by regulations of the United States
 
 6 Department of Health and Human Services."
 
 7                              Part IV
 
 8      SECTION 13.  Statutory material to be repealed is bracketed.
 
 9 New statutory material is underscored.
 
10      SECTION 14.  This Act shall take effect upon its approval;
 
11 provided that:
 
12      (1)  Section 2 shall take effect on July 1, 1999; and
 
13      (2)  Part II shall be repealed on June 30, 2002, and
 
14           sections 334E-2(a) and 334-60.2, Hawaii Revised
 
15           Statutes, are reenacted in the form in which they read
 
16           on the day before the approval of this Act.