(REPRINTED WITH ADOPTED AMENDMENTS) FOURTH REPRINT
Assembly Bill No. 375-Assemblymen Giunchigliani, Arberry, Buckley, Amodei, Freeman, Bache, Tiffany, Anderson, Lee, Koivisto, Parks, Lambert, Williams, Berman, de Braga, Collins, Chowning, Nolan, Manendo, Price, Segerblom, Carpenter, Hickey, Perkins, Marvel, Herrera, Goldwater and Close
April 17, 1997
____________
Referred to Concurrent Committees on Health and Human
Services and Commerce
SUMMARY--Makes various changes concerning mental health care. (BDR 39-1267)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: Yes.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to mental health care; making various changes concerning mentally ill persons; specifying additional rights of clients of certain facilities; revising provisions governing emergency admissions of persons to certain facilities; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1 Chapter 433 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 9, inclusive, of this act.
Sec. 2 "Rights" includes, without limitation, all rights provided to a client pursuant to NRS 433.456 to 433.534, inclusive, and sections 3 to 9, inclusive, of this act, and any regulations adopted pursuant thereto.
Sec. 3 Each client admitted for evaluation, treatment or training to a facility has the following rights concerning admission to the facility, a list of which must be prominently posted in all facilities providing those services and must be otherwise brought to the attention of the client by such additional means as prescribed by regulation:
1. The right not to be admitted to the facility under false pretenses or as a result of any improper, unethical or unlawful conduct by a staff member of the facility to collect money from the insurance company of the client or for any other financial purpose.
2. The right to receive a copy, on request, of the criteria upon which the facility makes its decision to admit or discharge a client from the facility. Such criteria must not, for emergency admissions or involuntary court-ordered admissions, be based on the availability of insurance coverage or any other financial considerations.
Sec. 4 1. Each client admitted for evaluation, treatment or training to a facility has the following rights concerning involuntary commitment to the facility, a list of which must be prominently posted in all facilities providing those services and must be otherwise brought to the attention of the client by such additional means as prescribed by regulation:
(a) To request and receive a second evaluation by a psychiatrist or psychologist who does not have a contractual or business relationship with the facility. The evaluation must:
(1) Include, without limitation, a recommendation of whether the client should be involuntarily committed to the facility; and
(2) Be paid for by the client if the insurance carrier of the client refuses to pay for the evaluation.
(b) To receive a copy of the procedure of the facility regarding involuntary commitment and treatment.
(c) To receive a list of his rights concerning involuntary commitment or treatment.
2. If the results of an evaluation conducted by a psychiatrist or psychologist pursuant to subsection 1 conflicts in any manner with the results of an evaluation conducted by the facility, the facility may request and receive a third evaluation of the client to resolve the conflicting portions of the previous evaluations.
Sec. 5 Each client admitted for evaluation, treatment or training to a facility has the following rights concerning the suspension or violation of his rights, a list of which must be prominently posted in all facilities providing those services and must be otherwise brought to the attention of the client by such additional means as prescribed by regulation:
1. To receive a list of his rights.
2. To receive a copy of the policy of the facility that sets forth the clinical or medical circumstances under which his rights may be suspended or violated.
3. To receive a list of the clinically appropriate options available to the client or his family to remedy an actual or a suspected suspension or violation of his rights.
4. To have all policies of the facility regarding the rights of clients prominently posted in the facility.
Sec. 6 Each facility shall, within a reasonable time after a client is admitted to the facility for evaluation, treatment or training, ask the client to sign a document that reflects that he has received a list of his rights and has had those rights explained to him.
Sec. 7 (Deleted by amendment.)
Sec. 8 1. Each facility shall make all of its decisions, policies, procedures and practices regarding emergency admissions or involuntary court-ordered admissions based upon clinical efficiency rather than cost containment.
2. This section does not preclude a public facility from making decisions, policies, procedures and practices within the limits of the money made available to the facility.
Sec. 9 An officer, director or employee of a facility shall not retaliate against any person for having:
1. Reported any violation of law; or
2. Provided information regarding a violation of law,
by the facility or a staff member of the facility.
Sec. 10 NRS 433.044 is hereby amended to read as follows:
433.044"Client" means any person who seeks, on his own or [others'] another's initiative, and can benefit from care, treatment and training [in any division facility.] provided by the division.
Sec. 11 NRS 433.456 is hereby amended to read as follows:
433.456 As used in NRS 433.458 to 433.534, inclusive, and sections 3 to 9, inclusive, of this act, unless the context otherwise requires, the words and terms defined in NRS 433.458, 433.459 and 433.461 and section 2 of this act, have the meanings ascribed to them in those sections.
Sec. 12 NRS 433.482 is hereby amended to read as follows:
433.482 Each client admitted for evaluation, treatment or training to a facility has the following personal rights, a list of which must be prominently posted in all facilities providing those services and must be otherwise brought to the attention of the client by such additional means as prescribed by regulation:
1. To wear his own clothing, to keep and use his own personal possessions, including his toilet articles, unless those articles may be used to endanger his or others' lives, and to keep and be allowed to spend a reasonable sum of his own money for expenses and small purchases.
2. To have access to individual space for storage for his private use.
3. To see visitors each day.
4. To have reasonable access to telephones, both to make and receive confidential calls.
5. To have ready access to materials for writing letters, including stamps, and to mail and receive unopened correspondence, but:
(a) For the purposes of this subsection, packages are not considered as correspondence; and
(b) Correspondence identified as containing a check payable to a client may be subject to control and safekeeping by the administrative officer of that facility or his designee, so long as the client's record of treatment documents the action.
6. To have reasonable access to an interpreter if the client does not speak English or is hearing impaired.
7. To designate a person who must be kept informed by the facility of the client's medical and mental condition, if the client signs a release allowing the facility to provide such information to the person.
8. To have access to his medical records denied to any person other than:
(a) A member of the staff of the facility or related medical personnel, as appropriate;
(b) A person who obtains a waiver by the client of his right to keep the medical records confidential; or
(c) A person who obtains a court order authorizing the access.
9. Other personal rights as specified by regulation of the commission.
Sec. 13 Chapter 433A of NRS is hereby amended by adding thereto a new section to read as follows:
1. If a mentally ill person is admitted to a public or private mental health facility or hospital as a voluntary client, the facility or hospital shall not change the status of the person to an emergency admission unless the hospital or facility receives, before the change in status is made, an application for an emergency admission pursuant to NRS 433A.160 and the certificate of a psychiatrist, psychologist or physician pursuant to NRS 433A.170.
2. A person whose status is changed pursuant to subsection 1 must not be detained in excess of 48 hours after the change in status is made, unless within that period a written petition is filed with the clerk of the district court pursuant to NRS 433A.200.
3. If the period specified in subsection 2 expires on a day on which the office of the clerk of the district court is not open, the written petition must be filed on or before the close of the business day next following the expiration of that period.
Sec. 14 NRS 433A.014 is hereby amended to read as follows:
433A.014 "Client" means any person who seeks, on his own or another's initiative, and can benefit from care, treatment or training [in a division facility.] provided by the division.
Sec. 15 NRS 433A.115 is hereby amended to read as follows:
433A.1151. As used in NRS 433A.120 to 433A.330, inclusive, and section 13 of this act, unless the context otherwise requires, "mentally ill person" means any person whose capacity to exercise self-control, judgment and discretion in the conduct of his affairs and social relations or to care for his personal needs is diminished , as a result of a mental illness, to the extent that he presents a clear and present danger of harm to himself or others, but does not include any person in whom that capacity is diminished by epilepsy, mental retardation, Alzheimer's disease, brief periods of intoxication caused by alcohol or drugs, or dependence upon or addiction to alcohol or drugs, unless a mental illness that can be diagnosed is also present which contributes to the diminished capacity of the person.
2. A person presents a clear and present danger of harm to himself if, within the next preceding 30 days, he has [:] , as a result of a mental illness:
(a) Acted in a manner from which it may reasonably be inferred that, without the care, supervision or continued assistance of others, he will be unable to satisfy his need for nourishment, personal or medical care, shelter, self-protection or safety, and if there exists a reasonable probability that his death, serious bodily injury or physical debilitation will occur within the next following 30 days unless he is admitted to a mental health facility pursuant to the provisions of NRS 433A.120 to 433A.330, inclusive, and section 13 of this act, and adequate treatment is provided to him;
(b) Attempted or threatened to commit suicide or committed acts in furtherance of a threat to commit suicide, and if there exists a reasonable probability that he will commit suicide unless he is admitted to a mental health facility pursuant to the provisions of NRS 433A.120 to 433A.330, inclusive, and section 13 of this act, and adequate treatment is provided to him; or
(c) Mutilated himself, attempted or threatened to mutilate himself or committed acts in furtherance of a threat to mutilate himself, and if there exists a reasonable probability that he will mutilate himself unless he is admitted to a mental health facility pursuant to the provisions of NRS 433A.120 to 433A.330, inclusive, and section 13 of this act, and adequate treatment is provided to him.
3. A person presents a clear and present danger of harm to others if, within the next preceding 30 days, he has , as a result of a mental illness, inflicted or attempted to inflict serious bodily harm on any other person, or made threats to inflict harm and committed acts in furtherance of those threats, and if there exists a reasonable probability that he will do so again unless he is admitted to a mental health facility pursuant to the provisions of NRS 433A.120 to 433A.330, inclusive, and section 13 of this act, and adequate treatment is provided to him.
Sec. 16 NRS 433A.140 is hereby amended to read as follows:
433A.1401. Any person may apply to [any] :
(a) A public or private mental health facility in the State of Nevada for admission to [such] the facility ; or
(b) A division facility to receive care, treatment or training provided by the division,
as a voluntary client for the purposes of observation, diagnosis, care and treatment. In the case of a person who has not attained the age of majority, application for voluntary admission or care, treatment or training may be made on his behalf by his spouse, parent or legal guardian.
2. If the application is for admission to a division facility, or for care, treatment or training provided by the division, the applicant must be admitted or provided such services as a voluntary client if an examination by [admitting] personnel of the facility qualified to make such a determination reveals that the person needs and may benefit from services offered by the mental health facility.
3. Any person admitted to a public or private mental health facility as a voluntary client must be released immediately after the filing of a written request for release with the responsible physician or his designee within the normal working day [.] , unless, within 24 hours after the request, the facility changes the status of the person to an emergency admission pursuant to section 13 of this act. When a person is released pursuant to this subsection, the facility and its agents and employees are not liable for any debts or contractual obligations, medical or otherwise, incurred or damages caused by the actions of the person.
4. Any person admitted to a public or private mental health facility as a voluntary client who has not requested release may nonetheless be released by the medical director of the facility when examining personnel at the facility determine that the client has recovered or has improved to such an extent that he is not considered a danger to himself or others and that the services of that facility are no longer beneficial to him or advisable.
5. A person who requests care, treatment or training from the division pursuant to this section must be evaluated by the personnel of the division to determine whether he is eligible for the services offered by the division. The evaluation must be conducted:
(a) Within 72 hours if the person has requested inpatient services; or
(b) Within 72 regular operating hours, excluding weekends and holidays, if the person has requested community-based or outpatient services.
6. This section does not preclude a public facility from making decisions, policies, procedures and practices within the limits of the money made available to the facility.
Sec. 17 (Deleted by amendment.)
Sec. 18 NRS 433A.160 is hereby amended to read as follows:
433A.160 1. Application for an emergency admission of an allegedly mentally ill person for evaluation and observation may only be made by an accredited agent of the department, an officer authorized to make arrests in the State of Nevada or a physician, psychologist, marriage and family therapist, social worker or registered nurse. The agent, officer, physician, psychologist, marriage and family therapist, social worker or registered nurse may take an allegedly mentally ill person into custody without a warrant to apply for emergency admission for evaluation, observation and treatment under NRS 433A.150 and may transport the person or arrange the transportation for him with a local law enforcement agency to a public or private mental health facility for that purpose.
2. The application must reveal the circumstances under which the person was taken into custody and the reasons therefor.
3. For the purposes of subsection 1, "an accredited agent of the department" means any person appointed or designated by the director of the department to take into custody and transport to a mental health facility pursuant to subsections 1 and 2 those persons in need of emergency admission.
4. Any person who has reason to believe that another person is mentally ill may apply to the district attorney of the county where the allegedly mentally ill person is found, and the district attorney may, if satisfied that as a result of mental illness the person is likely to harm himself or others:
(a) Issue an order to any peace officer for the immediate apprehension of the person and his transportation to a public or private mental health facility; and
(b) Make application for the admission of the person under the emergency admission provisions of NRS 433A.150.
5. [Each] Except as otherwise provided in this subsection, each person admitted to a public or private mental health facility or hospital under an emergency admission must be evaluated at the time of admission by a psychiatrist or [physician who is not a psychiatrist.] a psychologist. If a psychiatrist or a psychologist is not available to conduct an evaluation at the time of admission, a physician may conduct the evaluation. Each such emergency admission must be approved by a psychiatrist.
Sec. 19 NRS 433A.170 is hereby amended to read as follows:
433A.170[The] Except as otherwise provided in this section, the administrative officer of a facility operated by the division or of any other public or private mental health facility or hospital shall not accept an application for an emergency admission under NRS 433A.150 and 433A.160 unless that application is accompanied by a certificate of a psychiatrist [,] or a licensed psychologist [or physician] stating that he has examined the person alleged to be mentally ill and that he has concluded that as a result of mental illness the person is likely to harm himself or others. [This] If a psychiatrist or licensed psychologist is not available to conduct an examination, a physician may conduct the examination. The certificate required by this section may be obtained from a psychiatrist, licensed psychologist [,] or physician who is employed by the public or private mental health facility to which the application is made.
Sec. 20. NRS 433A.220 is hereby amended to read as follows:
433A.2201. Immediately after he receives any petition filed pursuant to NRS 433A.200 or 433A.210, the clerk of the district court shall transmit the petition to the appropriate district judge, who shall set a time , date and place for its hearing . [, which] The date must be:
(a) Within 14 calendar days after the date on which the petition is received by the clerk; [or]
(b) If at the time the petition is received by the clerk the subject of the petition was admitted to a hospital or public or private mental health facility pursuant to NRS 433A.160, within 5 judicial days after the date on which the petition is received by the clerk [.] ; or
(c) If the district attorney filed a petition for the emergency admission of the subject of the petition, within 5 judicial days after the date on which the petition is received by the clerk.
2. The court shall give notice of the petition and of the time , date and place of any proceedings thereon to the subject of the petition, his attorney, if known, the petitioner, the district attorney of the county in which the court has its principal office, the local office of an agency or organization
that receives money from the Federal Government pursuant to 42 U.S.C. §§ 10801 et seq., to protect and advocate the rights of persons with mental illnesses and the administrative office of any public or private mental health facility in which the subject of the petition is detained.
Sec. 21. NRS 433A.390 is hereby amended to read as follows:
433A.390 1. When a client, involuntarily admitted to a mental health facility by court order, is released at the end of the time specified pursuant to NRS 433A.310, written notice must be given to the admitting court at least 10 days before the release of the client. The client may then be released without requiring further orders of the court.
2. An involuntarily [court admitted] court-admitted client may be conditionally released before the period specified in NRS 433A.310 when:
(a) An evaluation team established under NRS 433A.250 or two persons professionally qualified in the field of psychiatric mental health, at least one of them being a physician, determines that the client has recovered from his mental illness or has improved to such an extent that he is no longer considered to present a clear and present danger of harm to himself or others; and
(b) Under advisement from the evaluation team or two persons professionally qualified in the field of psychiatric mental health, at least one of them being a physician, the medical director of the mental health facility authorizes the release and gives written notice to the admitting court . [10 days before the release of the client.]
3. The release of an involuntarily court-admitted client pursuant to subsection 2 becomes unconditional 10 days after the release unless the admitting court, within that period, issues an order providing otherwise.