Text: HSB00556 Text: HSB00558 Text: HSB00500 - HSB00599 Text: HSB 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. 2 27 2. An individual is an appropriate candidate for an order 2 28 for outpatient treatment under this chapter if all of the 2 29 following are true: 2 30 a. The individual is at least eighteen years old. 2 31 b. The individual is suffering from a mental illness. 2 32 c. Without outpatient treatment, within the reasonably 2 33 foreseeable future, at least one of the following is true: 2 34 (1) The individual is likely to cause physical injury to 2 35 the individual or to others. 3 1 (2) The individual is likely to lack substantial capacity 3 2 to take care of the individual's basic needs for nourishment, 3 3 shelter, clothing, or health. 3 4 d. At least one of the following will be true if the 3 5 individual undergoes outpatient treatment: 3 6 (1) The individual alone will likely be capable of taking 3 7 care of the individual's basic needs for nourishment, shelter, 3 8 clothing, and health. 3 9 (2) The individual will be capable of taking care of the 3 10 individual's basic needs for nourishment, shelter, clothing, 3 11 and health, with the help of family, friends, or others with 3 12 responsibility for the individual's well-being. 3 13 e. The individual has previously failed to comply with 3 14 reasonable treatment recommendations. 3 15 f. The individual has previously been determined to be 3 16 seriously mentally impaired, as defined in section 229.1, and 3 17 has been hospitalized for inpatient treatment pursuant to the 3 18 procedures in chapter 229. 3 19 g. As a result of the individual's mental illness, the 3 20 individual lacks the capacity to make rational treatment 3 21 decisions. 3 22 h. It is likely that the individual will benefit from 3 23 outpatient treatment. 3 24 Sec. 6. NEW SECTION. 229B.4 APPLICATION FOR OUTPATIENT 3 25 TREATMENT ORDER. 3 26 1. An application for an outpatient treatment order may be 3 27 commenced by any interested person by filing a verified 3 28 application with the clerk of the district court of the county 3 29 where the respondent is presently located, or which is the 3 30 respondent's place of residence. 3 31 2. The clerk, or the clerk's designee, shall assist the 3 32 applicant in completing the application. 3 33 3. The application shall include the following 3 34 information: 3 35 a. The applicant's belief that the respondent meets the 4 1 criteria set forth in section 229B.3 as an appropriate 4 2 candidate for an outpatient treatment order. 4 3 b. Any pertinent facts. 4 4 4. The application shall be accompanied by one of the 4 5 following: 4 6 a. A written statement of a psychiatrist, licensed 4 7 physician, or other qualified mental health professional 4 8 supporting the application. 4 9 b. One or more affidavits corroborating the application. 4 10 c. Testimony supporting the application. The testimony 4 11 may include oral testimony taken over the telephone and 4 12 reduced to writing by the clerk or the clerk's designee. 4 13 Sec. 7. NEW SECTION. 229B.5 SERVICE OF NOTICE UPON 4 14 RESPONDENT. 4 15 1. Upon the filing of an application for an outpatient 4 16 treatment order, the clerk of the district court shall docket 4 17 the case and immediately notify a district judge, a district 4 18 associate judge, a magistrate, or a judicial hospitalization 4 19 referee, who shall review the application and accompanying 4 20 documentation. 4 21 2. If the application is adequate as to form and content, 4 22 the court shall set a time and place for the hearing on the 4 23 application. The hearing shall be held within five business 4 24 days after notice to the respondent, but not less than forty- 4 25 eight hours after notice to the respondent, unless the 4 26 respondent waives the forty-eight-hour notice requirement. 4 27 3. The court shall direct the clerk to send copies of the 4 28 application and supporting documentation, together with notice 4 29 informing the respondent of the procedures required by this 4 30 chapter, to a process server for immediate service upon the 4 31 respondent. The process server shall serve the respondent in 4 32 plain clothes via an unmarked car, if the judge, magistrate, 4 33 or referee so requires. 4 34 Sec. 8. NEW SECTION. 229B.6 PROCEDURE AFTER APPLICATION 4 35 IS FILED. 5 1 As soon as practicable after the filing of an application 5 2 for an outpatient treatment order, the court shall do all of 5 3 the following: 5 4 1. Determine whether the respondent has an attorney to 5 5 represent the respondent in the proceeding on the outpatient 5 6 treatment order. If the court determines that the respondent 5 7 does not have an attorney, the court shall determine whether 5 8 the respondent is financially able to employ an attorney and 5 9 is capable of meaningfully assisting in selecting one. 5 10 If the respondent is unable to obtain an attorney for lack 5 11 of funds, or is unable to meaningfully choose and retain an 5 12 attorney, the court shall assign an attorney to represent the 5 13 respondent. 5 14 If the respondent is financially unable to pay an attorney, 5 15 the attorney shall be compensated in substantially the manner 5 16 provided by section 815.7, except that if the county has a 5 17 public defender, the court may designate the public defender 5 18 or an attorney on the public defender's staff to act as the 5 19 respondent's attorney. 5 20 The respondent's attorney shall represent the respondent at 5 21 all stages of the proceedings, and shall represent the 5 22 respondent at hearing on the outpatient treatment order. 5 23 2. Determine whether the respondent has an assigned 5 24 patient advocate. If not, the court shall attempt to 5 25 determine if the respondent has a county of legal settlement. 5 26 If the respondent has a county of legal settlement, the court 5 27 shall assign the patient advocate from that county to the 5 28 respondent. If the respondent is determined to be a state 5 29 case, or if the court is unable to determine the county of 5 30 legal settlement prior to the time of the hearing, or in any 5 31 other circumstance, the court shall assign to the respondent 5 32 the patient advocate in the county in which the court has 5 33 venue. 5 34 3. Cause copies of the application and supporting 5 35 documentation to be sent for review to the county attorney, 6 1 the respondent's attorney of record, and the patient advocate. 6 2 The application and supporting documentation shall be 6 3 personally delivered by a method that assures confidentiality. 6 4 4. Issue a written order that requires an examination of 6 5 the respondent, prior to the hearing, by one or more able and 6 6 willing psychiatrists, or, if none are available, by one or 6 7 more licensed physicians who shall submit a written report on 6 8 the examination to the court as required by section 229B.7. 6 9 Sec. 9. NEW SECTION. 229B.7 PHYSICIAN'S EXAMINATION – 6 10 REPORT. 6 11 1. An examination of the respondent shall be conducted by 6 12 one or more licensed physicians, as required by the court's 6 13 order, within two business days. The court shall make every 6 14 reasonable effort to assign the examination to a qualified 6 15 licensed psychiatrist. 6 16 2. If the respondent so desires, the respondent shall be 6 17 entitled to a separate examination by a licensed psychiatrist, 6 18 licensed physician, or qualified mental health professional of 6 19 the respondent's own choice. The reasonable cost of such 6 20 separate examination shall, if the respondent lacks sufficient 6 21 funds to pay the cost, be paid from county funds upon order of 6 22 the court. 6 23 3. A licensed physician conducting an examination pursuant 6 24 to this section may consult with or request the participation 6 25 in the examination of any qualified mental health 6 26 professional, and may include with or attach to the written 6 27 report of the examination any findings or observations of such 6 28 professional. 6 29 4. The psychiatrist or licensed physician or physicians 6 30 assigned to conduct the examination pursuant to section 6 31 229B.6, subsection 4, shall immediately inform the court if 6 32 the respondent declines to be examined. If the court is 6 33 informed that the respondent has declined to be examined by 6 34 the psychiatrist or licensed physician or physicians pursuant 6 35 to the court order, and if the court believes that it will 7 1 prove helpful, the court may order the assigned patient 7 2 advocate to assist in encouraging the respondent to comply 7 3 with the examination order. If necessary, the court may order 7 4 such limited detention of the respondent as is required to 7 5 facilitate the examination of the respondent by the 7 6 psychiatrist or licensed physician or physicians who have been 7 7 ordered pursuant to section 229B.6, subsection 4, to examine 7 8 the respondent, but in no event shall the detention last 7 9 longer than twenty-four hours. 7 10 5. The psychiatrist or physician shall file a written 7 11 report of the examination as soon as possible. The court 7 12 shall encourage the examining psychiatrist or physician to 7 13 file the report at least twenty-four hours before the hearing 7 14 to assist all parties in preparing for the hearing. A written 7 15 report of any psychiatrist, physician, or qualified mental 7 16 health professional chosen by the respondent may be similarly 7 17 filed with the clerk of the district court. The clerk shall 7 18 immediately cause any report to be shown to the judge who 7 19 issued the order, to the respondent's attorney of record, and 7 20 the county attorney. 7 21 Sec. 10. NEW SECTION. 229B.8 CLINICAL OR OBJECTIVELY 7 22 OBSERVABLE EVIDENCE OF FORESEEABLE DANGEROUSNESS. 7 23 Unless the respondent refuses to cooperate with the 7 24 psychiatrist or physician in the examination, the evidence for 7 25 a determination that the requirements of section 229B.3 have 7 26 been met must include evidence of objectively observable 7 27 events such as contained in section 229B.17, subsection 1, 7 28 paragraph "b", in addition to the clinical examination. 7 29 Sec. 11. NEW SECTION. 229B.9 ORDER FOR INPATIENT 7 30 TREATMENT. 7 31 1. If in the opinion of the chief medical officer, or the 7 32 chief medical officer's agent, a person ordered to that 7 33 facility or program on an outpatient basis under this chapter 7 34 is seriously mentally impaired as defined in section 229.1, 7 35 subsection 15, and would be more appropriately placed in 8 1 inpatient status or in an alternative placement, or other more 8 2 highly supervised setting than ordered outpatient treatment, 8 3 the chief medical officer, or the chief medical officer's 8 4 agent, shall initiate an application for an order of 8 5 involuntary hospitalization pursuant to section 229.6. 8 6 2. If the court orders immediate custody pursuant to 8 7 section 229.11, the respondent may be treated in accordance 8 8 with the provisions of the outpatient treatment order, or any 8 9 modifications thereof, in accordance with section 229B.12, 8 10 while in custody awaiting the involuntary hospitalization 8 11 hearing, notwithstanding the provisions of section 229.14, 8 12 subsection 3; section 229.15, subsection 2; section 229.23, 8 13 subsection 2; and the Iowa supreme court rules for involuntary 8 14 hospitalization. 8 15 3. If the respondent is a physical danger to the 8 16 respondent or others while in custody awaiting a hearing under 8 17 section 229.6, the respondent may be treated in accordance 8 18 with the provisions of section 229.23, subsection 2, to 8 19 preserve the respondent's life or to avoid physical injury to 8 20 the respondent or others. 8 21 4. If in the chief medical officer's opinion the 8 22 respondent should be immediately detained before the hearing 8 23 under section 229.6, but there are no means of immediate 8 24 access to the district court, an emergency detention may be 8 25 initiated in accordance with the procedures in section 229.22. 8 26 Sec. 12. NEW SECTION. 229B.10 OUTPATIENT TREATMENT 8 27 HEARING PROCEDURE. 8 28 1. At the outpatient treatment order hearing, evidence in 8 29 support of the contentions made in the application shall be 8 30 presented by the county attorney. 8 31 2. During the hearing, the applicant and the respondent 8 32 shall have an opportunity to testify. 8 33 3. The county attorney and the respondent may present and 8 34 cross-examine witnesses, and the court may receive the 8 35 testimony of family members of the respondent or of any other 9 1 interested person. 9 2 4. The respondent has the right to be present at the 9 3 hearing. If the respondent exercises that right and has been 9 4 medicated within twelve hours, or such longer period of time 9 5 as the court may designate, prior to the beginning of the 9 6 hearing or an adjourned session thereof, the judge shall be 9 7 informed of that fact and of the probable effects of the 9 8 medication upon convening of the hearing. 9 9 5. All persons not necessary for the conduct of the 9 10 proceeding shall be excluded, except that the court may admit 9 11 persons having a legitimate interest in the proceeding and 9 12 shall permit the respondent's patient advocate to attend the 9 13 hearing. 9 14 6. Upon the motion of the county attorney, the court may 9 15 in exceptional circumstances exclude the respondent during a 9 16 witness's testimony if the court determines that it would be 9 17 so antitherapeutic for the respondent to be present during 9 18 that testimony that it justifies overriding the respondent's 9 19 right to be present at the hearing. 9 20 7. The respondent's welfare shall be paramount and the 9 21 hearing shall be conducted in as informal a manner as may be 9 22 consistent with orderly procedure, but the issue shall be 9 23 tried as a civil matter. 9 24 a. Discovery as is permitted under the Iowa rules of civil 9 25 procedure shall be available to all parties. 9 26 b. The court shall receive all relevant and material 9 27 evidence that may be offered and need not be bound by the 9 28 rules of evidence. 9 29 c. There shall be a presumption in favor of the 9 30 respondent, and the burden of evidence in support of the 9 31 contentions made in the application shall be upon the 9 32 applicant. 9 33 8. If upon completion of the hearing the court finds that 9 34 the contention that the respondent should be ordered to 9 35 outpatient treatment has not been sustained by clear and 10 1 convincing evidence, the court shall deny the application and 10 2 terminate the proceeding. 10 3 9. The clerk of the district court shall furnish copies of 10 4 any orders to the respondent, and to the applicant if the 10 5 applicant files a written waiver signed by the respondent. 10 6 Sec. 13. NEW SECTION. 229B.11 EVALUATION AND ORDER. 10 7 If the court finds that the evidence presented at the 10 8 hearing demonstrates that the respondent meets the criteria 10 9 set forth in section 229B.3 by clear and convincing evidence, 10 10 the court shall immediately order the respondent to an 10 11 outpatient treatment facility or program, subject to the 10 12 requirements of section 229B.12. 10 13 Sec. 14. NEW SECTION. 229B.12 TREATMENT PLAN – CHOICE 10 14 OF PROVIDER – ADVANCE DIRECTIVE. 10 15 1. The chief medical officer of the facility or program 10 16 where the respondent is treated as an outpatient, or the chief 10 17 medical officer's agent, shall submit to the clerk of the 10 18 district court, as soon as practical, but no later than thirty 10 19 days after the respondent has been ordered as an outpatient, a 10 20 treatment plan, including any outpatient treatment 10 21 recommendations that the respondent is required to follow. 10 22 2. The chief medical officer of the facility or program to 10 23 which the respondent has been ordered as an outpatient shall 10 24 submit a copy of the treatment plan to the clerk of the 10 25 district court. 10 26 3. The clerk of the district court shall send a copy of 10 27 the outpatient treatment recommendations that the respondent 10 28 is required to follow to the court, to the respondent's 10 29 patient advocate, and to the respondent's attorney of record, 10 30 who may relay the respondent's objections to the treatment 10 31 plan, if any, and provide alternative treatment 10 32 recommendations. 10 33 4. The court may accept the chief medical officer's 10 34 treatment plan or require a revised treatment plan. 10 35 5. If the respondent wishes to receive outpatient 11 1 treatment from a licensed physician, qualified mental health 11 2 professional, or treatment facility that is willing to treat 11 3 the respondent as a court-ordered outpatient, the court shall 11 4 order the respondent to the care of that physician, qualified 11 5 mental health professional, or facility upon the respondent's 11 6 written request, provided that if the chosen provider is not a 11 7 contract provider with the county of legal settlement, the 11 8 county of legal settlement, state, or other government payor 11 9 shall only be obligated to pay to the noncontract provider the 11 10 average cost paid for ordered outpatient treatment to contract 11 11 providers. 11 12 6. A respondent may execute an advance directive, or 11 13 durable power of attorney for health care decisions, in 11 14 accordance with chapter 144B. If validly executed, a durable 11 15 power of attorney for health care decisions shall be binding 11 16 on the court and on any treating mental health professional 11 17 provided that the decisions made by the agent possessing the 11 18 power of attorney, and the instructions, if any, to the agent 11 19 in the executed power of attorney for health care decisions 11 20 are within accepted medical standards and practices. If 11 21 disputed, decisions regarding an advance directive or durable 11 22 power of attorney for health care decisions shall be made by 11 23 the judicial trier of fact under this section. This section 11 24 does not require a physician or qualified mental health 11 25 professional to accept as an outpatient an individual who has 11 26 executed a durable power of attorney for health care decisions 11 27 that provides for treatment, either by instructions or by the 11 28 power of attorney's decision, that in the physician or 11 29 qualified mental health professional's judgment would not be 11 30 an appropriate treatment for the outpatient's condition. 11 31 Sec. 15. NEW SECTION. 229B.13 REVIEW HEARING. 11 32 1. For any respondent ordered to undergo outpatient 11 33 treatment, a review hearing shall be conducted every twelve 11 34 months to determine whether or not the respondent shall remain 11 35 under order to receive outpatient treatment. 12 1 2. At any review hearing: 12 2 a. The case for continued outpatient treatment shall be 12 3 presented by the county attorney. 12 4 b. The respondent shall have the right to an attorney, 12 5 including at a rehearing for probable cause under section 12 6 229B.18. 12 7 3. The court shall make the same determinations with 12 8 regard to the respondent's legal representation at each review 12 9 hearing in the same manner as required prior to an initial 12 10 hearing pursuant to section 229B.6, subsection 1. 12 11 4. At any review hearing, if the respondent has 12 12 substantially complied with the required treatment plan for 12 13 the prior twelve months, a rebuttable presumption arises that 12 14 the respondent has the capacity to make rational treatment 12 15 decisions. In deciding whether that presumption is overcome, 12 16 the court shall consider, among other factors, how frequently 12 17 and how recently the respondent has failed to follow 12 18 reasonable treatment recommendations, and whether such 12 19 failures, if any exist, have led to the respondent's 12 20 hospitalization, failure to be able to take care of the 12 21 respondent's basic needs for nourishment, shelter, clothing, 12 22 or health, or to the respondent's being dangerous to self or 12 23 others. 12 24 5. Yearly review hearings shall be conducted in accordance 12 25 with the procedures for initial hearings in section 229B.10, 12 26 except as specifically modified by this section. 12 27 Sec. 16. NEW SECTION. 229B.14 PERIODIC REPORTS. 12 28 1. The chief medical officer of the facility or program 12 29 where the respondent obtains treatment as an outpatient, or 12 30 the chief medical officer's agent, shall furnish reports on 12 31 the respondent's progress every six months to the court, to 12 32 the respondent's patient advocate, and to the respondent. 12 33 2. If in the chief medical officer's opinion providing a 12 34 copy of a report to the respondent would substantially hinder 12 35 the respondent's progress, and the chief medical officer so 13 1 informs the court and the respondent's patient advocate, the 13 2 chief medical officer need not provide a copy of the progress 13 3 report to the respondent, unless the respondent makes an 13 4 affirmative request for one. 13 5 3. Even if the chief medical officer informs the court 13 6 that it would substantially hinder the respondent's progress 13 7 to receive a copy of the report, the chief medical officer 13 8 shall still provide a report to the court and to the 13 9 respondent's patient advocate. 13 10 Sec. 17. NEW SECTION. 229B.15 FAILURE TO TIMELY FILE 13 11 PROGRESS REPORTS. 13 12 1. If the progress reports required by section 229B.14 are 13 13 not filed in a timely manner or if services to a respondent 13 14 are not provided, the court shall so inform the single entry 13 15 point process and direct the single entry point process not to 13 16 compensate the outpatient treatment facility or program. 13 17 2. If the mental health facility or program where the 13 18 respondent obtains outpatient treatment does not provide 13 19 progress reports in a timely manner or if services to the 13 20 respondent are not provided, but the mental health facility or 13 21 program is compensated by federal, private, or other agency 13 22 not state or local, the mental health facility or program 13 23 where the respondent has obtained treatment may be penalized 13 24 by the court in the amount of compensation to which the 13 25 facility or program would otherwise be entitled. The amounts 13 26 collected from such penalties shall be distributed in a fair 13 27 manner to the counties as a surplusage or repayment for mental 13 28 health service expenditures incurred. 13 29 3. Judicial hospitalization referees shall have the 13 30 authority to assess penalties and issue orders under this 13 31 section. 13 32 Sec. 18. NEW SECTION. 229B.16 NOTIFICATION OF OUTPATIENT 13 33 NONCOMPLIANCE – RESPONSE. 13 34 1. If the respondent does not comply with the court's 13 35 order for outpatient treatment, the chief medical officer 14 1 shall promptly notify the court upon becoming aware of any 14 2 such noncompliance. 14 3 2. The court may take reasonable steps to ensure 14 4 compliance with the court's outpatient treatment order, 14 5 including, but not limited to, any or all of the following: 14 6 a. Directing that the respondent's patient advocate remind 14 7 the respondent of the respondent's treatment obligations and 14 8 attempt to persuade the noncompliant respondent to comply with 14 9 any required chemotherapy. 14 10 b. Presenting the respondent to the treatment facility or 14 11 program for treatment. 14 12 3. The court may order the respondent to appear before the 14 13 court. If necessary, the court may order the sheriff to bring 14 14 the respondent before the court. 14 15 4. Unless the court has good reason based upon past 14 16 experience with the respondent or the respondent's patient 14 17 advocate that the above methods will not be effective in 14 18 ensuring compliance with the court's outpatient treatment 14 19 order, or immediate treatment is necessary, the court shall 14 20 attempt to secure compliance by one or more of the above 14 21 reasonable steps before ordering the sheriff to bring the 14 22 noncompliant respondent to treatment. If necessary, the court 14 23 shall order the sheriff to bring the respondent to the 14 24 treatment facility or program for treatment. 14 25 Sec. 19. NEW SECTION. 229B.17 EVIDENCE – OUTPATIENT 14 26 TREATMENT ORDER. 14 27 1. In determining whether the criteria of section 229B.3 14 28 are met by clear and convincing evidence and therefore that 14 29 the respondent should be ordered to a treatment facility or 14 30 program, the court shall take into account, both as presently 14 31 experienced, and as likely to be the case in the reasonably 14 32 foreseeable future, at least the following evidence: 14 33 a. The subjective distress experienced by the respondent. 14 34 b. Any objectively observable functional impairment of the 14 35 respondent at work, in school, or in social interactions. 15 1 2. The same factors should be taken into account in 15 2 rehearings and writs under sections 229B.18 and 229B.19. 15 3 Sec. 20. NEW SECTION. 229B.18 REHEARING FOR PROBABLE 15 4 CAUSE. 15 5 1. A respondent, a family member, the respondent's 15 6 advocate, or an individual who can demonstrate that the person 15 7 has a substantial interest in the welfare of the respondent 15 8 may petition for a rehearing on the grounds that the 15 9 respondent no longer meets the criteria for ordered outpatient 15 10 treatment. 15 11 2. Upon probable cause that one or more of the required 15 12 criterion for an outpatient treatment order can no longer be 15 13 proven by clear and convincing evidence, the court shall grant 15 14 the petition and assign a rehearing no sooner than three 15 15 business days after notification to the respondent per section 15 16 229B.5, but within ten business days of the date of service of 15 17 the petition upon the respondent. 15 18 3. Probable cause may be demonstrated by affidavit, 15 19 medical report, or any other means deemed appropriate by the 15 20 court. 15 21 4. The procedure set out in this section shall not be 15 22 available: 15 23 a. Until the respondent has been subject to an outpatient 15 24 treatment order for six months. 15 25 b. More than once every six months regarding the same 15 26 respondent. 15 27 5. At any such hearing the respondent shall have the right 15 28 to an attorney. If the respondent cannot afford an attorney, 15 29 the court shall assign one in accordance with the procedures 15 30 in section 229B.6. 15 31 6. At any probable cause hearing, evidence in support of a 15 32 continued outpatient treatment order shall be presented by the 15 33 county attorney. 15 34 7. Review hearings shall be conducted in accordance with 15 35 the procedures set for initial hearings in section 229B.10. 16 1 Sec. 21. NEW SECTION. 229B.19 CHALLENGE TO ORDER FOR 16 2 OUTPATIENT TREATMENT. 16 3 1. All respondents ordered to outpatient treatment shall 16 4 be entitled to the benefit of a writ of unconstitutional 16 5 deprivation of liberty, which is analogous to a writ of habeas 16 6 corpus. 16 7 2. The question of the constitutionality of the order to 16 8 outpatient treatment shall be decided at a hearing on the 16 9 writ. The hearing shall be before the district court, 16 10 pursuant to this section and chapter 663. 16 11 3. If the judge decides that the respondent should be 16 12 ordered to outpatient treatment, such decision shall be no bar 16 13 to the issuing of the writ a second time, whenever it shall be 16 14 alleged that such respondent no longer meets constitutional 16 15 requirements for being ordered to outpatient treatment. 16 16 4. The respondent shall have the right to be represented 16 17 by an attorney at the hearing. If the respondent cannot 16 18 afford an attorney, the court shall appoint one for the 16 19 respondent. 16 20 5. The attorney shall be compensated by the county of 16 21 legal settlement of the respondent, or, if no county of legal 16 22 settlement exists, then by the state. The attorney shall be 16 23 compensated with a maximum fee of three hundred dollars, at an 16 24 hourly rate consistent with section 815.7, to be exceeded only 16 25 upon motion to the court for good cause shown. 16 26 Sec. 22. NEW SECTION. 229B.20 DISCHARGE. 16 27 1. When, in the opinion of the chief medical officer of 16 28 the treatment facility or program where the respondent has 16 29 obtained treatment, the respondent no longer requires 16 30 outpatient treatment, the chief medical officer shall 16 31 immediately notify the court, and explain in detail why the 16 32 respondent no longer needs outpatient treatment and why the 16 33 respondent no longer meets the criteria for an order of 16 34 outpatient treatment. 16 35 2. The court shall issue an order approving the 17 1 respondent's discharge from the outpatient treatment facility 17 2 or program, or in its discretion, may require a hearing be 17 3 held to determine whether the respondent still meets the 17 4 criteria for an outpatient treatment order. 17 5 3. To justify termination of an outpatient treatment 17 6 order, the chief medical officer's report must explain in 17 7 detail, including reasons and evidence, why one or more of the 17 8 legal criterion for an outpatient treatment order is no longer 17 9 satisfied. A report by the chief medical officer asserting 17 10 only that the respondent no longer requires outpatient 17 11 treatment is insufficient to justify termination of an 17 12 outpatient treatment order. 17 13 4. The clerk of the district court shall send a copy of 17 14 the chief medical officer's recommendation and the court's 17 15 order to the respondent's patient advocate, and to the 17 16 respondent. 17 17 Sec. 23. NEW SECTION. 229B.21 TREATMENT PENDING APPEAL. 17 18 When a respondent appeals to the supreme court the decision 17 19 that the respondent should be ordered to outpatient treatment, 17 20 and the respondent was ordered to a treatment facility or 17 21 program before the court is informed of the respondent's 17 22 intent to appeal its finding, the respondent shall follow any 17 23 treatment plan prescribed by the chief medical officer of the 17 24 facility or program, or the officer's agent, and approved by 17 25 the court, even if the treatment plan or approval thereof 17 26 postdates the appeal, unless the supreme court orders 17 27 otherwise. 17 28 Sec. 24. NEW SECTION. 229B.22 CONFIDENTIALITY. 17 29 1. The medical records of any examining licensed physician 17 30 or treatment facility or program that treats any respondent 17 31 under this chapter shall be confidential in accordance with 17 32 the provisions in section 229.25 and chapter 228. 17 33 2. The records of proceedings for outpatient treatment 17 34 pursuant to this chapter shall be confidential in accordance 17 35 with the terms in section 229.24, chapter 228, and federal 18 1 law. 18 2 Sec. 25. NEW SECTION. 229B.23 PROVISION OF SUMMARY OF 18 3 PROCEDURES TO APPLICANT IN OUTPATIENT TREATMENT ORDER 18 4 APPLICATIONS. 18 5 1. The department of human services, in consultation with 18 6 the office of attorney general, shall develop a summary of the 18 7 procedures involved in outpatient treatment orders under this 18 8 chapter, and applications for information concerning the 18 9 participation of an applicant in the proceedings. 18 10 2. The summary shall be provided by the department, at the 18 11 department's expense, to the clerks of the district court who 18 12 shall make the summary available to all applicants prior to 18 13 the filing of a verified application under section 229B.4, or 18 14 to any other person upon request, and who shall attach a copy 18 15 of the summary to the notice of hearing which is served upon 18 16 the respondent under section 229B.5. 18 17 3. The summary may include, but is not limited to, the 18 18 following: 18 19 a. The criteria under section 229B.3 for ordering a person 18 20 to outpatient treatment. 18 21 b. A description of the hearing process. 18 22 c. An explanation of the applicant's right to testify and 18 23 examples of the kinds of relevant information which may be 18 24 introduced at the hearing. 18 25 d. An explanation of the duties of the county attorney in 18 26 outpatient treatment proceedings. 18 27 4. The summary required under this section may be combined 18 28 in the summary required under section 229.45, or may be 18 29 separately provided. 18 30 Sec. 26. NEW SECTION. 229B.24 APPLICATION FILED WITHOUT 18 31 PROBABLE CAUSE OR GOOD FAITH BELIEF. 18 32 1. If the court determines that the respondent does not 18 33 meet the criteria for outpatient treatment set forth in 18 34 section 229B.3, and that the application was filed without 18 35 probable cause, the court may order a hearing to determine if 19 1 the applicant shall pay the costs of the hearing and medical 19 2 examination. 19 3 2. The applicant shall pay the costs of the hearing and 19 4 medical examination under this chapter if the court concludes 19 5 that the application was filed without probable cause. 19 6 Sec. 27. NEW SECTION. 229B.25 APPEAL TO DISTRICT COURT. 19 7 If the hearing is before a judicial hospitalization 19 8 referee, and the respondent is ordered to outpatient 19 9 treatment, the respondent may appeal to the district court 19 10 within ten business days of the judicial hospitalization 19 11 referee's order. If appealed to the district court, the trial 19 12 shall be de novo. 19 13 Sec. 28. Section 331.756, subsection 46, Code Supplement 19 14 1999, is amended to read as follows: 19 15 46. Carry out duties relating to the hospitalization and 19 16 outpatient treatment of personsforwith mental illness as 19 17 provided insection 229.12chapters 229 and 229B. 19 18 Sec. 29. SUPREME COURT FORM. The supreme court is 19 19 directed to develop and implement new forms necessary to 19 20 implement this chapter. 19 21 Sec. 30. IMPLEMENTATION OF ACT. Section 25B.2, subsection 19 22 3, shall not apply to this Act. 19 23 EXPLANATION 19 24 This bill creates new Code chapter 229B that establishes a 19 25 procedure for outpatient mental health treatment. 19 26 The bill sets forth definitions, and a section regarding 19 27 the applicability of the single entry point process. 19 28 New Code section 229B.3 sets forth the criteria for 19 29 obtaining an outpatient treatment order, and new Code section 19 30 229B.4 addresses the application process. 19 31 New Code section 229B.5 addresses service of process, and 19 32 new Code section 229B.6 sets forth prehearing requirements for 19 33 the court. 19 34 New Code section 229B.7 addresses the prehearing medical 19 35 examination of the respondent. 20 1 New Code section 229B.10 sets forth the procedures related 20 2 to the hearing on the outpatient treatment order. New Code 20 3 sections 229B.8, 229B.9, 229B.11, and 229B.17 address 20 4 evidentiary standards and issues relating to the hearing and 20 5 order. 20 6 New Code section 229B.12 addresses the posthearing 20 7 treatment plan, while new Code section 229B.13 addresses the 20 8 procedure for periodic review hearings. New Code section 20 9 229B.14 sets forth the requirements for progress reports on 20 10 the respondent's treatment, and new Code section 229B.15 sets 20 11 forth penalties for untimely filings of such progress reports. 20 12 New Code section 229B.16 addresses the procedures for 20 13 dealing with a respondent who does not comply with the 20 14 treatment order. 20 15 New Code section 229B.19 addresses the applicable 20 16 procedures for challenging the constitutionality of an order 20 17 to outpatient treatment, and new Code section 229.18 addresses 20 18 rehearings for probable cause. 20 19 New Code section 229B.20 addresses the procedure for 20 20 discharge from treatment, and new Code section 229B.21 20 21 addresses treatment pending appeal. 20 22 New Code section 229B.22 addresses confidentiality issues, 20 23 and new Code section 229B.23 requires the department of human 20 24 services to develop a summary of the procedures under this 20 25 chapter for applicants and respondents, similar to the summary 20 26 required for involuntary hospitalizations. 20 27 New Code section 229B.24 addresses payment of costs for 20 28 applications filed without probably cause or a good faith 20 29 belief. New Code section 229B.25 addresses appeals to 20 30 district court from hearings before judicial hospitalization 20 31 referees. 20 32 Corresponding amendments are made to Code section 331.756, 20 33 regarding duties of the county attorney, and Code section 20 34 228.6, regarding disclosure of mental health information. 20 35 The bill also contains a direction to the courts regarding 21 1 development of new forms to encompass the procedures 21 2 implemented by the new Code chapter. 21 3 This bill may include a state mandate as defined in Code 21 4 section 25B.3. This bill makes inapplicable Code section 21 5 25B.2, subsection 3, which would relieve a political 21 6 subdivision from complying with a state mandate if funding for 21 7 the cost of the state mandate is not provided or specified. 21 8 Therefore, political subdivisions are required to comply with 21 9 any state mandate included in this bill. 21 10 LSB 5145YC 78 21 11 jj/gg/8.1
Text: HSB00556 Text: HSB00558 Text: HSB00500 - HSB00599 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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