AB575: Bill Text

AB575,26 Section 26. Subchapter II (title) of chapter 55 [precedes 55.50] of the statutes is created to read:

AB575,24,9 CHAPTER 55

AB575,24,10 SUBCHAPTER II

AB575,24,11 care and treatment for

AB575,24,12 individuals with dementia

AB575,27 Section 27. 55.50 of the statutes is created to read:

AB575,24,18 55.50 Applicability. This subchapter applies to the provision of behavioral and psychiatric evaluation, diagnosis, services, and treatment to individuals with dementia, which may be provided to address or alleviate symptoms or conditions associated with dementia or to address a mental illness or psychiatric condition of an individual with dementia that is not related to dementia.

AB575,28 Section 28. 55.55 of the statutes is created to read:

AB575,24,24 55.55 County designation of dementia crisis unit. (1) Subject to subs. (2), (3), and (4), the county department shall designate at least one unit or part of a unit of a public or private facility as a dementia crisis unit for the purpose of emergency and temporary protective placement of individuals who have dementia for psychiatric evaluation, diagnosis, services, or treatment.

AB575,25,7 (2) The county may not designate a dementia crisis unit under this section unless it finds that the facility in which the unit is located is qualified and equipped to provide, and competent in providing, diagnosis, evaluation, and treatment of dementia and medical, psychiatric, and behavioral care to individuals who have dementia and the designated unit or part of a unit provides a therapeutic environment that is appropriate for, and designed to prevent harm to, individuals who have dementia.

AB575,25,10 (3) To be designated as a dementia crisis unit under sub. (1), the facility shall make available the capability to obtain diagnoses and treatment for medical conditions but is not required to have medical facilities located on the premises.

AB575,25,16 (4) The county department shall 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 dementia crisis units under this section.

AB575,25,19 (5) The county department shall implement a procedure to periodically review any designation made under sub. (1) as necessary and appropriate to ensure the facility continues to meet the criteria for designation.

Note: Requires a county department to identify at least one dementia crisis unit for emergency and temporary protective placement for psychiatric evaluation, diagnosis, or treatment. A unit that has not been so identified by the county may not be used for emergency or temporary protective placements under the procedures created in the bill.

AB575,29 Section 29. 55.59 of the statutes is created to read:

AB575,26,9 55.59 Emergency or temporary protective placement in a dementia crisis unit. (1) Emergency placement authorized; grounds. If, from personal observation by, or a reliable report made by a person who identifies himself or herself to, a sheriff, police officer, fire fighter, guardian, if any, or authorized representative of a county department or an agency with which the county department contracts under s. 55.02 (2), it appears probable that an individual is so totally incapable of providing for his or her own care or custody as to create a substantial risk of serious physical harm to himself or herself or others as a result of dementia, mental illness, or a psychiatric condition if not immediately placed, the person who personally made the observation or to whom the report is made may take an individual into custody and transport the individual to a medical facility or a dementia crisis unit if all of the following are true:

AB575,26,11 (a) The individual has or, based on observation and currently available information, appears to have dementia.

AB575,26,14 (b) The individual has engaged in behavior that creates a substantial risk of serious physical harm to himself or herself or others, as manifested by recent acts or omissions.

AB575,26,23 (c) It appears probable that unless the individual is admitted to a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment, the individual will incur a substantial probability of physical harm, impairment, injury, or debilitation or will present a substantial probability of physical harm to others. The substantial probability shall be shown by evidence of recent behavior of the individual or of recent acts or attempts or a pattern of recent acts or omissions by the individual or by evidence that the individual or others are placed at substantial risk of serious physical harm to them as evidenced by a recent overt act, attempt, or threat by the individual to do serious physical harm to them.

AB575,27,3 (2) Emergency admission to dementia crisis unit. An individual who has been detained under sub. (1) may be admitted to a dementia crisis unit if all of the following are true:

AB575,27,10 (a) A physician has conducted a physical examination of the individual; has determined and documented in writing that there is a reasonable probability that the behavior described in sub. (1) is not caused by a physical condition or illness that could be treated safely and appropriately in a setting other than a dementia crisis unit; and recommends that the individual be placed in a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment for the purpose of addressing the behavior.

AB575,27,12 (b) The placement in a dementia crisis unit is in an environment that is appropriate for the individual.

AB575,27,16 (3) Transportation to dementia crisis unit. A person who is authorized to detain and transport an individual under sub. (1) may transport an individual to a dementia crisis unit for admission under sub. (2) if the individual was detained at a different facility under sub. (1).

AB575,28,3 (4) Statement; right to an attorney. A person who takes an individual into custody under sub. (1) shall prepare and sign a statement at the time of detention providing specific factual information concerning the person's observations or reports made to the person and the basis for taking the individual into custody under sub. (1). If the individual is admitted to a dementia crisis unit, the statement shall be filed with the director of the dementia crisis unit and with any petition under s. 55.075. At the time of admission, the director of the dementia crisis unit or the director's designee shall inform the individual, orally and in writing, of his or her right to contact an attorney and a member of his or her immediate family and the right to have an attorney provided at public expense, as provided under s. 55.105. The director or designee shall provide the individual with a copy of the statement by the person making the emergency protective placement.

AB575,28,5 (5) False statements. Whoever signs a statement under sub. (4) while knowing the information contained in the statement to be false is guilty of a Class H felony.

AB575,28,10 (6) Petition; contents. When an individual is protectively placed under this section, the person making the emergency protective placement shall immediately file a petition under s. 55.075 with the court. In addition to the allegations required under s. 55.08 (1), the petition shall allege that the grounds under subs. (1) and (2) are true.

AB575,28,22 (7) Hearing; conversion procedure. (a) The court shall hold a preliminary hearing within 96 hours of detention, excluding Saturdays, Sundays, and legal holidays, to establish probable cause to believe the allegations of the grounds for protective placement under s. 55.08 (1) and the grounds under subs. (1) and (2). An individual is considered to be detained when he or she is taken into custody for the purpose of emergency protective placement. At the request of the subject individual or his or her counsel or guardian ad litem, the court may postpone the hearing, but in no case may the postponement exceed 7 days after the date the individual was admitted to the dementia crisis unit for emergency protective placement. At the probable cause hearing under this subsection, the court shall make a finding of whether the individual who is the subject of the hearing is likely to be found incompetent.

AB575,29,5 (b) If, under par. (a), the court finds that the individual has dementia but is not likely to be found incompetent or that protective placement is otherwise not appropriate, the court may treat the petition under this section as a petition for commitment under s. 51.20 or 51.45 (13). The court shall review the petition filed under this section under the standards under s. 51.20 (1) (a) or 51.45 (13) (a) to determine whether an order of detention shall be issued without further notice. Placement shall be made in a facility described under s. 51.20 (2) (d) or 51.45 (13) (h). The court shall schedule the full, final hearing under s. 51.20 (7) (c) or 51.45 (13) (e).

AB575,29,16 (8) Order; temporary placement. Upon finding probable cause under sub. (7), the court may order temporary protective placement for up to 45 days in a dementia crisis unit, pending the hearing for permanent protective placement. If the court does not find probable cause for placement in a dementia crisis unit but does find probable cause for placement in a protective placement facility other than a dementia crisis unit, it shall so order. The court may order any protective services that may be required. The order, and any subsequent extension of the order under s. 55.61, shall state that the county in which the original order for protective placement of the individual was issued shall be responsible for transportation of the individual to any facility to which placement of the individual is ordered upon discharge of the individual from the dementia crisis unit.

AB575,30,2 (9) Medication and treatment. When an individual is protectively placed in a dementia crisis unit under this section, or remains in a dementia crisis unit pursuant to an extension of an order issued under this section, the director and staff of the dementia crisis unit may evaluate, diagnose and treat the individual if the individual consents. The individual has a right to refuse medication and treatment except as provided in an order under s. 55.14 or 55.70 or in a situation in which medication or treatment is necessary to prevent serious physical harm to the individual or others. The director of the dementia crisis unit or his or her designee shall advise the individual of these rights. The court may order the involuntary administration of psychotropic medication as an emergency protective service to the individual only as provided in s. 55.70.

AB575,30,8 (10) Transfer. When, upon the advice of the treatment staff, the director of a dementia crisis unit in which an individual has been placed for emergency or temporary protective placement under this section determines that the grounds for emergency or temporary protective placement no longer exist, he or she shall notify the county department in order to arrange for transfer of the individual to a facility described in s. 55.12.

AB575,30,15 (11) Liability. Any individual who acts in accordance with this section, including making a determination whether an individual has dementia or whether an individual evidences a substantial probability of harm, is not liable for any actions taken in good faith. The good faith of the actor shall be presumed in any civil action. Whoever asserts that the individual who acts in accordance with this section has not acted in good faith has the burden of proving that assertion by evidence that is clear, satisfactory, and convincing.

AB575,30 Section 30. 55.61 of the statutes is created to read:

AB575,30,20 55.61 Extension of temporary protective placement in a dementia crisis unit. (1) Extension authorized. The court may extend for up to 60 days an order for temporary protective placement in a dementia crisis unit under s. 55.59 (8) if the requirements of this section are met.

AB575,31,5 (2) Petition. (a) Filing; service. Subject to par. (b), an individual under an order for temporary protective placement in a dementia crisis unit; the individual's guardian; the individual's legal counsel or guardian ad litem, if any; the department; the county department that placed the individual or provided the protective services under an order of the court; an agency with which the county department contracts under s. 55.02 (2); or any interested person may file a petition for extension of an order for temporary protective placement in a dementia crisis unit. The person filing the petition shall have the petition served on the individual, the individual's guardian, the individual's legal counsel and guardian ad litem, if any, and the county department.

AB575,31,12 (b) Time limit. Except in an emergency, if the petition described under par. (a) is being filed, the person filing the petition for extension of temporary protective placement in a dementia crisis unit shall file the petition no fewer than 10 days before the date of expiration of the period of temporary protective placement ordered under s. 55.59 (8). If an emergency makes it impossible to file a petition sooner, a petition may be filed up to 72 hours prior to expiration of the period of temporary protective placement ordered under s. 55.59 (8).

AB575,31,15 (c) Allegations. A person filing the petition under par. (a) shall allege in the petition for extension of an order for temporary protective placement in a dementia crisis unit that all of the following are true:

AB575,31,17 1. The individual continues to meet the standards for protective placement under s. 55.08 (1).

AB575,31,18 2. The individual has dementia.

AB575,31,21 3. The individual has engaged in behavior that creates a substantial risk of serious physical harm to himself or herself or others, as manifested by recent acts or omissions.

AB575,32,3 4. A physician has conducted a physical examination of the individual who is the subject of the petition; has determined and documented in writing that there is a reasonable probability that the behavior is not caused by a physical condition or illness that could be treated safely and appropriately in a setting other than a dementia crisis unit; and recommends that the individual continue placement in the dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment.

AB575,32,13 5. Unless the individual continues placement in the dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment, the individual will incur a substantial probability of physical harm, impairment, injury, or debilitation or will present a substantial probability of physical harm to others. The individual submitting the petition shall allege a substantial probability of physical harm to the individual or others by providing evidence of recent behavior of the individual or of recent acts or attempts or a pattern of recent acts or omissions by the individual or by evidence that the individual or others are placed at substantial risk of serious physical harm to them as evidenced by a recent overt act, attempt, or threat by the individual to do serious physical harm to them.

AB575,32,15 6. Reasonable efforts have been made to locate an appropriate placement for the individual in a less restrictive setting.

AB575,32,24 (3) Examination. (a) Appointment of examiners. Subject to par. (b), if a petition is filed under this section, the court shall appoint 2 licensed physicians specializing in psychiatry, or one licensed physician and one licensed psychologist, or 2 licensed physicians one of whom shall have specialized training in psychiatry, if available, or 2 licensed physicians to personally examine the individual. The court shall appoint examiners who have the specialized knowledge that the court determines to be appropriate to the needs of the individual. The examiners may not be related to the individual by blood, marriage, or adoption and may not have any interest in his or her property.

AB575,33,6 (b) Choice of examiner. The individual to be examined may select one of the examiners appointed under par. (a) if the individual makes his or her selection known to the court within 24 hours after he or she receives the petition for extension of the temporary protective placement in the dementia crisis unit. The court may deny the individual's selection if the examiner does not meet the requirements of par. (a) or the individual's selection is not available.

AB575,33,14 (c) Right to additional examination. If the individual, the individual's attorney, or any other interested party with court permission requests, the individual who is the subject of the petition has a right to secure, at his or her own expense, an additional medical or psychological examination and to offer the evaluator's personal testimony as evidence at the hearing. If the individual who is the subject of the petition is indigent, requests an additional medical or psychological examination, and has approval of the court hearing the petition, the individual's county of legal residence shall pay a reasonable expense for the additional examination.

AB575,33,22 (d) Notice to examinee; remaining silent. Before the examination, the individual who is the subject of the examination shall be informed that his or her statements can be used as a basis for an extension of the current temporary protective placement in the dementia crisis unit, that he or she has the right to remain silent, and that the examiner is required to make a report to the court even if the subject individual remains silent. The issuance of such a warning to the individual prior to each examination establishes a presumption that the individual understands that he or she need not speak to the examiner.

AB575,34,11 (e) Examiner report; conclusions. The examiners shall personally observe and examine the individual at any suitable place and satisfy themselves, if reasonably possible, as to the individual's mental condition. Each examiner shall make an independent written report and file that report with the court. The report and testimony, if any, by the examiners shall be based on beliefs to a reasonable degree of medical certainty, or professional certainty if an examiner is a psychologist, in regard to the existence of the facts alleged in the petition and the appropriateness of various treatment modalities or facilities. If the examiners are unable to reach conclusions to a reasonable degree of medical or professional certainty, the examiners shall so state in their report and testimony, if any. The individual's treatment records shall be available to the examiners. The individual, the individual's attorney, and the individual's guardian ad litem shall have access to all psychiatric and other reports at least 72 hours in advance of the hearing under sub. (4).

AB575,34,19 (f) Discovery. On motion of either party, all parties shall produce at a reasonable time and place designated by the court all physical evidence which each party intends to introduce in evidence. Any party shall be permitted to inspect, copy, photograph, or transcribe such physical evidence in the presence of a person designated by the court. The order shall specify the time, place and manner of making the inspection, copies, photographs, or transcriptions, and may prescribe such terms and conditions as are just. The court may, if the motion is made by the individual, delay the hearing for any period necessary for completion of discovery.

AB575,35,3 (4) Hearing. A court shall hold a hearing on the petition for extension before the expiration of the order for temporary protective placement of the individual in a dementia crisis unit under s. 55.59 (8). A trial by a jury shall be held if demanded by the individual sought to be protected or his or her attorney or guardian ad litem. The hearing shall be held as part of the same proceedings in which the petition for permanent protective placement of the individual is heard. The petition shall be heard immediately after the order for permanent protective placement of the individual is made. If the court does not order permanent protective placement of the individual, the petition under this section shall be dismissed.

AB575,35,7 (5) Order. After a hearing under sub. (4) on a petition for extension of an order for temporary protective placement in a dementia crisis unit, the court shall make one of the following orders and shall identify in the order the information relied on as a basis for that order:

AB575,35,11 (a) If the court finds that the individual meets the standards for protective placement under s. 55.08 (1) and the allegations under sub. (2) (c) are true, it shall order continued temporary placement in the dementia crisis unit for a period not to exceed 60 days from the date of expiration of the original order under s. 55.59 (8).

AB575,35,17 (b) If the court finds that the individual meets the standards for protective placement under s. 55.08 (1) and the allegations under sub. (2) (c) are true, but that the individual would be better served in a different dementia crisis unit, it shall order transfer of the individual to that dementia crisis unit and temporary placement in that dementia crisis unit for a period not to exceed 60 days from the date of expiration of the original order under s. 55.59 (8).

AB575,35,21 (c) If the court finds that the individual meets the standards for protective placement under s. 55.08 (1) but the allegations under sub. (2) (c) are not true, the court shall order transfer of the individual to a protective placement facility under s. 55.12.

AB575,35,24 (d) If the court finds the individual no longer meets the standards for protective placement under s. 55.08 (1), it shall terminate the protective placement, as provided in s. 55.17.

AB575,36,14 (6) Subsequent extensions. A court may extend an order under sub. (5) (a) or (b) in increments of no more than 60 days. For each such extension, a person described under sub. (2) (a) shall file a petition alleging that the individual meets the standards for protective placement under s. 55.08 (1) and that the allegations under sub. (2) (c) are true no later than 10 days prior to the expiration of the most-recently issued order for temporary placement. If an emergency makes it impossible to file a petition sooner, a petition may be filed up to 72 hours prior to expiration of the most recently-issued order for temporary placement ordered under sub. (5). The petition shall be served on the individual, the individual's guardian, the individual's legal counsel and guardian ad litem, if any, and the county department. Examination shall be conducted as provided in sub. (3). A hearing shall be held prior to the expiration of the most-recently issued order for temporary placement. A trial by a jury shall be held if demanded by the individual or his or her attorney or guardian ad litem. After hearing, the court shall issue an order issued as provided in sub. (5).

AB575,31 Section 31. 55.65 of the statutes is created to read:

AB575,36,21 55.65 Temporary transfer to dementia crisis unit. (1) Transfer authorized. An individual who is under a protective placement order and has or, based on currently available information and observation, appears to have dementia, may be transferred to a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment for a period not to exceed 45 days if the requirements of this section are met.

AB575,37,5 (2) Petition. An individual under protective placement; the individual's guardian; the individual's legal counsel or guardian ad litem, if any; the department; the county department that placed the individual or provided the protective services under an order of the court; an agency with which the county department contracts under s. 55.02 (2); or any interested person may file a petition at any time for temporary transfer of the individual to a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment. The petition shall be served on the individual, the individual's guardian, the individual's legal counsel and guardian ad litem, if any, and the county department.

AB575,37,7 (3) Allegations. The person filing the petition under sub. (2) shall allege all of the following in the petition:

AB575,37,9 (a) The individual has been diagnosed with or, based upon currently available information, appears to have dementia.

AB575,37,12 (b) The individual has engaged in behavior that creates a substantial risk of serious physical harm to himself or herself or others as manifested by recent acts or omissions.

AB575,37,15 (c) A physician who has personal knowledge of the individual has conducted a physical examination of the individual within the past 7 days and, based on that examination, all of the following are true:

AB575,37,19 1. The physician has determined and documented in writing that there is a reasonable probability that the behavior is not caused by a physical condition or illness that could be treated safely and appropriately in a setting other than a dementia crisis unit.

AB575,37,22 2. The physician has determined that there is a reasonable probability that the individual's behavior or condition may be improved by transfer to a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment.

AB575,38,5 (d) Unless the individual is temporarily transferred to a dementia crisis unit for behavioral or psychiatric evaluation, diagnosis, services, or treatment, the individual will incur a substantial probability of being subject to a change in permanent placement to a more restrictive setting due to the inability of the current placement facility to provide for the safety of the individual or others due to the behavior of the individual. The person filing the petition shall allege the substantial probability of a change in placement to a more restrictive setting by showing all of the following:

AB575,38,10 1. Evidence of recent behavior of the individual or of recent acts or attempts or a pattern of recent acts or omissions by the individual or by evidence that the individual or others are placed at substantial risk of serious physical harm to them as evidenced by a recent overt act, attempt, or threat by the individual to do serious physical harm to them.

AB575,38,12 2. Evidence of the facility's response to behavior, acts, attempts, omissions or threats identified in subd. 1., as documented in records maintained by the facility.

AB575,38,16 (e) The protective placement facility has made reasonable efforts to address or accommodate the behavior or condition for which behavioral or psychiatric evaluation, diagnosis, services, or treatment in a dementia crisis unit is sought and these efforts are documented in the individual's plan of care.

AB575,38,17 (f) The placement is in an environment that is appropriate for the individual.

AB575,38,18 (g) One of the following is true:

AB575,38,22 1. The protective placement facility has a plan in place for the orderly return of the individual to the protective placement facility upon discharge from the dementia crisis unit which specifies the conditions under which the individual will be readmitted to the facility and a copy of the plan is included with the petition.

AB575,39,2 2. The protective placement facility has determined that readmission of the individual to the protective placement facility upon discharge from the dementia crisis unit is not in the best interests of the individual and includes with the petition specific factual information supporting this conclusion.

AB575,39,8 (h) The protective placement facility has prepared detailed documentation of the behaviors or condition of the individual that necessitate inpatient behavioral or psychiatric evaluation, diagnosis, services, or treatment, including detailed information about the physical examination conducted under par. (c) and efforts taken by the facility under par. (e), and this documentation will be provided to the dementia crisis unit.

AB575,39,11 (4) Consent of guardian required. No individual may be transferred under this section without the written consent of the individual's guardian except in the case of an emergency transfer under sub. (6).

AB575,39,14 (5) Consent of county department. No individual may be transferred under this section without the written consent of the county department except in the case of an emergency transfer under sub. (6).

AB575,39,22 (6) Emergency transfer; petition. If an emergency makes it impossible to file a petition as specified in sub. (2) or to obtain the prior written consent of the guardian specified in sub. (4), the individual may be transferred without the prior written consent of the guardian, without written consent of the county department, and without a prior court order. A petition containing all of the allegations in sub. (3) and identification of the specific facts and circumstances which made it impossible to carry out the transfer under the nonemergency procedures shall be filed immediately upon transfer.

AB575,40,2 (7) Hearing. (a) The court shall order a hearing within 72 hours after an individual is transferred under sub. (6) or a petition is filed under sub. (2). At the request of the individual or his or her counsel or guardian ad litem, the hearing may be postponed, but in no case may the postponement exceed 7 days from the date of the emergency transfer.

AB575,40,5 (b) The court shall notify the petitioner, the individual under protective placement, the individual's guardian, the individual's attorney, if any, and the county department of the time and place of the hearing.

AB575,40,8 (c) A guardian ad litem shall be appointed to represent the individual under protective placement at the hearing. If the individual is indigent, the county in which the hearing is held shall be liable for guardian ad litem fees.

AB575,40,12 (d) The court shall refer the individual under protective placement for appointment of legal counsel as provided under s. 55.105 if the individual, the individual's guardian ad litem, or anyone on the individual's behalf requests that counsel be appointed for the individual.

AB575,40,15 (e) The petitioner, the individual under protective placement, the individual's guardian, the individual's guardian ad litem, and the individual's attorney, if any, have the right to attend the hearing and to present and cross-examine witnesses.

AB575,40,17 (8) Standard for transfer. In determining whether to approve a proposed or emergency transfer the court shall consider all of the following:

AB575,40,18 (a) Whether there is probable cause to believe the allegations under sub. (3).

AB575,40,20 (b) Whether the proposed transfer to a dementia crisis unit is in the best interests of the individual.

AB575,40,23 (c) In the case of an emergency transfer, whether there is probable cause to believe that specific facts and circumstances specified under sub. (6) made it impossible to carry out the transfer under nonemergency procedures.

AB575,40,25 (9) Order relating to transfer. Following the hearing under sub. (7), the court shall do one of the following:

AB575,41,6 (a) If the court finds that the individual continues to meet the standards for protective placement under s. 55.08 (1) and the allegations under sub. (3) and, if applicable, sub. (6) are not true, the court shall issue an order prohibiting the transfer. The court shall identify in the order the information relied upon as a basis for the order and shall make findings based on the allegations under sub. (3) and, if applicable, sub. (6) in support of the denial of the transfer.