A bill

 

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY AMENDING SECTION 44-17-410, RELATING TO EMERGENCY ADMISSIONS OF INDIVIDUALS SUFFERING FROM MENTAL ILLNESS WHO POSE A DANGER TO THEMSELVES OR OTHERS, SO AS TO MAKE CHANGES TO THE ADMISSION AND COMMITMENT PROCESS, TO ENSURE THAT THE TREATING FACILITY HAS A COMPLETE MEDICAL HISTORY OF THESE PATIENTS, INCLUDING PRIOR HOSPITALIZATIONS, TO SPECIFY INFORMATION THAT MUST BE INCLUDED IN REPORTS OF DESIGNATED EXAMINERS, AND FOR OTHER PURPOSES; BY AMENDING SECTION 44-17-580, RELATING TO INDIVIDUALS WITH MENTAL ILLNESS WHO DO NOT COMPLY WITH THE COURT-ORDERED OUTPATIENT TREATMENT, SO AS TO ADDRESS REQUIREMENTS OF SUPPLEMENTAL OR RULE TO SHOW CAUSE HEARINGS TO ADDRESS NONCOMPLIANCE; AND BY ADDING SECTION 44-12-70 SO AS TO REQUIRE THE DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES TO MAINTAIN AN INTEGRATED DATABASE WITH COMPLETE MEDICAL RECORDS OF PATIENTS SERVED AT DEPARTMENT FACILITIES, A REGISTRY OF ORDERS OF TREATMENT, AND AN INVENTORY OF AVAILABLE FACILITY BEDS AND WAITLISTS.

 

Be it enacted by the General Assembly of the State of South Carolina:

 

SECTION 1.  Section 44-17-410 of the S.C. Code is amended to read:

 

    Section 44-17-410. A person may be admitted to a public or private hospital, mental health clinic, or mental health facility for emergency admission upon:

    (1) written affidavit under oath by a person stating:

       (a) a belief that the individual is a person with a mental illness as defined in Section 44-23-10(21) and because of this condition there is the likelihood of serious harm as defined in Section 44-23-10(13) to himself or others if not immediately hospitalized;

       (b) the specific type of serious harm thought probable if the person is not immediately hospitalized and the factual basis for this belief;

    (2) a certification in triplicate by at least one licensed physician within two calendar days of the affidavit in item (1) above stating that the physician has examined the person and is of the opinion that the person is mentally ill and because of this condition is likely to cause harm to himself through neglect, inability to care for himself, or personal injury, or otherwise, or to others if not immediately hospitalized. The certification must contain the grounds for the opinion. A person for whom a certificate has been issued may not be admitted on the basis of that certificate after the expiration of three calendar days after the date of the examination;

    (3) within forty-eight hours after admission, exclusive of Saturdays, Sundays, and legal holidays, the place of admission shall forward the affidavit and certification to the probate court of the county in which the person resides or, in extenuating circumstances, where the acts or conduct leading to the hospitalization occurred.

    Within forty-eight hours of receipt of the affidavit and certification exclusive of Saturdays, Sundays, and legal holidays, the court shall conduct preliminary review of all the evidence to determine if probable cause exists to continue emergency detention of the patient. If the court finds that probable cause does not exist, it shall issue an order of release for the patient. Upon a finding of probable cause, the court shall make a written order detailing its findings and may order the continued detention of the patient. No public or private hospital, mental health clinic, or mental health facility may detain a person involuntarily without the affidavit required by item (1) above or the certification required by item (2) above.

    Upon the receipt of an order finding probable cause, the place of admission shall request all medical records relating to previous mental health treatment for the person. The Department of Behavioral Health and Developmental Disabilities shall securely release to the place of admission within forty-eight hours of the request the medical records from all of its offices relating to that patient, a list of the number and dates of previous emergency hospitalizations, and a list of the courts which have placed the person under an order for treatment and the dates of the ordered treatment.

    With each affidavit and certification, the treatment facility shall provide the court with a designated examiner appointment form listing the names of two designated examiners at the treatment facility. All designated examiners must be trained by the Department of Behavioral Health and Developmental Disabilities. The department is responsible for ensuring that every designated examiner receives training and continuing education on the statutory responsibilities of designated examiners.

    If the court appoints these two designated examiners, the examination must be performed at the treatment facility and a report must be submitted to the court within seven days from the date of admission. The court may appoint independent designated examiners who shall submit a report to the court within the time allotted above. In the process of examination by the designated examiners, previous hospitalization records must be considered. At least one of the designated examiners appointed by the court must be a licensed physician or a psychiatric mental health nurse practitioner. The designated examiners' reports must include the grounds for the examiners' conclusions.:

       (1) the grounds for the designated examiners' conclusions;

       (2) whether the person is a "person with a mental illness" as the term is defined in Section 44-23-10, including any current diagnosis;

       (3) what the person's current therapeutic and medication needs may be, if any, including whether the medication been fully titrated to a therapeutic level, and, if not, when it will be complete;

       (4) whether the person is experiencing any current symptoms;

       (5) whether the likelihood of serious harm set forth in the affidavit exists or, if it is no longer a likelihood, why and how it has been resolved, taking into consideration the person's history of violence, if any, and access to deadly weapons, if any;

       (6) discussion of each specific harm listed in the affidavit or certificate, any harms observed at the treatment center, whether the harms have been resolved, and whether there are ongoing concerns about any harms;

       (7) the person's prior treatment history for at least the previous five years, including the frequency of treatment center readmittance, whether noncompliance with medication or treatment was a cause for this inpatient stay, and whether the person is under a current order for treatment;

       (8) other relevant medical conditions and diagnoses impacting the person, including chemical dependency, if present, and if the person is experiencing chemical dependency issues, whether involuntary proceedings related to that illness are appropriate in accordance with Sections 44-17-410 and 44-52-60; and

       (9) whether voluntary or involuntary treatment would be best for the person and why.

    If the designated examiners' report concludes that the patient is not mentally ill to the extent that involuntary treatment is required, the court may dismiss the petition if the court has found in a written order that the designated examiners have:

       (1) fulfilled the designated examination report statutory requirements; and

       (2) no further testimony is necessary to elaborate on the reports.

    If the report of the designated examiners is that the patient is not mentally ill to the extent that involuntary treatment is required and reasons have been set forth in the report, the court shall dismiss the petition and the patient must be discharged immediately by the facility If the designated examiners' report recommends voluntary or outpatient treatment, the report must address information relevant to the person receiving the treatment upon discharge, including social, housing, or environmental impediments to the person receiving the recommended treatment on an outpatient basis and available social support and transportation upon discharge to address the impediments and ensure the likelihood of completing recommended treatment.

    The person must be discharged immediately by the treatment facility after it has provided the person with a physical copy of the written order, unless the designated examiners report that the patient is a chemically dependent person in need of emergency commitment and that procedures have been initiated pursuant to Section 44-52-50 or the person is participating in voluntary treatment at the treatment facility. In which case,If proceedings pursuant to Section 44-52-50 are necessary, emergency commitment procedures must be complied with in accordance with Chapter 52, and the facility shall transfer the patient to an appropriate treatment facility as defined by Section 44-52-10, provided that confirmation has been obtained from the facility that a bed is available; transportation must be provided by the Office of Mental Health.

    If the report of the designated examiners is that the patient is mentally ill and involuntary treatment is required, the court may order that the person be detained, appoint counsel for the patient if counsel has not been retained, and fix a date for a full hearing to be held pursuant to Section 44-17-570 within fifteen days from the date of admission. The court shall give notice of the hearing pursuant to Section 44-17-420.

    The examiners' report must be available to the person's counsel before the full hearing. The person must be given the opportunity to request an independent designated examiner pursuant to Section 44-17-530.

    If before the hearing, the designated examiners determine that the patient is no longer mentally ill to the extent that involuntary treatment is required, they shall cause a supplemental report to be submitted to the court. If the court receives a supplemental report at least forty-eight hours before the hearing stating that the patient is no longer mentally ill to the extent involuntary treatment is required, and setting forth the reasons for the examiners' conclusions, the court shall dismiss the petition and the patient must be discharged immediately by the facility may dismiss the petition if the court has found in a written order that the examiners have:

       (1) fulfilled the designated examination report statutory requirements; and

       (2) no further testimony is necessary to elaborate on the reports.

 

SECTION 2.  Section 44-17-580 of the S.C. Code is amended to read:

 

    Section 44-17-580. (A) If, upon completion of the hearing and consideration of the record, the court finds upon clear and convincing evidence that the person is mentally ill, needs involuntary treatment and because of his condition:

       (1) lacks sufficient insight or capacity to make responsible decisions with respect to his treatment; or

       (2) there is a likelihood of serious harm to himself or others, the court shall order in-patient or out-patient treatment at a mental health facility, public or private, designated by the Office of Mental Health and may order out-patient treatment following in-patient treatment. If the court finds that the person is not mentally ill andor not in need of involuntary treatment, the court shall dismiss the proceedings.

    (B)(1) If the court orders out-patient treatment and the respondent fails to adhere to the prescribed out-patient treatment order or program, including taking prescribed medications, the treatment facility immediately shall report the failure to the court on an affidavit providing specific details regarding the respondent's noncompliance with the court order and what action or consequences the treatment provider is recommending and the court, upon notice to the respondent and his counselappointment of counsel and a guardian ad litem for the respondent, shall order a supplemental hearing and may further order in-patient treatment in a designated facility as needed.  The probate court issuing the order for out-patient treatment shall maintain jurisdiction over the person for the purpose of supplemental proceedings as set forth in this chapter and every order issued pursuant to this subsection must be so conditioned.  An order for in-patient treatment at a mental health facility does not raise a presumption of incompetency and no rights may be denied a person unless specifically ordered by the court. shall order a supplemental hearing or rule to show cause proceeding.

       (2) Notice of the first supplemental or rule to show cause hearing must be personally served on the respondent. Notice of the hearing also must be provided by mail or electronic delivery at least five days prior to the hearing to the respondent's counsel, the affiant, the petitioner in the original action, and any other interested person as the term "interested person" is defined in Section 44-23-10. 

       (3) The local Office of Mental Health facility must make a designated examiner available to attend the hearing.

       (4) The court shall conduct the supplemental or rule to show cause hearing in the manner described in Section 44-17-570. The affiant shall appear to testify at the hearing. If necessary, the court may allow another employee of the treatment facility with knowledge of the matter to be substituted in for the affiant to testify at the hearing.

       (5) Should the person, after service, fail to attend the supplemental or rule to show cause hearing, the probate court shall issue a bench warrant for his or her detention unless that person is hospitalized.

       (6) At the supplemental or rule to show cause hearing, the court shall apply a clear and convincing standard of review to determine if the respondent has not been compliant with the court's prior order. If the court makes that finding, the court may:

           (a) order further in-patient treatment in a designated facility as needed;

           (b) order outpatient treatment; or

           (c)(i) upon a finding of wilful contempt of the court order, order the respondent to the local detention center for contempt in which case the court must hold a review hearing on the contempt at least monthly to address the respondent's compliance with the treatment order.

               (ii) At each review hearing, the court will address the actions of the respondent that constitute continued contempt of court and the need for continued detention, and the treatment facility shall have a staff person attend the hearing to testify.

           (d) At each supplemental or rule to show cause hearing, the court shall provide the date and time of the next supplemental or rule to show cause hearing on the record to all of the parties. This shall serve as appropriate notice to all parties. If an interested party would like to receive electronic notification of a hearing, he or she may make that request in writing to the court.

       (7) If the court receives written notice from the respondent, respondent's counsel, respondent's guardian, petitioner, detention center administration, or other interested member of the respondent's family that the respondent is ready to comply with treatment, the court shall hold a hearing within forty-eight hours of service on the petitioner of that written notice to address the respondent's willingness to comply with the treatment order. Notice will be provided via electronic mail to all interested parties who have provided their electronic contact information to the court. The respondent must be personally served with notice of the hearing.

       (8) The respondent may not be held for safekeeping pursuant to Section 44-23-220.

    (C) The probate court issuing the order for out-patient treatment shall maintain jurisdiction over the person for the purpose of supplemental proceedings as set forth in this chapter and every order issued pursuant to this subsection must be so conditioned. An order for in-patient treatment at a mental health facility does not raise a presumption of incompetency and no rights may be denied a person unless specifically ordered by the court.

    (D) A person who has complied with the prescribed out-patient treatment order and program and completed the program may request relief from the court from the order by filing an affidavit stating that the person has completed their treatment, records showing the treatment is complete, and a filing fee of no more than twenty dollars. Upon receipt, the probate court shall appoint the person counsel and order a hearing, at which the treatment facility shall have a staff person attend to testify regarding the alleged compliance with treatment and provide an informed perspective, based on the person's previous treatment and history and current condition, as to whether or not treatment should continue to be ordered. The court may exercise discretion to limit these filings to no more than one request for relief in a year.

 

SECTION 3.  Chapter 12, Title 44 of the S.C. Code is amended by adding:

 

    Section 44-12-70.  The Department of Behavioral Health and Developmental Disabilities shall develop and maintain an integrated and secure database where each patient treated by any of its offices has his medical records stored in keeping with federal and state law related to the oversight of medical records. The database also must contain a registry of orders for treatment to any of its offices, which must include a listing of which court issued the order, at which location the treatment was ordered, and for what duration the treatment was ordered. Any court with jurisdiction to issue an order addressed by this section must securely provide a copy of the order to the department within ten days of issuance, not counting weekends or holidays. The database also must contain a listing of all patients currently on a waitlist for a bed at any facility maintained by the department and their place on that waitlist and immediately shall furnish that information to the court which issued the order upon request. Information contained in this database only may be disclosed in accordance with a request from a probate court or pursuant to Section 44-22-100 or 44-17-410.

 

SECTION 4.  This act takes effect upon approval by the Governor.

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