HF 123 (LSB 1763YH (6) 91)

HOUSE FILE 123

BY  A. MEYER

A BILL FOR

An Act relating to orders for treatment of persons experiencing psychiatric deterioration.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 125.75, subsection 2, paragraph a, Code 2025, is amended to read as follows:
   a.  State the applicant’s belief that the respondent is a person who is experiencing psychiatric deterioration as defined in section 229.1, or who presents a danger to self or others and lacks judgmental capacity due to either any of the following:
   (1)  A substance use disorder as defined in section 125.2.
   (2)  A serious mental impairment as defined in section 229.1.
    Sec. 2.  Section 218.46, subsection 2, Code 2025, is amended to read as follows:
   2.  The department may provide services and facilities for the scientific observation, rechecking, and treatment of persons with mental illness within the state. Application by, or on behalf of, any person for such services and facilities shall be made to the director on forms furnished by the department. The time and place of admission of any person to outpatient or clinical services and facilities for scientific observation, rechecking, and treatment and the use of such services and facilities for the benefit of persons who have already been hospitalized for psychiatric evaluation and appropriate treatment or involuntarily hospitalized as seriously mentally ill shall be in accordance with rules and regulations adopted by the department.
    Sec. 3.  Section 225.11, Code 2025, is amended to read as follows:
   225.11  Initiating commitment procedures.
   When a court finds upon completion of a hearing held pursuant to section 229.12 that the contention that a respondent is seriously mentally impaired, or is experiencing psychiatric deterioration, has been sustained by clear and convincing evidence, and the application filed under section 229.6 also contends or the court otherwise concludes that it would be appropriate to refer the respondent to the state psychiatric hospital for a complete psychiatric evaluation and appropriate treatment pursuant to section 229.13, the judge may order that a financial investigation be made in the manner prescribed by section 225.13. If the costs of a respondent’s evaluation or treatment are payable in whole or in part by a county, an order under this section shall be for referral of the respondent through the regional administrator for the respondent’s county of residence for an evaluation and referral of the respondent to an appropriate placement or service, which may include the state psychiatric hospital for additional evaluation or treatment. 
    Sec. 4.  Section 229.1, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  16A.  “Psychiatric deterioration” means a deterioration of a person’s mental health described by all of the following:
   a.  The deterioration makes the person unable to understand the need to treat the person’s mental health condition.
   b.  Based on the person’s history the person is unlikely to seek treatment for the deterioration.
   c.  Within a reasonable degree of medical certainty, unless the person receives treatment, the deterioration is likely to continue until the person has a serious mental impairment.
    Sec. 5.  Section 229.4, subsection 3, Code 2025, is amended to read as follows:
   3.  If the chief medical officer of the hospital, not later than the end of the next secular business day on which the office of the clerk of the district court for the county in which the hospital is located is open and which follows the submission of the written request for release of the patient, files with that clerk a certification that in the chief medical officer’s opinion the patient is seriously mentally impaired, or experiencing psychiatric deterioration, the release may be postponed for the period of time the court determines is necessary to permit commencement of judicial procedure for involuntary hospitalization. That period of time may not exceed five days, exclusive of days on which the clerk’s office is not open unless the period of time is extended by order of a district court judge for good cause shown. Until disposition of the application for involuntary hospitalization of the patient is determined, if an application is timely filed, the chief medical officer may detain the patient in the hospital and may provide treatment which is necessary to preserve the patient’s life, or to appropriately control behavior by the patient which is likely to result in physical injury to the patient or to others if allowed to continue, but may not otherwise provide treatment to the patient without the patient’s consent.
    Sec. 6.  Section 229.5, Code 2025, is amended to read as follows:
   229.5  Departure without notice.
   If a voluntary patient departs from the hospital without notice, and in the opinion of the chief medical officer the patient is seriously mentally impaired, or experiencing psychiatric deterioration, the chief medical officer may file an application on the departed voluntary patient pursuant to section 229.6, and request that an order for immediate custody be entered by the court pursuant to section 229.11.
    Sec. 7.  Section 229.6, subsection 2, paragraph a, Code 2025, is amended to read as follows:
   a.  State the applicant’s belief that the respondent is a person who is experiencing psychiatric deterioration, or who presents a danger to self or others and lacks judgmental capacity due to either any of the following:
   (1)  A substance use disorder as defined in section 125.2.
   (2)  A serious mental impairment as defined in section 229.1.
    Sec. 8.  Section 229.10, subsections 3 and 4, Code 2025, are amended to read as follows:
   3.  If the report of one or more of the court-designated physicians or mental health professionals is to the effect that the individual is not seriously mentally impaired and is not experiencing psychiatric deterioration, the court shall without taking further action terminate the proceeding and dismiss the application on its own motion and without notice.
   4.  If the report of one or more of the court-designated physicians or mental health professionals is to the effect that the respondent is seriously mentally impaired, or is experiencing psychiatric deterioration, the court shall schedule a hearing on the application as soon as possible. The hearing shall be held not more than forty-eight hours after the report is filed, excluding Saturdays, Sundays and holidays, unless an extension for good cause is requested by the respondent, or as soon thereafter as possible if the court considers that sufficient grounds exist for delaying the hearing.
    Sec. 9.  Section 229.11, subsection 1, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   If the applicant requests that the respondent be taken into immediate custody and the judge, upon reviewing the application and accompanying documentation, finds probable cause to believe that the respondent has a serious mental impairment and is likely to injure the respondent or other persons if allowed to remain at liberty, or the respondent is experiencing psychiatric deterioration, the judge may enter a written order directing that the respondent be taken into immediate custody by the sheriff or the sheriff’s deputy and be detained until the hospitalization hearing. The hospitalization hearing shall be held no more than five days after the date of the order, except that if the fifth day after the date of the order is a Saturday, Sunday, or a holiday, the hearing may be held on the next succeeding business day. If the expenses of a respondent are payable in whole or in part by a mental health and disability services region, for a placement in accordance with paragraph “a”, the judge shall give notice of the placement to the regional administrator for the county in which the court is located, and for a placement in accordance with paragraph “b” or “c”, the judge shall order the placement in a hospital or facility designated through the regional administrator. The judge may order the respondent detained for the period of time until the hearing is held, and no longer, in accordance with paragraph “a”, if possible, and if not then in accordance with paragraph “b”, or, only if neither of these alternatives is available, in accordance with paragraph “c”. Detention may be in any of the following:
    Sec. 10.  Section 229.12, subsection 3, paragraph c, Code 2025, is amended to read as follows:
   c.  If upon completion of the hearing the court finds that the contention that the respondent is seriously mentally impaired, or is experiencing psychiatric deterioration, has not been sustained by clear and convincing evidence, it shall deny the application and terminate the proceeding.
    Sec. 11.  Section 229.13, subsection 1, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   If upon completion of the hospitalization hearing the court finds by clear and convincing evidence that the respondent has a serious mental impairment, or is experiencing psychiatric deterioration, the court shall order the respondent committed as expeditiously as possible for a complete psychiatric evaluation and appropriate treatment as follows:
    Sec. 12.  Section 229.13, subsection 7, paragraph a, subparagraph (3), Code 2025, is amended to read as follows:
   (3)  If the respondent chooses to be treated by the appropriate medication which may include the use of oral medicine or injectable antipsychotic medicine but the mental health professional acting within the scope of the mental health professional’s practice at the outpatient psychiatric clinic, hospital, or other suitable facility determines that the respondent’s behavior continues to be likely to result in physical injury to the respondent’s self or others if allowed to continue, the mental health professional acting within the scope of the mental health professional’s practice shall comply with the provisions of subparagraph (1) and, following notice and hearing held in accordance with the procedures in section 229.12, the court may order the respondent treated on an inpatient basis requiring full-time custody, care, and treatment in a hospital until such time as the chief medical officer reports that the respondent does not require further treatment for serious mental impairment or psychiatric deterioration, or has indicated the respondent is willing to submit to treatment on another basis as ordered by the court.
    Sec. 13.  Section 229.14, subsection 1, paragraphs a, b, c, and d, Code 2025, are amended to read as follows:
   a.  That the respondent does not, as of the date of the report, require further treatment for serious mental impairment or psychiatric deterioration. If the report so states, the court shall order the respondent’s immediate release from involuntary hospitalization and terminate the proceedings.
   b.  That the respondent is seriously mentally impaired and or experiencing psychiatric deterioration, is in need of full-time custody, care, and inpatient treatment in a hospital, and is considered likely to benefit from treatment. The report shall include the chief medical officer’s recommendation for further treatment.
   c.  That the respondent is seriously mentally impaired or experiencing psychiatric deterioration, and is in need of treatment, but does not require full-time hospitalization. If the report so states, it shall include the chief medical officer’s recommendation for treatment of the respondent on an outpatient or other appropriate basis.
   d.  The respondent is seriously mentally impaired or experiencing psychiatric deterioration, and is in need of full-time custody and care, but is unlikely to benefit from further inpatient treatment in a hospital. The report shall include the chief medical officer’s recommendation for an appropriate alternative placement for the respondent.
    Sec. 14.  Section 229.14, subsection 2, paragraph d, Code 2025, is amended to read as follows:
   d.  If the court orders treatment of the respondent on an outpatient or other appropriate basis as described in the chief medical officer’s report pursuant to subsection 1, paragraph “c”, the order shall provide that, should the respondent fail or refuse to submit to treatment in accordance with the court’s order, the court may order that the respondent be taken into immediate custody as provided by section 229.11 and, following notice and hearing held in accordance with the procedures of section 229.12, may order the respondent treated on an inpatient basis requiring full-time custody, care, and treatment in a hospital until such time as the chief medical officer reports that the respondent does not require further treatment for serious mental impairment or psychiatric deterioration, or has indicated the respondent is willing to submit to treatment on another basis as ordered by the court. If a patient is transferred for treatment to another provider under this paragraph, the treatment provider who will be providing the outpatient or other appropriate treatment shall be provided with copies of relevant court orders by the former treatment provider.
    Sec. 15.  Section 229.16, Code 2025, is amended to read as follows:
   229.16  Discharge and termination of proceeding.
   When the condition of a patient who is hospitalized pursuant to a report issued under section 229.14, subsection 1, paragraph “b”, or is receiving treatment pursuant to a report issued under section 229.14, subsection 1, paragraph “c”, or is in full-time care and custody pursuant to a report issued under section 229.14, subsection 1, paragraph “d”, is such that in the opinion of the chief medical officer the patient no longer requires treatment or care for serious mental impairment, or psychiatric deterioration, the chief medical officer shall tentatively discharge the patient and immediately report that fact to the court which ordered the patient’s hospitalization or care and custody. Upon receiving the report, the court shall issue an order confirming the patient’s discharge from the hospital or from care and custody, as the case may be, and shall terminate the proceedings pursuant to which the order was issued. Copies of the order shall be sent by regular mail to the hospital, the patient, and the applicant if the applicant has filed a written waiver signed by the patient.
    Sec. 16.  Section 229.17, Code 2025, is amended to read as follows:
   229.17  Status of respondent during appeal.
   If a respondent appeals to the supreme court from a finding that the contention the respondent is seriously mentally impaired, or is experiencing psychiatric deterioration, has been sustained, and the respondent was previously ordered taken into immediate custody under section 229.11 or has been hospitalized for psychiatric evaluation and appropriate treatment under section 229.13 before the court is informed of intent to appeal its finding, the respondent shall remain in custody as previously ordered by the court, the time limit stated in section 229.11 notwithstanding, or shall remain in the hospital subject to compliance by the hospital with sections 229.13 through 229.16, as the case may be, unless the supreme court orders otherwise. If a respondent appeals to the supreme court regarding a placement order, the respondent shall remain in placement unless the supreme court orders otherwise.
    Sec. 17.  Section 229.19, subsection 1, paragraph c, Code 2025, is amended to read as follows:
   c.  The advocate’s responsibility with respect to any patient shall begin at whatever time the attorney employed or appointed to represent that patient as respondent in hospitalization proceedings, conducted under sections 229.6 through 229.13, reports to the court that the attorney’s services are no longer required and requests the court’s approval to withdraw as counsel for that patient. However, if the patient is found to be seriously mentally impaired, or experiencing psychiatric deterioration, at the hospitalization hearing, the attorney representing the patient shall automatically be relieved of responsibility in the case and an advocate shall be assigned to the patient at the conclusion of the hearing unless the attorney indicates an intent to continue the attorney’s services and the court so directs. If the court directs the attorney to remain on the case, the attorney shall assume all the duties of an advocate. The clerk shall furnish the advocate with a copy of the court’s order approving the withdrawal and shall inform the patient of the name of the patient’s advocate.
    Sec. 18.  Section 229.21, subsection 3, paragraphs a and b, Code 2025, are amended to read as follows:
   a.  Any respondent with respect to whom the magistrate or judicial hospitalization referee has found the contention that the respondent is seriously mentally impaired, is experiencing psychiatric deterioration, or is a person with a substance use disorder sustained by clear and convincing evidence presented at a hearing held under section 229.12 or section 125.82, may appeal from the magistrate’s or referee’s finding to a judge of the district court by giving the clerk notice in writing, within ten days after the magistrate’s or referee’s finding is made, that an appeal is taken. The appeal may be signed by the respondent or by the respondent’s next friend, guardian, or attorney.
   b.  An order of a magistrate or judicial hospitalization referee with a finding that the respondent is seriously mentally impaired, is experiencing psychiatric deterioration, or is a person with a substance use disorder shall include the following notice, located conspicuously on the face of the order:
  NOTE:  The respondent may appeal from this order to a judge of the district court by giving written notice of the appeal to the clerk of the district court within ten days after the date of this order. The appeal may be signed by the respondent or by the respondent’s next friend, guardian, or attorney. For a more complete description of the respondent’s appeal rights, consult section 229.21 of the Code of Iowa or an attorney.
    Sec. 19.  Section 229.22, subsection 1, Code 2025, is amended to read as follows:
   1.  The procedure prescribed by this section shall be used when it appears that a person should be immediately detained due to serious mental impairment or psychiatric deterioration, but an application has not been filed naming the person as the respondent pursuant to section 229.6, and the person cannot be ordered into immediate custody and detained pursuant to section 229.11.
    Sec. 20.  Section 229.22, subsection 2, paragraph a, subparagraph (4), subparagraph division (a), Code 2025, is amended to read as follows:
   (a)  If the examining physician, examining physician assistant, examining mental health professional, or examining psychiatric advanced registered nurse practitioner finds that there is reason to believe that the person is seriously mentally impaired, and because of that impairment is likely to physically injure the person’s self or others if not immediately detained, or the person is experiencing psychiatric deterioration, the facility shall have the authority to detain the person for a period of no longer than twelve hours. Within twelve hours of detaining a person pursuant to this section, the examining physician, examining physician assistant, examining mental health professional, or examining psychiatric advanced registered nurse practitioner shall communicate with the nearest available magistrate. 
    Sec. 21.  Section 229.22, subsection 2, paragraph b, Code 2025, is amended to read as follows:
   b.  If the magistrate orders that the person be detained, the magistrate shall, by the close of business on the next working day, file a written order with the clerk in the county where it is anticipated that an application may be filed under section 229.6. The order may be filed by facsimile if necessary. A peace officer from the law enforcement agency that took the person into custody, if no request was made under paragraph “a”, may inform the magistrate that an arrest warrant has been issued for or charges are pending against the person and request that any written order issued under this paragraph require the facility or hospital to notify the law enforcement agency about the discharge of the person prior to discharge. The order shall state the circumstances under which the person was taken into custody or otherwise brought to a facility or hospital, and the grounds supporting the finding of probable cause to believe that the person is seriously mentally impaired and likely to injure the person’s self or others if not immediately detained, or the person is experiencing psychiatric deterioration. The order shall also include any law enforcement agency notification requirements if applicable. The order shall confirm the oral order authorizing the person’s detention including any order given to transport the person to an appropriate facility or hospital. A peace officer from the law enforcement agency that took the person into custody may also request an order, separate from the written order, requiring the facility or hospital to notify the law enforcement agency about the discharge of the person prior to discharge. The clerk shall provide a copy of the written order or any separate order to the chief medical officer of the facility or hospital to which the person was originally taken, to any subsequent facility to which the person was transported, and to any law enforcement department, ambulance service, or transportation service under contract with a mental health and disability services region that transported the person pursuant to the magistrate’s order. A transportation service that contracts with a mental health and disability services region for purposes of this paragraph shall provide a secure transportation vehicle and shall employ staff that has received or is receiving mental health training.
    Sec. 22.  Section 229.26, Code 2025, is amended to read as follows:
   229.26  Exclusive procedure for involuntary hospitalization.
   Sections 229.6 through 229.19 constitute the exclusive procedure for involuntary hospitalization of persons by reason of serious mental impairment, or psychiatric deterioration, in this state, except that this chapter does not negate the provisions of section 904.503 relating to transfer of prisoners with mental illness to state mental health institutes and does not apply to commitments of persons under chapter 812 or the rules of criminal procedure, Iowa court rules, or negate the provisions of section 232.51 relating to disposition of children with mental illness.
    Sec. 23.  Section 229.28, subsection 1, unnumbered paragraph 1, Code 2025, is amended to read as follows:
   When a court finds that the contention that a respondent is seriously mentally impaired, or is experiencing psychiatric deterioration, has been sustained or proposes to order continued hospitalization of any person, or an alternative placement, as described under section 229.14, subsection 1, paragraph “b” or “d”, and the court is furnished evidence that the respondent or patient is eligible for care and treatment in a facility operated by the United States department of veterans affairs or another agency of the United States government and that the facility is willing to receive the respondent or patient, the court may so order.
    Sec. 24.  Section 229.31, Code 2025, is amended to read as follows:
   229.31  Commission of inquiry.
   A sworn complaint, alleging that a named person is not seriously mentally impaired or experiencing psychiatric deterioration, and is unjustly deprived of liberty in any hospital in the state, may be filed by any person with the clerk of the district court of the county in which such named person is so confined, or of the county in which such named person is a resident. Upon receiving the complaint, a judge of that court shall appoint a commission of not more than three persons to inquire into the truth of the allegations. One of the commissioners shall be a physician and if additional commissioners are appointed, one of the additional commissioners shall be a lawyer.
    Sec. 25.  Section 229.33, Code 2025, is amended to read as follows:
   229.33  Hearing.
   If, on such report and statement, and the hearing of testimony if any is offered, the judge shall find that such person is not seriously mentally impaired, and is not experiencing psychiatric deterioration, the judge shall order the person’s discharge; if the contrary, the judge shall so state, and authorize the continued detention of the person, subject to all applicable requirements of this chapter.
    Sec. 26.  Section 229.37, Code 2025, is amended to read as follows:
   229.37  Habeas corpus.
   All persons confined as seriously mentally impaired, or as experiencing psychiatric deterioration, shall be entitled to the benefit of the writ of habeas corpus, and the question of serious mental impairment, or psychiatric deterioration, shall be decided at the hearing. If the judge shall decide that the person is seriously mentally impaired, or experiencing psychiatric deterioration, such decision shall be no bar to the issuing of the writ a second time, whenever it shall be alleged that such person is no longer seriously mentally impaired or experiencing psychiatric deterioration.
    Sec. 27.  Section 602.8102, subsection 41, Code 2025, is amended to read as follows:
   41.  Carry out duties relating to the involuntary commitment of persons with mental impairments commitments as provided in chapter 125 and involuntary hospitalizations as provided in chapter 229.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to orders for treatment of persons experiencing psychiatric deterioration.
   Under current law, a court may order the treatment of a person if the court finds by clear and convincing evidence that the person is seriously mentally impaired. The bill allows a court to also order the treatment of a person if the court finds by clear and convincing evidence that the person is experiencing psychiatric deterioration. The bill defines “psychiatric deterioration” as a deterioration of a person’s mental health such that based on that person’s history the person is unlikely to seek treatment, the person is unable to understand the need to treat the person’s mental health condition, and, within a reasonable degree of medical certainty, the person is likely to continue to deteriorate until they have a serious mental impairment unless they receive treatment.
   The bill makes conforming changes to Code sections 125.75 (substance abuse disorders —— application), 218.46 (scientific investigation), 225.11 (psychiatric hospital —— initiating commitment procedures), and 602.8102 (clerk of district court —— general duties) and Code chapter 229 (hospitalization of persons with mental illness).