LRB-1315/1
TJD:sac:rs
2013 - 2014 LEGISLATURE
December 18, 2013 - Introduced by
Joint Legislative Council. Referred to
Committee on Health.
AB575,1,10
1An Act to renumber and amend 55.02 (3);
to amend 51.01 (4r), 51.01 (13) (b),
251.15 (1) (a) (intro.), 51.61 (1) (intro.), 51.67, 55.01 (1v), 55.10 (1), 55.12 (2),
355.135 (1), 55.14 (1) (b) 2., 55.14 (3) (e) (intro.) and (4), 55.15 (1) and 55.18 (1)
4(b); and
to create 51.01 (4v), 51.12, 51.15 (1m), 51.20 (1) (a) 1m., 51.20 (1) (aw),
5subchapter I (title) of chapter 55 [precedes 55.001], 55.01 (1x), 55.01 (1y), 55.02
6(3) (a) and (b), 55.13 (6), 55.14 (3) (em) and (4m), subchapter II (title) of chapter
755 [precedes 55.50], 55.50, 55.55, 55.59, 55.61, 55.65, 55.67, 55.70, 55.73 and
855.74 of the statutes;
relating to: psychiatric and behavioral care and
9treatment for individuals with dementia, dementia care units, and providing
10a penalty.
Analysis by the Legislative Reference Bureau
This bill is explained in the Notes provided by the Joint Legislative Council in
the bill.
Because this bill creates a new crime or revises a penalty for an existing crime,
the Joint Review Committee on Criminal Penalties may be requested to prepare a
report concerning the proposed penalty and the costs or savings that are likely to
result if the bill is enacted.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
Law Revision Committee prefatory note: This bill was prepared for the Joint
Legislative Council's Special Committee on Legal Interventions for Persons With
Alzheimer's Disease and Related Dementias.
Overview
The bill creates a new subchapter in ch. 55 titled "Care and Treatment for
Individuals With Dementia." The subchapter applies to the provision of behavioral and
psychiatric evaluation, diagnosis, services and treatment and the involuntary
administration of psychotropic medication to individuals with dementia to address or
alleviate symptoms or conditions associated with dementia, mental illness, and other
psychiatric conditions.
The bill specifies that individuals with dementia generally are not subject to ch. 51
emergency detention and involuntary commitment procedures. The bill creates
alternative procedures within ch. 55 under which individuals with dementia may be
protectively placed in or transferred to dementia crisis units, in a planned manner or in
an emergency situation, for the purpose of behavioral or psychiatric evaluation,
diagnosis, services, or treatment.
"Dementia" is defined under the bill for purposes of chs. 51 and 55 as deterioration
or loss of intellectual faculties, reasoning power, memory, and will due to organic brain
disease characterized by confusion, disorientation, apathy, or stupor of varying degrees
that is not capable of being reversed and from which recovery is impossible. Dementia
includes, but is not limited to, Alzheimer's disease.
"Dementia crisis unit" is defined as a unit or part of a unit of a public or private
facility that has been identified by a county department as qualified and equipped to
provide, and competent in providing, diagnosis, evaluation, and treatment of dementia
and medical, psychiatric, and behavioral care to individuals with dementia and that
provides a therapeutic environment that is appropriate for, and designed to prevent harm
to, individuals with dementia. Medical facilities need not be located on the premises, but
the capacity to provide diagnosis and treatment for medical conditions must be available.
Applicability of Ch. 51 Emergency Detention, Involuntary Commitment,
and Conversion to Individuals With Dementia
The bill specifies that "mental illness," for purposes of ch. 51 involuntary
commitment, does not include dementia.
The bill specifies that a law enforcement officer may take a person into custody for
emergency detention under ch. 51 only if, based on observation and currently available
information, the individual does not appear to have dementia.
The bill specifies that a person who has dementia or who, based on observation and
currently available information, appears to have dementia, may not be involuntarily
committed under ch. 51 unless he or she is competent.
Under current law, if the court determines, after a hearing on probable cause for
involuntary commitment under ch. 51, that there is probable cause to believe that the
subject individual is a fit subject for guardianship and protective placement or services,
the court may appoint a temporary guardian and order temporary protective placement
or services under ch. 55 for a period not to exceed 30 days, and must proceed as if a petition
had been made for guardianship and protective placement or services. This procedure
is commonly referred to as a "conversion" from ch. 51 to ch. 55. Under current law, if the
individual is in a ch. 51 treatment facility at the time of conversion, the individual may
remain in the facility during the period of temporary protective placement if no other
appropriate facility is available.
The bill specifies that if an individual is in a ch. 51 treatment facility at the time
of conversion, and the individual has or appears to have dementia, the individual may
remain in that facility only if the facility is identified by a county as a dementia crisis unit,
as described below, and the unit provides an environment that is appropriate for the
individual.
Requirement That Corporation Counsel Assist in Prosecuting
Conversion Cases
Current law provides that the corporation counsel of the county in which a petition
under ch. 55 is brought may, or if requested by the court, must, assist in conducting
proceedings under this chapter.
The bill specifies that the corporation counsel of the county in which a petition
under ch. 55 is brought must assist in conducting ch. 55 proceedings if both of the
following are true: (a) the proceedings were initiated under ch. 51 and subsequently
converted to ch. 55 proceedings; and (b) the subject individual has dementia.
County Designation of Dementia Crisis Unit for Emergency and
Temporary Protective Placements
The bill requires each county department to identify at least one location as a
dementia crisis unit for the purpose of emergency and temporary protective placement
for behavioral or psychiatric evaluation, diagnosis, services, or treatment. The county
may not identify a location as a dementia crisis unit unless it finds that the location is
qualified and equipped to provide, and competent in providing, the diagnosis, evaluation
and treatment of dementia and medical, psychiatric, and behavioral care to individuals
with dementia and it provides a therapeutic environment that is appropriate for, and
designed to prevent harm to, individuals with dementia. Medical facilities need not be
located on the premises, but the capacity to provide diagnosis and treatment for medical
conditions must be available.
The bill requires the county department to solicit information and advice from the
public, including family caregivers of individuals with dementia, organizations
concerned with Alzheimer's disease and dementia, the treatment of mental illness or the
provision of long-term care, and any other appropriate individuals or organizations, to
aid it in carrying out its responsibility to designate one or more locations as dementia
crisis units.
The county department must implement a procedure to periodically review and
update the designation of one or more locations as dementia crisis units as necessary and
appropriate.
County and Department of Health Services Reports
The bill requires each county department to prepare and submit a report to the
Department of Health Services (DHS) that identifies each location that it has designated
as a dementia crisis unit for the purpose of emergency and temporary protective
placements. The report must specify the capacity of each designated unit, describe the
process used to solicit information and advice from the public and summarize the
information and advice received. The report must be updated whenever the county newly
designates a unit or revokes a unit's designation.
The bill also requires each county department to annually prepare and submit a
report to DHS that states the total number of petitions for emergency protective
placement or temporary transfer of an individual with dementia to a dementia crisis unit
filed in the county and the total number of those petitions that resulted in a placement
in a dementia crisis unit.
The bill requires DHS, by June 30 of each even-numbered year, to submit to the
legislature a report that includes all of the following:
(a) Identification of the dementia crisis units designated by counties and the
capacity of those units, as provided in reports submitted to DHS by county departments.
(b) A summary of the procedures used by counties to solicit information and advice
from the public when making dementia crisis unit designations, as provided in reports
submitted to DHS by county departments.
(c) A summary of the information provided to DHS by counties regarding the
number of petitions filed for emergency protective placement or temporary transfer of an
individual with dementia to a dementia crisis unit.
IAPM as an Emergency Protective Service for Individuals With Dementia
Current Law
Under current law, involuntary administration of psychotropic medication (IAPM)
may be ordered as a protective service under s. 55.14. "Involuntary administration of
psychotropic medication" means any of the following:
1. Placing psychotropic medication in an individual's food or drink with knowledge
that the individual protests receipt of the psychotropic medication.
2. Forcibly restraining an individual to enable administration of psychotropic
medication.
3. Requiring an individual to take psychotropic medication as a condition of
receiving privileges or benefits.
Under current law, all of the requirements applicable to a petition for protective
services must be met, including the filing of a petition for guardianship if the individual
does not already have a guardian. In addition, a petition continuing extensive allegations
specific to the issue of IAPM must be filed, a guardian ad litem must make a report to the
court, the individual's physician must provide a detailed written statement, and the
individual has a right to an independent medical or psychological examination. The court
must hold a hearing on the petition for IAPM within 30 days. If the individual does not
already have a guardian, a petition for guardianship must be heard, and a guardian
appointed, before the hearing on the petition for IAPM. IAPM may not begin until the
court has issued the order.
Under current law, emergency protective services may be provided to an individual
for up to 72 hours, without a court order, if there is reason to believe that if those services
are not provided, the individual, or others, will incur a substantial risk of serious physical
harm. The services may not be provided for longer than 72 hours unless a petition for
protective services is filed, a hearing is held, and the court finds probable cause to believe
the criteria for the provision of protective services exist. If the individual is not under
guardianship, a petition for guardianship must accompany the petition for protective
services.
There is some disagreement as to whether, under current law, IAPM may be
provided as an emergency protective service under s. 55.135.
The Bill
