Senate Bill 269 By: Senators Hatchett of the 50th, Watson of the 1st and Kirkpatrick of the 32nd A BILL TO BE ENTITLED AN ACT To amend Chapter 3 of Title 37 of the Official Code of Georgia Annotated, relating to examination, treatment, etc., for mental illness, so as to provide certain procedures and notifications for involuntary outpatient commitments; to provide for a definition; to provide for a nurse examiner to determine and certify that a patient admitted to or examined at a facility is a mentally ill person requiring involuntary treatment; to provide for a nurse examiner to discharge a patient meeting outpatient care criteria; to provide for written notification of certain information; to provide for obligations of referring facilities and receiving facilities; to provide for a nurse examiner to update a patient's individualized service plan, prepare a report, and petition the hearing examiners; to provide for related matters; to provide for an effective date; to repeal conflicting laws; and for other purposes. BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: SECTION 1. Chapter 3 of Title 37 of the Official Code of Georgia Annotated, relating to examination, treatment, etc., for mental illness, is amended in Code Section 37-3-1, relating to definitions, by adding a new paragraph to read as follows: "(12.05) 'Nurse examiner' means a clinical nurse specialist in psychiatric/mental health or nurse practitioner licensed or authorized to practice nursing in this state pursuant to Chapter 26 of Title 43 and approved by the department to conduct certain examinations, determinations, and certifications under Code Sections 37-3-90, 37-3-91, and 37-3-91.1." SECTION 2. Said chapter is further amended in Code Section 37-3-81.1, relating to disposition of patient upon hearing, by revising paragraph (2) of subsection (a) as follows: "(2) That the patient is an outpatient, the court shall further determine, based upon either the individualized service plan required to be prepared under subsection (c) of Code Section 37-3-64, or subsection (b) of Code Section 37-3-91, or subsection (b) of Code Section 37-3-91.1 or the individualized service plan proposed by the physician or psychologist chosen by the patient, whether there is available outpatient treatment for the patient which meets the requirements of the plan chosen by the court and whether the patient will likely obtain that such treatment so as to minimize the likelihood of the patient's becoming an inpatient. If the court determines that there is such available outpatient treatment which the patient will likely obtain so as to minimize the likelihood of the patient's becoming an inpatient, then the court shall order the patient to obtain that such treatment and shall discharge the patient subject to such order;" SECTION 3. Said chapter is further amended in Code Section 37-3-90, relating to physician's or psychologist's determination and certification as to necessity of involuntary care, treatment of patient as inpatient or outpatient, and minors, by revising subsections (a) and (b) as follows: "(a) When a physician, or psychologist at a, or nurse examiner at an emergency receiving facility, evaluating facility, or treatment facility or on behalf of a such facility determines and certifies under this article that there is reason to believe a patient admitted to or examined at the facility is a mentally ill person requiring involuntary treatment, that such physician, or psychologist, or nurse examiner shall further determine and certify whether there is reason to believe the patient is: (1) An inpatient or outpatient; and (2) If an outpatient, whether there is available outpatient treatment. (b) Unless otherwise specifically provided, the determination and certification as to paragraphs (1) and (2) of pursuant to subsection (a) of this Code section shall be made within the time period required for determining whether a patient is a mentally ill person requiring involuntary treatment, except that if such determination is made by a physician or psychologist at or on behalf of a community mental health center, the determination and certification shall be made within four hours after the patient is examined by the physician or psychologist." SECTION 4. Said chapter is further amended by revising Code Section 37-3-91, relating to discharge of persons meeting outpatient care criteria, as follows: "37-3-91. (a) A person who is in the physical custody of a community mental health center, emergency receiving facility, or evaluating facility and who is determined by a physician, or a psychologist, or nurse examiner at or on behalf of that such facility, to meet all of the outpatient treatment requirements of paragraphs (1) and (2) of provided in subsection (c) of Code Section 37-3-90 shall be discharged from that such facility as provided in this Code section pending a full and fair hearing or waiver thereof under Code Section 37-3-92. That discharge from a community mental health center shall occur within four hours after the patient is examined by a physician or a psychologist at or on behalf of that center. That Such discharge from an emergency receiving facility shall occur within 48 hours after the patient's admission thereto. That to such facility. Such discharge from an evaluating facility shall occur no later than the expiration of the five-day evaluation period established under Code Section 37-3-64. (b) Prior to a psychologist's or nurse examiner's discharging the patient under subsection (a) of this Code section, the treating such psychologist or nurse examiner shall obtain the concurrence of a physician. In addition, within the time period the facility is authorized to retain the patient, the facility at which or on behalf of which the patient was examined, which facility shall be the 'referring facility' for purposes of this part, shall prepare an individualized service plan for the patient. Such This plan shall be prepared in consultation with the facility at which available outpatient treatment is to be provided the patient, which facility shall be the 'receiving facility' for purposes of this part. The referring facility shall also make arrangements with the receiving facility to provide interim outpatient treatment, in accordance with the individualized service plan, to the patient pending the full and fair hearing or waiver thereof. Nothing in this Code section shall prevent a referring facility for a patient from also being the receiving facility for that such patient. (c) Prior to discharge, the referring facility shall provide to the patient written notification of: (1) The time, date, place, and address for an appointment with the receiving facility; (2) The consequences if the patient does not obtain the treatment or attend the appointment with the receiving facility; and (3) That a full and fair hearing under Code Section 37-3-92 shall be provided at a future time and date unless waived. (d) At any appointment during the interim outpatient treatment, the receiving facility shall provide to the patient: (1) A written copy of the individualized service plan for such patient; and (2) Written notification of the consequences if the patient does not follow the individualized service plan. (c) A patient for whom interim outpatient treatment is arranged pursuant to subsection (b) of this Code section shall obtain that treatment or be subject to the provisions of Code Section 37-3-82. Written notice of the time, date, place, and address for that interim outpatient treatment shall be provided the patient prior to the patient's discharge, along with written notification that if the patient does not comply with the interim outpatient treatment or attend or waive a hearing, the time and date of which hearing will later be provided the patient, the patient may be involuntarily admitted for examination, treatment, or both. (e) Notice of the discharge shall be provided to persons other than the patient in the same manner and under the same conditions as required by subsection (c) of Code Section 37-3-43 and subsection (d) of Code Section 37-3-64, and that. Such notice shall also include a notice regarding the interim outpatient treatment and the consequences if the patient does not obtain the treatment or attend or waive the hearing. (d)(f) Within three days after a referring facility has discharged a patient pursuant to subsection (a) of this Code section, that such facility shall transmit to the receiving facility a copy of the referring facility's examination report, individualized service plan, and such other necessary clinical information the referring facility may have regarding the patient. Within five days after receiving such report, plan, and information, the receiving facility shall petition the court of the county in which the patient is located for a full and fair hearing pursuant to Code Section 37-3-92 and shall include with the petition a copy of the examination report, the individualized service plan, and the address to which the patient was discharged by the referring facility. (e)(g) Notwithstanding the provisions of subsection (a) of this Code section, a patient detained in a treatment facility pursuant to a certificate and petition under Code Section 37-3-81, whether or not that such patient is subsequently determined by that such facility during the time of such detention to meet all of the outpatient treatment requirements of paragraphs (1) and (2) of provided in subsection (c) of Code Section 37-3-90, may not be discharged from that such facility until a full and fair hearing is held pursuant to Code Section 37-3-81.1, which hearing may not be waived by any patient so determined to meet all of such outpatient treatment requirements." SECTION 5. Said chapter is further amended by adding a new Code section to read as follows: "37-3-91.1. (a) When a physician, psychologist, or nurse examiner on behalf of a community mental health center determines and certifies under this article that there is reason to believe a patient examined outside of an emergency receiving facility, evaluating facility, or treatment facility is a mentally ill person requiring involuntary treatment, such physician, psychologist, or nurse examiner shall further determine and certify whether there is reason to believe the patient is: (1) An inpatient or outpatient; and (2) If an outpatient, whether there is available outpatient treatment. (b) Within three days of the determination and certification that a patient is an outpatient pursuant to subsection (a) of this Code section, the community mental health center at which or on behalf of which the person was examined, which shall be the 'referring facility' for purposes of this part, shall prepare an individualized service plan for such patient. This plan shall be prepared in consultation with the facility at which available outpatient treatment is to be provided the patient, which facility shall be the 'receiving facility' for purposes of this part. The referring facility shall also make arrangements with the receiving facility to provide interim outpatient treatment, in accordance with the individualized service plan, to such patient pending the full and fair hearing or waiver thereof. Nothing in this Code section shall prevent a referring facility for a patient from also being the receiving facility for such patient. (c) The referring facility shall provide to the patient written notification of: (1) The time, date, place, and address for an appointment with the receiving facility; (2) The consequences if the patient does not obtain the treatment or attend the appointment with the receiving facility; and (3) That a full and fair hearing under Code Section 37-3-92 shall be provided at a future time and date unless waived. (d) At any appointment during the interim outpatient treatment, the receiving facility shall provide to the patient: (1) A written copy of the individualized service plan for the patient; and (2) Written notification of the consequences if the patient does not follow the individualized service plan. (e) Within three days of the determination and certification that a patient is an outpatient pursuant to subsection (a) of this Code section, the referring facility shall transmit to the receiving facility a copy of the referring facility's examination report, the individualized service plan, and such other necessary clinical information the referring facility has regarding such patient. Within five days of receiving such report, plan, and information, the receiving facility shall petition the court of the county in which the patient is located for a full and fair hearing pursuant to Code Section 37-3-92 and shall include with such petition a copy of the examination report, the individualized service plan, and the last known address for the patient. (f) A determination and certification made pursuant to subsection (a) of this Code section shall not authorize a facility to detain such patient. Nothing in this Code section shall prevent a certification by a physician under Code Section 37-3-41." SECTION 6. Said chapter is further amended in Code Section 37-3-92, relating to hearing, notice, waiver of hearing, apprehension and detention of patient failing to appear, and treatment upon waiver, by revising subsection (a) as follows: "(a) Except when a hearing is waived as provided in this subsection, within 30 days after the filing of the petition under subsection (d) (f) of Code Section 37-3-91 or subsection (e) of Code Section 37-3-91.1, the court shall hold a full and fair hearing. At least ten days prior to that such hearing, the court shall have served on the patient and the such patient's representatives the same notices and information required by paragraphs (1) through (4) of subsection (a) of Code Section 37-3-81, as well as a notice that the patient may waive in writing the hearing but if the patient does not either attend or waive the hearing the court may order the patient to be taken into custody, hospitalized, evaluated, and treated. The patient and such patient's representatives shall have the rights specified in those notices. Hearings held pursuant to this subsection shall be held as provided in Code Section 37-3-81.1, and the court holding the hearing may issue any order authorized by and subject to the limitations of that Code Section 37-3-81.1 such Code section." SECTION 7. Said chapter is further amended in Code Section 37-3-93, relating to court order for outpatient treatment, physician's or psychologist's petition to extend order, review of petition, hearing on extension petition, and patients under juvenile court jurisdiction, by revising subsection (b) as follows: "(b) If it is necessary to continue available outpatient treatment beyond the period authorized pursuant to subsection (a) of this Code section, at least 60 days prior to the expiration of that period the physician, or psychologist, or nurse examiner responsible for that such treatment or the person responsible for the patient's treatment under the direction and with approval of the physician or psychologist such physician, psychologist, or nurse examiner shall: (1) Update the patient's individualized service plan; (2) Prepare a report containing evidence that the patient meets all the requirements for available outpatient treatment under paragraphs (1) and (2) of provided in subsection (c) of Code Section 37-3-90; and (3) Petition the hearing examiners appointed to hold hearings under Code Section 37-3-83 for an order requiring the patient to obtain available outpatient treatment beyond the period previously ordered for the patient. The petition shall contain a plain and simple statement that the patient or the such patient's representatives may file a request for a hearing with a hearing examiner appointed to hold hearings pursuant to Code Section 37-3-83 within 15 days after service of the petition, that the patient has a right to counsel at the hearing, that the patient or the such patient's representatives may apply immediately to the court to have counsel appointed if the patient cannot afford counsel, and that the court will appoint counsel for the patient unless the patient indicates in writing that the patient he or she does not desire to be represented by counsel or has made the patient's his or her own arrangements for counsel." SECTION 8. This Act shall become effective upon its approval by the Governor or upon its becoming law without such approval. SECTION 9. All laws and parts of laws in conflict with this Act are repealed.