S*1116 Session 109 (1991-1992)
S*1116(Rat #0295, Act #0279 of 1992) General Bill, By Bryan, H.U. Fielding,
D.L. Hinds, C.T. Hinson, Peeler and M.T. Rose
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.
12/02/91 Senate Prefiled
12/02/91 Senate Referred to Committee on Medical Affairs
01/14/92 Senate Introduced and read first time SJ-32
01/14/92 Senate Referred to Committee on Medical Affairs SJ-32
01/28/92 Senate Recalled from Committee on Medical Affairs SJ-6
01/29/92 Senate Read second time SJ-7
02/05/92 Senate Read third time and sent to House SJ-12
02/06/92 House Introduced and read first time HJ-3
02/06/92 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-4
02/19/92 House Committee report: Favorable Medical, Military,
Public and Municipal Affairs HJ-8
02/26/92 House Read second time HJ-41
02/27/92 House Read third time and enrolled HJ-14
03/04/92 Ratified R 295
03/10/92 Signed By Governor
03/10/92 Effective date 03/10/92
03/10/92 Act No. 279
04/14/92 Copies available
(A279, R295, S1116)
AN ACT 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:
Definitions
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) `Commission' means the South Carolina Commission on
Alcohol and Drug Abuse.
(2) `Commissioner' means the State Commissioner of Mental
Health.
(3) `Court' means probate court.
(4) `Department' means the State Department of Mental
Health.
(5) `Facility' means a residential program operated by the
department.
(6) `Independent examination' means an examination of a
patient by a qualified employee of the department.
(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.
(8) `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.
(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.
(10) `Multi-disciplinary team' means persons drawn from
or representing the professional disciplines or service areas
included in the treatment plan.
(11) `Patient' means an individual undergoing treatment in
the department.
(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.
(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.
(14) `Treatment' means the attempted correction or
facilitation of a mental illness or alcohol and drug
abuse."
Rights apply in state mental health facilities
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
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."
Individualized treatment plan
SECTION 3. Section 44-22-70(A) of the 1976 Code, as added
by Act 127 of 1991, is amended to read:
"(A) The individualized plan of treatment must be
reviewed every thirty days by the 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."
Confidentiality
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."
Clothing
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. 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;".
Personal property, claimed and unclaimed
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;".
Mechanical restraints, removed every two hours
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 mechanical
restraint must 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."
Temporary leave of absence up to ninety days
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 ninety days."
Repeal
SECTION 9. Sections 44-17-650, 44-23-1010, 44-23-1060, and
44-52-180 of the 1976 Code are repealed.
Time effective
SECTION 10. This act takes effect upon approval by the
Governor.
Approved the 10th day of March, 1992. |