REPORT TITLE:
Involuntary psychiatric trtmnt


DESCRIPTION:
Authorizes the adoption of administrative rules allowing an
interdisciplinary panel of mental health clinicians to review
applications by the department of health for involuntary
psychiatric treatment with medication for patients at in-patient
psychiatric facilities. (SD1)

 
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THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO INVOLUNTARY PSYCHIATRIC TREATMENT.



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

 1      SECTION 1.  The purpose of this Act is to authorize the
 
 2 department of health to adopt administrative rules to establish
 
 3 an administrative process allowing involuntary medication of
 
 4 psychiatric patients institutionalized at the Hawaii state
 
 5 hospital in order to alleviate mental illness and restore
 
 6 competency while protecting the rights of patients.
 
 7      SECTION 2.  Chapter 334, Hawaii Revised Statutes, is amended
 
 8 by adding two new sections to part III to be appropriately
 
 9 designated and to read as follows:
 
10      "§334-     Involuntary treatment with psychiatric
 
11 medication.  (a)  The director shall adopt rules pursuant to
 
12 chapter 91 to enable interdisciplinary clinical review panels to
 
13 authorize the involuntary administration of psychotropic
 
14 medication for appropriate patients committed to in-patient
 
15 psychiatric facilities or the state hospital established under
 
16 section 334-31 for purposes of:
 
17      (1)  Involuntary hospitalization under section 334-60.2;
 
18      (2)  Examination with respect to physical or mental illness,
 
19           disease, or defect under section 704-404; or
 

 
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 1      (3)  Placement in the custody of the director and placed in
 
 2           an appropriate institution under section 704-406,
 
 3           704-411, or 704-413(3).
 
 4      (b)  The rules shall:
 
 5      (1)  Permit involuntary administration of psychotropic
 
 6           medication only when medically appropriate and,
 
 7           considering less intrusive alternatives, essential for
 
 8           the sake of the individual or the safety of others, or
 
 9           both, or when treatment is necessary to obtain an
 
10           adjudication of the individuals guilt or innocence for
 
11           defendants committed under section 704-404 or 704-406,
 
12           when treatment is necessary to obtain an adjudication
 
13           of the individual's guilt or innocence; and
 
14      (2)  Include an appeals process to a separate panel,
 
15           appointed by the director, whose decision shall be
 
16           deemed the final administrative decision, which may be
 
17           appealed to the circuit court within fourteen days.
 
18 The administrative process established under the rules shall not
 
19 be construed as a contested case under chapter 91."
 
20      SECTION 3.  Section 334E-2, Hawaii Revised Statutes, is
 
21 amended by amending subsection (a) to read as follows:
 
22      "(a)  Any patient in a psychiatric facility shall be
 
23 afforded rights; and any psychiatric facility shall provide the
 

 
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 1 rights to all patients; provided that when a patient is not able
 
 2 to exercise the patient's rights, the patient's legal guardian or
 
 3 legal representative shall have the authority to exercise the
 
 4 [same] rights on behalf of the patient.  The rights shall
 
 5 include, but not be limited to, the following:
 
 6      (1)  Access to written rules and regulations with which the
 
 7           patient is expected to comply;
 
 8      (2)  Access to the facility's grievance procedure or to the
 
 9           department of health as provided in section 334-3;
 
10      (3)  Freedom from reprisal;
 
11      (4)  Privacy, respect, and personal dignity;
 
12      (5)  A humane environment;
 
13      (6)  Freedom from discriminatory treatment based on race,
 
14           color, creed, national origin, age, and sex;
 
15      (7)  A written treatment plan based on the individual
 
16           patient;
 
17      (8)  Participation in the planning of the patient's
 
18           treatment plan;
 
19      (9)  Refusal of treatment except in emergency situations or
 
20           where a court order or administrative authorization
 
21           pursuant to section 334-    exists;
 
22     (10)  Refusal to participate in experimentation;
 
23     (11)  The choice of physician if the physician chosen agrees;
 

 
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 1     (12)  A qualified, competent staff;
 
 2     (13)  A medical examination before initiation of non-
 
 3           emergency treatment;
 
 4     (14)  Confidentiality of the patient's records;
 
 5     (15)  Access to the patient's records;
 
 6     (16)  Knowledge of rights withheld or removed by a court or
 
 7           by law;
 
 8     (17)  Physical exercise and recreation;
 
 9     (18)  Adequate diet;
 
10     (19)  Knowledge of the names and titles of staff members with
 
11           whom the patient has frequent contact;
 
12     (20)  The right to work at the facility and fair compensation
 
13           for work done; provided that work is available and is
 
14           part of the patient's treatment plan;
 
15     (21)  Visitation rights, unless the patient poses a danger to
 
16           self or others; provided that [where] if visitation is
 
17           prohibited, the legal guardian or legal representative
 
18           shall be allowed to visit the patient upon request;
 
19     (22)  Uncensored communication;
 
20     (23)  Notice of and reasons for an impending transfer;
 
21     (24)  Freedom from seclusion or restraint, except:
 
22           (A)  When necessary to prevent injury to self of
 
23                others; or
 

 
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 1           (B)  When part of the treatment plan; or
 
 2           (C)  When necessary to preserve the rights of other
 
 3                patients or staff;
 
 4     (25)  Disclosure to a court, at an involuntary civil
 
 5           commitment hearing, of all treatment procedures which
 
 6           have been administered prior to the hearing; and
 
 7     (26)  Receipt by the patient and the patient's guardian or
 
 8           legal guardian, if the patient has one, of this
 
 9           enunciation of rights at the time of admission."
 
10      SECTION 4.  Section 334-60.2, Hawaii Revised Statutes, is
 
11 amended to read as follows:
 
12      "§334-60.2  Involuntary hospitalization criteria[.]; right
 
13 to counsel.  (a)  A person may be committed to a psychiatric
 
14 facility for involuntary hospitalization, if the court finds:
 
15      (1)  That the person is mentally ill or suffering from
 
16           substance abuse;
 
17      (2)  That the person is imminently dangerous to self or
 
18           others, is gravely disabled or is obviously ill; and
 
19      (3)  That the person is in need of care or treatment, or
 
20           both, and there is no suitable alternative available
 
21           through existing facilities and programs which would be
 
22           less restrictive than hospitalization.
 
23      (b)  A person under subsection (a) shall have the right to
 

 
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 1 counsel paid for by the State, if the person has no counsel for
 
 2 any reason, for proceedings for involuntary hospitalization."
 
 3      SECTION 5.  The department of health shall report to the
 
 4 legislature prior to the convening of the regular session of
 
 5 2000, 2001, and 2002, on the effect of section 2 of this Act on
 
 6 committed patients and institutional staff.  The first report for
 
 7 the 2000 regular session shall include a draft of administrative
 
 8 rules required to be adopted under section 2 of this Act and
 
 9 recommendations for statutory amendments, if any.
 
10      SECTION 6.  Statutory material to be repealed is bracketed.
 
11 New statutory material is underscored.
 
12      SECTION 7.  This Act shall take effect upon its approval,
 
13 and shall be repealed on June 30, 2002; provided that sections
 
14 334E-2 and 334-60.2, Hawaii Revised Statutes, are reenacted in
 
15 the form in which they read on the day before the approval of
 
16 this Act.
 

 
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