Bill Text: NC H564 | 2017-2018 | Regular Session | Amended
Bill Title: Revise IVC Laws to Improve Behavioral Health
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2017-04-06 - Ref To Com On Health [H564 Detail]
Download: North_Carolina-2017-H564-Amended.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2017
H 1
HOUSE BILL 564*
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Short Title: Revise IVC Laws to Improve Behavioral Health. |
(Public) |
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Sponsors: |
Representatives Dobson, S. Martin, Lambeth, and Malone (Primary Sponsors). For a complete list of sponsors, refer to the North Carolina General Assembly web site. |
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Referred to: |
Health |
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April 6, 2017
A BILL TO BE ENTITLED
AN ACT REVISING the laws pertaining to involuntary commitment IN ORDER TO IMPROVE the delivery of behavioral health services in north carolina.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 122C‑3 reads as rewritten:
"§ 122C‑3. Definitions.
The following definitions apply in this Chapter:
(8a) "Commitment examiner" means a physician, an eligible psychologist, or any health professional or mental health professional who is certified under G.S. 122C‑263.1 to perform the first examination for involuntary commitment described in G.S. 122C‑263(c) or G.S. 122C‑283(c) as required by Parts 7 and 8 of this Article.
(16a) "Incapable" with respect to an individual means in the opinion of a physician or eligible psychologist, the individual currently lacks sufficient understanding or capacity to make and communicate mental health treatment decisions. An adult individual who is incapable is not the same as an incompetent adult unless the adult individual has been adjudicated incompetent under Chapter 35A of the General Statutes.
(17) "Incompetent
adult" means an adult individual who has been adjudicated incompetent.incompetent
under Chapter 35A of the General Statutes.
(20) "Legally responsible
person" means: (i) when applied to an adult, who has been adjudicated
incompetent, a guardian; (ii) when applied to a minor, a parent, guardian, a
person standing in loco parentis, or a legal custodian other than a parent who
has been granted specific authority by law or in a custody order to consent for
medical care, including psychiatric treatment; or (iii) when applied to an
adult who is incapable as defined in G.S. 122C‑72(c) and who has not
been adjudicated incompetent, a health care agent named pursuant to a valid
health care power of attorney.attorney; provided, however, that if an
incapable adult does not have a health care agent or guardian, "legally
responsible person" means one of the persons specified in subdivisions (3)
through (7) of subsection (c) of G.S. 90‑21.13, to be selected based
on the priority indicated in said subdivisions (3) through (7).
(20b) "Local management
entity" or "LME" means an area authority, county program, or
consolidated human services agency. It is a collective term that refers to
functional responsibilities rather than governance structure.area
authority.
(27a) "Outpatient treatment physician or center" as used in Part 7 of Article 5 of this Chapter means a physician or center that provides treatment services directly to the outpatient commitment respondent. An LME/MCO that contracts with an outpatient treatment physician or center to provide outpatient treatment services to a respondent is not an outpatient treatment physician or center. Every LME/MCO is responsible for contracting with qualified providers of services in accordance with G.S. 122C‑141, 122C‑142(a), 122C‑115.2(b)(1)b., and 122C‑115.4(b)(2) to ensure the availability of qualified providers of outpatient commitment services to clients of LME/MCOs who are respondents to outpatient commitment proceedings and meet the criteria for outpatient commitment. An LME/MCO provider shall not be designated as an outpatient treatment physician or center on an outpatient commitment order unless the respondent is a client of an LME/MCO or is eligible for services through an LME/MCO, or the respondent otherwise qualifies for the provision of services offered by the provider.
(29a) "Program director" means the director of a
county program established pursuant to G.S. 122C‑115.1.
."
SECTION 2. G.S. 122C‑4 reads as rewritten:
"§ 122C‑4. Use
of phrase "client or his the legally responsible
person."
(a) Except as otherwise provided by law, whenever in
this Chapter the phrase "client or his the legally
responsible person" is used, and the client is a minor or an incompetent
adult, the duty or right involved shall be exercised not by the client, but by
the legally responsible person.
(b) Except as otherwise provided by law, whenever in this Chapter the phrase "client or the legally responsible person" is used, and the client is an incapable adult who has not been adjudicated incompetent under Chapter 35A of the General Statutes, the duty or right involved shall be exercised not by the client but by a health care agent named pursuant to a valid health care power of attorney, if one exists, or by the client as expressed in a valid advance instruction for mental health treatment, if one exists. If no health care power of attorney or advance instruction for mental health treatment exists, the legally responsible person for an incapable adult who has not been adjudicated incompetent under Chapter 35A of the General Statutes shall be one of the persons listed in subdivisions (3) through (7) of subsection (c) of G.S. 90‑21.13, to be selected based on the priority order indicated in said subdivisions (3) through (7)."
SECTION 3. G.S. 122C‑53 reads as rewritten:
"§ 122C‑53. Exceptions; client.
(a) A facility may disclose
confidential information if the client or his the legally
responsible person consents in writing to the release of the information to a
specified person. This release is valid for a specified length of time and is
subject to revocation by the consenting individual.
(b) A facility may disclose (i) the fact of admission or discharge of a client and (ii) the time and location of the admission or discharge to the client's next of kin whenever the responsible professional determines that the disclosure is in the best interest of the client.
(c) Upon request a client
shall have access to confidential information in his client the
client's record except information that would be injurious to the client's
physical or mental well‑being as determined by the attending physician
or, if there is none, by the facility director or his the facility
director's designee. If the attending physician or, if there is none, the
facility director or his the facility director's designee has
refused to provide confidential information to a client, the client may request
that the information be sent to a physician or psychologist of the client's
choice, and in this event the information shall be so provided.
(d) Except as provided by
G.S. 90‑21.4(b), upon request the legally responsible person of a
client shall have access to confidential information in the client's record;
except information that would be injurious to the client's physical or mental
well‑being as determined by the attending physician or, if there is none,
by the facility director or his the facility director's designee.
If the attending physician or, if there is none, the facility director or his
the facility director's designee has refused to provide confidential
information to the legally responsible person, the legally responsible person
may request that the information be sent to a physician or psychologist of the
legally responsible person's choice, and in this event the information shall be
so provided.
(e) A client advocate's
access to confidential information and his the client's responsibility
for safeguarding this information are as provided by subsection (g) of this
section.
(f) As used in subsection (g) of this section, the following terms have the meanings specified:
(1) "Internal client
advocate" means a client advocate who is employed by the facility or has a
written contractual agreement with the Department or with the facility to
provide monitoring and advocacy services to clients in the facility in which
the client is receiving services; andservices.
(2) "External client
advocate" means a client advocate acting on behalf of a particular client
with the written consent and authorization;authorization under either
of the following circumstances:
a. In the case of a client
who is an adult and who has not been adjudicated incompetent under Chapter 35A
or former Chapters 33 or 35 of the General Statutes, of the client; orclient.
b. In the case of any other
client, of the client and his the legally responsible person.
(g) An internal client
advocate shall be granted, without the consent of the client or his the
legally responsible person, access to routine reports and other
confidential information necessary to fulfill his monitoring and
advocacy functions. In this role, the internal client advocate may disclose
confidential information received to the client involved, to his or her legally
responsible person, to the director of the facility or his the
director's designee, to other individuals within the facility who are
involved in the treatment or habilitation of the client, or to the Secretary in
accordance with the rules of the Commission. Any further disclosure shall
require the written consent of the client and his the legally
responsible person. An external client advocate shall have access to
confidential information only upon the written consent of the client and his
the legally responsible person. In this role, the external client
advocate may use the information only as authorized by the client and his the
legally responsible person.
(h) In accordance with G.S. 122C‑205, the facility shall notify the appropriate individuals upon the escape from and subsequent return of clients to a 24‑hour facility.
(i) Upon the request of (i) a client who is an adult and who has not been adjudicated incompetent under Chapter 35A or former Chapters 33 or 35 of the General Statutes, or (ii) the legally responsible person for any other client, a facility shall disclose to an attorney confidential information relating to that client."
SECTION 4. G.S. 122C‑54 reads as rewritten:
"§ 122C‑54. Exceptions; abuse reports and court proceedings.
(a1) Upon a determination by
the facility director or his the facility director's designee
that disclosure is in the best interests of the client, a facility may disclose
confidential information for purposes of filing a petition for involuntary
commitment of a client pursuant to Article 5 of this Chapter or for purposes of
filing a petition for the adjudication of incompetency of the client and the
appointment of a guardian or an interim guardian under Chapter 35A of the
General Statutes.
(c) Certified copies of
written results of examinations by physicians and other medical and court records
in the cases of clients voluntarily admitted or involuntarily committed and
facing district court hearings and rehearings pursuant to Article 5 of this
Chapter shall be furnished by the facility to the client's counsel, the
attorney representing the State's interest, and the court. Notwithstanding
the confidentiality of these records, the client's counsel shall have access to
any medical and court records the client's counsel deems relevant to the court
proceeding and shall not be required to obtain the client's consent in order to
access these records. The confidentiality of client information shall be
preserved in all matters except those pertaining to the necessity for admission
or continued stay in the facility or commitment under review. The relevance
of confidential information for which disclosure is sought in a particular case
shall be determined by the court with jurisdiction over the matter.
(d) Any individual seeking
confidential information contained in the court files or the court records of a
proceeding made pursuant to Article 5 of this Chapter Chapter, except
for the respondent, may file a written motion in the cause setting out why
the information is needed. A district court judge may issue an order to
disclose the confidential information sought if he the judge finds
(i) the order is appropriate under the circumstances and if he finds
that(ii) it is in the best interest of the individual admitted or
committed or of the public to have the information disclosed. An individual
who is or has been a respondent in a proceeding pursuant to Article 5 of this
Chapter shall be provided the court records of the proceeding upon submitting a
written request to the clerk of superior court in the county in which the
proceeding is pending. The clerk of court shall take reasonable and appropriate
measures to verify the identity of the individual making the request. The
respondent's legally responsible person shall exercise the respondent's right
to access the court records if the respondent is a minor or an incompetent
adult at the time of the request.
(e) Upon the request of the
legally responsible person or the minor admitted or committed, and after that
minor has both been released and reached adulthood, the court records of that
minor made in proceedings pursuant to Article 5 of this Chapter may be expunged
from the files of the court. The minor and his the minor's legally
responsible person shall be informed in writing by the court of the right
provided by this subsection at the time that the application for admission is
filed with the court.
(g) A facility may disclose
confidential information to an attorney who represents either the facility or
an employee of the facility, if such information is relevant to litigation, to
the operations of the facility, or to the provision of services by the facility.
An employee may discuss confidential information with his the
employee's attorney or with an attorney representing the facility in which he
the employee is employed.
."
SECTION 5. G.S. 122C‑55 reads as rewritten:
"§ 122C‑55. Exceptions; care and treatment.
(a) Any facility may share
confidential information regarding any client of that facility with any other
facility when necessary to coordinate appropriate and effective care, treatment
or habilitation of the client. For the purposes of this section, coordinate the
following definitions apply:
(1) "Coordinate" means the provision, coordination, or management of mental health, developmental disabilities, and substance abuse services and other health or related services by one or more facilities and includes the referral of a client from one facility to another.
(2) "Facility" and "area facility" include an area authority.
(3) "Secretary" includes the Community Care of North Carolina Program, or other primary care case management programs that contract with the Department to provide a primary care case management program for recipients of publicly funded health and related services.
(a1) Any facility may share
confidential information regarding any client of that facility with the
Secretary, and the Secretary may share confidential information regarding any
client with a facility when necessary to conduct quality assessment and
improvement activities or to coordinate appropriate and effective care,
treatment or habilitation of the client. For purposes of this subsection,
subsection (a6), and subsection (a7) of this section, the purposes or
activities for which confidential information may be disclosed include, but are
not limited to, case management and care coordination, disease management,
outcomes evaluation, the development of clinical guidelines and protocols, the
development of care management plans and systems, population‑based
activities relating to improving or reducing health care costs, and the
provision, coordination, or management of mental health, developmental
disabilities, and substance abuse services and other health or related
services. As used in this section, "facility" includes an LME and
"Secretary" includes the Community Care of North Carolina Program, or
other primary care case management programs that contract with the Department
to provide a primary care case management program for recipients of publicly
funded health and related services.
."
SECTION 6. G.S. 122C‑115.4(b) is amended by adding a new subdivision to read:
"(7a) Community crisis services planning in accordance with G.S. 122C‑202.2."
SECTION 7. G.S. 122C‑117(a)(14) reads as rewritten:
"(14) Maintain a 24‑hour
a day, seven day a week crisis response service.service and adopt a
community crisis services plan in accordance with G.S. 122C‑202.2.
Crisis response shall include telephone and face‑to‑face
capabilities. Crisis phone response shall include triage and referral to
appropriate face‑to‑face crisis providers and shall be initiated
within one hour of notification. Crisis services do not require prior
authorization but shall be delivered in compliance with appropriate policies
and procedures. Crisis services shall be designed for prevention, intervention,
and resolution, not merely triage and transfer, and shall be provided in the
least restrictive setting possible, consistent with individual and family need
and community safety."
SECTION 8. Part 1 of Article 5 of Chapter 122C of the General Statutes is amended by adding a new section to read:
"§ 122C‑202.2. LME/MCO community crisis services plan; commitment examiners; transporting agencies; training; collaboration.
(a) Every LME/MCO shall adopt a community crisis services plan developed in accordance with this section to facilitate the implementation of Parts 7 and 8 of this Article within its catchment area. The community crisis services plan for the LME/MCO's catchment area shall be comprised of separate plans, known as "local area crisis services plans" or "local plans," for each of the local areas or regions within the catchment area that the LME/MCO identifies as an appropriate local planning area, taking into consideration the available resources and interested stakeholders within a particular geographic area or region of the catchment area. Each LME/MCO may determine the number and geographic boundaries of the local planning areas within its catchment area. Each local area crisis services plan shall, for the local area covered by the local plan, do at least all of the following:
(1) Identify one or more area facilities where a respondent subject to a transportation and custody order must be taken for a first examination by a commitment examiner as required by G.S. 122C‑263(a) and G.S. 122C‑283(a). If an area facility is identified in the plan as an appropriate facility for conducting the first examination for commitment, law enforcement officers, and any persons designated to provide transportation and custody under G.S. 122C‑251(g), shall transport the commitment respondent to the area facility in accordance with, and under circumstances addressed in, the local area crisis services plan. If no area facility is available in the local planning area to conduct the first examination for commitment, the local plan shall identify an acute care hospital or hospitals or other location for first examination. This subdivision applies when a magistrate or clerk of court orders a respondent to be taken into custody for examination by a commitment examiner. This subdivision does not apply when the respondent is already present on the premises of a location and the first examiner at that location is the affiant who is petitioning to initiate the commitment process.
(2) Identify any persons that the LME/MCO has designated under G.S. 122C‑251(g) to be responsible for all or part of the transportation and custody of respondents in involuntary commitment proceedings under this Article, to the extent that the LME/MCO has exercised its authority under G.S. 122C‑251(g). Any plan adopted by an LME/MCO under G.S. 122C‑251(g) shall be included as a part of the local area crisis services plan for the area to which it pertains. Counties and cities shall retain the responsibilities for custody and transportation set forth in this Article except as otherwise set forth in a plan developed and adopted pursuant G.S. 122C‑251(g).
(3) Identify appropriate and available training for law enforcement personnel, and any persons designated under G.S. 122C‑251(g), who provide transportation and custody of involuntary commitment respondents. To the extent feasible, law enforcement officers shall participate in the training program identified by the LME/MCO. Persons who are designated under G.S. 122C‑251(g) to provide all or part of the transportation and custody required for involuntary commitment proceedings under this Article and who are not law enforcement officers shall participate in the training. To the extent feasible, the identified training shall address the use of de‑escalation strategies and techniques, the safe use of force and restraint, respondent rights relevant to custody and transportation, the location of any area facilities identified by the LME/MCO pursuant to subdivision (1) of this subsection, and the completion and return of the custody order to the clerk of superior court. The training identified by the LME/MCO may be comprised of one or more programs, and may include a crisis intervention team program or other mental health training program or a combination of these programs. To the extent feasible, the LME/MCO shall identify training that includes a component for dialogue with consumers of mental health, developmental disabilities, and substance abuse services.
(b) Law enforcement agencies, acute care hospitals, magistrates or clerks of court, area facilities with identified commitment examiners, the LME/MCO, and other relevant community partners or stakeholders shall participate in the development of the local area crisis services plans described in this section.
(c) The plans adopted under this section may address any matters necessary to facilitate the custody, transportation, examination, and treatment of respondents to commitment proceedings under Parts 7 and 8 of this Article."
SECTION 9. G.S. 122C‑206 reads as rewritten:
"§ 122C‑206. Transfers of clients between 24‑hour
facilities.facilities; transfer of clients from 24‑hour
facilities to acute care hospitals.
(a) Before transferring a
voluntary adult client from one 24‑hour facility to another, the
responsible professional at the original facility shall: (i) get authorization
from the receiving facility that the facility will admit the client; (ii) get
consent from the client; and (iii) if consent to share information is granted
by the client,client or if disclosure of the information is permitted
under G.S. 122C‑53(b), notify the next of kin of the time and
location of the transfer. The preceding requirements of this paragraph may be
waived if the client has been admitted under emergency procedures to a State
facility not serving the client's region of the State. Following an emergency
admission, the client may be transferred to the appropriate State facility
without consent according to the rules of the Commission.
(b) Before transferring a respondent held for a district court hearing or a committed respondent from one 24‑hour facility to another, the responsible professional at the original facility shall:
(1) Obtain authorization from the receiving facility that the facility will admit the respondent; and
(2) Provide reasonable notice
to the respondent, or respondent or the legally responsible
person, and to the respondent's counsel, of the reason for the transfer
and document the notice in the client's record.
No later that than 24
hours after the transfer, the responsible professional at the original facility
shall notify the petitioner, the clerk of court, the respondent's counsel, and,
if consent is granted by the respondent, respondent or disclosure of
the information is permitted under G.S. 122C‑53(b), the next of
kin, that the transfer is completed.complete. If the transfer is
completed before the judicial commitment hearing, these proceedings shall be
initiated by the receiving facility. If the respondent is a minor, an
incompetent adult, or an individual with a health care power of attorney who is
deemed incapable, then the responsible professional at the original facility
shall, not later than 24 hours after the transfer, notify the client's legally
responsible person of the location of the transfer and that the transfer is
complete.
(c) Minors and incompetent
adults, admitted pursuant to Parts 3 and 4 of this Article, may be transferred
from one 24‑hour facility to another following the same procedures
specified in subsection (b) of this section. In addition, the legally
responsible person shall be consulted before the proposed transfer.transfer
and notified, within 24 hours after the transfer is complete, of the location
of the transfer and that the transfer is complete. If the transfer is
completed before the judicial determination required in G.S. 122C‑223
or G.S. 122C‑232, these proceedings shall be initiated by the
receiving facility.
(c1) If a client described in
subsections (b) or (c) of this section is to be transferred from one 24‑hour
facility to another another, or to an acute care hospital pursuant to
subsection (e) of this section, and transportation is needed, the
responsible professional at the original facility shall notify the clerk of
court or magistrate, and the clerk of court or magistrate shall issue a custody
order for transportation of the client as provided by G.S. 122C‑251.
(d) Minors and incompetent adults, admitted pursuant to Part 5 of this Article and incapable adults admitted pursuant to Part 2A of this Article, may be transferred from one 24‑hour facility to another provided that prior to transfer the responsible professional at the original facility shall:
(1) Obtain authorization from the receiving facility that the facility will admit the client; and
(2) Provide reasonable notice to the client regarding the reason for transfer and document the notice in the client's record; and
(3) Provide reasonable notice to and consult with the legally responsible person regarding the reason for the transfer and document the notice and consultation in the client's record.
No later than 24 hours after the transfer, the responsible professional at the original facility shall notify the legally responsible person that the transfer is completed.
(e) The responsible professional may transfer a client from one 24‑hour facility to another or to an acute care hospital for emergency medical treatment, emergency medical evaluation, or emergency surgery without notice to or consent from the client. Within a reasonable period of time the responsible professional shall notify the next of kin or the legally responsible person of the client of the time and location of the transfer.
(f) When a client is transferred
from one 24‑hour facility to another facility solely for
medical reasons, the client shall be returned to the original facility when the
medical care is completed unless the responsible professionals at both
facilities concur that discharge of the client who is not subject to
G.S. 122C‑266(b) is appropriate.
(f1) When a client is transferred from a 24‑hour facility to an acute care hospital solely for medical reasons, the hospital shall return the client to the original facility as soon as the next client space becomes available at the original facility after completion of the client's medical care, and the original facility must accept the return of the client; provided, however, that if the responsible professionals at both facilities concur that discharge of a client who is not subject to G.S. 122C‑266(b) is appropriate, the client shall be released. If, at the time of the transfer, a client is being held under a custody order pending a second commitment examination or a district court hearing under involuntary commitment proceedings, the custody order shall remain valid throughout the period of time necessary to complete the client's medical care and transport the client between the 24‑hour facility and the acute care hospital; provided, however, that the requirement for a timely hearing under G.S. 122C‑268(a) applies. Any decision to terminate the proceedings because the respondent no longer meets the criteria for commitment or because a hearing cannot be held within the time required by G.S. 122C‑268(a) shall be documented and reported to the clerk of superior court in accordance with G.S. 122C‑266(c).
(g) The Commission may adopt rules to implement this section."
SECTION 10. G.S. 122C‑210.1 reads as rewritten:
"§ 122C‑210.1. Immunity from liability.
No facility facility,
including an area facility, a facility licensed under this Chapter, an acute
care hospital, a general hospital, or an area authority, LME, or LME/MCO, or
any of its officials, staff, or employees, or any physician or other individual
who is responsible for the custody, transportation, examination,
management, supervision, treatment, or release of a client and who follows
accepted professional judgment, practice, and standards takes reasonable
measures in good faith under the authority of this Article and is not grossly
negligent is civilly or criminally liable, personally or otherwise,
for actions arising from these responsibilities or for actions of the client.
This immunity is in addition to any other legal immunity from liability to
which these facilities facilities, agencies, or individuals may
be entitled and applies to actions performed in connection with, or arising out
of, the admission custody, transportation, examination, admission, or
commitment of any individual pursuant to this Article."
SECTION 11. G.S. 122C‑210.3 reads as rewritten:
"§ 122C‑210.3. Electronic and facsimile transmission of custody orders.
A custody order entered by the clerk or magistrate pursuant to this Chapter may be delivered to the law enforcement officer or other person designated under G.S. 122C‑251(g) by electronic or facsimile transmission."
SECTION 12. G.S. 122C‑211 reads as rewritten:
"§ 122C‑211. Admissions.
(a) Except as provided in
subsections (b) through (f1) of this section, any individual, including a
parent in a family unit, in need of treatment for mental illness or substance
abuse may seek voluntary admission at any facility by presenting himself or
herself for evaluation to the facility. No physician's statement is
necessary, but a written application for evaluation or admission, signed by the
individual seeking admission, admission or the individual's legally
responsible person, is required. The application form shall be available at
all times at all facilities. However, no one shall be denied admission because
application forms are not available. An evaluation shall determine whether the
individual is in need of care, treatment, habilitation or rehabilitation for
mental illness or substance abuse or further evaluation by the facility.
Information provided by family members regarding the individual's need for
treatment shall be reviewed in the evaluation. If applicable, information
provided in an advance instruction for mental health treatment by the client or
the client's legally responsible person shall be reviewed in the evaluation. An
individual may not be accepted as a client if the facility determines that the
individual does not need or cannot benefit from the care, treatment,
habilitation, or rehabilitation available and that the individual is not in
need of further evaluation by the facility. The facility shall give to an
individual who is denied admission a referral to another facility or facilities
that may be able to provide the treatment needed by the client.
(b) In 24‑hour facilities the application shall acknowledge that the applicant may be held by the facility for a period of 72 hours after any written request for release that the applicant may make, and shall acknowledge that the 24‑hour facility may have the legal right to petition for involuntary commitment of the applicant during that period. At the time of application, the facility shall tell the applicant about procedures for discharge.
(c) Any individual who voluntarily seeks admission to a 24‑hour facility in which medical care is an integral component of the treatment shall be examined and evaluated by a physician of the facility within 24 hours of admission. The evaluation shall determine whether the individual is in need of treatment for mental illness or substance abuse or further evaluation by the facility. If the evaluating physician determines that the individual will not benefit from the treatment available, the individual shall not be accepted as a client.
(d) Any individual who voluntarily seeks admission to any 24‑hour facility, other than one in which medical care is an integral component of the treatment, shall have a medical examination within 30 days before or after admission if it is reasonably expected that the individual will receive treatment for more than 30 days or shall produce a current, valid physical examination report, signed by a physician, completed within 12 months prior to the current admission. When applicable, this examination may be included in an examination conducted to meet the requirements of G.S. 122C‑223 or G.S. 122C‑232.
(e) When an individual from a single portal area
seeks admission to an area or State 24‑hour facility, the admission shall
follow the procedures as prescribed in the area plan. When an individual from a
single portal area presents himself for admission to the facility directly and
is in need of an emergency admission, the individual may be accepted for
admission. The facility shall notify the area authority within 24 hours of the
admission. Further planning of treatment for the client is the joint
responsibility of the area authority and the facility as prescribed in the area
plan.
(f) A family unit may voluntarily seek admission to a 24‑hour substance abuse facility that is able to provide, directly or by contract, treatment, habilitation, or rehabilitation services that will specifically address the family unit's needs. These services shall include gender‑specific substance abuse treatment, habilitation, or rehabilitation for the parent as well as assessment, well‑child care, and, as needed, early intervention services for the child. A family unit that voluntarily seeks admission to a 24‑hour substance abuse facility shall be evaluated by the facility to determine whether the family unit would benefit from the services of the facility. A facility shall not accept a family unit as a client if the facility determines that the family unit does not need or cannot benefit from the care, habilitation, or rehabilitation available at the facility. The facility shall give to a family unit that is denied admission a referral to another facility or facilities that may be able to provide treatment needed by the family unit. Except as otherwise provided, this section applies to a parent in a family unit seeking admission under this section.
(f1) An individual in need of treatment for mental
illness may be admitted to a facility pursuant to an advance instruction for
mental health treatment or pursuant to the authority of a health care agent
named in a valid health care power of attorney, provided that the individual is
incapable, as defined in G.S. 122C‑72(4) at the time of the need for
admission. An individual admitted to a facility pursuant to an advance
instruction for mental health treatment may not be retained for more than 10
days, except as provided for in subsection (b) of this section. When a health
care power of attorney authorizes a health care agent to seek the admission of
an incapable individual, the health care agent shall act for the individual in
applying for admission to a facility and in consenting to medical treatment at
the facility when consent is required, provided that the individual is
incapable.
(g) As used in this Part, the term "family unit" means a parent and the parent's dependent children under the age of three years."
SECTION 13. G.S. 122C‑212 reads as rewritten:
"§ 122C‑212. Discharges.
(a) Except as provided in subsections
subsection (b) and (c) of this section, an individual who has
been voluntarily admitted to a facility shall be discharged upon his or her own
request. A request for discharge from a 24‑hour facility shall be in
writing.
(b) An individual who has been voluntarily admitted to a 24‑hour facility may be held for 72 hours after his or her written application for discharge is submitted.
(c) When an individual from a single portal area who
has been voluntarily admitted to an area or State 24‑hour facility is
discharged, the discharge shall follow the procedures as prescribed in the area
plan."
SECTION 14. Article 5 of Chapter 122C of the General Statutes is amended by adding a new Part to read:
"Part 2A. Voluntary Admissions and Discharges; Incapable Adults; Facilities for Individuals With Mental Illness and Substance Use Disorder.
"§ 122C‑213. Voluntary admission of individuals determined to be incapable.
(a) An individual in need of treatment for mental illness and who is incapable, as defined in G.S. 122C‑3 and G.S. 122C‑72, may be admitted to and treated in a facility pursuant to an advance instruction for mental health treatment executed in accordance with Part 2 of Article 3 of this Chapter or pursuant to the authority of a health care agent named in a valid health care power of attorney executed in accordance with Article 3 of Chapter 32A of the General Statutes.
(b) Except as otherwise provided in this Part, G.S. 122C‑211 applies to admissions of incapable adults under this Part.
(c) An individual making an advance instruction for mental health treatment may grant or withhold consent for mental health treatment, including the use of psychotropic medication, electroconvulsive treatment, and admission to and retention in a 24‑hour facility for mental illness. An attending physician or other mental health treatment provider shall act in accordance with an advance instruction for mental health treatment upon a determination that the individual making the advance instruction is incapable, in which case, the provisions of Part 2 of Article 3 of this Chapter apply.
(d) When a health care power of attorney authorizes a health care agent pursuant to G.S. 32A‑19 to make mental health treatment decisions for an incapable individual, the health care agent shall act for the individual in applying for admission and consenting to treatment at a facility, consistent with the extent and limitations of authority granted in the health care power of attorney for as long as the individual remains incapable.
(e) A 24‑hour facility may not hold an individual who is determined to be incapable at the time of admission and who is admitted pursuant to an advance instruction for mental health treatment for more than 15 days, except as provided in G.S. 122C‑211(b); provided, however, that an individual who regains sufficient understanding and capacity to make and communicate mental health treatment decisions may elect to continue his or her admission and treatment pursuant to the individual's informed consent in accordance with G.S. 122C‑211.
"§ 122C‑214. Discharge of individuals determined to be incapable.
(a) The responsible professional shall unconditionally discharge an individual admitted to a facility pursuant to this Part at any time it is determined that the individual is no longer mentally ill or in need of treatment at the facility.
(b) An individual who has been voluntarily admitted to a facility pursuant to this Part and who is no longer deemed incapable shall be discharged upon his or her own request. An individual's request for discharge from a 24‑hour facility shall be in writing. A facility may hold an individual who has been voluntarily admitted to a 24‑hour facility pursuant to this Part for up to 72 hours after the individual submits a written request for discharge, but the facility shall release the individual upon the expiration of 72 hours following submission of the written request for discharge unless the responsible professional obtains an order under Part 7 or 8 of this Article to hold the client.
(c) A health care agent named in a valid health care power of attorney may submit on behalf of an individual admitted to a facility under this Part a written request to have the individual discharged from the facility, provided (i) the individual remains incapable at the time of the request and (ii) the request is consistent with the authority expressed in the health care power of attorney. A facility may hold an individual for up to 72 hours after a health care agent submits a written request for the individual's discharge but shall release the individual upon the expiration of 72 hours following submission of the written request for discharge unless the responsible professional obtains an order under Part 7 or 8 of this Article to hold the client.
(d) If, in the opinion of a physician or eligible psychologist, an individual admitted to a facility under this Part regains sufficient understanding and capacity to make and communicate mental health treatment decisions while in treatment, and the individual refuses to sign an authorization for continued treatment within 72 hours after regaining decisional capacity, the facility shall discharge the individual unless the responsible professional obtains an order under Part 7 or 8 of this Article to hold the client.
(e) In any case in which an order is issued authorizing the involuntary commitment of an individual admitted to a facility under this Part, the facility's further treatment and holding of the individual shall be in accordance with Part 7 or 8 of this Article, whichever is applicable.
"§§ 122C‑215 through 122C‑220: Reserved for future codification purposes."
SECTION 15. G.S. 122C‑221(a) reads as rewritten:
"(a) Except as otherwise provided in this Part, a minor may be admitted to a facility if the minor is mentally ill or a substance abuser and in need of treatment. Except as otherwise provided in this Part, the provisions of G.S. 122C‑211 shall apply to admissions of minors under this Part. Except as provided in G.S. 90‑21.5, in applying for admission to a facility, in consenting to medical treatment when consent is required, and in any other legal procedure under this Article, the legally responsible person shall act for the minor. The application for admission of the minor shall be in writing and signed by the legally responsible person. If a minor reaches the age of 18 while in treatment under this Part, further treatment is authorized only on the written authorization of the client or under the provisions of Part 7 or Part 8 of Article 5 of this Chapter."
SECTION 16. G.S. 122C‑224(c) reads as rewritten:
"(c) Within 24 hours
after admission, the facility shall notify the clerk of court in the county
where the facility is located that the minor has been admitted and that a
hearing for concurrence in the admission must be scheduled. At the time notice
is given to schedule a hearing, the facility shall (i) notify the clerk
of the names and addresses of the legally responsible person and the
responsible professional.professional and (ii) provide the clerk with a copy of the legally
responsible person's written application for admission of the minor and the
facility's written evaluation of the minor, both of which are required under G.S. 122C‑211(a)."
SECTION 17. Part 4 of Article 5 of Chapter 122C of the General Statutes is amended by adding a new section to read:
"§ 122C‑230. Applicability of Part 4.
This Part applies to adults who are adjudicated incompetent by a court of competent jurisdiction. This Part does not apply to the admission of adults who are deemed incapable but who have not been adjudicated incompetent."
SECTION 18. G.S. 122C‑232 reads as rewritten:
"§ 122C‑232. Judicial determination.
(a) When an incompetent
adult is admitted to a 24‑hour facility where the incompetent adult will
be subjected to the same restrictions on his freedom of movement present
in the State facilities for the mentally ill, or to similar restrictions, a
hearing shall be held in the district court in the county in which the 24‑hour
facility is located within 10 days of after the day that the
incompetent adult is admitted to the facility. A continuance of not more than
five days may be granted upon motion of:any of the following:
(1) The court;court.
(2) Respondent's counsel;
orcounsel.
(3) The responsible professional.
The Commission shall adopt rules governing procedures for admission to other 24‑hour facilities not falling within the category of facilities where freedom of movement is restricted; these rules shall be designed to ensure that no incompetent adult is improperly admitted to or remains in a facility.
(a1) Prior to admission, the facility shall provide the incompetent adult and the legally responsible person with written information describing the procedures for court review of the admission and the procedures for discharge.
(a2) Within 24 hours after admission, the facility shall notify the clerk of court of the county in which the facility is located that the incompetent adult has been admitted and that a hearing for concurrence in the admission must be scheduled. At the time the facility provides notice to the court to schedule a hearing for concurrence, the facility shall notify the clerk of the names and addresses of the legally responsible person and the responsible professional and provide a copy of the legally responsible person's written application for evaluation or admission of the incompetent adult and the facility's evaluation of the incompetent adult.
(b) In any case requiring the hearing described in subsection (a) of this section, no petition is necessary; the written application for voluntary admission shall serve as the initiating document for the hearing. The court shall determine whether the incompetent adult is mentally ill or a substance abuser and is in need of further treatment at the facility. Further treatment at the facility should be undertaken only when lesser measures will be insufficient. If the court finds by clear, cogent, and convincing evidence that these requirements have been met, the court shall concur with the voluntary admission of the incompetent adult and set the length of the authorized admission for a period not to exceed 90 days. If the court finds that these requirements have not been met, it shall order that the incompetent adult be released. A finding of dangerousness to self or others is not necessary to support the determination that further treatment should be undertaken.
(c) Unless otherwise provided in this Part, the hearing specified in subsection (a) of this section, including the provisions for representation of indigent incompetent adults, all subsequent proceedings, and conditional release are governed by the involuntary commitment procedures of Part 7 of this Article.
(d) In addition to the notice
of hearings and rehearings to the incompetent adult and his or her counsel
required under Part 7 of this Article, notice shall be given by the clerk to
the legally responsible person,person or his successor.a
successor to the legally responsible person. The legally responsible person,person
or his a successor to the legally responsible person may
also file with the clerk of court a written waiver of his the right
to receive notice."
SECTION 19. G.S. 122C‑251 reads as rewritten:
"§ 122C‑251. Transportation.Custody and transportation.
(a) Except as provided in
subsections (f) and (g), transportation of a respondent within a county under
the involuntary commitment proceedings of this Article, including admission and
discharge, shall be provided by the city or county. The city has the duty to
provide transportation of a respondent who is a resident of the city or who is
can be taken into custody in the city limits. The county has the
duty to provide transportation for a respondent who resides in the county
outside city limits or who is can be taken into custody outside
of city limits. However, cities and counties may contract with each other to
provide transportation.
(b) Except as provided in subsections (f) and (g) or in G.S. 122C‑408(b), transportation between counties under the involuntary commitment proceedings of this Article for admission to a 24‑hour facility shall be provided by the county where the respondent is taken into custody. Transportation between counties under the involuntary commitment proceedings of this Article for respondents held in 24‑hour facilities who have requested a change of venue for the district court hearing shall be provided by the county where the petition for involuntary commitment was initiated. Transportation between counties under the involuntary commitment proceedings of this Article for discharge of a respondent from a 24‑hour facility shall be provided by the county of residence of the respondent. However, a respondent being discharged from a facility may use his own transportation at his own expense. Transportation between counties under the involuntary commitment proceedings of this Article for a first examination at a location described in G.S. 122C‑263(a) and G.S. 122C‑238(a) shall be provided by the county where the respondent is taken into custody.
(c) Transportation of a
respondent may be (i) by city‑ or county‑owned vehicles
orvehicles, (ii) by private vehicle by contract with the city or county.county,
or (iii) as provided in a plan adopted under subsection (g) of this section.
To the extent feasible, law enforcement officers transporting respondents shall
dress in plain clothes and shall travel in unmarked vehicles. Further, law
enforcement officers, to the extent possible,feasible, shall
advise respondents when taking them into custody that they are not under arrest
and have not committed a crime, but are being taken into custody and transported
to receive treatment and for their own safety and that of others.
(d) To the extent feasible,
in providing transportation of a respondent, a city or county shall provide a
driver or attendant who is the same sex as the respondent, unless the law‑enforcement
law enforcement officer allows a family member of the respondent to
accompany the respondent in lieu of an attendant of the same sex as the
respondent.
(e) In taking custody and
providing transportation as required by this section, the law‑enforcementlaw
enforcement officer may not use reasonable force to restrain
the respondent if unless it appears necessary to protect himself,the
law enforcement officer, the respondent, or others. The law enforcement
officer shall use the least restrictive and most reasonable restraint under the
circumstances and afford the respondent as much dignity as the circumstances
permit, taking into consideration the age, medical condition, special needs,
and behavior of the respondent. To the extent feasible, the law enforcement
officer's application of force or restraint shall avoid aggravating or
worsening the respondent's preexisting injuries or medical conditions. To the
extent feasible, the law enforcement officer shall consult a parent, caretaker,
or other legally responsible person prior to restraining a minor. The law
enforcement officer shall record on the return of service portion of the
custody order the type of mechanical restraint used on a respondent, if any,
when taking the respondent into custody or transporting the respondent. No law‑enforcementlaw
enforcement officer may be held criminally or civilly liable for assault,
false imprisonment, or other torts or crimes on account of reasonable measures
taken under the authority of this Article. The limitations and conditions in
this subsection on the use of force and restraint do not apply to acute care
hospitals or general hospitals and their employees or contractors when the use
of force and restraint by these entities and persons is governed by rules for accreditation
adopted by accrediting bodies that review these entities and persons for
compliance with the accreditation rules.
(f) Notwithstanding the provisions of subsections (a), (b), and (c) of this section, a clerk, a magistrate, or a district court judge, where applicable, may authorize the family or immediate friends of the respondent, if they so request, to transport the respondent in accordance with the procedures of this Article. This authorization shall only be granted in cases where the danger to the public, the family or friends of the respondent, or the respondent himself or herself is not substantial. The family or immediate friends of the respondent shall bear the costs of providing this transportation.
(g) The governing body of a city
or county city, county, or LME/MCO may adopt a plan for the
custody and transportation of respondents in involuntary commitment
proceedings in under this Article. Law‑enforcement
personnel, The plan may designate law enforcement officers, volunteers,
or other public or private agency personnel may be designated to provide
all or parts of the custody and transportation required by involuntary
commitment proceedings.proceedings, including taking a respondent
into custody as ordered by a clerk of superior court or magistrate. Persons
so designated shall be trained in accordance with G.S. 122C‑202.2(a)(3)
and the plan shall assure adequate safety and protections for both the
public and the respondent. Law enforcement, Affected law enforcement
agencies, acute care hospitals, magistrates, clerks of superior court, area
facilities, other affected agencies, and the area authority shall
participate in the planning. If any person other than a law‑enforcement
agency is designated by a city or county, the person so designated Any
person or agency designated by a city, county, or LME/MCO to provide all or
parts of the custody and transportation required by involuntary commitment
proceedings shall provide the custody and transportation and follow
the procedures in this Article. References in this Article to a law‑enforcement
law enforcement officer apply to this person.designated
person or agency. A person shall not be
designated without the consent of (i) the person or (ii) the agency that
employs the person or contracts for the person's services. Counties and cities shall retain the responsibilities set
forth in this Article, except as otherwise described in a plan developed and
adopted pursuant this subsection.
(h) The cost and expenses for
custody and transportation of transporting a respondent to or
from a 24‑hour facilityas required by the involuntary commitment
procedures of this Article is the responsibility of the county of residence
of the respondent.respondent unless otherwise provided in a plan
adopted under subsection (g) of this section. The State (when providing
transportation under G.S. 122C‑408(b)), a city, or a county is
entitled to recover the reasonable cost of transportation from the county of
residence of the respondent. The county of residence of the respondent shall
reimburse the State, another county, or a city the reasonable transportation
costs incurred as authorized by this subsection. The county of residence of the
respondent is entitled to recover the reasonable cost of transportation it has
paid to the State, a city, or a county. Provided that the county of residence
provides the respondent or other individual liable for the respondent's support
a reasonable notice and opportunity to object to the reimbursement, the county
of residence of the respondent may recover that cost from:
(1) The respondent, if the respondent is not indigent;
(2) Any person or entity that is legally liable for the resident's support and maintenance provided there is sufficient property to pay the cost;
(3) Any person or entity that is contractually responsible for the cost; or
(4) Any person or entity that otherwise is liable under federal, State, or local law for the cost."
SECTION 20. G.S. 122C‑253 reads as rewritten:
"§ 122C‑253. Fees under commitment order.
Nothing contained in Parts 6, 7, or
8 of this Article requires a private physician, private psychologist, commitment
examiner, or private facility to accept a respondent as a client either
before or after commitment. Treatment at a private facility or by a private physician
orphysician, private psychologist psychologist, or
commitment examiner is at the expense of the respondent to the extent that
the charges are not disposed of by contract between the area authority and the
private facility. An area authority and its contract agencies shall set and
recover fees for inpatient or outpatient treatment services provided under a
commitment order in accordance with G.S. 122C‑146."
SECTION 21. G.S. 122C‑255 reads as rewritten:
"§ 122C‑255. Report required.
Beginning January 1, 2012, eachEach 24‑hour residential
facility that (i) falls under the category of nonhospital medical
detoxification, facility‑based crisis service, or inpatient hospital
treatment, (ii) is not a State facility under the jurisdiction of the Secretary
of Health and Human Services, and (iii) is designated by the Secretary of
Health and Human Services as a facility for the custody and treatment of
individuals under a petition of involuntary commitment pursuant to
G.S. 122C‑252 and 10A NCAC 26C .0101 shall submit a written report
on involuntary commitments each January 1 and each July 1 to the Department of
Health and Human Services, Division of Mental Health, Developmental
Disabilities, and Substance Abuse Services. The report shall include all of the
following:
(1) The number and primary presenting conditions of individuals receiving treatment from the facility under a petition of involuntary commitment.
(2) The number of individuals for whom an involuntary commitment proceeding was initiated at the facility, who were referred to a different facility or program.
(3) The reason for referring the individuals described in subdivision (2) of this section to a different facility or program, including the need for more intensive medical supervision."
SECTION 22. G.S. 122C‑261 reads as rewritten:
"§ 122C‑261. Affidavit and petition before clerk or magistrate when immediate hospitalization is not necessary; custody order.
(a) Anyone who has knowledge
of an individual who is mentally ill and either (i) dangerous to self, as
defined in G.S. 122C‑3(11)a., or dangerous to others, as defined in
G.S. 122C‑3(11)b., or (ii) in need of treatment in order to prevent
further disability or deterioration that would predictably result in
dangerousness, may appear before a clerk or assistant or deputy clerk of
superior court or a magistrate and execute an affidavit to this effect, and
petition the clerk or magistrate for issuance of an order to take the
respondent into custody for examination by a physician or eligible psychologist.commitment
examiner. The affidavit shall include the facts on which the affiant's
opinion is based. If the affiant has knowledge or reasonably believes that the
respondent, in addition to being mentally ill, is also mentally retarded, this
fact shall be stated in the affidavit. Jurisdiction under this subsection is in
the clerk or magistrate in the county where the respondent resides or is found.
(b) If the clerk or
magistrate finds reasonable grounds to believe that the facts alleged in the
affidavit are true and that the respondent is probably mentally ill and either
(i) dangerous to self, as defined in G.S. 122C‑3(11)a., or dangerous
to others, as defined in G.S. 122C‑3(11)b., or (ii) in need of
treatment in order to prevent further disability or deterioration that would
predictably result in dangerousness, the clerk or magistrate shall issue an
order to a law enforcement officer or any other person authorized under
G.S. 122C‑251 to take the respondent into custody for examination by
a physician or eligible psychologist.commitment examiner. If the
clerk or magistrate finds that, in addition to probably being mentally ill, the
respondent is also probably mentally retarded, the clerk or magistrate shall
contact the area authority before issuing a custody order and the area authority
shall designate the facility to which the respondent is to be taken for
examination by a physician or eligible psychologist.commitment
examiner. The clerk or magistrate shall provide the petitioner and the
respondent, if present, with specific information regarding the next steps that
will occur for the respondent.
(c) If the clerk or magistrate issues a custody order, the clerk or magistrate shall also make inquiry in any reliable way as to whether the respondent is indigent within the meaning of G.S. 7A‑450. A magistrate shall report the result of this inquiry to the clerk.
(d) If the affiant is a physician
or eligible psychologist,commitment examiner, all of the following
apply:
(1) The If the
affiant has examined the respondent, the affiant may execute the affidavit
before any official authorized to administer oaths. This affiant is not
required to appear before the clerk or magistrate for this purpose. This
affiant shall file the affidavit with the clerk or magistrate by delivering to
the clerk or magistrate the original affidavit or affidavit, by
transmitting a copy in paper form that is printed through the facsimile
transmission of the affidavit.affidavit, or by delivering the
affidavit through electronic transmission. If the affidavit is filed
through electronic or facsimile transmission, the affiant shall mail the
original affidavit no later than five days after the facsimile transmission of
the affidavit to the clerk or magistrate to be filed by the clerk or magistrate
with the facsimile copy of the affidavit.
(2) This affiant's examination shall comply with the requirements of the initial examination as provided in G.S. 122C‑263(c). The affiant shall document in writing and file the examination findings with the affidavit delivered to the clerk or magistrate in accordance with subdivision (d)(1) of this section.
(3) If the physician or
eligible psychologistcommitment examiner recommends outpatient
commitment according to the criteria for outpatient commitment set forth in G.S. 122C‑263(d)(1)
and the clerk or magistrate finds probable cause to believe that the
respondent meets the criteria for outpatient commitment, the clerk or
magistrate shall issue an order that a hearing before a district court judge be
held to determine whether the respondent will be involuntarily committed. The
physician or eligible psychologist shall provide the respondent with written
notice of any scheduled appointment and the name, address, and telephone number
of the proposed outpatient treatment physician or center. The physician or
eligible psychologistThe commitment examiner shall contact the local
management entityLME/MCO that serves the county where the respondent
resides or the local management entityLME/MCO that coordinated
services for the respondent to inform the local management entityLME/MCO
that the respondent is being recommended for outpatient commitment. The
LME/MCO shall determine whether the respondent is a client of the LME/MCO or
eligible for services through the LME/MCO and, if so, shall identify and
schedule an appointment with a proposed outpatient treatment physician or center
and provide the commitment examiner with the name, address, and telephone
number of the proposed outpatient treatment physician or center and the date
and time that the respondent has been scheduled for an appointment with an
the outpatient treatment physician or center. The commitment
examiner shall provide the respondent with written notice of any scheduled
appointment and the name, address, and telephone number of the proposed
outpatient treatment physician or center.
(4) If the physician or
eligible psychologistcommitment examiner recommends inpatient
commitment based on the criteria for inpatient commitment set forth in G.S. 122C‑263(d)(2)
and the clerk or magistrate finds probable cause to believe that the
respondent meets the criteria for inpatient commitment, the clerk or magistrate
shall issue an order to a law enforcement officer or any other person
authorized under G.S. 122C‑251(g) to take the respondent into
custody for transportation to or custody at a 24‑hour facility
described in G.S. 122C‑252, providedG.S. 122C‑252;
provided, however, that if a 24‑hour facility is not immediately
available or appropriate to the respondent's medical condition, the respondent
may be temporarily detained under appropriate supervision and, upon further
examination, released in accordance with G.S. 122C‑263(d)(2).
(5) If the affiant is a physician or eligible psychologist at a 24‑hour facility described in G.S. 122C‑252 who recommends inpatient commitment; the respondent is physically present on the premises of the same 24‑hour facility; and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for inpatient commitment, then the clerk or magistrate may issue an order by facsimile transmission or may issue an electronically scanned order by electronic transmission to the physician or eligible psychologist at the 24‑hour facility, or a designee, to take the respondent into custody at the 24‑hour facility and proceed according to G.S. 122C‑266. Upon receipt of the custody order, the physician or eligible psychologist at the 24‑hour facility, or a designee, shall immediately (i) notify the respondent that the respondent is not under arrest and has not committed a crime but is being taken into custody to receive treatment and for the respondent's own safety and the safety of others, (ii) take the respondent into custody, and (iii) complete and sign the appropriate portion of the custody order and return the order to the clerk or magistrate either by facsimile transmission or by scanning it and sending it by electronic transmission. The physician or eligible psychologist, or a designee, shall mail the original custody order no later than five days after returning it by means of facsimile or electronic transmission to the clerk or magistrate. The clerk or magistrate shall file the original custody order with the copy of the custody order that was electronically returned.
Notwithstanding the provisions of this subdivision, a clerk or magistrate shall not issue a custody order to a physician or eligible psychologist at a 24‑hour facility, or a designee, if the physician or eligible psychologist, or a designee, has not completed training in proper service and return of service. As used in this subdivision, the term "designee" includes the 24‑hour facility's on‑site police security personnel.
The Department of Health and Human Services shall cooperate and collaborate with the Administrative Office of the Courts and the UNC School of Government to develop protocols to implement this section, including a procedure for notifying clerks and magistrates of the names of the physicians, psychologists, and designees who have completed the training. The Secretary of the Department shall oversee implementation of these protocols.
(6) If the clerk or magistrate finds probable cause to believe that the respondent, in addition to being mentally ill, is also mentally retarded, the clerk or magistrate shall contact the area authority before issuing the order and the area authority shall designate the facility to which the respondent is to be transported.
(7) If a physician or
eligible psychologistcommitment examiner executes an affidavit for
inpatient commitment of a respondent, a second physician who is not
the commitment examiner who performed the examination under this section shall
be required to perform the examination required by G.S. 122C‑266.
(8) No commitment examiner, area facility, acute care hospital, general hospital, or other site of first examination, or its officials, staff, employees, or other individuals responsible for the custody, examination, detention, management, supervision, treatment, or release of an individual examined for commitment and who follows accepted professional judgment, standards, and practice, shall be held liable in any civil or criminal action for taking reasonable measures to temporarily detain an individual for the period of time necessary to complete a commitment examination, submit an affidavit to the magistrate or clerk of court, and await the issuance of a custody order as authorized by subsection (d) of this section, as long as the commitment examiner has a reasonable and good‑faith belief that detention pending the examination and issuance of a custody order is necessary to protect the individual or others from bodily harm or life endangerment. If the individual is temporarily detained under the circumstances described in this subdivision, the examiner shall certify in the affidavit delivered to the clerk or magistrate in accordance with subdivision (d)(1) of this section the reason the individual requires temporary detention pending the issuance of a custody order.
(e) Except as provided in subdivision (5) of subsection (d) of this section, upon receipt of the custody order of the clerk or magistrate or a custody order issued by the court pursuant to G.S. 15A‑1003, a law enforcement officer or other person designated in the order shall take the respondent into custody within 24 hours after the order is signed, and proceed according to G.S. 122C‑263. The custody order is valid throughout the State.
(f) When a petition is filed for an individual who
is a resident of a single portal area, the procedures for examination by a
physician or eligible psychologist as set forth in G.S. 122C‑263
shall be carried out in accordance with the area plan. Prior to issuance of a
custody order for a respondent who resides in an area authority with a single
portal plan, the clerk or magistrate shall communicate with the area authority
to determine the appropriate 24‑hour facility to which the respondent
should be admitted according to the area plan or to determine if there are more
appropriate resources available through the area authority to assist the
petitioner or the respondent. When an individual from a single portal area is
presented for commitment at a 24‑hour area or State facility directly,
the individual may not be accepted for admission until the facility notifies
the area authority and the area authority agrees to the admission. If the area
authority does not agree to the admission, it shall determine the appropriate
24‑hour facility to which the individual should be admitted according to
the area plan or determine if there are more appropriate resources available
through the area authority to assist the individual. If the area authority
agrees to the admission, further planning of treatment for the client is the
joint responsibility of the area authority and the facility as prescribed in
the area plan.
Notwithstanding the provisions of this section, in no event shall an individual known or reasonably believed to be mentally retarded be admitted to a State psychiatric hospital, except as follows:
(1) Persons described in G.S. 122C‑266(b);
(2) Persons admitted pursuant to G.S. 15A‑1321;
(3) Respondents who are so extremely dangerous as to pose a serious threat to the community and to other patients committed to non‑State hospital psychiatric inpatient units, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee; and
(4) Respondents who are so gravely disabled by both multiple disorders and medical fragility or multiple disorders and deafness that alternative care is inappropriate, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee.
Individuals transported to a State facility for the mentally ill who are not admitted by the facility may be transported by law enforcement officers or designated staff of the State facility in State‑owned vehicles to an appropriate 24‑hour facility that provides psychiatric inpatient care.
No later than 24 hours after the transfer, the responsible professional at the original facility shall notify the petitioner, the clerk of court, and, if consent is granted by the respondent, the next of kin, that the transfer has been completed."
SECTION 23. G.S. 122C‑262 reads as rewritten:
"§ 122C‑262. Special emergency procedure for individuals needing immediate hospitalization.
(a) Anyone, including a law
enforcement officer, who has knowledge of an individual who is subject to
inpatient commitment according to the criteria of G.S. 122C‑261(a)G.S. 122C‑263(d)(2)
and who requires immediate hospitalization to prevent harm to self or others,
may transport the individual directly to an area facility or other place,
including a State facility for the mentally ill, for examination by a physician
or eligible psychologistcommitment examiner in accordance with
G.S. 122C‑263(c).
(b) Upon examination by the physician
or eligible psychologist,commitment examiner, if the individual
meets the inpatient commitment criteria required specified in
G.S. 122C‑261(a), the physician or eligible psychologist G.S. 122C‑263(d)(2)
and requires immediate hospitalization to prevent harm to self or others, the
commitment examiner shall so certify in writing before any official
authorized to administer oaths. The certificate shall also state the reason
that the individual requires immediate hospitalization. If the physician or
eligible psychologistcommitment examiner knows or has reason to
believe that the individual is mentally retarded, the certificate shall so
state.
(c) If the physician or
eligible psychologistcommitment examiner executes the oath,
appearance before a magistrate shall be waived. The physician or eligible psychologistcommitment
examiner shall send a copy of the certificate to the clerk of superior
court by the most reliable and expeditious means. If it cannot be reasonably
anticipated that the clerk will receive the copy within 24 hours, excluding
Saturday, Sunday, and holidays, of the time that it was signed, the physician
or eligible psychologistcommitment examiner shall also communicate
the findings to the clerk by telephone.
(d) Anyone, including a law
enforcement officer if necessary, may transport the individual to a 24‑hour
facility described in G.S. 122C‑252 for examination and treatment
pending a district court hearing. If there is no area 24‑hour facility
and if the respondent is indigent and unable to pay for care at a private 24‑hour
facility, the law enforcement officer or other designated person providing
transportation shall take the respondent to a State facility for the mentally
ill designated by the Commission in accordance with G.S. 143B‑147(a)(1)a
and immediately notify the clerk of superior court of this action. The physician's
or eligible psychologist'scommitment examiner's certificate shall
serve as the custody order and the law enforcement officer or other designated
person shall provide transportation in accordance with the provisions of
G.S. 122C‑251. If a 24‑hour facility is not immediately
available or appropriate to the respondent's medical condition, the respondent
may be temporarily detained under appropriate supervision in accordance with G.S. 122C‑263(d)(2)
and released in accordance with G.S. 122C‑263(d)(2).
In the event an individual known or reasonably believed to be mentally retarded is transported to a State facility for the mentally ill, in no event shall that individual be admitted to that facility except as follows:
(1) Persons described in G.S. 122C‑266(b);
(2) Persons admitted pursuant to G.S. 15A‑1321;
(3) Respondents who are so extremely dangerous as to pose a serious threat to the community and to other patients committed to non‑State hospital psychiatric inpatient units, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee; and
(4) Respondents who are so gravely disabled by both multiple disorders and medical fragility or multiple disorders and deafness that alternative care is inappropriate, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee.
Individuals transported to a State facility for the mentally ill who are not admitted by the facility may be transported by law enforcement officers or designated staff of the State facility in State‑owned vehicles to an appropriate 24‑hour facility that provides psychiatric inpatient care.
No later than 24 hours after the transfer, the responsible professional at the original facility shall notify the petitioner, the clerk of court, and, if consent is granted by the respondent, the next of kin, that the transfer has been completed.
(e) Respondents received at a 24‑hour facility under the provisions of this section shall be examined by a second physician in accordance with G.S. 122C‑266. After receipt of notification that the district court has determined reasonable grounds for the commitment, further proceedings shall be carried out in the same way as for all other respondents under this Part.
(f) If, upon examination of a respondent presented in accordance with subsection (a) of this section, the commitment examiner finds that the individual meets the criteria for inpatient commitment specified in G.S. 122C‑263(d)(2) but does not require immediate hospitalization to prevent harm to self or others, the commitment examiner may petition the clerk or magistrate in accordance with G.S. 122C‑261(d) for an order to take the individual into custody for transport to a 24‑hour facility described in G.S. 122C‑252. If the commitment examiner recommends inpatient commitment and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for inpatient commitment, the clerk or magistrate shall issue an order for transport to or custody at a 24‑hour facility described in G.S. 122C‑252; provided, however, that if a 24‑hour facility is not immediately available or appropriate to the respondent's medical condition, the respondent may be temporarily detained under appropriate supervision in accordance with G.S. 122C‑263(d)(2) and released in accordance with G.S. 122C‑263(d)(2).
(g) This section applies exclusively to an individual who is transported to an examination by a commitment examiner in accordance with subsection (a) of this section."
SECTION 24. G.S. 122C‑263 reads as rewritten:
"§ 122C‑263. Duties of law‑enforcementlaw
enforcement officer; first examination by physician or eligible
psychologist.examination.
(a) Without unnecessary
delay after assuming custody, the law enforcement officer or the individual
designated by the clerk or magistrate under G.S. 122C‑251(g) to
provide transportation shall take the respondent to an area facility identified
by the LME/MCO in the community crisis services plan adopted pursuant to G.S. 122C‑202.2
for examination by a physician or eligible psychologist; if a physician
or eligible psychologist commitment examiner. If an area facility
identified in the plan or one of its commitment examiners is not available
in the area facility,available, or if there is no area facility
identified in the plan, the person designated to provide transportation
shall take the respondent to any physician or eligible psychologist locally
available. If a physician or eligible psychologist acute care hospital
identified by the LME/MCO in the community crisis services plan adopted
pursuant to G.S. 122C‑202.2. If a commitment examiner is not
immediately available, available in such area facility or acute care
hospital, the respondent may be temporarily detained in an area
facility, if one is available; if an area facility is not available, the
respondent may be detained under appropriate supervision in the respondent's
home, in a private hospital or a clinic, in a general hospital, or in a State
facility for the mentally ill, under appropriate supervision in such
area facility or acute care hospital but not in a jail or other penal
facility. If no identified facility or acute care hospital is available, the
law enforcement officer or other designated individual shall transport the
respondent to any commitment examiner available in a private hospital or
clinic, a general hospital, or a State facility for the mentally ill.
(a1) An area facility that is identified by the LME/MCO in accordance with G.S. 122C 202.2 as a site for conducting first examinations under subsection (a) of this section shall be capable of performing a medical screening examination of the respondent that consists of a history and physical appropriate to the respondent's complaint or condition, with ancillary testing as necessary. The medical screening examination shall be conducted by a physician or other individual who is determined by the area facility to be qualified to perform the medical screening and is practicing within the scope of his or her licensure. The respondent may either be in the physical face to face presence of the medical screening examiner or may be examined utilizing telemedicine equipment and procedures. If the area facility in subsection (a) of this section determines that an individual qualified to perform a medical screening examination appropriate to the respondent's complaint or condition is not available on‑site or via telemedicine, the area facility shall identify and contact another area facility that is capable of performing the medical screening, or an acute care hospital, and the law enforcement officer or other designated person shall transport the respondent to the identified facility or hospital.
(a2) The responsible professional at an area facility or other site of first examination may transfer a respondent to an acute care hospital for emergency medical treatment, emergency medical evaluation, emergency surgery, or other medical treatment that the site of first examination is unable to provide by directing the law enforcement officer or other person designated under G.S. 122C 251(g) to transport the respondent to an identified acute care hospital. When the respondent is transferred solely for medical reasons, the original facility shall accept the return of the respondent and the respondent shall be returned to the original facility after the medical care is completed unless the responsible professionals at both facilities concur that the respondent no longer meets the criteria for commitment and recommend that the commitment proceedings be terminated. Any decision to terminate the proceedings shall be documented and reported to the clerk of superior court in accordance with subsection (e) of this section.
(b) The examination set
forth in subsection (a) of this section is not required if:under any
of the following circumstances:
(1) The affiant who obtained
the custody order is a physician or eligible psychologist commitment
examiner who recommends inpatient commitment;commitment.
(2) The custody order states
that the respondent was charged with a violent crime, including a crime
involving assault with a deadly weapon, and he the respondent was
found incapable of proceeding; orproceeding.
(3) Repealed by Session Laws 1987, c. 596, s. 3.
In any of these cases, the law‑enforcementlaw
enforcement officer shall take the respondent directly to a 24‑hour
facility described in G.S. 122C‑252.
(c) The physician or
eligible psychologistcommitment examiner described in subsection (a)
of this section shall examine the respondent as soon as possible, and in any
event within 24 hours,hours after the respondent is presented for
examination. When the examination set forth in subsection (a) of this section
is performed by a physician or eligible psychologistcommitment
examiner, the respondent may either be in the physical face‑to‑face
presence of the physician or eligible psychologistcommitment examiner
or may be examined utilizing telemedicine equipment and procedures. A physician
or eligible psychologistcommitment examiner who examines a
respondent by means of telemedicine must be satisfied to a reasonable medical
certainty that the determinations made in accordance with subsection (d) of
this section would not be different if the examination had been done in the
physical presence of the physician or eligible psychologist. A physician or
eligible psychologistcommitment examiner. A commitment examiner who
is not so satisfied must note that the examination was not satisfactorily
accomplished, and the respondent must be taken for a face‑to‑face
examination in the physical presence of a person authorized to perform
examinations under this section. As used in this subsection,section,
"telemedicine" is the use of two‑way real‑time
interactive audio and video between places of lesser and greater medical
capability or expertise to provide and support health care when distance
separates participants who are in different geographical locations. A recipient
is referred by one provider to receive the services of another provider via
telemedicine.
The examination shall include but
is not limited to an assessment of the respondent's:at least all
of the following with respect to the respondent:
(1) Current and previous
mental illness and mental retardation including, if available, previous
treatment history;history.
(2) Dangerousness to self, as
defined in G.S. 122C‑3(11)a. or others, as defined in G.S. 122C‑3(11)b.;G.S. 122C‑3(11)b.
(3) Ability to survive safely
without inpatient commitment, including the availability of supervision from
family, friends or others; andothers.
(4) Capacity to make an informed decision concerning treatment.
(d) After the conclusion of
the examination the physician or eligible psychologistcommitment
examiner shall make the following determinations:
(1) If the physician or
eligible psychologistcommitment examiner finds that:all of
the following:
a. The respondent is
mentally ill;ill.
b. The respondent is capable
of surviving safely in the community with available supervision from family,
friends, or others;others.
c. Based on the respondent's
psychiatric history, the respondent is in need of treatment in order to prevent
further disability or deterioration that would predictably result in
dangerousness as defined by G.S. 122C‑3(11); andG.S. 122C‑3(11).
d. The respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision to seek voluntarily or comply with recommended treatment.
The physician
or eligible psychologistcommitment examiner shall so show on the
examination report and shall recommend outpatient commitment. In addition the
examining physician or eligible psychologistcommitment examiner
shall show the name, address, and telephone number of the proposed outpatient
treatment physician or center.center in accordance with subsection
(f) of this section. The person designated in the order to provide transportation
shall return the respondent to the respondent's regular residence or, with the
respondent's consent, to the home of a consenting individual located in the
originating county, and the respondent shall be released from custody.
(2) If the physician or
eligible psychologistcommitment examiner finds that the respondent
is mentally ill and is dangerous to self, as defined in G.S. 122C‑3(11)a.,
or others, as defined in G.S. 122C‑3(11)b., the physician or
eligible psychologistcommitment examiner shall recommend inpatient
commitment, and shall so show on the examination report. If, in addition to
mental illness and dangerousness, the physician or eligible psychologistcommitment
examiner also finds that the respondent is known or reasonably believed to
be mentally retarded, this finding shall be shown on the report. The Without
unnecessary delay, and in any event within six hours after the comment examiner's
finding and recommendation, the law enforcement officer or other designated
person shall take the respondent to a 24‑hour facility described in
G.S. 122C‑252 pending a district court hearing. If there is no area
24‑hour facility and if the respondent is indigent and unable to pay for
care at a private 24‑hour facility, the law enforcement officer or other
designated person shall take the respondent to a State facility for the
mentally ill designated by the Commission in accordance with G.S. 143B‑147(a)(1)a.
for custody, observation, and treatment and immediately notify the clerk of
superior court of this action. If a 24‑hour facility is not immediately
available or appropriate to the respondent's medical condition, the respondent
may be temporarily detained under appropriate supervision at the site of the
first examination, provided that at anytime that a physician or eligible
psychologistexamination. Upon the commitment examiner's determination
that a 24‑hour facility is available and medically appropriate, the law
enforcement officer or other designated person shall commence transporting the
respondent without unnecessary delay and, in any event, within six hours after
receiving a request for transportation by the commitment examiner. At any time
during the respondent's temporary detention under appropriate supervision, if a
commitment examiner determines that the respondent is no longer in need of
inpatient commitment, the proceedings shall be terminated and the respondent
transported and released in accordance with subdivision (3) of this subsection.
However, if the physician or eligible psychologistcommitment examiner
determines that the respondent meets the criteria for outpatient commitment, as
defined in subdivision (1) of this subsection, the physician or eligible
psychologistcommitment examiner may recommend outpatient commitment,
and the respondent shall be transported and released in accordance with
subdivision (1) of this subsection. Any decision to terminate the proceedings
or to recommend outpatient commitment after an initial recommendation of
inpatient commitment shall be documented and reported to the clerk of superior
court in accordance with subsection (e) of this section. If the respondent is
temporarily detained and a 24‑hour facility is not available or medically
appropriate seven days after the issuance of the custody order, a physician
or psychologistcommitment examiner shall report this fact to the
clerk of superior court and the proceedings shall be terminated. Termination of
proceedings pursuant to this subdivision shall not prohibit or prevent the
initiation of new involuntary commitment proceedings when appropriate. A
commitment examiner may initiate a new involuntary commitment proceeding prior
to the expiration of this seven‑day period, as long as the respondent
continues to meet applicable criteria. Affidavits filed in support of
proceedings terminated pursuant to this subdivision may not be submitted in
support of any subsequent petitions for involuntary commitment. If the affiant
initiating new commitment proceedings is a physician or eligible
psychologistcommitment examiner, the affiant shall conduct a new
examination and may not rely upon examinations conducted as part of proceedings
terminated pursuant to this subdivision.
In the event an individual known or reasonably believed to be mentally retarded is transported to a State facility for the mentally ill, in no event shall that individual be admitted to that facility except as follows:
a. Persons described in G.S. 122C‑266(b);
b. Persons admitted pursuant to G.S. 15A‑1321;
c. Respondents who are so extremely dangerous as to pose a serious threat to the community and to other patients committed to non‑State hospital psychiatric inpatient units, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee; and
d. Respondents who are so gravely disabled by both multiple disorders and medical fragility or multiple disorders and deafness that alternative care is inappropriate, as determined by the Director of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services or his designee.
Individuals transported to a State facility for the mentally ill who are not admitted by the facility may be transported by law enforcement officers or designated staff of the State facility in State‑owned vehicles to an appropriate 24‑hour facility that provides psychiatric inpatient care.
No later than 24 hours after the transfer, the responsible professional at the original facility shall notify the petitioner, the clerk of court, and, if consent is granted by the respondent, the next of kin, that the transfer has been completed.
(3) If the physician or
eligible psychologistcommitment examiner finds that neither
condition described in subdivisions (1) or (2) of this subsection exists, the
proceedings shall be terminated. The person designated in the order to provide
transportation shall return the respondent to the respondent's regular
residence or, with the respondent's consent, to the home of a consenting
individual located in the originating county and the respondent shall be
released from custody.
(e) The findings of the physician
or eligible psychologistcommitment examiner and the facts on which
they are based shall be in writing in all cases. The physician or eligible
psychologistcommitment examiner shall send a copy of the findings to
the clerk of superior court by the most reliable and expeditious means. If it
cannot be reasonably anticipated that the clerk will receive the copy within 48
hours of the time that it was signed, the physician or eligible psychologistcommitment
examiner shall also communicate his findings to the clerk by telephone.
(f) When outpatient
commitment is recommended, the examining physician or eligible psychologist,commitment
examiner, if different from the proposed outpatient treatment physician or
center, shall give the respondent a written notice listing the name,
address, and telephone number of the proposed outpatient treatment physician or
center and directing the respondent to appear at the address at a specified
date and time. The examining physician or eligible psychologist before the
appointment shall notify by telephone the designated outpatient treatment
physician or center and shall send a copy of the notice and his examination
report to the physician or center.shall contact the LME/MCO that serves
the county where the respondent resides or the LME/MCO that coordinated
services for the respondent to inform the LME/MCO that the respondent is being
recommended for outpatient commitment. The LME/MCO shall determine whether the
respondent is a client of the LME/MCO or eligible for services through the
LME/MCO and, if so, shall identify and schedule an appointment with a proposed
outpatient treatment physician or center and provide the commitment examiner
with the name, address, and telephone number of the proposed outpatient
treatment physician or center and the date and time the respondent has been
scheduled for an appointment with the outpatient treatment physician or center.
The commitment examiner shall give the respondent a written notice listing the
name, address, and telephone number of the proposed outpatient treatment
physician or center and directing the respondent to appear at the address at a
specified date and time. Prior to the appointment, the commitment examiner
shall notify by telephone the designated outpatient treatment physician or
center and shall send a copy of the notice and the commitment examiner's
examination report to the physician or center.
(g) The physician or
eligible psychologist, commitment examiner, at the completion of the
examination, shall provide the respondent with specific information regarding
the next steps that will occur."
SECTION 25. G.S. 122C‑263.1 reads as rewritten:
"§ 122C‑263.1. Secretary's authority to waive
requirement of first examination by physician or eligible psychologist;certify
commitment examiners; training of certified providers commitment
examiners performing first examinations.examinations; LME/MCO
responsibilities.
(a) Physicians and
eligible psychologists are qualified to perform the commitment examinations
required under G.S. 122C‑263(c) and G.S. 122C‑283(c). The
Secretary of Health and Human Services may, upon request of an LME, waive
the requirements of G.S. 122C‑261 through G.S. 122C‑263
and G.S. 122C‑281 through G.S. 122C‑283 pertaining to
initial (first‑level) examinations by a physician or eligible
psychologist of individuals meeting the criteria of G.S. 122C‑261(a)
or G.S. 122C‑281(a), as applicable, as follows:may
individually certify to perform the first commitment examinations required by G.S. 122C‑261
through G.S. 122C‑263 and G.S. 122C‑281 through G.S. 122C‑283,
other health, mental health, and substance abuse professionals whose scope of
practice includes diagnosing and documenting psychiatric or substance use
disorders and conducting mental status examinations to determine capacity to
give informed consent to treatment as follows:
(1) The Secretary has
received a request from an LME to substitute for a physician or eligible
psychologist, request:
a. To certify a licensed clinical social
worker, a master's level psychiatric nurse, or nurse practitioner, a
licensed professional counselor, or a physician's assistant to conduct the
first examinations described in G.S. 122C‑263(c) and G.S. 122C‑283(c).
b. To certify a master's level certified licensed
clinical addictions specialist in accordance with subdivision (8) of
this subsection to conduct the initial (first‑level) examinations of
individuals meeting the criteria of G.S. 122C‑261(a) or
G.S. 122C‑281(a). In making this type of request, the LME shall
specifically describe all of the following:to conduct the first
examination described in G.S. 122C‑283(c).
a. How the purpose of the statutory requirement
would be better served by waiving the requirement and substituting the proposed
change under the waiver.
b. How the waiver will enable the LME to improve
the delivery or management of mental health, developmental disabilities, and
substance abuse services.
c. How the health, safety, and welfare of individuals
will continue to be at least as well protected under the waiver as under the
statutory requirement.
(2) The Secretary shall review the request and may approve it upon finding all of the following:
a. The request meets the requirements of this section.
b. The request furthers the purposes of State
policy under G.S. 122C‑2 and mental health, developmental
disabilities, and substance abuse services reform.
c. The request improves the delivery of mental
health, developmental disabilities, and substance abuse services in the
counties affected by the waiver and also protects the health, safety, and
welfare of individuals receiving these services.
d. The Department determines that the applicant possesses the professional licensure, registration, or certification to qualify the applicant as a professional whose scope of practice includes diagnosing and documenting psychiatric or substance use disorders and conducting mental status examinations to determine capacity to give informed consent to treatment.
e. The applicant for certification has successfully completed the Department's standardized training program for involuntary commitment and has successfully passed the examination for that program.
(3) The Secretary shall evaluate the effectiveness,
quality, and efficiency of mental health, developmental disabilities, and
substance abuse services and protection of health, safety, and welfare under
the waiver.
(4) A waiver certification
granted by the Secretary under this section shall be in effect for a period
of up to three years and may be rescinded at any time within this period if the
Secretary finds the LME certified individual has failed to meet
the requirements of this section. Certification may be renewed every three
years upon completion of a refresher training program approved by the
Department.
(5) In no event shall the substitution
certification of a licensed clinical social worker, master's level psychiatric
nurse,nurse practitioner, licensed professional counselor, physician
assistant, or master's level certified clinical addictions specialist under
a waiver granted under this section be construed as authorization to expand
the scope of practice of the licensed clinical social worker, the master's
level psychiatric nurse,nurse practitioner, licensed professional
counselor, physician assistant, or the master's level certified
clinical addictions specialist.
(6) The Department shall
require that individuals performing certified to perform initial
examinations under the waiver havethis section have successfully
completed the Department's standardized involuntary commitment training
program and examination. The Department shall maintain a list of these
individuals on its Internet Web site.
(7) As part of its waiver request, the LME shall
document the availability of a physician to provide backup support.
(7a) No less than annually, the Department shall submit a list of certified first commitment examiners to the Chief District Court Judge of each judicial district in North Carolina and maintain a current list of certified first commitment examiners on its Internet Web site.
(8) A master's level certified
licensed clinical addiction specialist shall only be authorized to
conduct the initial examination of individuals meeting the criteria of
G.S. 122C‑281(a).
(b) The Division of
Mental Health, Developmental Disabilities, and Substance Abuse Services Department
shall expand its standardized certification training program to include
refresher training for all certified providers performing initial examinations
pursuant to subsection (a) of this section."
SECTION 26. G.S. 122C‑264 reads as rewritten:
"§ 122C‑264. Duties of clerk of superior court and the district attorney.
(a) Upon receipt of a physician's
or eligible psychologist'scommitment examiner's finding that the
respondent meets the criteria of G.S. 122C‑263(d)(1) and that
outpatient commitment is recommended, the clerk of superior court of the county
where the petition was initiated, upon direction of a district court judge,
shall calendar the matter for hearing and shall notify the respondent, the
proposed outpatient treatment physician or center, and the petitioner of the
time and place of the hearing. The petitioner may file a written waiver of his
right to notice under this subsection with the clerk of court.
(b) Upon receipt by the
clerk of superior court pursuant to G.S. 122C‑266(c) of a
physician's or eligible psychologist's finding that a respondent meets
the criteria of G.S. 122C‑263(d)(2) and that inpatient commitment is
recommended, the clerk of superior court of the county where the 24‑hour
facility is located shall, after determination required by G.S. 122C‑261(c)
and upon direction of a district court judge, assign counsel if necessary,
calendar the matter for hearing, and notify the respondent, his counsel, and
the petitioner of the time and place of the hearing. The petitioner may file a
written waiver of his right to notice under this subsection with the clerk of
court.
(b1) Upon receipt of a physician's
or eligible psychologist'scommitment examiner's certificate that a
respondent meets the criteria of G.S. 122C‑261(a) and that immediate
hospitalization is needed pursuant to G.S. 122C‑262, the clerk of
superior court of the county where the treatment facility is located shall submit
the certificate to the Chief District Court Judge. The court shall review the
certificate within 24 hours, excluding Saturday, Sunday, and holidays, for a
finding of reasonable grounds in accordance with 122C‑261(b). The clerk
shall notify the treatment facility of the court's findings by telephone and
shall proceed as set forth in subsections (b), (c), and (f) of this section.
."
SECTION 27. G.S. 122C‑265 reads as rewritten:
"§ 122C‑265. Outpatient commitment; examination and treatment pending hearing.
(a) If a respondent, who has
been recommended for outpatient commitment by an examining physician or
eligible psychologist a commitment examiner different from the
proposed outpatient treatment physician or center, fails to appear for
examination by the proposed outpatient treatment physician or center at the
designated time, the physician or center shall notify the clerk of superior
court who shall issue an order to a law‑enforcement officer or other
person authorized under G.S. 122C‑251 to take the respondent into
custody and take him immediately to the outpatient treatment physician or
center for evaluation. The custody order is valid throughout the State. The law‑enforcement
officer may wait during the examination and return the respondent to his home
after the examination.
(b) The examining
physician commitment examiner or the proposed outpatient treatment
physician or center may prescribe to the respondent reasonable and appropriate
medication and treatment that are consistent with accepted medical standards
pending the district court hearing.
(c) In no event may a respondent released on a recommendation that he or she meets the outpatient commitment criteria be physically forced to take medication or forceably detained for treatment pending a district court hearing.
(d) If at any time pending
the district court hearing the outpatient treatment physician or center
determines that the respondent does not meet the criteria of G.S. 122C‑263(d)(1),
he the physician shall release the respondent and notify the
clerk of court and the proceedings shall be terminated.
(e) If a respondent becomes
dangerous to himself, self, as defined in G.S. 122C‑3(11)a.,
or others, as defined in G.S. 122C‑3(11)b., pending a district court
hearing on outpatient commitment, new proceedings for involuntary inpatient
commitment may be initiated.
(f) If an inpatient commitment proceeding is initiated pending the hearing for outpatient commitment and the respondent is admitted to a 24‑hour facility to be held for an inpatient commitment hearing, notice shall be sent by the clerk of court in the county where the respondent is being held to the clerk of court of the county where the outpatient commitment was initiated and the outpatient commitment proceeding shall be terminated."
SECTION 28. G.S. 122C‑266(a)(2) reads as rewritten:
"(2) If the physician finds that the respondent meets the criteria for outpatient commitment under G.S. 122C‑263(d)(1), the physician shall show these findings on the physician's examination report, release the respondent pending the district court hearing, and notify the clerk of superior court of the county where the petition was initiated of these findings. In addition, the examining physician shall show on the examination report the name, address, and telephone number of the proposed outpatient treatment physician or center. The physician shall contact the LME/MCO that serves the county in which the respondent resides or that coordinated services for the respondent to inform the LME/MCO that the respondent is being recommended for outpatient commitment. The LME/MCO shall determine whether the respondent is a client of the LME/MCO or eligible for services through the LME/MCO and, if so, shall identify and schedule an appointment with a proposed outpatient treatment physician or center and provide the commitment examiner with the name, address, and telephone number of the proposed outpatient treatment physician or center and the date and time that the respondent has been scheduled for an appointment with the outpatient treatment physician or center. The physician shall give the respondent a written notice listing the name, address, and telephone number of the proposed outpatient treatment physician or center and directing the respondent to appear at that address at a specified date and time. The examining physician before the appointment shall notify by telephone and shall send a copy of the notice and the examination report to the proposed outpatient treatment physician or center."
SECTION 29. G.S. 122C‑267(c) reads as rewritten:
"(c) Certified copies of
reports and findings of physicians and psychologistscommitment
examiners and medical records of previous and current treatment are
admissible in evidence."
SECTION 30. G.S. 122C‑268 reads as rewritten:
"§ 122C‑268. Inpatient commitment; district court hearing.
(a) A hearing shall be held
in district court within 10 days of the day the respondent is taken into law
enforcement custody pursuant to G.S. 122C‑261(e) or G.S. 122C‑262.
If a respondent temporarily detained under G.S. 122C‑263(d)(2) is
subject to a series of successive custody orders issued pursuant to G.S. 122C‑263(d)(2),
the hearing shall be held within 10 days after the day that the respondent is
taken into custody under the most recent custody order. A continuance of
not more than five days may be granted upon motion of:of any of the
following:
(1) The court;court.
(2) Respondent's counsel;
orcounsel.
(3) The State, sufficiently in advance to avoid movement of the respondent.
(f) Certified copies of
reports and findings of physicians and psychologistscommitment
examiners and previous and current medical records are admissible in
evidence, but the respondent's right to confront and cross‑examine
witnesses may not be denied.
(g) Hearings may To
the extent feasible, hearings shall be held in an appropriate room not
used for treatment of clients at the facility in which the respondent is
being treated if itin a manner approved by the chief district court
judge if the facility is located within the presiding judge's
district court district as defined in G.S. 7A‑133, by interactive
videoconferencing between a treatment facility and a courtroom, orG.S. 7A‑133.
Hearings may be held in the judge's chambers. A hearing may not be held in
a regular courtroom, over objection of the respondent, if in the discretion of
a judge a more suitable place is available. A hearing may be held by audio
and video transmission between the treatment facility and a courtroom in a
manner that allows (i) the judge and the respondent to see and hear each other
and (ii) the respondent to communicate fully and confidentially with the
respondent's counsel during the proceeding. Prior to any hearing held by audio
and video transmission, the chief district court judge shall submit to the
Administrative Office of the Courts the procedures and type of equipment for
audio and video transmission for approval by the Administrative Office of the
Courts. Notwithstanding the provisions of this subsection, if the respondent,
through counsel, objects to a hearing held by audio and video transmission, the
hearing shall be held in the physical presence of the presiding district court
judge. Regardless of the manner and location for hearings, hearings shall be
held in a manner that complies with any applicable federal and State laws
governing the confidentiality and security of confidential information,
including any information transmitted from the treatment facility by audio and
video transmission.
."
SECTION 31. G.S. 122C‑271 reads as rewritten:
"§ 122C‑271. Disposition.
(a) If an examining
physician or eligible psychologista commitment examiner has
recommended outpatient commitment and the respondent has been released pending
the district court hearing, the court may make one of the following
dispositions:
(1) If the court finds by clear, cogent, and convincing evidence that the respondent is mentally ill; that he is capable of surviving safely in the community with available supervision from family, friends, or others; that based on respondent's treatment history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined in G.S. 122C‑3(11); and that the respondent's current mental status or the nature of his illness limits or negates his ability to make an informed decision to seek voluntarily or comply with recommended treatment, it may order outpatient commitment for a period not in excess of 90 days.
(2) If the court does not
find that the respondent meets the criteria of commitment set out in
subdivision (1) of this subsection, the respondent shall be discharged and the facility
at which he was last a clientproposed outpatient physician or center
so notified.
(3) Before ordering any outpatient commitment under this subsection, the court shall make findings of fact as to the availability of outpatient treatment from an outpatient treatment physician or center that has agreed to accept the respondent as a client of outpatient treatment services. The court shall show on the order the outpatient treatment physician or center that is to be responsible for the management and supervision of the respondent's outpatient commitment. If the designated outpatient treatment physician or center will be monitoring and supervising the respondent's outpatient commitment pursuant to a contract for services with an LME/MCO, the court shall show on the order the identity of the LME/MCO. The clerk of court shall send a copy of the outpatient commitment order to the designated outpatient treatment physician or center and to the respondent client or the legally responsible person. If the designated outpatient treatment physician or center will be monitoring and supervising the respondent's outpatient commitment pursuant to a contract for services with an LME/MCO, the clerk of court shall also send a copy of the order to that LME/MCO. Copies of outpatient commitment orders sent by the clerk of court to an outpatient treatment center or physician under this section, including orders sent to an LME/MCO, shall be sent by the most reliable and expeditious means, but in no event less than 48 hours after the hearing.
(b) If the respondent has been held in a 24‑hour facility pending the district court hearing pursuant to G.S. 122C‑268, the court may make one of the following dispositions:
(1) If the court finds by clear, cogent, and convincing evidence that the respondent is mentally ill; that the respondent is capable of surviving safely in the community with available supervision from family, friends, or others; that based on respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined by G.S. 122C‑3(11); and that the respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision voluntarily to seek or comply with recommended treatment, it may order outpatient commitment for a period not in excess of 90 days. If the commitment proceedings were initiated as the result of the respondent's being charged with a violent crime, including a crime involving an assault with a deadly weapon, and the respondent was found incapable of proceeding, the commitment order shall so show.
(2) If the court finds by clear, cogent, and convincing evidence that the respondent is mentally ill and is dangerous to self, as defined in G.S. 122C‑3(11)a., or others, as defined in G.S. 122C‑3(11)b., it may order inpatient commitment at a 24‑hour facility described in G.S. 122C‑252 for a period not in excess of 90 days. However, no respondent found to be both mentally retarded and mentally ill may be committed to a State, area or private facility for the mentally retarded. An individual who is mentally ill and dangerous to self, as defined in G.S. 122C‑3(11)a., or others, as defined in G.S. 122C‑3(11)b., may also be committed to a combination of inpatient and outpatient commitment at both a 24‑hour facility and an outpatient treatment physician or center for a period not in excess of 90 days. If the commitment proceedings were initiated as the result of the respondent's being charged with a violent crime, including a crime involving an assault with a deadly weapon, and the respondent was found incapable of proceeding, the commitment order shall so show. If the court orders inpatient commitment for a respondent who is under an outpatient commitment order, the outpatient commitment is terminated; and the clerk of the superior court of the county where the district court hearing is held shall send a notice of the inpatient commitment to the clerk of superior court where the outpatient commitment was being supervised.
(3) If the court does not find that the respondent meets either of the commitment criteria set out in subdivisions (1) and (2) of this subsection, the respondent shall be discharged, and the facility in which the respondent was last a client so notified.
(4) Before ordering any
outpatient commitment, the court shall make findings of fact as to the
availability of outpatient treatment. The court shall also show on the order
the outpatient treatment physician or center who is to be responsible for the
management and supervision of the respondent's outpatient commitment. When an
outpatient commitment order is issued for a respondent held in a 24‑hour
facility, the court may order the respondent held at the facility for no more
than 72 hours in order for the facility to notify the designated outpatient
treatment physician or center of the treatment needs of the respondent.including
any combination of inpatient and outpatient commitment, the 24‑hour
facility shall identify for the court an outpatient treatment physician or
center that meets all of the following criteria:
a. Has participated in discharge planning for the respondent.
b. Has agreed to accept the respondent as a client of outpatient treatment services.
c. Has scheduled the respondent for an outpatient appointment to take place no later than seven days after the respondent's discharge from the 24‑hour facility.
The court shall make
findings of fact as to the availability of an outpatient treatment physician or
center that has met the conditions of this subsection. If the respondent is a
client of an LME/MCO or eligible for services through an LME/MCO, and before
the court orders any outpatient commitment, the LME/MCO shall participate in
the respondent's discharge planning and assist the 24‑hour facility in
identifying an outpatient treatment physician or center that is able to comply
with the provisions of this subsection. The court shall show on the order the
outpatient treatment physician or center who is responsible for the management
and supervision of the respondent's outpatient commitment. If the treatment
center or physician shall be providing outpatient treatment services to the
respondent pursuant to a contract for services with an LME/MCO, the order shall
also show the LME/MCO. The clerk of court in the county where the facility
is located shall send a copy of the outpatient commitment order to the
designated outpatient treatment physician or center.center and to the
respondent or the legally responsible person. If the designated outpatient
treatment physician or center shall be monitoring and supervising the
respondent's outpatient commitment pursuant to a contract for services with an
LME/MCO, the clerk of court shall also send a copy of the order to the LME/MCO.
Copies of outpatient commitment orders sent by the clerk of court to an
outpatient treatment center or physician pursuant to this subdivision,
including orders sent to an LME/MCO, shall be sent by the most reliable and
expeditious means, but in no event less than 48 hours after the hearing. If
the outpatient commitment will be supervised in a county other than the county
where the commitment originated, the court shall order venue for further court
proceedings to be transferred to the county where the outpatient commitment
will be supervised. Upon an order changing venue, the clerk of superior court
in the county where the commitment originated shall transfer the file to the
clerk of superior court in the county where the outpatient commitment is to be
supervised.
(c) If the respondent was found not guilty by reason of insanity and has been held in a 24‑hour facility pending the court hearing held pursuant to G.S. 122C‑268.1, the court may make one of the following dispositions:
(1) If the court finds that the respondent has not proved by a preponderance of the evidence that he no longer has a mental illness or that he is no longer dangerous to others, it shall order inpatient treatment at a 24‑hour facility for a period not to exceed 90 days.
(2) If the court finds that the respondent has proven by a preponderance of the evidence that he no longer has a mental illness or that he is no longer dangerous to others, the court shall order the respondent discharged and released."
SECTION 32. G.S. 122C‑276(c) reads as rewritten:
"(c) Subject to the
provisions of G.S. 122C‑269(c), rehearings shall be held at the
facility in which the respondent is receiving treatment. as authorized
in G.S. 122C‑268(g). The judge is a judge of the district court
of the district court district as defined in G.S. 7A‑133 in which
the facility is located or a district court judge temporarily assigned to that
district."
SECTION 33. G.S. 122C‑281 reads as rewritten:
"§ 122C‑281. Affidavit and petition before clerk or magistrate; custody order.
(a) Any individual who has
knowledge of a substance abuser who is dangerous to himself self or
others may appear before a clerk or assistant or deputy clerk of superior court
or a magistrate, execute an affidavit to this effect, and petition the clerk or
magistrate for issuance of an order to take the respondent into custody for
examination by a physician or eligible psychologist.commitment
examiner. The affidavit shall include the facts on which the affiant's
opinion is based. Jurisdiction under this subsection is in the clerk or
magistrate in the county where the respondent resides or is found.
(b) If the clerk or
magistrate finds reasonable grounds to believe that the facts alleged in the
affidavit are true and that the respondent is probably a substance abuser and
dangerous to himself self or others, he the clerk or
magistrate shall issue an order to a law‑enforcementlaw
enforcement officer or any other person authorized by G.S. 122C‑251
to take the respondent into custody for examination by a physician or
eligible psychologist.commitment examiner.
(c) If the clerk or
magistrate issues a custody order, he the clerk or magistrate shall
also make inquiry in any reliable way as to whether the respondent is indigent
within the meaning of G.S. 7A‑450. A magistrate shall report the
result of this inquiry to the clerk.
(d) If the affiant is a physician
or eligible psychologist,commitment examiner who has examined the
respondent, he or she may execute the affidavit before any official
authorized to administer oaths. He The commitment examiner is not
required to appear before the clerk or magistrate for this purpose. His The
commitment examiner's examination shall comply with the requirements of the
initial examination as provided in G.S. 122C‑283(c). Such affiant
shall file the affidavit and examination findings with the clerk of court in
the manner described in G.S. 122C‑261(d)(1). If the physician
or eligible psychologistcommitment examiner recommends commitment
and the clerk or magistrate finds probable cause to believe that the respondent
meets the criteria for commitment, he the clerk or magistrate shall
issue an order to a law enforcement officer or other person designated under
G.S. 122C‑251(g) to take the respondent into custody for
transportation to or custody at a 24‑hour facility or release
the respondent,facility; or if the respondent is released pending
hearing, as described in G.S. 122C‑283(d)(1).G.S. 122C‑283(d)(1),
order that a hearing be held as provided in G.S. 122C‑284(a). If
a physician or eligible psychologist executes an affidavit for commitment of a
respondent, a second qualified professional shall perform the examination
required by G.S. 122C‑285.
(e) Upon receipt of the
custody order of the clerk or magistrate, a law‑enforcementlaw
enforcement officer or other person designated in the order shall take the
respondent into custody within 24 hours after the order is signed. The custody
order is valid throughout the State.
(e1) No commitment examiner, area facility, acute care hospital, general hospital, or other site of first examination, or their officials, staff, employees, or other individuals responsible for the custody, examination, detention, management, supervision, treatment, or release of an individual examined for commitment and who follows accepted professional judgment, standards, and practice, shall be held liable in any civil or criminal action for taking reasonable measures to temporarily detain an individual for the period of time necessary to complete a commitment examination, submit an affidavit to the magistrate or clerk of court, and await the issuance of a custody order as authorized by subsection (d) of this section, as long as the commitment examiner has a reasonable and good‑faith belief that detention pending the examination and issuance of a custody order is necessary to protect the individual or others from bodily harm or life endangerment. If the individual is temporarily detained under the circumstances described in this subsection, the commitment examiner shall certify in the affidavit delivered to the clerk or magistrate in accordance with subdivision (d)(1) of this section the reason the individual requires temporary detention pending the issuance of a custody order.
(f) When a petition is filed for an individual who
is a resident of a single portal area, the procedures for examination by a
physician or eligible psychologist as set forth in G.S. 122C‑283(c)
shall be carried out in accordance with the area plan. When an individual from
a single portal area is presented for commitment at a facility directly, he may
be accepted for admission in accordance with G.S. 122C‑285. The
facility shall notify the area authority within 24 hours of admission and
further planning of treatment for the individual is the joint responsibility of
the area authority and the facility as prescribed in the area plan."
SECTION 34. G.S. 122C‑282 reads as rewritten:
"§ 122C‑282. Special emergency procedure for violent individuals.
When an individual subject to
commitment under the provisions of this Part is also violent and requires
restraint and when delay in taking him the individual to a physician
or eligible psychologistcommitment examiner for examination would
likely endanger life or property, a law‑enforcementlaw
enforcement officer may take the person into custody and take him or her
immediately before a magistrate or clerk. The law‑enforcementlaw
enforcement officer shall execute the affidavit required by G.S. 122C‑281
and in addition shall swear that the respondent is violent and requires
restraint and that delay in taking the respondent to a physician or eligible
psychologistcommitment examiner for an examination would endanger
life or property.
If the clerk or magistrate finds by
clear, cogent, and convincing evidence that the facts stated in the affidavit
are true, that the respondent is in fact violent and requires restraint, and
that delay in taking the respondent to a physician or eligible psychologistcommitment
examiner for an examination would endanger life or property, he the
clerk or magistrate shall order the law‑enforcementlaw
enforcement officer to take the respondent directly to a 24‑hour
facility described in G.S. 122C‑252.
Respondents received at a 24‑hour facility under the provisions of this section shall be examined and processed thereafter in the same way as all other respondents under this Part."
SECTION 35. G.S. 122C‑283 reads as rewritten:
"§ 122C‑283. Duties of law‑enforcement officer;
first examination by physician or eligible psychologist.commitment
examiner.
(a) Without unnecessary
delay after assuming custody, the law‑enforcement officer or the
individual designated by the clerk or magistrate under G.S. 122C‑251(g)
to provide transportation shall take the respondent to an area facility identified
by the LME/MCO in the crisis services plan adopted pursuant to G.S. 122C‑202.2
for examination by a physician or eligible psychologist; if a physician
or eligible psychologistcommitment examiner. If the area facility identified
in the plan or one of the facility's commitment examiners is not available
in the area facility, heavailable, the person designated to provide
transportation shall take the respondent to any physician or eligible
psychologist locally available. If a physician or eligible psychologist is not
immediately available, the respondent may be temporarily detained in an area
facility if one is available; if an area facility is not available, he may be
detained under appropriate supervision, in his home,other area facility
or an acute care hospital as identified and provided in the LME/MCO's community
crisis services plan adopted pursuant to G.S. 122C‑202.2. If no
identified facility or hospital is available, the respondent shall be
transported to any commitment examiner available in a private hospital or a
clinic, or in a general hospital,hospital. If a commitment examiner
is not available in an area facility or acute care hospital, the respondent may
be temporarily detained under appropriate supervision in the area facility or
hospital but not in a jail or other penal facility.
(a1) An area facility that is identified by the LME/MCO in accordance with G.S. 122C‑202.2 as a site for conducting first examinations under subsection (a) of this section shall be capable of performing a medical screening examination of the respondent that consists of a history and physical appropriate to the respondent's complaint or condition, with ancillary testing as necessary. The medical screening examination shall be conducted by a physician or other individual who is determined by the area facility to be qualified to perform the medical screening and is practicing within the scope of his or her licensure. The respondent may either be in the physical face‑to‑face presence of the medical screening examiner or may be examined utilizing telemedicine equipment and procedures. If the area facility in subsection (a) of this section determines that an individual qualified to perform a medical screening examination appropriate to the respondent's complaint or condition is not available on‑site or via telemedicine, the area facility shall identify and contact another area facility that is capable of performing the medical screening, or an acute care hospital, and the law enforcement officer or other designated person shall transport the respondent to the identified facility or hospital.
(a2) The responsible professional at an area facility or other site of first examination may transfer a respondent to an acute care hospital for emergency medical treatment, emergency medical evaluation, emergency surgery, or other medical treatment that the site of first examination is unable to provide by directing the law enforcement officer or other person designated under G.S. 122C‑251(g) to transport the respondent to an identified acute care hospital. When the respondent is transferred solely for medical reasons, the original facility shall accept the return of the respondent and the respondent shall be returned to the original facility after the medical care is completed unless the responsible professionals at both facilities concur that the respondent no longer meets the criteria for commitment and recommend that the commitment proceedings be terminated. Any decision to terminate the proceedings shall be documented and reported to the clerk of superior court in accordance with subsection (e) of this section.
(b) The examination set
forth in subsection (a) of this section is not required if:under
either of the following circumstances:
(1) The affiant who obtained
the custody order is a physician or eligible psychologist; orcommitment
examiner.
(2) The respondent is in custody under the special emergency procedure described in G.S. 122C‑282.
In these cases when it is recommended that the respondent be detained in a 24‑hour facility, the law‑enforcement officer shall take the respondent directly to a 24‑hour facility described in G.S. 122C‑252.
(c) The physician or
eligible psychologistcommitment examiner described in subsection (a)
of this section shall examine the respondent as soon as possible, and in any
event within 24 hours, after the respondent is presented for examination. The
examination shall include but is not limited to an assessment of the respondent's:
(1) Current and previous substance abuse including, if available, previous treatment history; and
(2) Dangerousness to himself or others as defined in G.S. 122C‑3(11).
(d) After the conclusion of
the examinationexamination, the physician or eligible
psychologistcommitment examiner shall make the following
determinations:
(1) If the physician or
eligible psychologistcommitment examiner finds that the respondent
is a substance abuser and is dangerous to himself self or others,
he the commitment examiner shall recommend commitment and whether
the respondent should be released or be held at a 24‑hour facility
pending hearing and shall so show on [the] his examination report. Based on the
physician's or eligible psychologist'scommitment examiner's recommendationrecommendation,
the law‑enforcementlaw enforcement officer or other
designated individual shall take the respondent to a 24‑hour facility
described in G.S. 122C‑252 or release the respondent. If a 24‑hour
facility is not immediately available or medically appropriate, the respondent
may be temporarily detained under appropriate supervision and the procedures
described in G.S. 122C‑263(d)(2) shall apply.
(2) If the physician or
eligible psychologistcommitment examiner finds that the condition
described in subdivision (1) of this subsection does not exist, the respondent
shall be released and the proceedings terminated.
(e) The findings of the physician
or eligible psychologistcommitment examiner and the facts on which
they are based shall be in writing in all cases. A copy of the findings shall
be sent to the clerk of superior court by the most reliable and expeditious
means. If it cannot be reasonably anticipated that the clerk will receive the
copy within 48 hours of after the time that it was signed,
the physician or eligible psychologistcommitment examiner shall
also communicate his the findings to the clerk by
telephone."
SECTION 36. G.S. 122C‑284 reads as rewritten:
"§ 122C‑284. Duties of clerk of superior court.
(a) Upon receipt by the
clerk of superior court of a physician's or eligible psychologist's
finding made by a commitment examiner or other qualified professional pursuant
to G.S. 122C‑285(c) that a respondent is a substance abuser and
dangerous to himself self or others and that commitment is
recommended, the clerk of superior court of the county where the facility is
located, if the respondent is held in a 24‑hour facility, or the clerk of
superior court where the petition was initiated shall upon direction of a
district court judge assign counsel, calendar the matter for hearing, and
notify the respondent, his respondent's counsel, and the
petitioner of the time and place of the hearing. The petitioner may file a
written waiver of his the right to notice under this subsection
with the clerk of court.
(b) Notice to the respondent required by subsection (a) of this section shall be given as provided in G.S. 1A‑1, Rule 4(j) at least 72 hours before the hearing. Notice to other individuals shall be given by mailing at least 72 hours before the hearing a copy by first‑class mail postage prepaid to the individual at his or her last known address. G.S. 1A‑1, Rule 6 shall not apply.
(c) Upon receipt of notice that transportation is necessary to take a committed respondent to a 24‑hour facility pursuant to G.S. 122C‑290(b), the clerk shall issue a custody order for the respondent.
(d) The clerk of superior court shall upon the direction of a district court judge calendar all hearings, supplemental hearings, and rehearings and provide all notices required by this Part."
SECTION 37. G.S. 122C‑285 reads as rewritten:
"§ 122C‑285. Commitment; second examination and treatment pending hearing.
(a) Within 24 hours of
arrival at a 24‑hour facility described in G.S. 122C‑252, the respondent
shall be examined by a qualified professional. This professional shall be a
physician if the initial commitment evaluation was conducted by an eligible
psychologist.a commitment examiner who is not a physician. The
examination shall include the assessment specified in G.S. 122C‑283(c).
If the physician or qualified professional finds that the respondent is
a substance abuser and is dangerous to himself self or others, he
the physician or qualified professional shall hold and treat the
respondent at the facility or designate other treatment pending the district
court hearing. If the physician or qualified professional finds that the
respondent does not meet the criteria for commitment under G.S. 122C‑283(d)(1),
he the physician or qualified professional shall release the
respondent and the proceeding shall be terminated. In this case the reasons for
the release shall be reported in writing to the clerk of superior court of the
county in which the custody order originated. If the respondent is released,
the law‑enforcement law enforcement officer or other person
designated to provide transportation shall return the respondent to the
originating county.
(b) If the 24‑hour
facility described in G.S. 122C‑252 is the facility in which the
first examination by a physician or eligible psychologistcommitment
examiner occurred and is the same facility in which the respondent is held,
the second examination must occur not later than the following regular working
day.
(c) The findings of the physician or qualified professional along with the facts on which they are based shall be made in writing in all cases. A copy of the written findings shall be sent to the clerk of superior court by reliable and expeditious means."
SECTION 38. G.S. 122C‑286 reads as rewritten:
"§ 122C‑286. Commitment; district court hearing.
(a) A hearing shall be held in district court within 10 days of the day the respondent is taken into custody. If a respondent temporarily detained under G.S. 122C‑263(d)(2) is subject to a series of successive custody orders issued pursuant to G.S. 122C‑263(d)(2), the hearing shall be held within 10 days after the day the respondent is taken into custody under the most recent custody order. Upon its own motion or upon motion of the responsible professional, the respondent, or the State, the court may grant a continuance of not more than five days.
(b) The respondent shall be
present at the hearing.hearing unless the respondent, through
counsel, submits a written waiver of personal appearance. A subpoena may be
issued to compel the respondent's presence at a hearing. The petitioner and the
responsible professional of the area authority facility or the
proposed treating physician or his a designee of the proposed
treating physician may be present and may provide testimony.
(c) Certified copies of
reports and findings of physicians and psychologistsphysicians,
psychologists, and other commitment examiners and medical records of
previous and current treatment are admissible in evidence, but the respondent's
right to confront and cross‑examine witnesses shall not be denied.
(d) The respondent may be
represented by counsel of his choice. If the respondent is indigent
within the meaning of G.S. 7A‑450, counsel shall be appointed to
represent the respondent in accordance with rules adopted by the Office of
Indigent Defense Services.
(e) Hearings may be held at a facility if it is located within the judge's district court district as defined in G.S. 7A‑133 or in the judge's chambers. A hearing may not be held in a regular courtroom, over objection of the respondent, if in the discretion of a judge a more suitable place is available.
(f) The hearing shall be closed to the public unless the respondent requests otherwise. The hearing for a respondent being held at a 24‑four facility shall be held in a location and in the manner provided in G.S. 122C‑268(g).
(g) A copy of all documents admitted into evidence and a transcript of the proceedings shall be furnished to the respondent on request by the clerk upon the direction of a district court judge. If the respondent is indigent, the copies shall be provided at State expense.
(h) To support a commitment
order, the court shall find by clear, cogent, and convincing evidence that the
respondent meets the criteria specified in G.S. 122C‑283(d)(1). The
court shall record the facts that support its findings and shall show on the
order the area authority facility or physician who is responsible
for the management and supervision of the respondent's treatment."
SECTION 39. G.S. 122C‑287 reads as rewritten:
"§ 122C‑287. Disposition.
The court may make one of the following dispositions:
(1) If the court finds by
clear, cogent, and convincing evidence that the respondent is a substance
abuser and is dangerous to himself self or others, it shall order
for a period not in excess of 180 days commitment to and treatment by an area authority
facility or physician who is responsible for the management and
supervision of the respondent's commitment and treatment. Before ordering
commitment to and treatment by an area facility or a physician who is not a
physician at an inpatient facility, the court shall follow the procedures
specified in G.S. 122C‑271(a)(3) and G.S. 122C‑271(b)(4),
as applicable. The court shall not order commitment to an area facility unless
the respondent is eligible for services at the area facility through an LME/MCO
or otherwise qualifies for the provision of services offered by the provider.
(2) If the court finds that the respondent does not meet the commitment criteria set out in subdivision (1) of this subsection, the respondent shall be discharged and the facility in which he was last treated so notified."
SECTION 40. G.S. 122C‑290 reads as rewritten:
"§ 122C‑290. Duties for follow‑up on commitment order.
(a) The area authority facility
or physician responsible for management and supervision of the respondent's
commitment and treatment may prescribe or administer to the respondent
reasonable and appropriate treatment either on an outpatient basis or in a 24‑hour
facility.
(b) If the respondent whose
treatment is provided on an outpatient basis fails to comply with all or part
of the prescribed treatment after reasonable effort to solicit the respondent's
compliance or whose treatment is provided on an inpatient basis is discharged
in accordance with G.S. 122C‑205.1(b), the area authority facility
or physician may request the clerk or magistrate to order the respondent
taken into custody for the purpose of examination. Upon receipt of this
request, the clerk or magistrate shall issue an order to a law enforcement
officer to take the respondent into custody and to take him immediately to the
designated area authority facility or physician for examination.
The custody order is valid throughout the State. The law enforcement officer
shall turn the respondent over to the custody of the physician or area authority
facility who shall conduct the examination and release the
respondent or have the respondent taken to a 24‑hour facility upon a
determination that treatment in the facility will benefit the respondent.
Transportation to the 24‑hour facility shall be provided as specified in
G.S. 122C‑251, upon notice to the clerk or magistrate that
transportation is necessary, or as provided in G.S. 122C‑408(b). If
placement in a 24‑hour facility is to exceed 45 consecutive days, the
area authority facility or physician shall notify the clerk of
court by the 30th day and request a supplemental hearing as specified in
G.S. 122C‑291.
(c) If the respondent
intends to move or moves to another county within the State, the area authority
facility or physician shall notify the clerk of court in the county
where the commitment is being supervised and request that a supplemental
hearing be calendared.
(d) If the respondent moves
to another state or to an unknown location, the designated area authority facility
or physician shall notify the clerk of superior court of the county where
the commitment is supervised and the commitment shall be terminated."
SECTION 41. G.S. 122C‑291 reads as rewritten:
"§ 122C‑291. Supplemental hearings.
(a) Upon receipt of a
request for a supplemental hearing, the clerk shall calendar a hearing to be
held within 14 days and notify, at least 72 hours before the hearing, the
petitioner, the respondent, his attorney, if any, and the designated area authority
facility or physician. Notice shall be provided in accordance with
G.S. 122C‑284(b). The procedures for the hearing shall follow
G.S. 122C‑286.
(b) At the supplemental
hearing for a respondent who has moved or may move to another county, the court
shall determine if the respondent meets the criteria for commitment set out in
G.S. 122C‑283(d)(1). If the court determines that the respondent no
longer meets the criteria for commitment, it shall discharge the respondent
from the order and dismiss the case. If the court determines that the
respondent continues to meet the criteria for commitment, it shall continue the
commitment but shall designate an area authority facility or
physician at the respondent's new residence to be responsible for the
management or supervision of the respondent's commitment. The court shall order
the respondent to appear for treatment at the address of the newly designated
area authority facility or physician and shall order venue for
further court proceedings under the commitment to be transferred to the new
county of supervision. Upon an order changing venue, the clerk of court in the
county where the commitment has been supervised shall transfer the records
regarding the commitment to the clerk of court in the county where the
commitment will be supervised. Also, the clerk of court in the county where the
commitment has been supervised shall send a copy of the court's order directing
the continuation of treatment under new supervision to the newly designated
area authority facility or physician.
(c) At a supplemental hearing for a respondent to be held longer than 45 consecutive days in a 24‑hour facility, the court shall determine if the respondent meets the criteria for commitment set out in G.S. 122C‑283(d)(1). If the court determines that the respondent continues to meet the criteria and that further treatment in the 24‑hour facility is necessary, the court may authorize continued care in the facility for not more than 90 days, after which a rehearing for the purpose of determining the need for continued care in the 24‑hour facility shall be held, or the court may order the respondent released from the 24‑hour facility and continued on the commitment on an outpatient basis. If the court determines that the respondent no longer meets the criteria for commitment the respondent shall be released and his case dismissed.
(d) At any time during the term of commitment order, a respondent may apply to the court for a supplemental hearing for the purpose of discharge from the order. The application shall be made in writing to the clerk of superior court. At the supplemental hearing the court shall determine whether the respondent continues to meet the criteria for commitment. The court may reissue or change the commitment order or discharge the respondent and dismiss the case."
SECTION 42. G.S. 122C‑292 reads as rewritten:
"§ 122C‑292. Rehearings.
(a) Fifteen days before the
end of the initial or subsequent periods of commitment if the area authority
facility or physician determines that the respondent continues to
meet the criteria specified in G.S. 122C‑283(d)(1), the clerk of
superior court of the county where commitment is supervised shall be notified.
The clerk, at least 10 days before the end of the commitment period, on order
of the district court, shall calendar the rehearing. If the respondent no
longer meets the criteria, the area authority facility or
physician shall so notify the clerk who shall dismiss the case.
(b) Rehearings are governed
by the same notice and procedures as initial hearings, and the respondent has
the same rights he hadthat were available to the respondent at
the initial hearing including the right to appeal.
(c) If the court finds that
the respondent no longer meets the criteria of G.S. 122C‑283(d)(1),
it shall unconditionally discharge him. A copy of the discharge order shall be
furnished by the clerk to the designated area authority facility or
physician. If the respondent continues to meet the criteria of G.S. 122C‑283(d)(1),
the court may order commitment for additional periods not in excess of 365 days
each."
SECTION 43. G.S. 122C‑293 reads as rewritten:
"§ 122C‑293. Release by area authority or physician.
The area authority facility
or physician as designated in the order shall discharge a committed
respondent unconditionally at any time he the physician determines
that the respondent no longer meets the criteria of G.S. 122C‑283(d)(1).
Notice of discharge and the reasons for the release shall be reported in
writing to the clerk of superior court of the county in which the commitment
was ordered."
SECTION 44. G.S. 122C‑294 reads as rewritten:
"§ 122C‑294. Local plan.
Each area authority shall develop a
local plan in accordance with G.S. 122C‑202.2 with local law‑enforcement
agencies, local courts, local hospitals, and local medical societiesothers
as necessary to facilitate implementation of this Part."
SECTION 45.(a) Each LME/MCO shall submit to the Department of Health and Human Services a copy of its current community crisis services plan adopted pursuant to G.S. 122C‑202.2, as enacted by this act, by the earlier of (i) 12 months after the date the Department receives notification that the federal Centers for Medicaid and Medicare has approved all necessary waivers and State Plan amendments for Medicaid and NC Health Choice transformation as provided for in S.L. 2015‑245, as amended, or (ii) six months prior to the date the Department actually initiates capitated contracts with Prepaid Health Plans, as defined in Section 4 of S.L. 2015‑245, as amended, for the delivery of Medicaid and NC Health Choice services. The Department shall notify each LME/MCO when the earlier of these conditions occurs.
SECTION 45.(b) This section is effective when it becomes law.
SECTION 46. Except as otherwise provided, this act becomes effective December 1, 2017, and applies to proceedings initiated on or after that date.
