PRINTER'S NO. 2101
No. 1506 Session of 2000
INTRODUCED BY GREENLEAF, LOEPER, HART, KITCHEN, HOLL, LEMMOND,
TARTAGLIONE, THOMPSON AND TOMLINSON, AUGUST 23, 2000
REFERRED TO PUBLIC HEALTH AND WELFARE, AUGUST 23, 2000
AN ACT
1 Amending the act of July 9, 1976 (P.L.817, No.143), entitled "An
2 act relating to mental health procedures; providing for the
3 treatment and rights of mentally disabled persons, for
4 voluntary and involuntary examination and treatment and for
5 determinations affecting those charged with crime or under
6 sentence," adding provisions relating to assisted outpatient
7 treatment programs.
8 The General Assembly of the Commonwealth of Pennsylvania
9 hereby enacts as follows:
10 Section 1. The act of July 9, 1976 (P.L.817, No.143), known
11 as the Mental Health Procedures Act, is amended by adding an
12 article to read:
13 ARTICLE III-A
14 Assisted Outpatient Treatment
15 Section 301-A. Definitions.--The following words and phrases
16 when used in this article shall have the meanings given to them
17 in this section unless the context clearly indicates otherwise:
18 "Assisted outpatient" or "patient." A person under a court
19 order to receive assisted outpatient treatment.
20 "Assisted outpatient treatment." Any of the following
1 categories of outpatient services which have been ordered by the
2 court pursuant to section 305-A:
3 (1) Case management services or assertive community
4 treatment team services to provide care coordination.
5 (2) Medication.
6 (3) Periodic blood tests or urinalysis to determine
7 compliance with prescribed medications.
8 (4) Individual or group therapy.
9 (5) Day or partial programming activities.
10 (6) Educational and vocational training or activities.
11 (7) Alcohol or substance abuse treatment and counseling and
12 periodic tests for the presence of alcohol or illegal drugs for
13 persons with a history of alcohol or substance abuse.
14 (8) Supervision of living arrangements.
15 (9) Any other services within an individualized treatment
16 plan developed pursuant to Article I prescribed to treat the
17 person's mental illness and to assist the person in living and
18 functioning in the community, or to attempt to prevent a relapse
19 or deterioration that may reasonably be predicted to result in
20 suicide or the need for hospitalization.
21 "Assisted outpatient treatment program" or "program." A
22 system to arrange for and coordinate the provision of assisted
23 outpatient treatment, to monitor treatment compliance by
24 assisted outpatients, to evaluate the condition or needs of
25 assisted outpatients, to take appropriate steps to address the
26 needs of assisted outpatients and to ensure compliance with
27 court orders.
28 "Director." The director of a hospital licensed or operated
29 by the Department of Public Welfare which operates, directs and
30 supervises an assisted outpatient treatment program, or the
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1 county administrator which operates, directs and supervises an
2 assisted outpatient treatment program.
3 "Program coordinator." An individual appointed under section
4 302-A(a), who is responsible for the oversight and monitoring of
5 assisted outpatient treatment programs.
6 "Subject of the petition" or "subject." A person who is
7 alleged in a petition, filed pursuant to the provisions of
8 section 305-A, to meet the criteria for assisted outpatient
9 treatment.
10 Section 302-A. Program Coordinators to be Appointed.--(a)
11 Duty of Secretary.--The Secretary of Public Welfare shall
12 appoint program coordinators of assisted outpatient treatment,
13 who shall be responsible for the oversight and monitoring of
14 assisted outpatient treatment programs established pursuant to
15 section 305-A. County administrators shall work in conjunction
16 with the program coordinators to coordinate the implementation
17 of assisted outpatient treatment programs.
18 (b) Oversight and Monitoring Duties.--The oversight and
19 monitoring role of the program coordinator of the assisted
20 outpatient treatment program shall include each of the
21 following:
22 (1) That each assisted outpatient receives the treatment
23 provided for in the court order issued pursuant to section 305-
24 A.
25 (2) That existing services located in the assisted
26 outpatient's community are utilized whenever practicable.
27 (3) That a case manager or assertive community treatment
28 team is designated for each assisted outpatient.
29 (4) That a mechanism exists for a case manager, or assertive
30 community treatment team, to regularly report the assisted
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1 outpatient's compliance, or lack of compliance with treatment,
2 to the director of the assisted outpatient treatment program.
3 (5) That assisted outpatient treatment services are
4 delivered in a timely manner.
5 (c) Standards to be Developed.--The Secretary of Public
6 Welfare shall develop standards designed to ensure that case
7 managers or assertive community treatment teams have appropriate
8 training and have clinically manageable caseloads designed to
9 provide effective case management or other care coordination
10 services for persons subject to a court order under section 305-
11 A.
12 (d) Corrective Action to be Taken.--Upon review or receiving
13 notice that services are not being delivered in a timely manner,
14 the program coordinator shall require the director of the
15 assisted outpatient treatment program to immediately commence
16 corrective action and inform the program coordinator of the
17 corrective action taken. Failure of a director to take
18 corrective action shall be reported by the program coordinator
19 to the Secretary of Public Welfare as well as to the court which
20 ordered the assisted outpatient treatment.
21 Section 303-A. Duties of County Administrators.--Each county
22 administrator shall be responsible for the filing of petitions
23 for assisted outpatient treatment pursuant to section 305-A, for
24 the receipt and investigation of reports of persons who are
25 alleged to be in need of that treatment and for coordinating the
26 delivery of court ordered services with program coordinators,
27 appointed by the Secretary of Public Welfare pursuant to section
28 302-A(a). In discharge of the duties imposed by section 305-A,
29 directors of community services may provide services directly,
30 or may coordinate services with the offices of the Secretary of
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1 Public Welfare or may contract with any public or private
2 provider to provide services for assisted outpatient treatment
3 programs as may be necessary to carry out the duties imposed
4 pursuant to this article.
5 Section 304-A. Directors of Assisted Outpatient Treatment
6 Programs.--(a) General Duties.--(1) Directors of assisted
7 outpatient treatment programs established pursuant to section
8 305-A shall provide a written report to the program
9 coordinators, appointed by the Secretary of Public Welfare
10 pursuant to section 302-A(a), within three days of the issuance
11 of a court order. The report shall demonstrate that mechanisms
12 are in place to ensure the delivery of services and medications
13 as required by the court order and shall include, but not be
14 limited to, the following:
15 (i) A copy of the court order.
16 (ii) A copy of the written treatment plan.
17 (iii) The identity of the case manager or assertive
18 community treatment team, including the name and contact data of
19 the organization which the case manager or assertive community
20 treatment team member represents.
21 (iv) The identity of providers of services.
22 (v) The date on which services have commenced or will
23 commence.
24 (2) The directors of assisted outpatient treatment programs
25 shall ensure the timely delivery of services described in
26 section 305-A pursuant to any court order issued thereunder.
27 Directors of assisted outpatient treatment programs shall
28 immediately commence corrective action upon receiving notice
29 from program coordinators, that services are not being provided
30 in a timely manner and the directors shall inform the program
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1 coordinator of the corrective action taken.
2 (b) Quarterly Reports to Program Coordinators.--Directors of
3 assisted outpatient treatment programs shall submit quarterly
4 reports to the program coordinators regarding the assisted
5 outpatient treatment program operated or administered by them.
6 The report shall include the following information:
7 (1) The names of individuals served by the program.
8 (2) The percentage of petitions for assisted outpatient
9 treatment that are granted by the court.
10 (3) Any change in status of assisted outpatients, including,
11 but not limited to, the number of individuals who have failed to
12 comply with court ordered assisted outpatient treatment.
13 (4) A description of material changes in written treatment
14 plans of assisted outpatients.
15 (5) Any change in case managers.
16 (6) A description of the categories of services which have
17 been ordered by the court.
18 (7) Living arrangements of individuals served by the program
19 including the number, if any, who are homeless.
20 (8) Any other information as required by the Secretary of
21 Public Welfare.
22 (9) Any recommendations to improve the program Statewide or
23 locally.
24 Section 305-A. Assisted Outpatient Treatment Program.--(a)
25 Director to Obtain Approval From Secretary.--A director may
26 operate, direct and supervise an assisted outpatient treatment
27 program as provided in this section, upon approval by the
28 Secretary of Public Welfare. The county administrator shall
29 operate, direct and supervise an assisted outpatient treatment
30 program as provided in this section, upon approval by the
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1 Secretary of Public Welfare. County Administrators shall be
2 permitted to satisfy the provisions of this article through the
3 operation of joint assisted outpatient treatment programs.
4 Nothing in this article shall be construed to preclude the
5 combination or coordination of efforts between and among
6 counties and hospitals in providing and coordinating assisted
7 outpatient treatment.
8 (b) Criteria for Assisted Outpatient Treatment.--A patient
9 may be ordered to obtain assisted outpatient treatment if the
10 court finds of the following:
11 (1) The patient is 18 years of age or older.
12 (2) The patient is suffering from a mental illness.
13 (3) The patient is unlikely to survive safely in the
14 community without supervision, based on a clinical
15 determination.
16 (4) The patient has a history of lack of compliance with
17 treatment for mental illness that has:
18 (i) at least twice within the preceding 36 months been a
19 significant factor in necessitating hospitalization in a
20 hospital, or receipt of services in a forensic or other mental
21 health unit of a correctional facility, not including any period
22 during which the person was hospitalized or imprisoned
23 immediately preceding the filing of the petition; or
24 (ii) resulted in one or more acts of serious violent
25 behavior toward self or others or threats of, or attempts at,
26 serious physical harm to self or others within the preceding 48
27 months, not including any period in which the person was
28 hospitalized or imprisoned immediately preceding the filing of
29 the petition.
30 (5) The patient is, as a result of the patient's mental
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1 illness, unlikely to voluntarily participate in the recommended
2 treatment pursuant to the treatment plan.
3 (6) In view of the patient's treatment history and current
4 behavior, the patient is in need of assisted outpatient
5 treatment in order to prevent a relapse or deterioration which
6 would be likely to pose a clear and present danger of harm to
7 others or to himself as determined under section 301.
8 (7) It is likely that the patient will benefit from assisted
9 outpatient treatment.
10 (c) Petition to the Court.--(1) A petition for an order
11 authorizing assisted outpatient treatment may be filed in the
12 court of common pleas of the county in which the subject of the
13 petition is present or reasonably believed to be present. A
14 petition to obtain an order authorizing assisted outpatient
15 treatment may be initiated only by the following persons:
16 (i) a person 18 years of age or older with whom the subject
17 of the petition resides; or
18 (ii) the parent, spouse, sibling 18 years of age or older,
19 or child 18 years of age or older of the subject of the
20 petition; or
21 (iii) the director of the facility in which the subject of
22 the petition is hospitalized; or
23 (iv) the director of any public or charitable organization,
24 agency or home providing mental health services to the subject
25 of the petition in whose institution the subject of the petition
26 resides; or
27 (v) a qualified psychiatrist who is either supervising the
28 treatment of or treating the subject of the petition for a
29 mental illness; or
30 (vi) the county administrator, or his designee; or
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1 (vii) a parole officer or probation officer assigned to
2 supervise the subject of the petition.
3 (2) The petition shall state:
4 (i) Each of the criteria for assisted outpatient treatment
5 as set forth in subsection (b).
6 (ii) The facts which support the petitioner's belief that
7 the person who is the subject of the petition meets each
8 criterion, provided that the hearing on the petition need not be
9 limited to the stated facts.
10 (iii) That the subject of the petition is present, or is
11 reasonably believed to be present, within the county where the
12 petition is filed.
13 (3) The petition shall be accompanied by an affirmation or
14 affidavit of a physician, who shall not be the petitioner, and
15 shall state either that:
16 (i) The physician has personally examined the person who is
17 the subject of the petition not more than ten days prior to the
18 submission of the petition, recommends assisted outpatient
19 treatment for the subject of the petition, and is willing and
20 able to testify at the hearing on the petition.
21 (ii) Not more than ten days prior to the filing of the
22 petition, the physician or his designee has made appropriate
23 attempts to elicit the cooperation of the subject of the
24 petition but has not been successful in persuading the subject
25 to submit to an examination, that the physician has reason to
26 suspect that the subject of the petition meets the criteria for
27 assisted outpatient treatment, and that the physician is willing
28 and able to examine the subject of the petition and testify at
29 the hearing on the petition.
30 (d) Right to Counsel.--The subject of the petition shall
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1 have the right to be represented by counsel at the expense of
2 the subject of the petition, at all stages of a proceeding
3 commenced under this section.
4 (e) Hearing.--(1) Upon receipt by the court of the petition
5 submitted pursuant to subsection (c), the court shall fix the
6 date for a hearing at a time not later than three days from the
7 date the petition is received by the court, excluding Saturdays,
8 Sundays and holidays. Adjournments shall be permitted only for
9 good cause shown. In granting adjournments, the court shall
10 consider the need for further examination by a physician or the
11 potential need to provide assisted outpatient treatment
12 expeditiously.
13 (2) The court shall cause the subject of the petition, the
14 petitioner, the physician whose affirmation or affidavit
15 accompanied the petition, the appropriate director, and such
16 other persons as the court may determine to be advised of the
17 date for the hearing.
18 (3) Upon the date for the hearing, or upon such other date
19 to which the proceeding may be adjourned, the court shall hear
20 testimony and, if it be deemed advisable and the subject of the
21 petition is available, examine the subject alleged to be in need
22 of assisted outpatient treatment in or out of court.
23 (4) If the subject of the petition does not appear at the
24 hearing, and appropriate attempts to elicit the attendance of
25 the subject have failed, the court may conduct the hearing in
26 the subject's absence. If the hearing is conducted without the
27 subject of the petition present, the court shall set forth the
28 factual basis for conducting the hearing without the presence of
29 the subject of the petition.
30 (5) The court may not order assisted outpatient treatment
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1 unless an examining physician, who has personally examined the
2 subject of the petition within the time period commencing ten
3 days before the filing of the petition, testifies in person at
4 the hearing.
5 (6) If the subject of the petition has refused to be
6 examined by a physician, the court may request the subject to
7 consent to an examination by a physician appointed by the court.
8 If the subject of the petition does not consent and the court
9 finds reasonable cause to believe that the allegations in the
10 petition are true, the court may order law enforcement officers
11 or of a sheriff's department to take the subject of the petition
12 into custody and transport him to a hospital for examination by
13 a physician. Retention of the subject of the petition under the
14 order shall not exceed 24 hours.
15 (7) The examination of the subject of the petition may be
16 performed by the physician whose affirmation or affidavit
17 accompanied the petition, if the physician is privileged by the
18 hospital or otherwise authorized by the hospital to do so. If
19 the examination is performed by another physician of the
20 hospital, the examining physician shall be authorized to consult
21 with the physician whose affirmation or affidavit accompanied
22 the petition regarding the issues of whether the allegations in
23 the petition are true and whether the subject meets the criteria
24 for assisted outpatient treatment.
25 (8) A physician who testifies pursuant to paragraph (5)
26 shall state the facts which support the allegation that the
27 subject meets each of the criteria for assisted outpatient
28 treatment, and the treatment is the least restrictive
29 alternative, the recommended assisted outpatient treatment, and
30 the rationale for the recommended assisted outpatient treatment.
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1 If the recommended assisted outpatient treatment includes
2 medication, the physician's testimony shall describe the types
3 or classes of medication which should be authorized, shall
4 describe the beneficial and detrimental physical and mental
5 effects of the medication, and shall recommend whether the
6 medication should be self-administered or administered by
7 authorized personnel.
8 (9) The subject of the petition shall be afforded an
9 opportunity to present evidence, to call witnesses on behalf of
10 the subject, and to cross-examine adverse witnesses.
11 (f) Written Individualized Treatment Plan.--(1) (i) The
12 court may not order assisted outpatient treatment unless an
13 examining physician appointed by the appropriate director
14 develops and provides to the court a proposed written
15 individualized treatment plan. The written individualized
16 treatment plan shall include case management services or
17 assertive community treatment teams to provide care
18 coordination, and all categories of services which the physician
19 recommends that the subject of the petition should receive.
20 (ii) If the written individualized treatment plan includes
21 medication, it shall state whether the medication should be
22 self-administered or administered by authorized personnel, and
23 shall specify type and dosage range of medication most likely to
24 provide maximum benefit for the subject.
25 (iii) If the written individualized treatment plan includes
26 alcohol or substance abuse counseling and treatment, the plan
27 may include a provision requiring relevant testing for either
28 alcohol or illegal substances provided the physician's clinical
29 basis for recommending the plan provides sufficient facts for
30 the court to find:
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1 (A) That the person has a history of alcohol or substance
2 abuse that is clinically related to the mental illness.
3 (B) That the testing is necessary to prevent a relapse or
4 deterioration which would be likely to result in serious harm to
5 the person or others.
6 (iv) In developing the plan, the physician shall provide the
7 following persons with an opportunity to actively participate in
8 the development of the plan: the subject of the petition; the
9 treating physician; and upon the request of the patient, an
10 individual significant to the patient including any relative,
11 close friend or individual otherwise concerned with the welfare
12 of the patient. If the petitioner is a director, the plan shall
13 be provided to the court no later than the date of the hearing
14 on the petition.
15 (2) The court shall not order assisted outpatient treatment
16 unless a physician testifies to explain the written proposed
17 treatment plan. The testimony shall state:
18 (i) The categories of assisted outpatient treatment
19 recommended.
20 (ii) The rationale for each category.
21 (iii) Facts which establish that the treatment is the least
22 restrictive alternative.
23 (iv) If the recommended assisted outpatient treatment
24 includes medication, the types or classes of medication
25 recommended, the beneficial and detrimental physical and mental
26 effects of the medication, and whether the medication should be
27 self-administered or administered by an authorized professional.
28 If the petitioner is a director the testimony shall be given at
29 the hearing on the petition.
30 (g) Disposition.--(1) If after hearing all relevant
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1 evidence, the court finds that the subject of the petition does
2 not meet the criteria for assisted outpatient treatment, the
3 court shall dismiss the petition.
4 (2) If after hearing all relevant evidence, the court finds
5 by clear and convincing evidence that the subject of the
6 petition meets the criteria for assisted outpatient treatment,
7 and there is no appropriate and feasible less restrictive
8 alternative, the court shall be authorized to order the subject
9 to receive assisted outpatient treatment for an initial period
10 not to exceed six months. In fashioning the order, the court
11 shall specifically make findings by clear and convincing
12 evidence that the proposed treatment is the least restrictive
13 treatment appropriate and feasible for the subject. The order
14 shall state the categories of assisted outpatient treatment
15 which the subject is to receive. The court may not order
16 treatment that has not been recommended by the examining
17 physician and included in the written treatment plan for
18 assisted outpatient treatment as required by subsection (f).
19 (3) If after hearing all relevant evidence the court finds
20 by clear and convincing evidence that the subject of the
21 petition meets the criteria for assisted outpatient treatment,
22 and the court has yet to be provided with a written
23 individualized treatment plan and testimony pursuant to
24 subsection (f), the court shall order the county administrator
25 to provide the court with the plan and testimony no later than
26 the third day, excluding Saturdays, Sundays and holidays,
27 immediately following the date of the order. Upon receiving the
28 plan and testimony, the court may order assisted outpatient
29 treatment as provided in paragraph (2).
30 (4) A court may order the patient to self-administer
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1 psychotropic drugs or accept the administration of the drugs by
2 authorized personnel as part of an assisted outpatient treatment
3 program. The order may specify the type and dosage range of
4 psychotropic drugs and the order shall be effective for the
5 duration of the assisted outpatient treatment.
6 (5) If the petitioner is the director of a hospital that
7 operates an assisted outpatient treatment program, the court
8 order shall direct the hospital director to provide or arrange
9 for all categories of assisted outpatient treatment for the
10 assisted outpatient throughout the period of the order. For all
11 other persons, the order shall require the director of community
12 services of the appropriate local governmental unit to provide
13 or arrange for all categories of assisted outpatient treatment
14 for the assisted outpatient throughout the period of the order.
15 (6) The director or his designee shall apply to the court
16 for approval before instituting a proposed material change in
17 the assisted outpatient treatment order unless the change is
18 contemplated in the order. Nonmaterial changes may be instituted
19 by the assisted outpatient treatment program without court
20 approval. For the purposes of this paragraph, a material change
21 shall mean an addition or deletion of a category of assisted
22 outpatient treatment from the order of the court, or any
23 deviation without the patient's consent from the terms of an
24 existing order relating to the administration of psychotropic
25 drugs.
26 (h) Applications for Additional Periods of Treatment.--If
27 the director determines that the condition of the patient
28 requires further assisted out patient treatment, the director
29 shall apply prior to the expiration of the period of assisted
30 outpatient treatment ordered by the court for a second or
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1 subsequent order authorizing continued assisted outpatient
2 treatment for a period not to exceed one year from the date of
3 the order. The procedures for obtaining any order pursuant to
4 this subsection shall be in accordance with this section,
5 provided that the time period included in subsection (b)(4)(i)
6 and (ii) shall not be applicable in determining the
7 appropriateness of additional periods of assisted outpatient
8 treatment. Any court order requiring periodic blood tests or
9 urinalysis for the presence of alcohol or illegal drugs shall be
10 subject to review after six months by the physician who
11 developed the written individualized treatment plan or another
12 physician designated by the director, and the physician shall be
13 authorized to terminate the blood tests or urinalysis without
14 further action by the court.
15 (i) Application for an Order to Stay, Vacate or Modify.--In
16 addition to any other right or remedy available by law with
17 respect to the order for assisted outpatient treatment, the
18 patient, the patient's counsel, or anyone acting on the
19 patient's behalf may apply on notice to the appropriate director
20 and the original petitioner, to the court to stay, vacate or
21 modify the order.
22 (j) Appeals.--Review of an order issued pursuant to this
23 section shall be had in like manner as specified in section 303.
24 (k) Failure to Comply with Assisted Outpatient Treatment.--
25 (1) Where in the clinical judgment of a physician, the patient
26 has failed or has refused to comply with the treatment ordered
27 by the court, and in the physician's clinical judgment, efforts
28 were made to solicit compliance, and, in the clinical judgment
29 of the physician, the patient may be in need of treatment under
30 section 302 or 303, the physician may request the director, the
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1 director's designee to direct the removal of the patient to an
2 appropriate hospital for an examination to determine if the
3 patient has a mental illness for which hospitalization is
4 necessary.
5 (2) If the patient refuses to take medications as required
6 by the court order, or he refuses to take, or fails a blood
7 test, urinalysis, or alcohol or drug test as required by the
8 court order, the physician may consider that refusal or failure
9 when determining whether the assisted outpatient is in need of
10 an examination to determine whether he has a mental illness for
11 which hospitalization is necessary.
12 (3) Upon the request of the physician, the director or the
13 director's designee may direct law enforcement officers or the
14 sheriff's department to take into custody and transport the
15 patient to the hospital operating the assisted outpatient
16 treatment program or to any hospital authorized by the director
17 of community services to receive such patients. The law
18 enforcement officials shall carry out the directive.
19 (4) Upon the request of the physician, the director, or the
20 director's designee, the court may authorize the patient to be
21 taken into custody and transported to the hospital operating the
22 assisted outpatient treatment program, or to any other hospital
23 authorized by the county administrator to receive such patients
24 in accordance with section 306. The patient may be retained for
25 observation, care and treatment and further examination in the
26 hospital for up to 72 hours to permit a physician to determine
27 whether the patient has a mental illness and is in need of
28 involuntary care and treatment in a hospital pursuant to this
29 act. Any continued involuntary retention in the hospital beyond
30 the initial 72-hour period shall be in accordance with this act
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1 relating to the involuntary admission and retention of a person.
2 If at any time during the 72-hour period the person is
3 determined not to meet the involuntary admission and retention
4 provisions of this act, and does not agree to stay in the
5 hospital as a voluntary or informal patient, he shall be
6 released. Failure to comply with an order of assisted outpatient
7 treatment shall not be grounds for involuntary civil commitment
8 or a finding of contempt of court.
9 (l) False Petition.--A person making a false statement or
10 providing false information or false testimony in a petition or
11 hearing under this section is subject to criminal prosecution
12 pursuant to 18 Pa.C.S. § 4903 (relating to false swearing).
13 (m) Construction.--Nothing in this section shall be
14 construed to affect the ability of the director of a hospital to
15 receive, admit, or retain patients who otherwise meet the
16 provisions of this act regarding receipt, retention or
17 admission.
18 (n) Educational Materials.--The Department of Public
19 Welfare, in consultation with the county administrator, shall
20 prepare educational and training materials on the use of this
21 section, which shall be made available to county providers of
22 services, judges, court personnel, law enforcement officials and
23 the general public.
24 Section 2. This act shall take effect in 60 days.
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