1.1                          A bill for an act 
  1.2             relating to civil commitment; modifying a definition; 
  1.3             specifying certain patient rights and examination 
  1.4             requirements; expanding voluntary consent procedures; 
  1.5             modifying the standard for and collection of 
  1.6             information for an emergency hold; requiring certain 
  1.7             hearings on neuroleptic medications to be combined 
  1.8             with a civil commitment proceeding; amending Minnesota 
  1.9             Statutes 2000, sections 253B.02, subdivision 13; 
  1.10            253B.03, subdivisions 5, 10, by adding a subdivision; 
  1.11            253B.04, subdivisions 1, 1a, by adding a subdivision; 
  1.12            253B.05, subdivision 1; 253B.066, subdivision 1; 
  1.13            253B.07, subdivisions 1, 2; 253B.09, subdivision 1. 
  1.14  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.15     Section 1.  Minnesota Statutes 2000, section 253B.02, 
  1.16  subdivision 13, is amended to read: 
  1.17     Subd. 13.  [MENTALLY ILL PERSON.] (a) "Mentally ill person" 
  1.18  means any person who has an organic disorder of the brain or a 
  1.19  substantial psychiatric disorder of thought, mood, perception, 
  1.20  orientation, or memory which grossly impairs judgment, behavior, 
  1.21  capacity to recognize reality, or to reason or understand, which 
  1.22  is manifested by instances of grossly disturbed behavior or 
  1.23  faulty perceptions and poses a substantial likelihood of 
  1.24  physical harm to self or others as demonstrated by: 
  1.25     (1) ~~a~~ an inability or failure for reasons other than 
  1.26  indigence to obtain necessary food, clothing, shelter, or 
  1.27  medical care as a result of the impairment~~; or~~ and it is more 
  1.28  probable than not that the person will suffer substantial harm, 
  1.29  significant psychiatric deterioration or debilitation, or 
  2.1   serious illness, unless appropriate treatment and services are 
  2.2   provided; 
  2.3      (2) a recent attempt or threat to physically harm self or 
  2.4   others; or 
  2.5      (3) recent and intentional conduct involving significant 
  2.6   damage to substantial property. 
  2.7      (b) A person is not mentally ill under this section if the 
  2.8   impairment is solely due to: 
  2.9      (1) epilepsy; 
  2.10     (2) mental retardation; 
  2.11     (3) brief periods of intoxication caused by alcohol, drugs, 
  2.12  or other mind-altering substances; or 
  2.13     (4) dependence upon or addiction to any alcohol, drugs, or 
  2.14  other mind-altering substances. 
  2.15     Sec. 2.  Minnesota Statutes 2000, section 253B.03, 
  2.16  subdivision 5, is amended to read: 
  2.17     Subd. 5.  [PERIODIC ASSESSMENT.] A patient has the right to 
  2.18  periodic medical assessment, including assessment of the medical 
  2.19  necessity of continuing care and, if the treatment facility 
  2.20  declines to provide continuing care, the right to receive 
  2.21  specific written reasons why continuing care is declined at the 
  2.22  time of the assessment.  The treatment facility shall assess the 
  2.23  physical and mental condition of every patient as frequently as 
  2.24  necessary, but not less often than annually.  If the patient 
  2.25  refuses to be examined, the facility shall document in the 
  2.26  patient's chart its attempts to examine the patient.  If a 
  2.27  person is committed as mentally retarded for an indeterminate 
  2.28  period of time, the three-year judicial review must include the 
  2.29  annual reviews for each year as outlined in Minnesota Rules, 
  2.30  part 9525.0075, subpart 6.  
  2.31     Sec. 3.  Minnesota Statutes 2000, section 253B.03, 
  2.32  subdivision 10, is amended to read: 
  2.33     Subd. 10.  [NOTIFICATION.] All persons admitted or 
  2.34  committed to a treatment facility shall be notified in writing 
  2.35  of their rights ~~under this chapter~~ regarding hospitalization and 
  2.36  other treatment at the time of admission.  This notification 
  3.1   must include: 
  3.2      (1) patient rights specified in this section and section 
  3.3   144.651, including nursing home discharge rights; 
  3.4      (2) the right to obtain treatment and services voluntarily 
  3.5   under this chapter; 
  3.6      (3) the right to voluntary admission and release under 
  3.7   section 253B.04; 
  3.8      (4) rights in case of an emergency admission under section 
  3.9   253B.05, including the right to documentation in support of an 
  3.10  emergency hold and the right to a summary hearing before a judge 
  3.11  if the patient believes an emergency hold is improper; 
  3.12     (5) the right to request expedited review under section 
  3.13  62M.05 if additional days of inpatient stay are denied; 
  3.14     (6) the right to continuing benefits pending appeal and to 
  3.15  an expedited administrative hearing under section 256.045 if the 
  3.16  patient is a recipient of medical assistance, general assistance 
  3.17  medical care, or MinnesotaCare; and 
  3.18     (7) the right to an external appeal process under section 
  3.19  62Q.73, including the right to a second opinion.  
  3.20     Sec. 4.  Minnesota Statutes 2000, section 253B.03, is 
  3.21  amended by adding a subdivision to read: 
  3.22     Subd. 11.  [PROXY.] A legally authorized health care proxy, 
  3.23  agent, guardian, or conservator may exercise the patient's 
  3.24  rights on the patient's behalf.  
  3.25     Sec. 5.  Minnesota Statutes 2000, section 253B.04, 
  3.26  subdivision 1, is amended to read: 
  3.27     Subdivision 1.  [VOLUNTARY ADMISSION AND TREATMENT.] (a) 
  3.28  Voluntary admission is preferred over involuntary commitment and 
  3.29  treatment.  Any person 16 years of age or older may request to 
  3.30  be admitted to a treatment facility as a voluntary patient for 
  3.31  observation, evaluation, diagnosis, care and treatment without 
  3.32  making formal written application.  Any person under the age of 
  3.33  16 years may be admitted as a patient with the consent of a 
  3.34  parent or legal guardian if it is determined by independent 
  3.35  examination that there is reasonable evidence that (1) the 
  3.36  proposed patient has a mental illness, or is mentally retarded 
  4.1   or chemically dependent; and (2) the proposed patient is 
  4.2   suitable for treatment.  The head of the treatment facility 
  4.3   shall not arbitrarily refuse any person seeking admission as a 
  4.4   voluntary patient.  In making decisions regarding admissions, 
  4.5   the facility shall use clinical admission criteria consistent 
  4.6   with the current applicable inpatient admission standards 
  4.7   established by the American Psychiatric Association or the 
  4.8   American Academy of Child and Adolescent Psychiatry.  These 
  4.9   criteria must be no more restrictive than, and must be 
  4.10  consistent with, the requirements of section 62Q.53.  The 
  4.11  facility may not refuse to admit a person voluntarily solely 
  4.12  because the person does not meet the criteria for involuntary 
  4.13  holds under section 253B.05 or the definition of mental illness 
  4.14  under section 253B.02, subdivision 13.  
  4.15     (b) In addition to the consent provisions of paragraph (a), 
  4.16  a person who is 16 or 17 years of age who refuses to consent 
  4.17  personally to admission may be admitted as a patient for mental 
  4.18  illness or chemical dependency treatment with the consent of a 
  4.19  parent or legal guardian if it is determined by an independent 
  4.20  examination that there is reasonable evidence that the proposed 
  4.21  patient is chemically dependent or has a mental illness and is 
  4.22  suitable for treatment.  The person conducting the examination 
  4.23  shall notify the proposed patient and the parent or legal 
  4.24  guardian of this determination. 
  4.25     Sec. 6.  Minnesota Statutes 2000, section 253B.04, 
  4.26  subdivision 1a, is amended to read: 
  4.27     Subd. 1a.  [VOLUNTARY TREATMENT OR ADMISSION FOR PERSONS 
  4.28  WITH MENTAL ILLNESS.] (a) A person with a mental illness may 
  4.29  seek or voluntarily agree to accept treatment or admission to a 
  4.30  facility.  If the mental health provider determines that the 
  4.31  person lacks the capacity to give informed consent for the 
  4.32  treatment or admission, and in the absence of a health care 
  4.33  power of attorney that authorizes consent, the designated agency 
  4.34  or its designee may give informed consent for mental health 
  4.35  treatment or admission to a treatment facility on behalf of the 
  4.36  person. 
  5.1      (b) The designated agency shall apply the following 
  5.2   criteria in determining the person's ability to give informed 
  5.3   consent: 
  5.4      (1) whether the person demonstrates an awareness of the 
  5.5   person's illness, and the reasons for treatment, its risks, 
  5.6   benefits and alternatives, and the possible consequences of 
  5.7   refusing treatment; and 
  5.8      (2) whether the person communicates verbally or nonverbally 
  5.9   a clear choice concerning treatment that is a reasoned one, not 
  5.10  based on delusion, even though it may not be in the person's 
  5.11  best interests. 
  5.12     (c) The basis for the designated agency's decision that the 
  5.13  person lacks the capacity to give informed consent for treatment 
  5.14  or admission, and that the patient has voluntarily accepted 
  5.15  treatment or admission, must be documented in writing. 
  5.16     (d) A mental health provider that provides treatment in 
  5.17  reliance on the written consent given by the designated agency 
  5.18  under this subdivision or by a substitute decision-maker 
  5.19  appointed by the court is not civilly or criminally liable for 
  5.20  performing treatment without consent.  This paragraph does not 
  5.21  affect any other liability that may result from the manner in 
  5.22  which the treatment is performed. 
  5.23     (e) A person who receives treatment or is admitted to a 
  5.24  facility under this subdivision or subdivision 1b has the right 
  5.25  to refuse treatment at any time or to be released from a 
  5.26  facility as provided under subdivision 2.  The person or any 
  5.27  interested person acting on the person's behalf may seek court 
  5.28  review within five days for a determination of whether the 
  5.29  person's agreement to accept treatment or admission is 
  5.30  voluntary.  At the time a person agrees to treatment or 
  5.31  admission to a facility under this subdivision, the designated 
  5.32  agency or its designee shall inform the person in writing of the 
  5.33  person's rights under this paragraph. 
  5.34     (f) This subdivision does not authorize the administration 
  5.35  of neuroleptic medications.  Neuroleptic medications may be 
  5.36  administered only as provided in section 253B.092. 
  6.1      Sec. 7.  Minnesota Statutes 2000, section 253B.04, is 
  6.2   amended by adding a subdivision to read: 
  6.3      Subd. 1b.  [COURT APPOINTMENT OF SUBSTITUTE 
  6.4   DECISION-MAKER.] If the designated agency or its designee 
  6.5   declines or refuses to give informed consent under subdivision 
  6.6   1a, the person who is seeking treatment or admission, or an 
  6.7   interested person acting on behalf of the person, may petition 
  6.8   the court for appointment of a substitute decision-maker who may 
  6.9   give informed consent for voluntary treatment and services.  In 
  6.10  making this determination, the court shall apply the criteria in 
  6.11  subdivision 1a, paragraph (b). 
  6.12     Sec. 8.  Minnesota Statutes 2000, section 253B.05, 
  6.13  subdivision 1, is amended to read: 
  6.14     Subdivision 1.  [EMERGENCY HOLD.] (a) Any person may be 
  6.15  admitted or held for emergency care and treatment in a treatment 
  6.16  facility with the consent of the head of the treatment facility 
  6.17  upon a written statement by an examiner that: 
  6.18     (1) the examiner has examined the person not more than 15 
  6.19  days prior to admission~~,~~; 
  6.20     (2) the examiner is of the opinion, for stated reasons, 
  6.21  that the person is mentally ill, mentally retarded or chemically 
  6.22  dependent, and is in ~~imminent~~ danger of causing injury to self 
  6.23  or others if not immediately ~~restrained,~~ detained; and 
  6.24     (3) an order of the court cannot be obtained in time to 
  6.25  prevent the anticipated injury.  
  6.26     (b) If the proposed patient has been brought to the 
  6.27  treatment facility by another person, the examiner shall make a 
  6.28  good-faith effort to obtain a statement of information that is 
  6.29  available from that person, which must be taken into 
  6.30  consideration in deciding whether to place the proposed patient 
  6.31  on an emergency hold.  The statement of information must include 
  6.32  direct observations of the proposed patient's behaviors, 
  6.33  reliable knowledge of recent and past behavior, and information 
  6.34  regarding psychiatric history, past treatment, and current 
  6.35  mental health providers.  The examiner shall also inquire into 
  6.36  the existence of health care directives under chapter 145, and 
  7.1   advance psychiatric directives under section 253B.03, 
  7.2   subdivision 6d. 
  7.3      (c) The examiner's statement shall be:  (1) sufficient 
  7.4   authority for a peace or health officer to transport a patient 
  7.5   to a treatment facility, (2) stated in behavioral terms and not 
  7.6   in conclusory language, and (3) of sufficient specificity to 
  7.7   provide an adequate record for review.  If ~~imminent~~ danger to 
  7.8   specific individuals is a basis for the emergency hold, the 
  7.9   statement must identify those individuals, to the extent 
  7.10  practicable.  A copy of the examiner's statement shall be 
  7.11  personally served on the person immediately upon admission and a 
  7.12  copy shall be maintained by the treatment facility.  
  7.13     Sec. 9.  Minnesota Statutes 2000, section 253B.066, 
  7.14  subdivision 1, is amended to read: 
  7.15     Subdivision 1.  [TREATMENT ALTERNATIVES.] If the court 
  7.16  orders early intervention under section 253B.065, subdivision 5, 
  7.17  the court may include in its order a variety of treatment 
  7.18  alternatives including, but not limited to, day treatment, 
  7.19  medication compliance monitoring, and short-term hospitalization 
  7.20  not to exceed ~~ten~~ 21 days. 
  7.21     If the court orders short-term hospitalization and the 
  7.22  proposed patient will not go voluntarily, the court may direct a 
  7.23  health officer, peace officer, or other person to take the 
  7.24  person into custody and transport the person to the hospital. 
  7.25     Sec. 10.  Minnesota Statutes 2000, section 253B.07, 
  7.26  subdivision 1, is amended to read: 
  7.27     Subdivision 1.  [PREPETITION SCREENING.] (a) Prior to 
  7.28  filing a petition for commitment of or early intervention for a 
  7.29  proposed patient, an interested person shall apply to the 
  7.30  designated agency in the county of the proposed patient's 
  7.31  residence or presence for conduct of a preliminary 
  7.32  investigation, except when the proposed patient has been 
  7.33  acquitted of a crime under section 611.026 and the county 
  7.34  attorney is required to file a petition for commitment.  The 
  7.35  designated agency shall appoint a screening team to conduct an 
  7.36  investigation ~~which shall include~~.  The petitioner may not be a 
  8.1   member of the screening team.  The investigation must include: 
  8.2      ~~(i)~~ (1) a personal interview with the proposed patient and 
  8.3   other individuals who appear to have knowledge of the condition 
  8.4   of the proposed patient.  If the proposed patient is not 
  8.5   interviewed, specific reasons must be documented; 
  8.6      ~~(ii)~~ (2) identification and investigation of specific 
  8.7   alleged conduct which is the basis for application; 
  8.8      ~~(iii)~~ (3) identification, exploration, and listing of 
  8.9   the specific reasons for rejecting or recommending alternatives 
  8.10  to involuntary placement; 
  8.11     ~~(iv)~~ (4) in the case of a commitment based on mental 
  8.12  illness, the following information, if it is known or available~~:~~ 
  8.13  ~~information~~, that may be relevant to the administration of 
  8.14  neuroleptic medications, ~~if necessary,~~ including the existence 
  8.15  of a declaration under section 253B.03, subdivision 6d, or a 
  8.16  health care directive under chapter 145C or a guardian, 
  8.17  conservator, proxy, or agent with authority to make health care 
  8.18  decisions for the proposed patient; information regarding the 
  8.19  capacity of the proposed patient to make decisions regarding 
  8.20  administration of neuroleptic medication; and whether the 
  8.21  proposed patient is likely to consent or refuse consent to 
  8.22  administration of the medication; ~~and~~ 
  8.23     ~~(v)~~ (5) seeking input from the proposed patient's health 
  8.24  plan company to provide the court with information about 
  8.25  services the enrollee needs and the least restrictive 
  8.26  alternatives~~.~~; and 
  8.27     (6) in the case of a commitment based on mental illness, 
  8.28  information listed in clause (4) for other purposes relevant to 
  8.29  treatment. 
  8.30     (b) In conducting the investigation required by this 
  8.31  subdivision, the screening team shall have access to all 
  8.32  relevant medical records of proposed patients currently in 
  8.33  treatment facilities.  Data collected pursuant to this clause 
  8.34  shall be considered private data on individuals.  The 
  8.35  prepetition screening report is not admissible as evidence 
  8.36  except by agreement of counsel and is not admissible in any 
  9.1   court proceedings unrelated to the commitment proceedings. 
  9.2      (c) The prepetition screening team shall provide a notice, 
  9.3   written in easily understood language, to the proposed patient, 
  9.4   the petitioner, persons named in a declaration under chapter 
  9.5   145C or section 253B.03, subdivision 6d, and, with the proposed 
  9.6   patient's consent, other interested parties.  The team shall ask 
  9.7   the patient if the patient wants the notice read and shall read 
  9.8   the notice to the patient upon request.  The notice must contain 
  9.9   information regarding the process, purpose, and legal effects of 
  9.10  civil commitment and early intervention.  The notice must inform 
  9.11  the proposed patient that: 
  9.12     (1) if a petition is filed, the patient has certain rights, 
  9.13  including the right to a court-appointed attorney, the right to 
  9.14  request a second examiner, the right to attend hearings, and the 
  9.15  right to oppose the proceeding and to present and contest 
  9.16  evidence; and 
  9.17     (2) if the proposed patient is committed to a state 
  9.18  regional treatment center or group home, the patient may be 
  9.19  billed for the cost of care and the state has the right to make 
  9.20  a claim against the patient's estate for this cost. 
  9.21     The ombudsman for mental health and mental retardation 
  9.22  shall develop a form for the notice, which includes the 
  9.23  requirements of this paragraph.  
  9.24     (d) When the prepetition screening team recommends 
  9.25  commitment, a written report shall be sent to the county 
  9.26  attorney for the county in which the petition is to be 
  9.27  filed.  The statement of facts contained in the written report 
  9.28  must meet the requirements of subdivision 2, paragraph (b). 
  9.29     ~~(d)~~ (e) The prepetition screening team shall refuse to 
  9.30  support a petition if the investigation does not disclose 
  9.31  evidence sufficient to support commitment.  Notice of the 
  9.32  prepetition screening team's decision shall be provided to the 
  9.33  prospective petitioner and to the proposed patient.  
  9.34     ~~(e)~~ (f) If the interested person wishes to proceed with a 
  9.35  petition contrary to the recommendation of the prepetition 
  9.36  screening team, application may be made directly to the county 
 10.1   attorney, who ~~may~~ shall determine whether or not to proceed with 
 10.2   the petition.  Notice of the county attorney's determination 
 10.3   shall be provided to the interested party.  
 10.4      ~~(f)~~ (g) If the proposed patient has been acquitted of a 
 10.5   crime under section 611.026, the county attorney shall apply to 
 10.6   the designated county agency in the county in which the 
 10.7   acquittal took place for a preliminary investigation unless 
 10.8   substantially the same information relevant to the proposed 
 10.9   patient's current mental condition, as could be obtained by a 
 10.10  preliminary investigation, is part of the court record in the 
 10.11  criminal proceeding or is contained in the report of a mental 
 10.12  examination conducted in connection with the criminal 
 10.13  proceeding.  If a court petitions for commitment pursuant to the 
 10.14  rules of criminal or juvenile procedure or a county attorney 
 10.15  petitions pursuant to acquittal of a criminal charge under 
 10.16  section 611.026, the prepetition investigation, if required by 
 10.17  this section, shall be completed within seven days after the 
 10.18  filing of the petition.  
 10.19     Sec. 11.  Minnesota Statutes 2000, section 253B.07, 
 10.20  subdivision 2, is amended to read: 
 10.21     Subd. 2.  [THE PETITION.] (a) Any interested person, except 
 10.22  a member of the prepetition screening team, may file a petition 
 10.23  for commitment in the district court of the county of the 
 10.24  proposed patient's residence or presence.  If the head of the 
 10.25  treatment facility believes that commitment is required and no 
 10.26  petition has been filed, the head of the treatment facility 
 10.27  shall petition for the commitment of the person. 
 10.28     (b) The petition shall set forth the name and address of 
 10.29  the proposed patient, the name and address of the patient's 
 10.30  nearest relatives, and the reasons for the petition.  The 
 10.31  petition must contain factual descriptions of the proposed 
 10.32  patient's recent behavior, including a description of the 
 10.33  behavior, where it occurred, and the time period over which it 
 10.34  occurred.  Each factual allegation must be supported by 
 10.35  observations of witnesses named in the petition.  Petitions 
 10.36  shall be stated in behavioral terms and shall not contain 
 11.1   judgmental or conclusory statements.  
 11.2      (c) The petition shall be accompanied by a written 
 11.3   statement by an examiner stating that the examiner has examined 
 11.4   the proposed patient within the 15 days preceding the filing of 
 11.5   the petition and is of the opinion that the proposed patient is 
 11.6   suffering a designated disability and should be committed to a 
 11.7   treatment facility.  The statement shall include the reasons for 
 11.8   the opinion.  In the case of a commitment based on mental 
 11.9   illness, the petition and the examiner's statement ~~may~~ shall 
 11.10  include, to the extent this information is available, a 
 11.11  statement and opinion regarding the proposed patient's need for 
 11.12  treatment with neuroleptic medication and the patient's capacity 
 11.13  to make decisions regarding the administration of neuroleptic 
 11.14  medications, and the reasons for the opinion.  If use of 
 11.15  neuroleptic medications is recommended, the petition for 
 11.16  commitment must include a request for proceedings under section 
 11.17  253B.092.  If a petitioner has been unable to secure a statement 
 11.18  from an examiner, the petition shall include documentation that 
 11.19  a reasonable effort has been made to secure the supporting 
 11.20  statement. 
 11.21     Sec. 12.  Minnesota Statutes 2000, section 253B.09, 
 11.22  subdivision 1, is amended to read: 
 11.23     Subdivision 1.  [STANDARD OF PROOF.] (a) If the court finds 
 11.24  by clear and convincing evidence that the proposed patient is a 
 11.25  mentally ill, mentally retarded, or chemically dependent person 
 11.26  and after careful consideration of reasonable alternative 
 11.27  dispositions, including but not limited to, dismissal of 
 11.28  petition, voluntary outpatient care, voluntary admission to a 
 11.29  treatment facility, appointment of a guardian or conservator, or 
 11.30  release before commitment as provided for in subdivision 4, it 
 11.31  finds that there is no suitable alternative to judicial 
 11.32  commitment, the court shall commit the patient to the least 
 11.33  restrictive treatment program or alternative programs which can 
 11.34  meet the patient's treatment needs consistent with section 
 11.35  253B.03, subdivision 7.  
 11.36     (b) In deciding on the least restrictive program, the court 
 12.1   shall consider a range of treatment alternatives including, but 
 12.2   not limited to, community-based nonresidential treatment, 
 12.3   community residential treatment, partial hospitalization, acute 
 12.4   care hospital, and regional treatment center services.  The 
 12.5   court shall also consider the proposed patient's treatment 
 12.6   preferences and willingness to participate voluntarily in the 
 12.7   treatment ordered.  The court may not commit a patient to a 
 12.8   facility or program that is not capable of meeting the patient's 
 12.9   needs.  
 12.10     (c) For purposes of findings under this chapter, none of 
 12.11  the following constitute a refusal to accept appropriate mental 
 12.12  health treatment: 
 12.13     (1) a willingness to take medication but a reasonable 
 12.14  disagreement about type or dosage; 
 12.15     (2) a good-faith effort to follow a reasonable alternative 
 12.16  treatment plan, including treatment as specified in a valid 
 12.17  advance directive under chapter 145C or section 253B.03, 
 12.18  subdivision 6d; 
 12.19     (3) an inability to obtain access to appropriate treatment 
 12.20  because of inadequate health care coverage or an insurer's 
 12.21  refusal or delay in providing coverage for the treatment; or 
 12.22     (4) an inability to obtain access to needed mental health 
 12.23  services because the provider will only accept patients who are 
 12.24  under a court order or because the provider gives persons under 
 12.25  a court order a priority over voluntary patients in obtaining 
 12.26  treatment and services.