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.