1.1                          A bill for an act 
  1.2             relating to health; modifying provisions relating to 
  1.3             the administration and prescription of neuroleptic 
  1.4             medications; changing the name of a court in certain 
  1.5             circumstances; amending Minnesota Statutes 1994, 
  1.6             sections 13.42, subdivision 3; 253B.03, subdivisions 
  1.7             6b and 6c; 253B.05, subdivisions 2 and 3; 253B.12, 
  1.8             subdivision 1; and 253B.17, subdivision 1. 
  1.9   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.10     Section 1.  Minnesota Statutes 1994, section 13.42, 
  1.11  subdivision 3, is amended to read: 
  1.12     Subd. 3.  [CLASSIFICATION OF MEDICAL DATA.] Unless the data 
  1.13  is summary data or a statute specifically provides a different 
  1.14  classification, medical data are private but are available only 
  1.15  to the subject of the data as provided in section 144.335, and 
  1.16  shall not be disclosed to others except: 
  1.17     (a) Pursuant to section 13.05; 
  1.18     (b) Pursuant to section 253B.03, subdivision 6c; 
  1.19     (c) Pursuant to a valid court order; 
  1.20     (c) (d) To administer federal funds or programs; 
  1.21     (d) (e) To the surviving spouse, parents, children, and 
  1.22  siblings of a deceased patient or client or, if there are no 
  1.23  surviving spouse, parents, children, or siblings, to the 
  1.24  surviving heirs of the nearest degree of kindred; 
  1.25     (e) (f) To communicate a patient's or client's condition to 
  1.26  a family member or other appropriate person in accordance with 
  1.27  acceptable medical practice, unless the patient or client 
  2.1   directs otherwise; or 
  2.2      (f) (g) As otherwise required by law. 
  2.3      Sec. 2.  Minnesota Statutes 1994, section 253B.03, 
  2.4   subdivision 6b, is amended to read: 
  2.5      Subd. 6b.  [CONSENT FOR MENTAL HEALTH TREATMENT.] A 
  2.6   competent person admitted or committed without commitment to a 
  2.7   treatment facility may be subjected to intrusive mental health 
  2.8   treatment only with the person's written informed consent.  For 
  2.9   purposes of this section, "intrusive mental health treatment" 
  2.10  means electroshock therapy and neuroleptic medication and does 
  2.11  not include treatment for mental retardation.  An incompetent 
  2.12  person who has prepared a directive under subdivision 6d 
  2.13  regarding treatment with intrusive therapies must be treated in 
  2.14  accordance with this section, except in cases of emergencies. 
  2.15     Sec. 3.  Minnesota Statutes 1994, section 253B.03, 
  2.16  subdivision 6c, is amended to read: 
  2.17     Subd. 6c.  [RECORDS; ADMINISTRATION OF NEUROLEPTIC 
  2.18  MEDICATIONS.] (a) A treating physician who makes medical 
  2.19  decisions under this subdivision regarding the prescription and 
  2.20  administration of neuroleptic medication may have access to the 
  2.21  physician's order section of a patient's records on past 
  2.22  administration of neuroleptic medication at any treatment 
  2.23  facility, if the patient lacks the capacity to authorize the 
  2.24  release of records.  Upon request of a treating physician under 
  2.25  this subdivision, a treatment facility shall supply complete 
  2.26  information relating to the past records on administration of 
  2.27  neuroleptic medication of a patient subject to this 
  2.28  subdivision.  A patient who has the capacity to authorize the 
  2.29  release of data retains the right to make decisions regarding 
  2.30  access to medical records as provided by section 144.335. 
  2.31     (b) Neuroleptic medications may be administered to persons 
  2.32  committed as mentally ill or mentally ill and dangerous only as 
  2.33  described in this subdivision.  For purposes of this section, 
  2.34  "patient" also includes a proposed patient who is the subject of 
  2.35  a petition for commitment. 
  2.36     (b) (c) A neuroleptic medication may be administered 
  3.1   treatment provider may prescribe and administer neuroleptic 
  3.2   medication without judicial review to a patient who: 
  3.3      (1) is competent to consent to neuroleptic medications if 
  3.4   the patient has given written, informed consent to 
  3.5   administration of the neuroleptic medication. the treatment and 
  3.6   has signed a written, informed consent; 
  3.7      (c) A neuroleptic medication may be administered to a 
  3.8   patient who (2) is not competent to consent to neuroleptic 
  3.9   medications if the patient, when competent, prepared a 
  3.10  declaration under subdivision 6d requesting the treatment or 
  3.11  authorizing a proxy to request the treatment or if a court 
  3.12  approves the administration of the neuroleptic medication. and 
  3.13  the proxy has requested the neuroleptic medication; 
  3.14     (d) A neuroleptic medication may be administered without 
  3.15  court review to a patient who (3) has not prepared a declaration 
  3.16  under subdivision 6d and who is not competent to consent to 
  3.17  neuroleptic medications if:  
  3.18     (1) (i) the patient does not object to or refuse the 
  3.19  medication; 
  3.20     (2) (ii) a guardian ad litem appointed by the court with 
  3.21  authority to consent to neuroleptic medications gives written, 
  3.22  informed consent to the administration of the neuroleptic 
  3.23  medication; and 
  3.24     (3) (iii) a multidisciplinary treatment review panel 
  3.25  composed of persons who are not engaged in providing direct care 
  3.26  to the patient gives written approval to administration of the 
  3.27  neuroleptic medication.; or 
  3.28     (e) A neuroleptic medication may be administered without 
  3.29  judicial review and without consent (4) refuses prescribed 
  3.30  neuroleptic medication and is in an emergency situation.  
  3.31  Medication may be administered for so long as the emergency 
  3.32  continues to exist, up to 14 days, if the treating physician 
  3.33  determines that the medication is necessary to prevent serious, 
  3.34  immediate physical harm to the patient or to others.  If a 
  3.35  petition for authorization to administer medication is filed 
  3.36  within the 14 days, the treating physician may continue the 
  4.1   medication through the date of the first court hearing, if the 
  4.2   emergency continues to exist.  If the petition for authorization 
  4.3   to administer medication is filed in conjunction with a petition 
  4.4   for commitment and the court makes a determination at the 
  4.5   preliminary hearing under section 253B.07, subdivision 7, that 
  4.6   there is sufficient cause to continue the physician's order 
  4.7   until the hearing under section 253B.08, the treating physician 
  4.8   may continue the medication until that hearing, if the emergency 
  4.9   continues to exist.  The treatment facility shall document the 
  4.10  emergency in the patient's medical record in specific behavioral 
  4.11  terms. 
  4.12     (f) A person who consents to treatment pursuant to this 
  4.13  subdivision is not civilly or criminally liable for the 
  4.14  performance of or the manner of performing the treatment.  A 
  4.15  person is not liable for performing treatment without consent if 
  4.16  written, informed consent was given pursuant to this 
  4.17  subdivision.  This provision does not affect any other liability 
  4.18  that may result from the manner in which the treatment is 
  4.19  performed. 
  4.20     (g) (d) The court may allow and order paid to a guardian ad 
  4.21  litem a reasonable fee for services provided under paragraph 
  4.22  (c), or the court may appoint a volunteer guardian ad litem. 
  4.23     (h) A medical director or patient may petition the 
  4.24  committing court, or the court to which venue has been 
  4.25  transferred, for a hearing concerning the administration of 
  4.26  neuroleptic medication.  A hearing may also be held pursuant to 
  4.27  section 253B.08, 253B.09, 253B.12, or 253B.18.  The hearing 
  4.28  concerning the administration of neuroleptic medication must be 
  4.29  held within 14 days from the date of the filing of the 
  4.30  petition.  The court may extend the time for hearing up to an 
  4.31  additional 15 days for good cause shown. 
  4.32     (e) A treatment facility must obtain judicial review to 
  4.33  administer neuroleptic medication to a patient who refuses to 
  4.34  take the medication, or when an independent medical review does 
  4.35  not support the prescribed treatment. 
  4.36     (f) A physician on behalf of a treatment facility may file 
  5.1   a petition requesting authorization to administer neuroleptic 
  5.2   medication to a patient who is not competent to consent to the 
  5.3   prescribed medication, as certified by a physician, and who 
  5.4   refuses to take the prescribed medication.  A patient may also 
  5.5   file a petition pursuant to section 253B.17 for a review of a 
  5.6   physician's order for neuroleptic medication.  
  5.7      (g) A petition may be filed with the district court in the 
  5.8   county of commitment or, with the consent of the committing 
  5.9   court, the county in which the patient is being held or treated. 
  5.10  The petition may be heard as part of any other district court 
  5.11  proceeding under this chapter.  The hearing must be held within 
  5.12  14 days from the date of the filing of the petition.  By 
  5.13  agreement of the parties, or for good cause shown, the court may 
  5.14  extend the time of hearing an additional 30 days.  
  5.15     (h) If the petitioning facility has a treatment review 
  5.16  panel, the panel shall review the appropriateness of the 
  5.17  proposed medication and submit its recommendations to the court, 
  5.18  to the county attorney, and to the patient's counsel at least 
  5.19  two days prior to the hearing. 
  5.20     (i) The patient must be examined by a court examiner prior 
  5.21  to the hearing.  If the patient refuses to participate in an 
  5.22  examination, the examiner may rely on the patient's medical 
  5.23  records to reach an opinion as to the appropriateness of 
  5.24  neuroleptic medication.  The patient is entitled to counsel and 
  5.25  a second examiner, if requested by the patient or patient's 
  5.26  counsel. 
  5.27     (j) At any time during the commitment proceedings, the 
  5.28  court may appoint a guardian ad litem upon the request of any 
  5.29  party, the recommendation of the prepetition screener, an 
  5.30  examining physician, the court's examiner, or upon the court's 
  5.31  own motion. 
  5.32     (k) The court shall determine by clear and convincing 
  5.33  evidence:  (1) whether the patient is incompetent to consent to 
  5.34  the neuroleptic medication because of the patient's mental 
  5.35  illness; (2) whether the involuntary administration of 
  5.36  medication is necessary to treat the patient's mental illness; 
  6.1   and (3) if evidence has been presented, what the wishes of the 
  6.2   patient when competent would be regarding administration of 
  6.3   neuroleptic medication.  The court may base its decision on 
  6.4   relevant and admissible evidence, including the testimony of a 
  6.5   treating physician or other qualified physician, a member of the 
  6.6   patient's treatment team, a court appointed examiner, witness 
  6.7   testimony, or the patient's medical records. 
  6.8      (l) If the patient is found to be competent to decide 
  6.9   whether to take neuroleptic medication, the treating facility 
  6.10  may not administer medication without the patient's informed 
  6.11  written consent or without the declaration of an emergency, or 
  6.12  until further review by the court. 
  6.13     (m) If the patient is found incompetent to decide whether 
  6.14  to take neuroleptic medication, the court may authorize the 
  6.15  treating facility, and any other community or treatment facility 
  6.16  to which the patient may be transferred or provisionally 
  6.17  discharged, to involuntarily administer the medication to the 
  6.18  patient.  A finding of incompetence under this section must not 
  6.19  be construed to determine the patient's competence for any other 
  6.20  purpose.  
  6.21     (n) The court may, but is not required to, limit the 
  6.22  maximum dosage of neuroleptic medication which may be 
  6.23  administered. 
  6.24     (o) The court may authorize the administration of 
  6.25  neuroleptic medication until the termination of a determinate 
  6.26  commitment.  If the patient is committed for an indeterminate 
  6.27  period, the court may authorize treatment of neuroleptic 
  6.28  medication for not more than two years, subject to the patient's 
  6.29  right to petition the court for review of the order.  The 
  6.30  treatment facility must submit annual reports to the court, 
  6.31  which shall provide copies to the patient and the respective 
  6.32  attorneys.  
  6.33     (p) If the patient is transferred from a facility which 
  6.34  does not have a treatment review panel to a facility which has a 
  6.35  treatment review panel, the receiving facility shall review the 
  6.36  appropriateness of the patient's medication within 30 days after 
  7.1   the patient begins treatment at the facility. 
  7.2      Sec. 4.  Minnesota Statutes 1994, section 253B.05, 
  7.3   subdivision 2, is amended to read: 
  7.4      Subd. 2.  [PEACE OR HEALTH OFFICER HOLD.] (a) A peace or 
  7.5   health officer may take a person into custody and transport the 
  7.6   person to a licensed physician or treatment facility if the 
  7.7   officer has reason to believe, either through direct observation 
  7.8   of the person's behavior, or upon reliable information of the 
  7.9   person's recent behavior and knowledge of the person's past 
  7.10  behavior or psychiatric treatment, that the person is mentally 
  7.11  ill or mentally retarded and in imminent danger of injuring self 
  7.12  or others if not immediately restrained.  A peace or health 
  7.13  officer or a person working under such officer's supervision, 
  7.14  may take a person who is believed to be chemically dependent or 
  7.15  is intoxicated in public into custody and transport the person 
  7.16  to a treatment facility.  If the person is intoxicated in public 
  7.17  or is believed to be chemically dependent and is not in danger 
  7.18  of causing self-harm or harm to any person or property, the 
  7.19  peace or health officer may transport the person home.  Written 
  7.20  application for admission of the person to a treatment facility 
  7.21  shall be made by the peace or health officer.  The application 
  7.22  shall contain a statement given by the peace or health officer 
  7.23  specifying the reasons for and circumstances under which the 
  7.24  person was taken into custody.  If imminent danger to specific 
  7.25  individuals is a basis for the emergency hold, the statement 
  7.26  must include identifying information on those individuals, to 
  7.27  the extent practicable.  A copy of the statement shall be made 
  7.28  available to the person taken into custody.  
  7.29     (b) A person may be admitted to a treatment facility for 
  7.30  emergency care and treatment under this subdivision with the 
  7.31  consent of the head of the facility under the following 
  7.32  circumstances:  a written statement is made by the medical 
  7.33  officer on duty at the facility that after preliminary 
  7.34  examination the person has symptoms of mental illness or mental 
  7.35  retardation and appears to be in imminent danger of harming self 
  7.36  or others; or, a written statement is made by the institution 
  8.1   program director or the director's designee on duty at the 
  8.2   facility that after preliminary examination the person has 
  8.3   symptoms of chemical dependency and appears to be in imminent 
  8.4   danger of harming self or others or is intoxicated in public. 
  8.5      Sec. 5.  Minnesota Statutes 1994, section 253B.05, 
  8.6   subdivision 3, is amended to read: 
  8.7      Subd. 3.  [DURATION OF HOLD.] (a) Any person held pursuant 
  8.8   to this section may be held up to 72 hours, exclusive of 
  8.9   Saturdays, Sundays, and legal holidays, after admission unless a 
  8.10  petition for the commitment of the person has been filed in the 
  8.11  probate court of the county of the person's residence or of the 
  8.12  county in which the treatment facility is located and the court 
  8.13  issues an order pursuant to section 253B.07, subdivision 6.  If 
  8.14  the head of the treatment facility believes that commitment is 
  8.15  required and no petition has been filed, the head of the 
  8.16  treatment facility shall file a petition for the commitment of 
  8.17  the person.  The hospitalized person may move to have the venue 
  8.18  of the petition changed to the probate court of the county of 
  8.19  the person's residence, if the person is a resident of Minnesota.
  8.20     (b) During the 72-hour hold period, a court may not release 
  8.21  a person held under this section unless the court has received a 
  8.22  written petition for release and held a summary hearing 
  8.23  regarding the release.  The petition must include the name of 
  8.24  the person being held, the basis for and location of the hold, 
  8.25  and a statement as to why the hold is improper.  The petition 
  8.26  also must include copies of any written documentation under 
  8.27  subdivision 1 or 2 in support of the hold, unless the person 
  8.28  holding the petitioner refuses to supply the documentation.  The 
  8.29  hearing must be held as soon as practicable and may be conducted 
  8.30  by means of a telephone conference call or similar method by 
  8.31  which the participants are able to simultaneously hear each 
  8.32  other.  If the court decides to release the person, the court 
  8.33  shall issue written findings supporting the decision, but may 
  8.34  not delay the release.  Before deciding to release the person, 
  8.35  the court shall make every reasonable effort to provide notice 
  8.36  of the proposed release to:  (1) any specific individuals 
  9.1   identified in a statement under subdivision 1 or 2 or in the 
  9.2   record as individuals who might be endangered if the person was 
  9.3   not held; and (2) the examiner whose written statement was a 
  9.4   basis for a hold under subdivision 1 or the peace or health 
  9.5   officer who applied for a hold under subdivision 2. 
  9.6      (c) If a treatment facility releases a person during the 
  9.7   72-hour hold period, the head of the treatment facility shall 
  9.8   immediately notify the agency which employs the peace or health 
  9.9   officer who transported the person to the treatment facility 
  9.10  under this section. 
  9.11     Sec. 6.  Minnesota Statutes 1994, section 253B.12, 
  9.12  subdivision 1, is amended to read: 
  9.13     Subdivision 1.  [REPORT.] Prior to the termination of the 
  9.14  initial commitment order or final discharge of the patient, the 
  9.15  head of the facility shall file a written report with the 
  9.16  committing court with a copy to the patient and patient's 
  9.17  counsel, setting forth in detailed narrative form at least the 
  9.18  following: 
  9.19     (1) the diagnosis of the patient with the supporting data; 
  9.20     (2) the anticipated discharge date; 
  9.21     (3) an individualized treatment plan; 
  9.22     (4) a detailed description of the discharge planning 
  9.23  process with suggested after care plan; 
  9.24     (5) whether the patient is in need of further care and 
  9.25  treatment with evidence to support the response; 
  9.26     (6) whether any further care and treatment must be provided 
  9.27  in a treatment facility with evidence to support the response; 
  9.28     (7) whether in the opinion of the head of the facility the 
  9.29  patient must continue to be committed to a treatment facility; 
  9.30  and 
  9.31     (8) whether in the opinion of the head of the facility the 
  9.32  patient satisfies the statutory requirement for continued 
  9.33  commitment, with documentation to support the opinion; and 
  9.34     (9) whether the administration of neuroleptic medication is 
  9.35  clinically indicated, whether the patient is able to give 
  9.36  informed consent to that medication, and the basis for these 
 10.1   opinions. 
 10.2      Sec. 7.  Minnesota Statutes 1994, section 253B.17, 
 10.3   subdivision 1, is amended to read: 
 10.4      Subdivision 1.  [PETITION.] Any patient, except one 
 10.5   committed as mentally ill and dangerous to the public, or any 
 10.6   interested person may petition the committing court or the court 
 10.7   to which venue has been transferred for an order that the 
 10.8   patient is not in need of continued institutionalization or for 
 10.9   an order that an individual is no longer mentally ill, mentally 
 10.10  retarded, or chemically dependent, or for any other relief as 
 10.11  the court deems just and equitable.  A patient committed as 
 10.12  mentally ill or mentally ill and dangerous may petition the 
 10.13  committing court or the court to which venue has been 
 10.14  transferred for a hearing concerning the administration of 
 10.15  neuroleptic medication.  A hearing may also be held pursuant to 
 10.16  sections 253B.08, 253B.09, 253B.12, and 253B.18. 
 10.17     Sec. 8.  [INSTRUCTION TO REVISOR.] 
 10.18     The revisor of statutes shall change the words "probate 
 10.19  court" to "district court," in Minnesota Statutes 1996 and 
 10.20  subsequent editions of the statutes.