H 4099 Session 109 (1991-1992)
H 4099 General Bill, By P.B. Harris, Carnell, J.L. Harris and J.G. Mattos
A Bill to amend Section 44-22-10, Code of Laws of South Carolina, 1976,
relating to definitions under the Rights of Mental Health Patients, so as to
revise these definitions; to amend Section 44-22-60, relating to rights of
patients upon admission to a facility, so as to clarify that rights of
patients apply when admitted to a Department of Mental Health facility rather
than to any mental health residential program; to amend Section 44-22-70,
relating to individualized treatment plans, so as to provide that such plan
must be reviewed in a long-term care facility every ninety days rather than
every sixty days; to amend Section 44-22-100, relating to confidentiality of
records, certificates, applications, and reports, so as to clarify that this
confidentiality extends to certain other Chapters in Title 44; to amend
Section 44-22-120, relating to certain rights that patients are assured, so as
to include the right to care for one's own clothing when able to do so and to
provide for the disposition of unclaimed personal property when a patient is
discharged; to amend Section 44-22-150, relating to mechanical restraints on
patients, so as to provide that the restraints must be removed every two
hours; to amend Section 44-22-210, relating to a patient's temporary leave of
absence, so as to extend the limitation on such a leave from fourteen to
ninety days; and to repeal Sections 44-17-650, 44-23-1010, 44-23-1060, and
44-52-180 relating to the rights of mental health patients.
01/14/92 House Introduced and read first time HJ-180
01/14/92 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-181
02/18/92 House Tabled in committee
A BILL
TO AMEND SECTION 44-22-10, CODE OF LAWS OF SOUTH
CAROLINA, 1976, RELATING TO DEFINITIONS UNDER THE
RIGHTS OF MENTAL HEALTH PATIENTS, SO AS TO REVISE
THESE DEFINITIONS; TO AMEND SECTION 44-22-60, RELATING
TO RIGHTS OF PATIENTS UPON ADMISSION TO A FACILITY,
SO AS TO CLARIFY THAT RIGHTS OF PATIENTS APPLY WHEN
ADMITTED TO A DEPARTMENT OF MENTAL HEALTH
FACILITY RATHER THAN TO ANY MENTAL HEALTH
RESIDENTIAL PROGRAM; TO AMEND SECTION 44-22-70,
RELATING TO INDIVIDUALIZED TREATMENT PLANS, SO AS
TO PROVIDE THAT SUCH PLAN MUST BE REVIEWED IN A
LONG-TERM CARE FACILITY EVERY NINETY DAYS RATHER
THAN EVERY SIXTY DAYS; TO AMEND SECTION 44-22-100,
RELATING TO CONFIDENTIALITY OF RECORDS,
CERTIFICATES, APPLICATIONS, AND REPORTS, SO AS TO
CLARIFY THAT THIS CONFIDENTIALITY EXTENDS TO
CERTAIN OTHER CHAPTERS IN TITLE 44; TO AMEND SECTION
44-22-120, RELATING TO CERTAIN RIGHTS THAT PATIENTS
ARE ASSURED, SO AS TO INCLUDE THE RIGHT TO CARE FOR
ONE'S OWN CLOTHING WHEN ABLE TO DO SO AND TO
PROVIDE FOR THE DISPOSITION OF UNCLAIMED PERSONAL
PROPERTY WHEN A PATIENT IS DISCHARGED; TO AMEND
SECTION 44-22-150, RELATING TO MECHANICAL RESTRAINTS
ON PATIENTS, SO AS TO PROVIDE THAT THE RESTRAINTS
MUST BE REMOVED EVERY TWO HOURS; TO AMEND
SECTION 44-22-210, RELATING TO A PATIENT'S TEMPORARY
LEAVE OF ABSENCE, SO AS TO EXTEND THE LIMITATION ON
SUCH A LEAVE FROM FOURTEEN TO NINETY DAYS; AND TO
REPEAL SECTIONS 44-17-650, 44-23-1010, 44-23-1060, AND
44-52-180 RELATING TO THE RIGHTS OF MENTAL HEALTH
PATIENTS.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Section 44-22-10 of the 1976 Code, as added by Act
127 of 1991, is amended to read:
"Section 44-22-10. As used in this chapter:
(1) `Best interests' means promoting personal well-being by
the intelligent assessment of the risks, benefits, and alternatives to the
patient of proposed electro-convulsive therapy, surgical treatment, or
experimental research, taking into account the potential relief of
suffering, the preservation or restoration of functioning, and the quality
of the patient's life with and without the proposed treatment.
(2) `Commission' means the South Carolina Commission on
Alcohol and Drug Abuse.
(3)(2) `Commissioner' means the State
Commissioner of Mental Health.
(4)(3) `Court' means probate court.
(5)(4) `Department' means the State Department of
Mental Health.
(6)(5) `Facility' means a residential program
operated or assisted by the department.
(7)(6) `Independent examination' means an
examination of a patient by a qualified employee of the department.
(8)(7) `Individual plan of treatment' means a plan
written by a multi-disciplinary team setting forth measurable goals and
objectives in prescribing an integrated program of individual designed
activities or therapies necessary to achieve the goals and objectives.
(9)(10) `Major medical treatment' means a
medical, surgical, or diagnostic intervention or procedure where a
general anesthetic is used or which involves significant invasions of
bodily integrity requiring an incision or producing substantial pain,
discomfort, debilitation, or having a significant recovery period. It does
not include a routine diagnosis or treatment such as the administration
of medications or nutrition or the extraction of bodily fluids for analysis,
dental care performed with local anesthetic, procedures which are
provided under emergency circumstances, or the withdrawal or
discontinuance of medical treatment which is sustaining life functions.
(10)(9) `Mental disability' means a medically
diagnosable, abnormal condition which is expected to continue for a
considerable length of time, whether correctable or uncorrectable, which
reasonably is expected to limit the person's functional ability.
(11)(10) `Multi-disciplinary team' means persons
drawn from or representing the professional disciplines or service areas
included in the treatment plan.
(12)(11) `Patient' means an individual undergoing
treatment in the department.
(13)(12) `Patient unable to consent' means a
patient unable to appreciate the nature and implications of his condition
and proposed health care, to make a reasoned decision concerning the
proposed health care, or to communicate that decision in an
unambiguous manner. This definition does not include a person under
eighteen years of age, and this chapter does not affect the delivery of
health care to that person unless he is married or has been determined
judicially to be emancipated. A patient's inability to consent must be
certified by two licensed physicians, each of whom has examined the
patient. However, in an emergency the patient's inability to consent may
be certified by a health care professional responsible for his care if the
health care professional states in writing in the patient's record that the
delay occasioned by obtaining certification from two licensed physicians
would be detrimental to his health. A certifying physician or other
health care professional shall give an opinion regarding the cause and
nature of the inability to consent, its extent, and its probable duration.
(14)(13) `Reasonably available' means that a
person to be contacted may be contacted with diligent efforts by the
attending physician or another person acting on behalf of the attending
physician.
(15)(14) `Treatment' means the attempted
correction or facilitation of a mental illness or alcohol and drug
abuse."
SECTION 2. Section 44-22-60 of the 1976 Code, as added by Act
127 of 1991, is amended to read:
"Section 44-22-60. (A) Before or when admitted to a
mental health residential program facility, a patient or
his guardian or parent must be provided with an explanation, in terms
and language appropriate to the person's ability to understand, of the
rights of the patient while under the care of the facility.
(B) Within six hours of admission a patient must be examined
by a physician. Within fourteen days of admission, a patient or his
parent or guardian must be provided with a written individualized plan
of treatment formulated by a multi-disciplinary team and the patient's
attending physician. Each patient or his parent or guardian shall
participate in an appropriate manner in the planning of services. An
interim treatment program based on the preadmission evaluation of the
patient must be implemented promptly upon admission. An
individualized treatment plan must contain:
(1) a statement of the nature and degree of the patient's mental
illness or chemical dependency and his needs;
(2) if a physical examination has been conducted, the patient's
physical condition;
(3) a description of intermediate and long-range treatment
goals and, if possible, future available services;
(4) criteria for release to a less restrictive environment,
including criteria for discharge and a description of services that may be
needed after discharge;
(5) a statement as to whether or not the patient may be
permitted outdoors on a daily basis and, if not, the reasons why.
Treatment plans must be updated upon periodic review as provided in
Section 44-22-70."
SECTION 3. Section 44-22-70(A) of the 1976 Code, as added by Act
127 of 1991, is amended to read:
"(A) Within six hours of admission a patient must be
seen by a physician. Within ten days following admission a treatment
team shall establish a treatment plan. For the first two months of
inpatient treatment the The individualized plan of
treatment must be reviewed every thirty days by the
treatment multi-disciplinary team during the first
two months of inpatient treatment. After two months of inpatient
treatment, the plan must be reviewed every sixty days,
except in long-term nursing care facilities the plan must be reviewed
every ninety days. This section does not prohibit review of the plan
on a more frequent basis."
SECTION 4. Section 44-22-100(A) of the 1976 Code, as added by
Act 127 of 1991, is amended to read:
"(A) Certificates, applications, records, and reports made for
the purpose of this chapter or Chapter 9, Chapter 11, Chapter 13,
Article 1 of Chapter 15, Chapter 17, Chapter 23, Chapter 24, Chapter 25,
Chapter 27, or Chapter 52 of this title and directly or indirectly
identifying a mentally ill or alcohol and drug abuse patient or former
patient or individual whose commitment has been sought must be kept
confidential and must not be disclosed unless:
(1) the individual identified or his guardian consents;
(2) a court directs that disclosure is necessary for the conduct
of proceedings before it and that failure to make the disclosure is
contrary to the public interest;
(3) disclosure is required for research conducted or authorized
by the department or the commission and with the consent of the patient;
(4) disclosure is necessary to cooperate with law enforcement,
health, welfare, and other state or federal agencies or when
furthering the welfare of the patient or his family; or
(5) disclosure is necessary to carry out the provisions of this
chapter or Chapter 9, Chapter 11, Chapter 13, Article 1 of Chapter 15,
Chapter 17, Chapter 23, Chapter 24, Chapter 25, Chapter 27, or
Chapter 52 of this title."
SECTION 5. Section 44-22-120(A)(3) of the 1976 Code, as added by
Act 127 of 1991, is amended to read:
"(3) wear his own clothes, have access to personal hygiene
articles, keep and spend a reasonable sum of his own money, and keep
and use his own personal possessions including articles for personal
grooming not provided for by the facility unless the clothes or personal
possessions are determined by a mental health professional to be
dangerous or otherwise inappropriate to the treatment regimen. If
clothing is provided by the facility, patients may select from neat, clean,
seasonal clothing that allows the patient to appear normal in the
community. The clothing must be considered the patient's
throughout his stay in the facility To the extent staff determines
a patient is able and willing to care for and maintain the patient's own
clothing, the patient must be assisted in maintaining this clothing during
the patient's stay in the facility;".
SECTION 6. Section 44-22-120(A)(4) of the 1976 Code, as added
by Act 127 of 1991, is amended to read:
"(4) have access to secure individual storage space for his
private use. Personal property of a patient brought into the hospital and
placed in storage by the hospital must be inventoried. Receipts must be
given to the patient and at least one other interested person. The
personal property may be reclaimed only by the patient, his spouse, or
his parent or guardian as long as he is living unless otherwise ordered by
the court. If property belonging to a patient is not reclaimed within
ninety days following the patient's discharge or death, the property may
be utilized by the department for the benefit of other patients or
programs ten days after written notice is sent to the individual or the
individual's family at the last known address;".
SECTION 7. Section 44-22-150 of the 1976 Code, as added by Act
127 of 1991, is amended to read:
"Section 44-22-150. (A) No patient residing in a mental
health or alcohol and drug abuse facility may be subjected to mechanical
restraint, seclusion, or a form of physical coercion or restraint unless the
action is authorized in writing by the attending or on-call
physician as being required by the medical needs of the patient and
unless the use of the restraint is a last resort in treatment.
(B) Each use of a restraint or seclusion and justification for it,
including a reasonably specific description of the actions by the patient
that warranted restraint or seclusion, must be entered into the clinical
record of the patient. These authorizations are not valid for more than
twenty-four hours during which the patient's condition must be charted
at fifteen-minute intervals. If the orders are extended beyond the
twenty-four hours, the extension must have written authorization and
justification by the attending physician and then only after he has
interviewed and evaluated the patient on an individual basis. Within
twenty-four hours a copy of the authorization and justification must be
forwarded to the facility supervisor for review. Patients under a form
of mechanical restraint or seclusion must be
allowed no less than fifteen minutes have the restraints removed
at least every two hours for motion and exercise. Mechanical
restraint must be employed to lessen the possibility of physical injury
and to ensure the least possible discomfort. In an emergency such as the
occurrence of, or serious threat of, extreme violence, injury to others,
personal injury, or attempted suicide, if the director of the facility or the
attending physician is not available, designated staff may authorize, in
writing, mechanical restraint, seclusion, or physical restraint as
necessary. The use must be reported immediately to the director or
attending physician who shall authorize its continuance or cessation and
shall make a written record of the reasons for the use and of his review.
The record and review must be entered into the patient's record. The
facility must have written policies and procedures governing the use of
mechanical restraints, seclusion, and physical restraints and clearly
delineate, in descending order, the personnel who may authorize the use
of restraints in emergency situations. The authorization must be posted
on each ward."
SECTION 8. Section 44-22-210(A) of the 1976 Code, as added by
Act 127 of 1991, is amended to read:
"(A) The head of a treatment facility or unit may permit the
patient to leave the facility on a temporary leave of absence for no
longer than two weeks ninety days."
SECTION 9. Sections 44-17-650, 44-23-1010, 44-23-1060, and
44-52-180 of the 1976 Code are repealed.
SECTION 10. This act takes effect upon approval by the
Governor.
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