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Connecticut Public Acts 1996

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Substitute Senate Bill No. 295

PUBLIC ACT NO. 96-215

AN ACT CONCERNING PATIENT'S RIGHTS, THE ESTABLISHMENT OF A TASK FORCE TO STUDY INVOLUNTARY OUTPATIENT COMMITMENT AND COMPETENCY TO STAND TRIAL.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 17a-543 of the general statutes, as amended by section 48 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(a) No patient shall receive medication for the treatment of the psychiatric disabilities of such patient without the informed consent of such patient, except in accordance with procedures set forth in subsections (b), (d), (e) and (f) of this section or in accordance with section 17a-566 or 54-56d AS AMENDED.

(b) No medical or surgical procedures may be performed without the patient's written informed consent or, if the patient has been declared incapable of caring for himself or herself pursuant to sections 45a-644 to 45a-662, inclusive, AS AMENDED and a conservator of the person has been appointed pursuant to section 45a-650, the written consent of such conservator. If the head of the hospital, in consultation with a physician, determines that the condition of an involuntary patient not declared incapable of caring for himself or herself pursuant to said sections is of an extremely critical nature and such patient is incapable of informed consent, medical or surgical procedures may be performed with the written informed consent of: (1) The patient's guardian, if he or she has one; or (2) such person's next of kin; or (3) a qualified physician appointed by a judge of the Probate Court. Notwithstanding the provisions of this section, if obtaining the consent provided for in this section would cause a medically harmful delay to a voluntary or involuntary patient whose condition is of an extremely critical nature, as determined by personal observation by a physician or the senior clinician on duty, emergency treatment may be provided without consent.

(c) No psychosurgery or shock therapy shall be administered to any patient without such patient's written informed consent, except as provided in this subsection. Such consent shall be for a maximum period of thirty days and may be revoked at any time. If it is determined by the head of the hospital and two qualified physicians that the patient has become incapable of giving informed consent, shock therapy may be administered upon order of the Court of Probate if, after hearing, such court finds that the patient is incapable of informed consent and there is no other reasonable alternative procedure.

(d) A facility may establish an internal procedure governing decisions concerning involuntary medication treatment for inpatients. This procedure shall provide (1) that any decision concerning involuntary medication treatment shall be made by a person who is not employed by the facility in which the patient is receiving treatment, provided the selection of such person shall not be made until the patient's advocate has had reasonable opportunity to discuss such selection with the facility, (2) written and oral notification to the patient of available advocacy services, (3) NOTICE TO THE PATIENT AND HIS ADVOCATE, IF ONE HAS BEEN CHOSEN, OF ANY PROCEEDING FOR THE DETERMINATION OF THE NECESSITY FOR INVOLUNTARY TREATMENT NOT LESS THAN FORTY-EIGHT HOURS PRIOR TO SUCH PROCEEDING [(3)] (4) the right of the patient to representation during any SUCH proceeding [for the determination of the necessity for involuntary medication treatment, (4)] (5) questioning of any witness at any such proceeding INCLUDING, IF REQUESTED, ONE OR BOTH OF THE PHYSICIANS WHO MADE THE DETERMINATION PURSUANT TO SUBSECTION (e) OF THIS SECTION CONCERNING THE PATIENT'S CAPACITY TO GIVE INFORMED CONSENT AND THE NECESSITY OF MEDICATION FOR THE PATIENT'S TREATMENT and [(5)] (6) a written decision. If a decision is made in accordance with the standards set forth in this section that a patient shall receive involuntary medication, and there is substantial probability that without such medication for the treatment of the psychiatric disabilities of such patient the condition of the patient will rapidly deteriorate, such involuntary medication may be provided for a period not to exceed thirty days or until a decision is made by the Probate Court under subsection (e) or (f), whichever is sooner.

(e) (1) If it is determined by the head of the hospital and two qualified physicians that a patient is incapable of giving informed consent to medication for the treatment of such patient's psychiatric disabilities and such medication is deemed to be necessary for such patient's treatment, a facility may utilize the procedures established in subsection (d) of this section and may apply to the Court of Probate for appointment of a conservator of the person WITH SPECIFIC AUTHORITY TO CONSENT TO THE ADMINISTRATION OF MEDICATION OR, IN A CASE WHERE A CONSERVATOR OF THE PERSON HAS PREVIOUSLY BEEN APPOINTED under section 45a-650 THE FACILITY OR THE CONSERVATOR MAY PETITION THE PROBATE COURT TO GRANT SUCH SPECIFIC AUTHORITY TO THE CONSERVATOR. The conservator shall meet with the patient and the physician, review the patient's written record and consider the risks and benefits from the medication, the likelihood and seriousness of adverse side effects, the preferences of the patient, the patient's religious views, and the prognosis with and without medication. After consideration of such information, the conservator shall either consent to the patient receiving medication for the treatment of the patient's psychiatric disabilities or refuse to consent to the patient receiving such medication. (2) THE AUTHORITY OF A CONSERVATOR TO CONSENT TO THE ADMINISTRATION OF MEDICATION UNDER SUBDIVISION (1) OF THIS SUBSECTION SHALL BE EFFECTIVE FOR NO MORE THAN ONE HUNDRED TWENTY DAYS. IN THE CASE OF CONTINUOUS HOSPITALIZATION OF THE PATIENT BEYOND SUCH ONE HUNDRED TWENTY DAYS, IF THE HEAD OF THE HOSPITAL AND TWO QUALIFIED PHYSICIANS DETERMINE THAT THE PATIENT CONTINUES TO BE INCAPABLE OF GIVING INFORMED CONSENT TO MEDICATION FOR THE TREATMENT OF SUCH PATIENT'S PSYCHIATRIC DISABILITIES AND SUCH MEDICATION IS DEEMED TO BE NECESSARY FOR SUCH PATIENT'S TREATMENT, THE AUTHORITY OF THE CONSERVATOR TO CONSENT TO THE ADMINISTRATION OF MEDICATION MAY BE EXTENDED FOR A PERIOD NOT TO EXCEED ONE HUNDRED TWENTY DAYS BY ORDER OF THE PROBATE COURT WITHOUT A HEARING UPON APPLICATION BY THE HEAD OF THE HOSPITAL. PROMPT NOTICE OF THE ORDER SHALL BE GIVEN TO THE PATIENT, CONSERVATOR AND FACILITY.

(f)(1) If it is determined by the head of the hospital and two qualified physicians that [(1)] (A) a patient is capable of giving informed consent but refuses to consent to medication for treatment of such patient's psychiatric disabilities, [(2)] (B) there is no less intrusive beneficial treatment and [(3)] (C) without medication, the psychiatric disabilities with which the patient has been diagnosed will continue unabated, and places the patient or others in direct threat of harm, as defined in subsection [(h)] (l) of section 17a-540, AS AMENDED, the facility may utilize the procedures established in subsection (d) of this section and may apply to the Court of Probate to authorize the administration to the patient of medication for the treatment of the patient's psychiatric disabilities, despite the refusal of the patient to consent to such medication. (2) AN ORDER AUTHORIZING THE ADMINISTRATION OF MEDICATION UNDER SUBDIVISION (1) OF THIS SUBSECTION SHALL BE EFFECTIVE FOR NO MORE THAN ONE HUNDRED TWENTY DAYS. IN THE CASE OF CONTINUOUS HOSPITALIZATION OF THE PATIENT BEYOND SUCH ONE HUNDRED TWENTY DAYS, IF THE HEAD OF THE HOSPITAL AND TWO QUALIFIED PHYSICIANS DETERMINE THAT (A) THE PATIENT CONTINUES TO BE CAPABLE OF GIVING INFORMED CONSENT BUT REFUSES TO CONSENT TO MEDICATION FOR TREATMENT OF SUCH PATIENT'S PSYCHIATRIC DISABILITIES, (B) THERE IS NO LESS INTRUSIVE BENEFICIAL TREATMENT AND (C) WITHOUT MEDICATION, THE PSYCHIATRIC DISABILITIES WITH WHICH THE PATIENT HAS BEEN DIAGNOSED WILL CONTINUE UNABATED, AND PLACES THE PATIENT OR OTHERS IN DIRECT THREAT OF HARM, AS DEFINED IN SUBSECTION (l) OF SECTION 17a-540, AS AMENDED, THE ORDER MAY BE EXTENDED FOR A PERIOD NOT TO EXCEED ONE HUNDRED TWENTY DAYS BY ORDER OF THE PROBATE COURT WITHOUT A HEARING. PROMPT NOTICE OF THE ORDER SHALL BE GIVEN TO THE PATIENT AND FACILITY.

[(g) No order for medication under subsection (e) or (f) of this section shall be effective for more than one hundred twenty days. Any hearing under subsection (e) or (f) of this section shall be conducted in accordance with the procedures set forth in sections 45a-649 and 45a-650, to the extent such provisions are not inconsistent with the standards of this section.]

[(h)] (g) If a decision has been made to administer involuntary medication to a patient pursuant to subsection (d) of this section, the patient may petition the Court of Probate to expedite the hearing on an application filed by the facility pursuant to subsection (e) or (f) of this section or, if no application has been filed, to hold a hearing to decide whether to allow the administration of involuntary medication. Either hearing shall be held within fifteen days after the date of the patient's petition.

[(i)] (h) For the purposes of this section, "voluntary patient" means any patient [eighteen] SIXTEEN years of age or older who applies in writing for, and is admitted to, a hospital for observation, diagnosis or treatment of a mental disorder.

(i) UNLESS THERE IS A SERIOUS RISK OF HARM TO THE PATIENT OR OTHERS, BASED UPON THE PATIENTS' PAST HISTORY OR CURRENT CONDITION, NOTHING IN THIS SECTION AUTHORIZES ANY FORM OF INVOLUNTARY MEDICAL, PSYCHOLOGICAL OR PSYCHIATRIC TREATMENT OF ANY PATIENT WHO IN THE SINCERE PRACTICE OF HIS RELIGIOUS BELIEFS IS BEING TREATED BY PRAYER ALONE IN ACCORDANCE WITH THE PRINCIPLES AND PRACTICES OF A CHURCH OR RELIGIOUS DENOMINATION BY A DULY ACCREDITED PRACTITIONER OR ORDAINED MINISTER, PRIEST OR RABBI THEREOF.

(j) THE DEPARTMENT OF MENTAL HEALTH SHALL ADOPT REGULATIONS, IN ACCORDANCE WITH CHAPTER 54, TO IMPLEMENT THE PURPOSES OF THIS SECTION.

Sec. 2. (a) There is established a task force to study issues relating to involuntary outpatient commitment and alternatives, including the impact on community mental health service programs and clients.

(b) The task force shall consist of: (1) The chairmen and ranking members of the judiciary committee or their designees; (2) the chairmen of the public health committee or their designees; (3) the chairmen of the appropriations subcommittee on public health or their designees; (4) one representative of the Office of Protection and Advocacy and one representative of the regional mental health boards appointed by the speaker of the House of Representatives; (5) two representatives of the Department of Mental Health and Addiction Services appointed by the president pro tempore of the Senate; (6) two consumers appointed by the majority leader of the House of Representatives; (7) one representative of the Connecticut Alliance for the Mentally Ill and one representative from the Connecticut Legal Rights Project appointed by the majority leader of the Senate; (8) one service provider appointed by the minority leader of the House of Representatives; and (9) one representative of the Connecticut Psychiatric Association appointed by the minority leader of the Senate. The chairmen of the judiciary committee or their designees shall chair the task force.

(c) All appointments to the task force shall be made within thirty days after the effective date of this section. Any vacancy shall be filled by the appointing authority.

(d) The speaker of the House of Representatives and the president pro tempore of the Senate shall select the chairpersons of the task force. Such chairpersons shall schedule the first meeting of the task force, which shall be held within sixty days after the effective date of this section.

(e) Not later than January 1, 1997, the task force shall submit a report on its findings and recommendations to the joint standing committee of the General Assembly having cognizance of matters relating to the judiciary, in accordance with the provisions of section 11-4a of the general statutes. The task force shall terminate on the date it submits such report or January 1, 1997, whichever is earlier.

Sec. 3. Subsection (b) of section 54-56d of the general statutes, as amended by section 11 of public act 95-257, is repealed and the following is substituted in lieu thereof:

(b) A defendant is presumed to be competent. The burden of proving that the defendant is not competent by [clear and convincing] A PREPONDERANCE OF THE evidence and the burden of going forward with the evidence are on the party raising the issue. The burden of going forward with the evidence shall be on the state if the court raises the issue. The court may call its own witnesses and conduct its own inquiry.

Sec. 4. This act shall take effect from its passage.

Approved June 4, 1996. Effective June 4, 1996.

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