House Resolution #5751 (2019)

HOUSE RESOLUTION CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY THE EFFICACY OF INVOLUNTARY INPATIENT TREATMENT FOR NON-COURT INVOLVED INDIVIDUALS DIAGNOSED WITH SUBSTANCE USE DISORDER

Authorizes a seventy-two (72) hour hold to be ordered by a physician in certain instances of substance use disorders.

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Changes since original draft

  • 2019 – H 5751
  • 2019 – H 5751 SUBSTITUTE A
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  • LC001618
  • LC001618/SUB A/4
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  • S TATE OF RHODE IS L AND
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2019
  • ____________
  • A N A C T
  • RELATING TO HEALTH AND SAFETY - EMERGENCY COMMITMENT FOR DRUG
  • INTOXICATION
  • H O U S E R E S O L U T I O N
  • CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY THE EFFICACY OF
  • INVOLUNTARY INPATIENT TREATMENT FOR NON-COURT INVOLVED
  • INDIVIDUALS DIAGNOSED WITH SUBSTANCE USE DISORDER
  • Introduced By: Representatives Casey, Canario, Jacquard, Hull, and Morin
  • Date Introduced: February 27, 2019
  • Date Introduced:February 27, 2019
  • Referred To: House Judiciary
  • It is enacted by the GeneralAssembly as follows:
  • SECTION 1. Chapter 23-10.1 of the GeneralLaws entitled "Emergency Commitment for Drug Intoxication" is hereby amended by adding thereto the following sections:
  • 23-10.1-7. Definitions.
  • As used in §§ 23-10.1-7 through 23-10.1-15:
  • (1) "Petition" means a petition for a seventy-two (72) hour hold filed pursuant to § 23- 10.1-8.
  • (2) "Respondent" means a person who is the subject of a petition for a seventy-two (72) hour hold filed pursuant to § 23-10.1-8.
  • (3) "Substance use disorder" means the chronic or habitual consumption or ingestion of drugs and intoxicating substance by a person to the extent that:
  • (i) Such consumption or ingestion substantially injures the person's health or substantially interferes with the person's socialor economic functioning; or
  • (ii) The person has lost the power of self-control over the use of such drugs and intoxicating substance.
  • 23-10.1-8. Seventy-two (72) hour hold for substance use disorder.
  • (a) A physician who concentrates in diagnosing and treating persons with substance use disorders and who while treating a person (hereinafter, the "respondent") for substance use, has reason to believe that the respondent is suffering from a substance use disorder and presents a danger or threat of danger to self, family, or others, if not treated for the substance use disorder, may request the district court or family court, as appropriate, to issue a seventy-two (72) hour hold on the respondent for in-patient treatment at a facility designed to provide in-patient treatment to persons with substance use disorders. A petition filed pursuant to this section shallbe in writing and shall include the factual basis for the finding that the respondent requires a seventy-two (72) hour hold pursuant to this section. A petition for a seventy-two (72) hour hold must allege that, upon information and belief, the respondent:
  • (1) Suffers from a substance use disorder;
  • (2) Presents an imminent threatof danger or threat of danger to self, family, or others as a result of substance use, or there exists a substantiallikelihood of such a threat in the near future;
  • (3) Has been treated in a hospital or emergency health care facility for a substance use disorder at least three (3) prior times; and
  • (4) Can reasonably benefit from treatment that can be administered in an inpatient facility during a seventy-two (72) hour period.
  • (b) A family member of the respondent, or a first responder to the respondent, including a member of the police, fire, or rescue unit (hereinafter a "first responder") who assisted in bringing the respondent to the physician or the facility where the physician is treating the respondent, may request the physician to issue such a petition, but only a physician may submit a petition as set forth in subsection (a) of this section.
  • (c) The petition may be filed and transmitted to the court physically or electronically, provided that the respondent shall, prior to such transmission, be provided the notices required pursuant to § 23-10.1-9.
  • (d) A parent or legal guardian may provide consent for the hold for their minor child or ward notwithstanding the objection of their minor child or ward.
  • 23-10.1-9. Notice and legal counsel.
  • (a) Prior to the filing of the petition, a respondent subject to a seventy-two (72) hour hold petition pursuant to § 23-10.1-8 shall be informed both verbally and in writing that the respondent is entitled to object to the hold and may request an immediate hearing before a judge of either the district court or family court, depending upon the age of the patient. The respondent shallalso be informed both verbally and in writing that the respondent is entitled to be represented by legal counsel. If the respondent is unable to procure legal counsel, a volunteer mentalhealth advocate shall be provided to the respondent as provided for in this chapter.
  • (b) If the respondent indicates he or she objects to the hold and requests a hearing, the petitioning physician shall note this on the petition prior to its transmission to court. A copy of
  • LC001618 - Page 2of 7 the petition shall also be given to the office of the mentalhealth advocate.
  • 23-10.1-10. Hearing.
  • (a) A respondent shall be entitled to be represented by legalcounseland receive services from the mental health advocate, who shall be notified of the petition. If reasonably possible and medically feasible, the respondent shall be transported to the appropriate court for a hearing before the duty judge. In the event the court is not open at the time the hold is requested, or if the respondent cannot otherwise be transported to the court, the hearing may be held by a video electronic teleconference with the duty judge of the appropriate court.
  • (b) Any facility conducting a hearing through an electronic teleconference shall ensure that the teleconferencing technology:
  • (1) Includes an audio and video feed which will allow dialogue, argument, and the presentation of evidence in realtime, and allows for the exchange of digital documents; and
  • (2) Provides encryption or other forms of protection to ensure that the transmission of information between the court and the medical facility is secure and meets the confidentiality requirements imposed by the Health Insurance Portability and Accountability Act, Pub. L. 104- 91, as amended (42 U.S.C. § 300gg et al.), as wellas with any rules and regulations promulgated by the department of health pursuant to § 23-10.1-14.
  • (c) The burden of proof on whether to impose a seventy-two (72) hour hold shall be on the party requesting the hold. The standard of determining whether or not to impose the seventy- two (72) hour hold shall be clear and convincing evidence.
  • (d) The court may order the hold and treatment of the respondent to continue for a period of up to seventy-two (72) hours upon a finding, upon clear and convincing evidence, that the allegations in the petition are correct. In making this determination, the court may take into account any exigent circumstances presented to the court. The court may also consider the difficulty in determining with absolute certainty as to whether a patient will benefit from a specific course of treatment. The court may order such further relief as it deems appropriate, including, but not limited to, the use of peer recovery support specialists, to meet and work with the respondent.
  • (e) The state shall provide for the cost of transporting a respondent to and from the appropriate court for any hearing held pursuant to this section.
  • (f) The provisions of § 23-10.1-5 shall not apply to a seventy-two (72) hour hold issued pursuant to this section.
  • 23-10.1-11. Advocates designated to assist the mental health advocate.
  • (a) The mental health advocate is authorized to maintain a list of attorney volunteers to
  • LC001618 - Page 3of 7 serve as volunteer mentalhealth advocates at hearings held for a seventy-two (72) hour hold. The mental health advocate may also designate law school students who have completed a fullyear's course in the study of evidence as volunteer mental health advocates, who may represent the respondent as volunteer mental health advocate at these hearings. All volunteer mental health advocates shallsuccessfully complete any trainings required by the mentalhealth advocate.
  • (b) Attorneys on the staff of the mental health advocate may also appear on behalf of respondents in the seventy-two (72) hour hold hearings.
  • 23-10.1-12. Seventy-two (72) hour holds to be in addition to other remedies.
  • The authorization of and proceedings for a seventy-two (72) hour hold pursuant to §§ 23- 10.1-8 through 23-10.1.-10 shall not preclude the concurrent or subsequent filing of other actions for involuntary commitment of substance users, including, but not limited to, actions brought pursuant to §§ 23-10.1-4 and 40.1-5-7.
  • 23-10.1-13. Exemption from liability.
  • A physician acting on the physician's good faith belief that the criteria for a seventy-two (72) hour hold pursuant to § 23-10.1-8 has been met, as well as the medical facility wherein the physician is working while filing the petition, shall be immune from any civil or criminal liability in regard to filing of a petition for the hold. The inpatient facility which accepts a respondent pursuant to an order issued under this chapter shall be immune from any actions for false imprisonment or of a similar nature for holding and treating the respondent during the seventy- two (72) hour period of the hold.
  • 23-10.1-14. Rules and regulations.
  • (a) The department of health shall promulgate rules and regulations to implement the provisions of §§ 23-10.1-7 through 23-10.1-15. Such rules and regulations shall include, but not be limited to:
  • (1) The qualifications for the type of facilities where a respondent may be held and treated during a seventy-two (72) hour hold;
  • (2) The type of treatments which may be offered;
  • (3) Forms that may be used to file the petition and which shall include provisions that shall encompass the required information; and
  • (4) Provisions to ensure the technology utilized to conduct electronic hearings is accurate, secure and confidential.
  • (b) The department of health shallconsult with the office of the mentalhealth advocate in promulgating the rules and regulations authorized by this section.
  • 23-10.1-15. Training to be offered.
  • LC001618 - Page 4of 7
  • (a) The department of health shall conduct training sessions on the procedures and criteria for filing a petition for a seventy-two (72) hour hold pursuant to the provisions of this chapter.
  • (b) The office of the mental health advocate shall conduct training sessions on the procedures and criteria for representing a respondent at a hearing for a seventy-two (72) hour hold pursuant to the provisions of this chapter.
  • SECTION 2. Chapter 27-18 of the General Laws entitled "Accident and Sickness Policies" is hereby amended to by adding thereto the following section:
  • 27-18-85. Coverage for seventy-two (72) hour holds.
  • Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended or renewed in this state on or after January 1, 2020, shall provide coverage for inpatient hospitalization for at least one seventy- two (72) hour period per calendar year, when such hospitalization is ordered by a court of competent jurisdiction pursuant to the provisions of chapter 10.1 of title 23.
  • SECTION 3. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service Corporations" is hereby amended to by adding thereto the following section:
  • 27-19-77. Coverage for seventy-two (72) hour holds.
  • Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended or renewed in this state on or after January 1, 2020, shall provide coverage for inpatient hospitalization for at least one seventy- two (72) hour period per calendar year, when such hospitalization is ordered by a court of competent jurisdiction pursuant to the provisions of chapter 10.1 of title 23.
  • SECTION 4. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service Corporations" is hereby amended to by adding thereto the following section:
  • 27-20-73. Coverage for seventy-two (72) hour holds.
  • Every individual or group health insurance contract, plan, or policy that provides prescription coverage that is delivered, issued for delivery, amended or renewed in this state on or after January 1, 2020, shall provide coverage for inpatient hospitalization for at least one seventy- two (72) hour period per calendar year, when such hospitalization is ordered by a court of competent jurisdiction pursuant to the provisions of chapter 10.1 of title 23.
  • SECTION 5. Chapter 27-41 of the General Laws entitled "Health Maintenance Organizations" is hereby amended to by adding thereto the following section:
  • 27-41-90. Coverage for seventy-two (72) hour holds.
  • Every individual or group health insurance contract, plan, or policy that provides
  • LC001618 - Page 5of 7 prescription coverage that is delivered, issued for delivery, amended or renewed in this state on or after January 1, 2020, shall provide coverage for inpatient hospitalization for at least one seventy- two (72) hour period per calendar year, when such hospitalization is ordered by a court of competent jurisdiction pursuant to the provisions of chapter 10.1 of title 23.
  • SECTION 6. This act shalltake effect on January 1, 2020. ======== LC001618 ========
  • LC001618 - Page 6of 7
  • RESOLVED, That a special legislative commission be and the same is hereby created consisting of seventeen (17) members: three (3) of whom shall be members of the Rhode Island House of Representatives, not more than two (2) from the same politicalparty, to be appointed by the Speaker of the House; one of whom shall be the Director of the Rhode Island Department of Health (RIDOH), or designee; one of whom shallbe the Director of the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals, or designee; one of whom shall be from the Warren Alpert Medical School of Brown University, to be appointed by the Speaker of the House; one of whom shall be the Rhode Island Mental Health Advocate, or designee; one of whom shall be the President of the Hospital Association of Rhode Island, or designee; one of whom shall be the Rhode Island state Attorney General, or designee; one of whom shall be a representative of the health insurance industry, to be appointed by the Speaker of the House; three (3) of whom shallbe representatives from groups that work with or advocate for persons who experience mental illness of substance use disorders, to be appointed by the Speaker of the House; one of whom shallbe the President and Chief Operating Officer of Butler Hospital, or designee; one of whom shall be the Chief Justice of the Rhode Island Supreme Court, or designee; one of whom shall be the Executive Director of the Rhode Island Medical Society, or designee; and one of whom shall be of the President of the Rhode Island Chapter of the American College of Emergency Physicians, or designee.
  • In lieu of any appointment of a member of the legislature to a permanent advisory commission, a legislative study commission, or any commission created by a General Assembly resolution, the appointing authority may appoint a member of the general public to serve in lieu of a legislator.
  • The purpose of said commission shall be to examine the need for an advance directive or other mechanism to hold persons who are under the immediate effects of a substance use disorder involving opioids, and shall include, but not be limited to, a study and review of:
  • Medical literature and expert opinions on the long-term relapse rates of individuals diagnosed with substance use disorder following involuntary inpatient treatment including:
  • The differences in outcomes for coerced and non-coerced patients;
  • The potential increased risk of an individual suffering a fatal overdose following a period of involuntary treatment;
  • The length of time necessary for detoxification of opioids and recommended time following detoxification to begin medication-assisted treatment;
  • The legal implications of holding a non-court involved individual who is diagnosed with substance use disorder but is no longer under the influence of substances;
  • Whether the current capacity, including acute treatment services, clinical stabilization services, transitional support services and recovery homes, is sufficient to treat individuals seeking voluntary treatment for substance use disorder;
  • The availability of other treatments for substance use disorder, including those treatments used in less restrictive settings; and
  • The effectiveness of the existing involuntary commitment procedures pursuant to this chapter at reducing long-term relapse rates.
  • Forthwith upon passage of this resolution, the members of the commission shall meet at the call of the Speaker of the House and organize and shall select a chairperson from among the legislators.
  • Vacancies in said commission shall be filled in like manner as the original appointment.
  • The membership of said commission shall receive no compensation for their services.
  • All departments and agencies of the state, shall furnish such advice and information, documentary and otherwise, to said commission and its agents as is deemed necessary or desirable by the commission to facilitate the purposes of this resolution.
  • The Speaker of the House is hereby authorized and directed to provide suitable quarters for said commission; and be it further
  • RESOLVED, That the commission shall report its findings and recommendations to the House of Representatives no later than June 18, 2020, and said commission shall expire on July
  • LC001618/SUB A/4 - Page 2of 4 13, 2020. ======== LC001618/SUB A/4 ========
  • LC001618/SUB A/4 - Page 3of 4
  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO HEALTH AND SAFETY - EMERGENCY COMMITMENT FOR DRUG
  • INTOXICATION
  • H O U S E R E S O L U T I O N
  • CREATING A SPECIAL LEGISLATIVE COMMISSION TO STUDY THE EFFICACY OF
  • INVOLUNTARY INPATIENT TREATMENT FOR NON-COURT INVOLVED
  • INDIVIDUALS DIAGNOSED WITH SUBSTANCE USE DISORDER
  • ***
  • This act would authorize a seventy-two (72) hour hold to be ordered by a physician in certain instances of substance use disorders. The hold could be continued beyond the seventy-two (72) hour period if ordered by a judge of the district or family court.
  • This act would take effect on January 1, 2020. ======== LC001618 ========
  • LC001618 - Page 7of 7
  • This resolution would create a seventeen (17) member special legislative study commission whose purpose it would be to make a comprehensive study of the efficacy of involuntary inpatient treatment for non-court involved individuals diagnosed with substance use disorder, and who would report back to the House of Representatives no later than June 18, 2020, and whose life would expire on July 13, 2020. ======== LC001618/SUB A/4 ========
  • LC001618/SUB A/4 - Page 4of 4

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