Text: HF02365 Text: HF02367 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 228.6, subsection 1, Code 1999, is 1 2 amended to read as follows: 1 3 1. A mental health professional or an employee of or agent 1 4 for a mental health facility may disclose mental health 1 5 information if and to the extent necessary, to meet the 1 6 requirements of section 229.24, 229.25, 230.20, 230.21, 1 7 230.25, 230.26, 230A.13, 232.74,or232.147, 229B.4, 229B.6, 1 8 229B.7, 229B.8, 229B.9, 229B.10, 229B.11, 229B.12, 229B.13, 1 9 229B.14, 229B.15, 229B.16, 229B.17, 229B.18, or 229B.20, or to 1 10 meet the compulsory reporting or disclosure requirements of 1 11 other state or federal law relating to the protection of human 1 12 health and safety. 1 13 Sec. 2. Section 228.6, subsection 3, Code 1999, is amended 1 14 to read as follows: 1 15 3. Mental health information may be disclosed by a mental 1 16 health professional if and to the extent necessary, to 1 17 initiate or complete civil commitment proceedings under 1 18 chapter 229, or in relation to proceedings for an order for 1 19 outpatient treatment under chapter 229B. 1 20 Sec. 3. NEW SECTION. 229B.1 DEFINITIONS. 1 21 1. "Chemotherapy" means treatment of an individual by use 1 22 of a drug or substance which cannot legally be delivered or 1 23 administered to the ultimate user without a physician's 1 24 prescription or medical order. 1 25 2. "Chief medical officer" means the medical director in 1 26 charge of a public or private hospital, or treatment program, 1 27 or that individual's physician-designee. 1 28 3. "Licensed physician" means an individual licensed under 1 29 the provisions of chapter 148, 150, or 150A to practice 1 30 medicine and surgery, osteopathy, or osteopathic medicine and 1 31 surgery. 1 32 4. "Mental illness" means every type of mental disease or 1 33 mental disorder, except that it does not refer to mental 1 34 retardation as defined in section 222.2, or to insanity, 1 35 diminished responsibility, or mental incompetency as the terms 2 1 are defined and used in the Iowa criminal code or in the rules 2 2 of criminal procedure, Iowa court rules. 2 3 5. "Qualified mental health professional" means an 2 4 individual experienced in the study and treatment of mental 2 5 disorders in the capacity of any one of the following: 2 6 a. A psychologist licensed under chapter 154B. 2 7 b. A registered nurse licensed under chapter 152. 2 8 c. A social worker licensed under chapter 154C. 2 9 6. "Respondent" means any person about whom an application 2 10 has been filed under section 229B.4, but who has not been 2 11 finally ordered to obtain outpatient treatment. 2 12 7. "Single entry point process" means the same as defined 2 13 in section 331.440. 2 14 Sec. 4. NEW SECTION. 229B.2 SINGLE ENTRY POINT PROCESS. 2 15 Notwithstanding any provision of this chapter to the 2 16 contrary, any person whose treatment expenses are payable in 2 17 whole or in part by a county shall be subject to all 2 18 requirements of the single entry point process. 2 19 Sec. 5. NEW SECTION. 229B.3 CRITERIA FOR ORDER FOR 2 20 OUTPATIENT TREATMENT. 2 21 1. For the purposes of this section, "rational treatment 2 22 decision" means a decision based upon plausible or good 2 23 reasons. An individual's treatment decision that is medically 2 24 inadvisable or that conflicts with the individual's 2 25 physician's recommendation may still be rational if it is 2 26 based upon plausible or good reasons. A refusal to follow a 2 27 physician's reasonable treatment plan does not fail to be 2 28 rational if it reflects a good faith attempt to follow a 2 29 reasonable alternative treatment plan or if it is protected by 2 30 a constitutional right to refuse treatment. 2 31 2. An individual is an appropriate candidate for an order 2 32 for outpatient treatment under this chapter if all of the 2 33 following are true: 2 34 a. The individual is at least eighteen years old. 2 35 b. The individual is suffering from a mental illness. 3 1 c. Without outpatient treatment, within the reasonably 3 2 foreseeable future, at least one of the following is true: 3 3 (1) The individual is more likely than not to cause 3 4 physical injury to the individual or to others. 3 5 (2) The individual is more likely than not to lack 3 6 substantial capacity to take care of the individual's basic 3 7 needs for nourishment, shelter, clothing, or health. 3 8 d. At least one of the following will be true if the 3 9 individual undergoes outpatient treatment: 3 10 (1) The individual alone will more likely than not be 3 11 capable of taking care of the individual's basic needs for 3 12 nourishment, shelter, clothing, and health. 3 13 (2) The individual will be capable of taking care of the 3 14 individual's basic needs for nourishment, shelter, clothing, 3 15 and health, with the help of family, friends, or others with 3 16 responsibility for the individual's well-being. 3 17 e. For at least one temporally extended prior period, the 3 18 respondent has failed to follow any reasonable treatment plan 3 19 at all without reasons or without adequate justification. 3 20 f. The individual has previously been determined to be 3 21 seriously mentally impaired, as defined in section 229.1, and 3 22 has been hospitalized for inpatient treatment pursuant to the 3 23 procedures in chapter 229. 3 24 g. As a result of the individual's mental illness, the 3 25 individual lacks the capacity to make rational treatment 3 26 decisions. 3 27 h. It is more likely than not that the individual will 3 28 benefit from outpatient treatment. 3 29 Sec. 6. NEW SECTION. 229B.4 APPLICATION FOR OUTPATIENT 3 30 TREATMENT ORDER. 3 31 1. An application for an outpatient treatment order may be 3 32 commenced by any interested person by filing a verified 3 33 application with the clerk of the district court of the county 3 34 where the respondent is presently located, or which is the 3 35 respondent's place of residence. 4 1 2. The clerk, or the clerk's designee, shall assist the 4 2 applicant in completing the application. 4 3 3. The application shall include the following 4 4 information: 4 5 a. The applicant's belief that the respondent meets the 4 6 criteria set forth in section 229B.3 as an appropriate 4 7 candidate for an outpatient treatment order. 4 8 b. Any pertinent facts. 4 9 4. The application shall be accompanied by one of the 4 10 following: 4 11 a. A written statement of a psychiatrist, licensed 4 12 physician, or other qualified mental health professional 4 13 supporting the application. 4 14 b. One or more affidavits corroborating the application. 4 15 c. Testimony supporting the application. The testimony 4 16 may include oral testimony taken over the telephone and 4 17 reduced to writing by the clerk or the clerk's designee. 4 18 Sec. 7. NEW SECTION. 229B.5 SERVICE OF NOTICE UPON 4 19 RESPONDENT. 4 20 1. Upon the filing of an application for an outpatient 4 21 treatment order, the clerk of the district court shall docket 4 22 the case and immediately notify a district judge, a district 4 23 associate judge, a magistrate, or a judicial hospitalization 4 24 referee, who shall review the application and accompanying 4 25 documentation. 4 26 2. If the application is adequate as to form and content, 4 27 the court shall set a time and place for the hearing on the 4 28 application. The hearing shall be held within five business 4 29 days after notice to the respondent, but not less than forty- 4 30 eight hours after notice to the respondent, unless the 4 31 respondent waives the forty-eight-hour notice requirement. 4 32 3. The court shall direct the clerk to send copies of the 4 33 application and supporting documentation, together with notice 4 34 informing the respondent of the procedures required by this 4 35 chapter, to a process server for immediate service upon the 5 1 respondent. The process server shall serve the respondent in 5 2 plain clothes via an unmarked car, if the judge, magistrate, 5 3 or referee so requires. 5 4 Sec. 8. NEW SECTION. 229B.6 PROCEDURE AFTER APPLICATION 5 5 IS FILED. 5 6 As soon as practicable after the filing of an application 5 7 for an outpatient treatment order, the court shall do all of 5 8 the following: 5 9 1. Determine whether the respondent has an attorney to 5 10 represent the respondent in the proceeding on the outpatient 5 11 treatment order. If the court determines that the respondent 5 12 does not have an attorney, the court shall determine whether 5 13 the respondent is financially able to employ an attorney and 5 14 is capable of meaningfully assisting in selecting one. 5 15 If the respondent is unable to obtain an attorney for lack 5 16 of funds, or is unable to meaningfully choose and retain an 5 17 attorney, the court shall assign an attorney to represent the 5 18 respondent. 5 19 If the respondent is financially unable to pay an attorney, 5 20 the attorney shall be compensated in substantially the manner 5 21 provided by section 815.7, except that if the county has a 5 22 public defender, the court may designate the public defender 5 23 or an attorney on the public defender's staff to act as the 5 24 respondent's attorney. 5 25 The respondent's attorney shall represent the respondent at 5 26 all stages of the proceedings, and shall represent the 5 27 respondent at hearing on the outpatient treatment order. 5 28 2. Determine whether the respondent has an assigned 5 29 patient advocate. If not, the court shall attempt to 5 30 determine if the respondent has a county of legal settlement. 5 31 If the respondent has a county of legal settlement, the court 5 32 shall assign the patient advocate from that county to the 5 33 respondent. If the respondent is determined to be a state 5 34 case, or if the court is unable to determine the county of 5 35 legal settlement prior to the time of the hearing, or in any 6 1 other circumstance, the court shall assign to the respondent 6 2 the patient advocate in the county in which the court has 6 3 venue. 6 4 3. Cause copies of the application and supporting 6 5 documentation to be sent for review to the county attorney, 6 6 the respondent's attorney of record, and the patient advocate. 6 7 The application and supporting documentation shall be 6 8 personally delivered by a method that assures confidentiality. 6 9 4. Issue a written order that requires an examination of 6 10 the respondent, prior to the hearing, by one or more able and 6 11 willing psychiatrists, or, if none are available, by one or 6 12 more licensed physicians who shall submit a written report on 6 13 the examination to the court as required by section 229B.7. 6 14 Sec. 9. NEW SECTION. 229B.7 PHYSICIAN'S EXAMINATION – 6 15 REPORT. 6 16 1. An examination of the respondent shall be conducted by 6 17 one or more licensed physicians, as required by the court's 6 18 order, within two business days. The court shall make every 6 19 reasonable effort to assign the examination to a qualified 6 20 licensed psychiatrist. 6 21 2. If the respondent so desires, the respondent shall be 6 22 entitled to a separate examination by a licensed psychiatrist, 6 23 licensed physician, or qualified mental health professional of 6 24 the respondent's own choice. The reasonable cost of such 6 25 separate examination shall, if the respondent lacks sufficient 6 26 funds to pay the cost, be paid from county funds upon order of 6 27 the court. 6 28 3. A licensed physician conducting an examination pursuant 6 29 to this section may consult with or request the participation 6 30 in the examination of any qualified mental health 6 31 professional, and may include with or attach to the written 6 32 report of the examination any findings or observations of such 6 33 professional. 6 34 4. The psychiatrist or licensed physician or physicians 6 35 assigned to conduct the examination pursuant to section 7 1 229B.6, subsection 4, shall immediately inform the court if 7 2 the respondent declines to be examined. If the court is 7 3 informed that the respondent has declined to be examined by 7 4 the psychiatrist or licensed physician or physicians pursuant 7 5 to the court order, and if the court believes that it will 7 6 prove helpful, the court may order the assigned patient 7 7 advocate to assist in encouraging the respondent to comply 7 8 with the examination order. If necessary, the court may order 7 9 such limited detention of the respondent as is required to 7 10 facilitate the examination of the respondent by the 7 11 psychiatrist or licensed physician or physicians who have been 7 12 ordered pursuant to section 229B.6, subsection 4, to examine 7 13 the respondent, but in no event shall the detention last 7 14 longer than twenty-four hours. 7 15 5. The psychiatrist or physician shall file a written 7 16 report of the examination as soon as possible. The court 7 17 shall encourage the examining psychiatrist or physician to 7 18 file the report at least twenty-four hours before the hearing 7 19 to assist all parties in preparing for the hearing. A written 7 20 report of any psychiatrist, physician, or qualified mental 7 21 health professional chosen by the respondent may be similarly 7 22 filed with the clerk of the district court. The clerk shall 7 23 immediately cause any report to be shown to the judge who 7 24 issued the order, to the respondent's attorney of record, and 7 25 the county attorney. 7 26 Sec. 10. NEW SECTION. 229B.8 CLINICAL OR OBJECTIVELY 7 27 OBSERVABLE EVIDENCE OF FORESEEABLE DANGEROUSNESS. 7 28 Unless the respondent refuses to cooperate with the 7 29 psychiatrist or physician assigned to examine the respondent, 7 30 the evidence for a determination that the requirements of 7 31 section 229B.3 have been met must include evidence of a 7 32 clinical examination by a psychiatrist or physician, in 7 33 addition to the evidence of objectively observable events 7 34 required by section 229B.17, subsection 1, paragraph "b". 7 35 This requirement shall also apply at any rehearing pursuant to 8 1 section 229B.13, 229B.18, or 229B.19. 8 2 Sec. 11. NEW SECTION. 229B.9 ORDER FOR INPATIENT 8 3 TREATMENT. 8 4 1. If in the opinion of the chief medical officer, or the 8 5 chief medical officer's agent, a person ordered to that 8 6 facility or program on an outpatient basis under this chapter 8 7 is seriously mentally impaired as defined in section 229.1, 8 8 subsection 15, and would be more appropriately placed in 8 9 inpatient status or in an alternative placement, or other more 8 10 highly supervised setting than ordered outpatient treatment, 8 11 the chief medical officer, or the chief medical officer's 8 12 agent, shall initiate an application for an order of 8 13 involuntary hospitalization pursuant to section 229.6. 8 14 2. If the court orders immediate custody pursuant to 8 15 section 229.11, the respondent may be treated in accordance 8 16 with the provisions of the outpatient treatment order, or any 8 17 modifications thereof, in accordance with section 229B.12, 8 18 while in custody awaiting the involuntary hospitalization 8 19 hearing, notwithstanding the provisions of section 229.14, 8 20 subsection 3; section 229.15, subsection 2; section 229.23, 8 21 subsection 2; and the Iowa supreme court rules for involuntary 8 22 hospitalization. 8 23 3. If the respondent is a physical danger to the 8 24 respondent or others while in custody awaiting a hearing under 8 25 section 229.6, the respondent may be treated in accordance 8 26 with the provisions of section 229.23, subsection 2, to 8 27 preserve the respondent's life or to avoid physical injury to 8 28 the respondent or others. 8 29 4. If in the chief medical officer's opinion the 8 30 respondent should be immediately detained before the hearing 8 31 under section 229.6, but there are no means of immediate 8 32 access to the district court, an emergency detention may be 8 33 initiated in accordance with the procedures in section 229.22. 8 34 Sec. 12. NEW SECTION. 229B.10 OUTPATIENT TREATMENT 8 35 HEARING PROCEDURE. 9 1 1. At the outpatient treatment order hearing, evidence in 9 2 support of the contentions made in the application shall be 9 3 presented by the county attorney. 9 4 2. During the hearing, the applicant and the respondent 9 5 shall have an opportunity to testify. 9 6 3. The county attorney and the respondent may present and 9 7 cross-examine witnesses, and the court may receive the 9 8 testimony of family members of the respondent or of any other 9 9 interested person. 9 10 4. The respondent has the right to be present at the 9 11 hearing. If the respondent exercises that right and has been 9 12 medicated within twelve hours, or such longer period of time 9 13 as the court may designate, prior to the beginning of the 9 14 hearing or an adjourned session thereof, the judge shall be 9 15 informed of that fact and of the probable effects of the 9 16 medication upon convening of the hearing. 9 17 5. All persons not necessary for the conduct of the 9 18 proceeding shall be excluded, except that the court may admit 9 19 persons having a legitimate interest in the proceeding and 9 20 shall permit the respondent's patient advocate to attend the 9 21 hearing. 9 22 6. Upon the motion of the county attorney, the court may 9 23 in exceptional circumstances exclude the respondent during a 9 24 witness's testimony if the court determines that it would be 9 25 likely to harm the respondent's mental health to be present 9 26 during that testimony that it justifies overriding the 9 27 respondent's right to be present at the hearing. 9 28 7. The respondent's welfare shall be paramount and the 9 29 hearing shall be conducted in as informal a manner as may be 9 30 consistent with orderly procedure, but the issue shall be 9 31 tried as a civil matter. 9 32 a. Discovery as is permitted under the Iowa rules of civil 9 33 procedure shall be available to all parties. 9 34 b. The court shall receive all relevant and material 9 35 evidence that may be offered and need not be bound by the 10 1 rules of evidence. 10 2 c. There shall be a presumption in favor of the 10 3 respondent, and the burden of evidence in support of the 10 4 contentions made in the application shall be upon the 10 5 applicant. 10 6 d. If the respondent has substantially complied for the 10 7 prior twelve months with any current treatment plans or 10 8 recommendations made as a result of proceedings previously 10 9 initiated under chapter 229 or this chapter, or current 10 10 treatment recommendations of any other physician of the 10 11 respondent, a rebuttable presumption arises that the 10 12 respondent has the capacity to make rational treatment 10 13 decisions. In deciding whether that presumption is overcome, 10 14 the court shall consider, among other factors, how frequently 10 15 and how recently the respondent has failed to follow 10 16 reasonable treatment recommendations, and whether such 10 17 failures, if any exist, have led to the respondent's 10 18 hospitalization, failure to be able to take care of the 10 19 respondent's basic needs for nourishment, shelter, clothing, 10 20 or health, or to the respondent's being dangerous to self or 10 21 others. 10 22 8. If upon completion of the hearing the court finds that 10 23 the contention that the respondent should be ordered to 10 24 outpatient treatment has not been sustained by clear and 10 25 convincing evidence, the court shall deny the application and 10 26 terminate the proceeding. 10 27 9. The clerk of the district court shall furnish copies of 10 28 any orders to the respondent, and to the applicant if the 10 29 applicant files a written waiver signed by the respondent. 10 30 Sec. 13. NEW SECTION. 229B.11 EVALUATION AND ORDER. 10 31 If the court finds that the evidence presented at the 10 32 hearing demonstrates that the respondent meets the criteria 10 33 set forth in section 229B.3 by clear and convincing evidence, 10 34 the court shall immediately order the respondent to an 10 35 outpatient treatment facility or program, subject to the 11 1 requirements of section 229B.12. 11 2 Sec. 14. NEW SECTION. 229B.12 TREATMENT PLAN – CHOICE 11 3 OF PROVIDER – ADVANCE DIRECTIVE. 11 4 1. The chief medical officer of the facility or program 11 5 where the respondent is treated as an outpatient, or the chief 11 6 medical officer's agent, shall submit to the clerk of the 11 7 district court, as soon as practical, but no later than thirty 11 8 days after the respondent has been ordered as an outpatient, a 11 9 treatment plan, including any outpatient treatment 11 10 recommendations that the respondent is required to follow. 11 11 2. The chief medical officer of the facility or program to 11 12 which the respondent has been ordered as an outpatient shall 11 13 submit a copy of the treatment plan to the clerk of the 11 14 district court. 11 15 3. The clerk of the district court shall send a copy of 11 16 the outpatient treatment recommendations that the respondent 11 17 is required to follow to the court, to the respondent's 11 18 patient advocate, and to the respondent's attorney of record, 11 19 who may relay the respondent's objections to the treatment 11 20 plan, if any, and provide alternative treatment 11 21 recommendations. 11 22 4. The court may accept the chief medical officer's 11 23 treatment plan or require a revised treatment plan. 11 24 5. If the respondent wishes to receive outpatient 11 25 treatment from a licensed physician or treatment facility that 11 26 is willing to treat the respondent as a court-ordered 11 27 outpatient, the court shall order the respondent to the care 11 28 of that physician, qualified mental health professional, or 11 29 facility upon the respondent's written request, provided that 11 30 if the chosen provider is not a contract provider with the 11 31 county of legal settlement, the county of legal settlement, 11 32 state, or other government payor shall only be obligated to 11 33 pay to the noncontract provider the average cost paid for 11 34 ordered outpatient treatment to contract providers. 11 35 6. A respondent may execute an advance directive, or 12 1 durable power of attorney for health care decisions, in 12 2 accordance with chapter 144B. If validly executed, a durable 12 3 power of attorney for health care decisions shall be binding 12 4 on the court and on any treating mental health professional 12 5 provided that the decisions made by the agent possessing the 12 6 power of attorney, and the instructions, if any, to the agent 12 7 in the executed power of attorney for health care decisions 12 8 are within accepted medical standards and practices. If 12 9 disputed, decisions regarding an advance directive or durable 12 10 power of attorney for health care decisions shall be made by 12 11 the judicial trier of fact under this section. This section 12 12 does not require a physician or qualified mental health 12 13 professional to accept as an outpatient an individual who has 12 14 executed a durable power of attorney for health care decisions 12 15 that provides for treatment, either by instructions or by the 12 16 power of attorney's decision, that in the physician or 12 17 qualified mental health professional's judgment would not be 12 18 an appropriate treatment for the outpatient's condition. 12 19 Sec. 15. NEW SECTION. 229B.13 REVIEW HEARING. 12 20 1. For any respondent ordered to undergo outpatient 12 21 treatment, a review hearing shall be conducted every twelve 12 22 months to determine whether or not the respondent shall remain 12 23 under order to receive outpatient treatment. 12 24 2. At any review hearing: 12 25 a. The case for continued outpatient treatment shall be 12 26 presented by the county attorney. 12 27 b. The respondent shall have the right to an attorney, 12 28 including at a rehearing for probable cause under section 12 29 229B.18. 12 30 3. The court shall make the same determinations with 12 31 regard to the respondent's legal representation at each review 12 32 hearing in the same manner as required prior to an initial 12 33 hearing pursuant to section 229B.6, subsection 1. 12 34 4. At any review hearing, if the respondent has 12 35 substantially complied with the required treatment plan for 13 1 the prior twelve months, a rebuttable presumption arises that 13 2 the respondent has the capacity to make rational treatment 13 3 decisions. In deciding whether that presumption is overcome, 13 4 the court shall consider, among other factors, how frequently 13 5 and how recently the respondent has failed to follow 13 6 reasonable treatment recommendations, and whether such 13 7 failures, if any exist, have led to the respondent's 13 8 hospitalization, failure to be able to take care of the 13 9 respondent's basic needs for nourishment, shelter, clothing, 13 10 or health, or to the respondent's being dangerous to self or 13 11 others. 13 12 5. Yearly review hearings shall be conducted in accordance 13 13 with the procedures for initial hearings in section 229B.10, 13 14 except as specifically modified by this section. 13 15 Sec. 16. NEW SECTION. 229B.14 PERIODIC REPORTS. 13 16 1. The chief medical officer of the facility or program 13 17 where the respondent obtains treatment as an outpatient, or 13 18 the chief medical officer's agent, shall furnish reports on 13 19 the respondent's progress every six months to the court, to 13 20 the respondent's patient advocate, and to the respondent. 13 21 2. If in the chief medical officer's opinion providing a 13 22 copy of a report to the respondent would substantially hinder 13 23 the respondent's progress, and the chief medical officer so 13 24 informs the court and the respondent's patient advocate, the 13 25 chief medical officer need not provide a copy of the progress 13 26 report to the respondent, unless the respondent makes an 13 27 affirmative request for one. 13 28 3. Even if the chief medical officer informs the court 13 29 that it would substantially hinder the respondent's progress 13 30 to receive a copy of the report, the chief medical officer 13 31 shall still provide a report to the court and to the 13 32 respondent's patient advocate. 13 33 Sec. 17. NEW SECTION. 229B.15 FAILURE TO TIMELY FILE 13 34 PROGRESS REPORTS. 13 35 1. If the progress reports required by section 229B.14 are 14 1 not filed in a timely manner or if services to a respondent 14 2 are not provided, the court shall so inform the single entry 14 3 point process and direct the single entry point process not to 14 4 compensate the outpatient treatment facility or program. 14 5 2. If the mental health facility or program where the 14 6 respondent obtains outpatient treatment does not provide 14 7 progress reports in a timely manner or if services to the 14 8 respondent are not provided, but the mental health facility or 14 9 program is compensated by federal, private, or other agency 14 10 not state or local, the mental health facility or program 14 11 where the respondent has obtained treatment may be penalized 14 12 by the court in the amount of compensation to which the 14 13 facility or program would otherwise be entitled. The amounts 14 14 collected from such penalties shall be distributed in a fair 14 15 manner to the counties as a surplusage or repayment for mental 14 16 health service expenditures incurred. 14 17 3. Judicial hospitalization referees shall have the 14 18 authority to assess penalties and issue orders under this 14 19 section. 14 20 Sec. 18. NEW SECTION. 229B.16 NOTIFICATION OF OUTPATIENT 14 21 NONCOMPLIANCE – RESPONSE. 14 22 1. If the respondent does not comply with the court's 14 23 order for outpatient treatment, the chief medical officer 14 24 shall promptly notify the court upon becoming aware of any 14 25 such noncompliance. 14 26 2. The court may take reasonable steps to ensure 14 27 compliance with the court's outpatient treatment order, 14 28 including, but not limited to, any or all of the following: 14 29 a. Directing that the respondent's patient advocate remind 14 30 the respondent of the respondent's treatment obligations and 14 31 attempt to persuade the noncompliant respondent to comply with 14 32 any required chemotherapy. 14 33 b. Presenting the respondent to the treatment facility or 14 34 program for treatment. 14 35 3. The court may order the respondent to appear before the 15 1 court. If necessary, the court may order the sheriff to bring 15 2 the respondent before the court. 15 3 4. Unless the court has good reason based upon past 15 4 experience with the respondent or the respondent's patient 15 5 advocate that the above methods will not be effective in 15 6 ensuring compliance with the court's outpatient treatment 15 7 order, or immediate treatment is necessary, the court shall 15 8 attempt to secure compliance by one or more of the above 15 9 reasonable steps before ordering the sheriff to bring the 15 10 noncompliant respondent to treatment. If necessary, the court 15 11 shall order the sheriff to bring the respondent to the 15 12 treatment facility or program for treatment. 15 13 Sec. 19. NEW SECTION. 229B.17 EVIDENCE – OUTPATIENT 15 14 TREATMENT ORDER. 15 15 1. In determining whether the criteria of section 229B.3 15 16 are met by clear and convincing evidence and therefore that 15 17 the respondent should be ordered to a treatment facility or 15 18 program, the court shall take into account, both as presently 15 19 experienced, and as likely to be the case in the reasonably 15 20 foreseeable future, at least the following evidence: 15 21 a. The subjective distress experienced by the respondent. 15 22 b. Any objectively observable functional impairment of the 15 23 respondent at work, in school, or in social interactions. 15 24 1A. In deciding whether the criteria of section 229B.3 15 25 have been met, the court shall consider, among other factors, 15 26 how frequently and how recently the respondent has failed to 15 27 follow reasonable treatment recommendations, and whether such 15 28 failures, if any exist, have led to the respondent's 15 29 hospitalization, failure to be able to take care of the 15 30 respondent's basic needs for nourishment, shelter, clothing, 15 31 or health, or to the respondent's being dangerous to self or 15 32 others. 15 33 2. The same factors should be taken into account in 15 34 rehearings and writs under sections 229B.13, 229B.18, and 15 35 229B.19. 16 1 Sec. 20. NEW SECTION. 229B.18 REHEARING FOR PROBABLE 16 2 CAUSE. 16 3 1. A respondent, a family member, the respondent's 16 4 advocate, or an individual who can demonstrate that the person 16 5 has a substantial interest in the welfare of the respondent 16 6 may petition for a rehearing on the grounds that the 16 7 respondent no longer meets the criteria for ordered outpatient 16 8 treatment. 16 9 2. Upon probable cause that one or more of the required 16 10 criterion for an outpatient treatment order can no longer be 16 11 proven by clear and convincing evidence, the court shall grant 16 12 the petition and assign a rehearing no sooner than three 16 13 business days after notification to the respondent per section 16 14 229B.5, but within ten business days of the date of service of 16 15 the petition upon the respondent. 16 16 3. Probable cause may be demonstrated by affidavit, 16 17 medical report, or any other means deemed appropriate by the 16 18 court. 16 19 4. The procedure set out in this section shall not be 16 20 available: 16 21 a. Until the respondent has been subject to an outpatient 16 22 treatment order for six months. 16 23 b. More than once every six months regarding the same 16 24 respondent. 16 25 5. At any such hearing the respondent shall have the right 16 26 to an attorney. If the respondent cannot afford an attorney, 16 27 the court shall assign one in accordance with the procedures 16 28 in section 229B.6. 16 29 6. At any probable cause hearing, evidence in support of a 16 30 continued outpatient treatment order shall be presented by the 16 31 county attorney. 16 32 7. Review hearings shall be conducted in accordance with 16 33 the procedures set for initial hearings in section 229B.10. 16 34 Sec. 21. NEW SECTION. 229B.19 CHALLENGE TO ORDER FOR 16 35 OUTPATIENT TREATMENT. 17 1 1. All respondents ordered to outpatient treatment shall 17 2 be entitled to the benefit of a writ of unconstitutional 17 3 deprivation of liberty, which is analogous to a writ of habeas 17 4 corpus. 17 5 2. The question of the constitutionality of the order to 17 6 outpatient treatment shall be decided at a hearing on the 17 7 writ. The hearing shall be before the district court, 17 8 pursuant to this section and chapter 663. 17 9 3. If the judge decides that the respondent should be 17 10 ordered to outpatient treatment, such decision shall be no bar 17 11 to the issuing of the writ a second time, whenever it shall be 17 12 alleged that such respondent no longer meets constitutional 17 13 requirements for being ordered to outpatient treatment. 17 14 4. The respondent shall have the right to be represented 17 15 by an attorney at the hearing. If the respondent cannot 17 16 afford an attorney, the court shall appoint one for the 17 17 respondent. 17 18 5. The attorney shall be compensated by the county of 17 19 legal settlement of the respondent, or, if no county of legal 17 20 settlement exists, then by the state. The attorney shall be 17 21 compensated with a maximum fee of three hundred dollars, at an 17 22 hourly rate consistent with section 815.7, to be exceeded only 17 23 upon motion to the court for good cause shown. 17 24 Sec. 22. NEW SECTION. 229B.20 DISCHARGE. 17 25 1. When, in the opinion of the chief medical officer of 17 26 the treatment facility or program where the respondent has 17 27 obtained treatment, the respondent no longer requires 17 28 outpatient treatment, the chief medical officer shall 17 29 immediately notify the court, and explain in detail why the 17 30 respondent no longer needs outpatient treatment and why the 17 31 respondent no longer meets the criterion for an order of 17 32 outpatient treatment. 17 33 2. The court shall issue an order approving the 17 34 respondent's discharge from the outpatient treatment facility 17 35 or program, or in its discretion, may require a hearing be 18 1 held to determine whether the respondent still meets the 18 2 criteria for an outpatient treatment order. 18 3 3. To justify termination of an outpatient treatment 18 4 order, the chief medical officer's report must explain in 18 5 detail, including reasons and evidence, why one or more of the 18 6 legal criterion for an outpatient treatment order is no longer 18 7 satisfied. A report by the chief medical officer asserting 18 8 only that the respondent no longer requires outpatient 18 9 treatment is insufficient to justify termination of an 18 10 outpatient treatment order. 18 11 4. The clerk of the district court shall send a copy of 18 12 the chief medical officer's recommendation and the court's 18 13 order to the respondent's patient advocate, and to the 18 14 respondent. 18 15 Sec. 23. NEW SECTION. 229B.21 TREATMENT PENDING APPEAL. 18 16 When a respondent appeals to the supreme court the decision 18 17 that the respondent should be ordered to outpatient treatment, 18 18 and the respondent was ordered to a treatment facility or 18 19 program before the court is informed of the respondent's 18 20 intent to appeal its finding, the respondent shall follow any 18 21 treatment plan prescribed by the chief medical officer of the 18 22 facility or program, or the officer's agent, and approved by 18 23 the court, even if the treatment plan or approval thereof 18 24 postdates the appeal, unless the supreme court orders 18 25 otherwise. 18 26 Sec. 24. NEW SECTION. 229B.22 CONFIDENTIALITY. 18 27 1. The medical records of any examining licensed physician 18 28 or treatment facility or program that treats any respondent 18 29 under this chapter shall be confidential in accordance with 18 30 the provisions in section 229.25 and chapter 228. 18 31 2. The records of proceedings for outpatient treatment 18 32 pursuant to this chapter shall be confidential in accordance 18 33 with the terms in section 229.24, chapter 228, and federal 18 34 law. 18 35 Sec. 25. NEW SECTION. 229B.23 PROVISION OF SUMMARY OF 19 1 PROCEDURES TO APPLICANT IN OUTPATIENT TREATMENT ORDER 19 2 APPLICATIONS. 19 3 1. The department of human services, in consultation with 19 4 the office of attorney general, shall develop a summary of the 19 5 procedures involved in outpatient treatment orders under this 19 6 chapter, and applications for information concerning the 19 7 participation of an applicant in the proceedings. 19 8 2. The summary shall be provided by the department, at the 19 9 department's expense, to the clerks of the district court who 19 10 shall make the summary available to all applicants prior to 19 11 the filing of a verified application under section 229B.4, or 19 12 to any other person upon request, and who shall attach a copy 19 13 of the summary to the notice of hearing which is served upon 19 14 the respondent under section 229B.5. 19 15 3. The summary may include, but is not limited to, the 19 16 following: 19 17 a. The criteria under section 229B.3 for ordering a person 19 18 to outpatient treatment. 19 19 b. A description of the hearing process. 19 20 c. An explanation of the applicant's right to testify and 19 21 examples of the kinds of relevant information which may be 19 22 introduced at the hearing. 19 23 d. An explanation of the duties of the county attorney in 19 24 outpatient treatment proceedings. 19 25 4. The summary required under this section may be combined 19 26 in the summary required under section 229.45, or may be 19 27 separately provided. 19 28 Sec. 26. NEW SECTION. 229B.24 APPLICATION FILED WITHOUT 19 29 PROBABLE CAUSE OR GOOD FAITH BELIEF. 19 30 1. If the court determines that the respondent does not 19 31 meet the criteria for outpatient treatment set forth in 19 32 section 229B.3, and that the application was filed without 19 33 probable cause, the court may order a hearing to determine if 19 34 the applicant shall pay the costs of the hearing and medical 19 35 examination. 20 1 2. The applicant shall pay the costs of the hearing and 20 2 medical examination under this chapter if the court concludes 20 3 that the application was filed without probable cause. 20 4 Sec. 27. NEW SECTION. 229B.25 APPEAL TO DISTRICT COURT. 20 5 If the hearing is before a judicial hospitalization 20 6 referee, and the respondent is ordered to outpatient 20 7 treatment, the respondent may appeal to the district court 20 8 within ten business days of the judicial hospitalization 20 9 referee's order. If appealed to the district court, the trial 20 10 shall be de novo. 20 11 Sec. 28. Section 331.756, subsection 46, Code Supplement 20 12 1999, is amended to read as follows: 20 13 46. Carry out duties relating to the hospitalization and 20 14 outpatient treatment of personsforwith mental illness as 20 15 provided insection 229.12chapters 229 and 229B. 20 16 Sec. 29. SUPREME COURT FORM. The supreme court is 20 17 directed to develop and implement new forms necessary to 20 18 implement this chapter. 20 19 Sec. 30. IMPLEMENTATION OF ACT. Section 25B.2, subsection 20 20 3, shall not apply to this Act. 20 21 EXPLANATION 20 22 This bill creates new Code chapter 229B that establishes a 20 23 procedure for outpatient mental health treatment. 20 24 The bill sets forth definitions, and a section regarding 20 25 the applicability of the single entry point process. 20 26 New Code section 229B.3 sets forth the criteria for 20 27 obtaining an outpatient treatment order, and new Code section 20 28 229B.4 addresses the application process. 20 29 New Code section 229B.5 addresses service of process, and 20 30 new Code section 229B.6 sets forth prehearing requirements for 20 31 the court. 20 32 New Code section 229B.7 addresses the prehearing medical 20 33 examination of the respondent. 20 34 New Code section 229B.10 sets forth the procedures related 20 35 to the hearing on the outpatient treatment order. New Code 21 1 sections 229B.8, 229B.9, 229B.11, and 229B.17 address 21 2 evidentiary standards and issues relating to the hearing and 21 3 order. 21 4 New Code section 229B.12 addresses the posthearing 21 5 treatment plan, while new Code section 229B.13 addresses the 21 6 procedure for periodic review hearings. New Code section 21 7 229B.14 sets forth the requirements for progress reports on 21 8 the respondent's treatment, and new Code section 229B.15 sets 21 9 forth penalties for untimely filings of such progress reports. 21 10 New Code section 229B.16 addresses the procedures for 21 11 dealing with a respondent who does not comply with the 21 12 treatment order. 21 13 New Code section 229B.19 addresses the applicable 21 14 procedures for challenging the constitutionality of an order 21 15 to outpatient treatment, and new Code section 229.18 addresses 21 16 rehearings for probable cause. 21 17 New Code section 229B.20 addresses the procedure for 21 18 discharge from treatment, and new Code section 229B.21 21 19 addresses treatment pending appeal. 21 20 New Code section 229B.22 addresses confidentiality issues, 21 21 and new Code section 229B.23 requires the department of human 21 22 services to develop a summary of the procedures under this 21 23 chapter for applicants and respondents, similar to the summary 21 24 required for involuntary hospitalizations. 21 25 New Code section 229B.24 addresses payment of costs for 21 26 applications filed without probably cause or a good faith 21 27 belief. New Code section 229B.25 addresses appeals to 21 28 district court from hearings before judicial hospitalization 21 29 referees. 21 30 Corresponding amendments are made to Code section 331.756, 21 31 regarding duties of the county attorney, and Code section 21 32 228.6, regarding disclosure of mental health information. 21 33 The bill also contains a direction to the courts regarding 21 34 development of new forms to encompass the procedures 21 35 implemented by the new Code chapter. 22 1 This bill may include a state mandate as defined in Code 22 2 section 25B.3. This bill makes inapplicable Code section 22 3 25B.2, subsection 3, which would relieve a political 22 4 subdivision from complying with a state mandate if funding for 22 5 the cost of the state mandate is not provided or specified. 22 6 Therefore, political subdivisions are required to comply with 22 7 any state mandate included in this bill. 22 8 LSB 5145HV 78 22 9 jj/gg/8
Text: HF02365 Text: HF02367 Text: HF02300 - HF02399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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