AB575: Bill Text

2. The protective placement facility has determined that readmission of the individual to the 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.

Consent of Guardian and County Department Required. Under the bill, the written consent of the individual's guardian and the county department are required in order to carry out a transfer to a dementia crisis unit, except in the case of an emergency transfer, as described below.

Hearing; Order to Transfer. The court must hold a hearing within 72 hours after the filing of a petition for transfer. At the request of the individual, or his or her counsel or guardian ad litem, the hearing may be postponed for up to 7 days from the date of emergency transfer.

At the hearing, the court must consider whether the standards for transfer described above have been met and whether the proposed transfer to a dementia crisis unit is in the best interests of the person under protective placement.

Following the hearing, the court must do one of the following:

(a) If the court finds that the individual continues to meet the standards for protective placement and the proposed transfer to a dementia crisis unit does not meet the standards for transfer, the court must issue an order prohibiting the transfer. The court must include the information relied upon as a basis for the order and make findings based on those standards in support of the denial of the transfer.

(b) If the court finds that the individual continues to meet the standards for protective placement and the proposed transfer to a dementia crisis unit meets the standards for transfer, the court must order the transfer of the individual to a dementia crisis unit for a period not to exceed 45 days.

(c) If the court finds that the individual no longer meets the standards for protective placement the court must terminate the protective placement.

Emergency Transfer of Placement of an Individual With Dementia to Dementia Crisis Unit; Probable Cause Hearing; Order

If an emergency makes it impossible to file a petition prior to transfer to a dementia crisis unit or to obtain the prior written consent of the guardian, the individual may be transferred without the prior written consent of the guardian and without a prior court order. A petition containing all of the allegations required for temporary transfer to a dementia crisis unit, and identification of the specific facts and circumstances which made it impossible to carry out the transfer under the nonemergency procedures, must be filed immediately upon transfer.

The court must hold a hearing within 72 hours of the transfer. At the request of the subject individual, or his or her counsel or guardian ad litem, the probable cause hearing may be postponed for up to 7 days from the date of the emergency transfer.

After the hearing, the court must issue an order based upon its findings, as set forth above in the description of nonemergency temporary transfer procedures. In addition to the factors that must be considered for nonemergency transfers, the court must also consider whether there is probable cause to believe the allegations that an emergency made it impossible to file a petition and carry out the transfer as a nonemergency transfer.

Transportation Upon Discharge. The order for transfer to a dementia crisis unit, and any subsequent extension of the order, must state that the county in which the original order for protective placement of the individual was issued is 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.

Extension of Temporary Transfer to a Dementia Crisis Unit

The order for temporary transfer to a dementia crisis unit may be extended for 60 days beyond the initial 45-day period of transfer if a petition for extension of the temporary placement is filed before expiration of the order for temporary placement, and the court orders the extension after a hearing. If requested, a jury trial must be held. Allegations similar to those required to be proven at the probable cause hearing must be proven. The court must also appoint 2 examiners, as is required for involuntary commitments under ch. 51, to examine the individual and provide a report to the court before the hearing or trial.

Subsequent Extensions of Temporary Transfer to a Dementia Crisis Unit

Temporary transfer to a dementia crisis unit may be subsequently extended in increments of no more than 60 days. For each such extension, a petition alleging that the individual meets the standards for temporary transfer to the dementia crisis unit must be filed no later than 10 days prior to the expiration of the most-recently issued order for temporary transfer. 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 transfer.

The petition must 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 by 2 experts must be conducted and a hearing must be held. The examiner's reports must be made available 72 hours in advance of the hearing. A trial by a jury must be provided if demanded by the individual sought to be protected or his or her attorney or guardian ad litem. After the hearing, if grounds for continued transfer to the dementia crisis unit are proven, the court must issue an order extending the temporary placement for up to 60 days.

Medication and Treatment of an Individual With Dementia in a Dementia Crisis Unit

When an individual with dementia is placed or remains in a dementia crisis unit under any of the new procedures created in the bill, 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 for involuntary administration of psychotropic medication as a protective service or an emergency protective service, or in a situation in which medication or treatment is necessary to prevent serious physical harm to the individual or others. The individual must be advised of these rights by the director of the dementia crisis unit or his or her designee.

Provisions Applicable to Dementia Crisis Units Used for Emergency or Temporary Protective Placements; Liability

Discharge

The bill provides that when, upon the advice of the treatment staff, the director of a dementia crisis unit to which an individual has been transferred or placed for emergency protective placement determines that the grounds for transfer or emergency placement no longer exist, he or she must notify the county department in order to arrange for transfer of the individual to a protective placement facility.

Liability

Any individual who acts in accordance with the provisions of the bill, including making a determination that an individual has or does not have dementia or evidences or does not evidence 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. The bill states that whomever 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.

AB575,1 Section 1. 51.01 (4r) of the statutes is amended to read:

AB575,13,6 51.01 (4r) "Degenerative brain disorder" means the loss or dysfunction of brain cells to the extent that the individual is substantially impaired in his or her ability to provide adequately for his or her own care or custody or to manage adequately his or her property or financial affairs. "Degenerative brain disorder" includes dementia.

AB575,2 Section 2. 51.01 (4v) of the statutes is created to read:

AB575,14,5 51.01 (4v) "Dementia" means 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 Alzheimer's disease.

AB575,3 Section 3. 51.01 (13) (b) of the statutes is amended to read:

AB575,14,10 51.01 (13) (b) "Mental illness", for purposes of involuntary commitment, means a substantial disorder of thought, mood, perception, orientation, or memory which grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life, but does not include dementia or alcoholism.

AB575,4 Section 4. 51.12 of the statutes is created to read:

AB575,14,14 51.12 Involuntary admissions under protective placement procedures. Admission to a dementia crisis unit as defined under s. 55.01 (1y) may be made under protective placement procedures under ss. 55.59 and 55.65.

AB575,5 Section 5. 51.15 (1) (a) (intro.) of the statutes is amended to read:

AB575,14,22 51.15 (1) (a) (intro.) A Except as provided in sub. (1m), a law enforcement officer or other person authorized to take a child into custody under ch. 48 or to take a juvenile into custody under ch. 938 may take an individual into custody if the officer or person has cause to believe that the individual is mentally ill, is drug dependent, or is developmentally disabled and, based on observation and currently available information, that the individual does not have or does not appear to have dementia, and that the individual evidences any of the following:

AB575,6 Section 6. 51.15 (1m) of the statutes is created to read:

AB575,15,5 51.15 (1m) Detention of individuals with dementia. An individual who has or, based on observation and currently available information, appears to have dementia may not be detained under this section. An individual who has or, based on observation and currently available information, appears to have dementia may be detained only as provided under s. 55.59 for purposes of emergency protective placement or as provided under s. 55.65 for purposes of transfer of protective placement.

AB575,7 Section 7. 51.20 (1) (a) 1m. of the statutes is created to read:

AB575,15,9 51.20 (1) (a) 1m. Based on observation and currently available information, the individual does not have or appear to have dementia or the individual has or appears to have dementia but is competent.

AB575,8 Section 8. 51.20 (1) (aw) of the statutes is created to read:

AB575,15,16 51.20 (1) (aw) Notwithstanding the prohibitions against emergency detention of a individual who has dementia under ss. 51.12 and 51.15 (1m), an individual who has or, based on observation and currently available information, appears to have dementia and who is competent may be involuntarily committed based on a petition filed under this section if the individual otherwise meets the criteria for involuntary commitment under sub. (1) (a).

AB575,9 Section 9. 51.61 (1) (intro.) of the statutes is amended to read:

AB575,16,11 51.61 (1) (intro.) In this section, "patient" means any individual who is receiving services for mental illness, developmental disabilities, alcoholism or drug dependency, including any individual who is admitted to a treatment facility in accordance with this chapter or ch. 48 or 55 or who is detained, committed or placed under this chapter or ch. 48, 55, 971, 975 or 980, or who is transferred to a treatment facility under s. 51.35 (3) or 51.37 or who is receiving care or treatment for those conditions through the department or a county department under s. 51.42 or 51.437 or in a private treatment facility. In this section, "patient" also means any individual who is receiving psychiatric or behavioral care or services in a dementia crisis unit, as defined in s. 55.01 (1y), under subch. II of ch. 55, to the extent that provisions of this section do not conflict with provisions of ch. 55 applicable to that individual. "Patient" does not include persons committed under ch. 975 who are transferred to or residing in any state prison listed under s. 302.01. In private hospitals and in public general hospitals, "patient" includes any individual who is admitted for the primary purpose of treatment of mental illness, developmental disability, alcoholism or drug abuse but does not include an individual who receives treatment in a hospital emergency room nor an individual who receives treatment on an outpatient basis at those hospitals, unless the individual is otherwise covered under this subsection. Except as provided in sub. (2), each patient shall:

AB575,10 Section 10. 51.67 of the statutes is amended to read:

AB575,17,17 51.67 Alternate procedure; protective services. If, after a hearing under s. 51.13 (4) or 51.20, the court finds that commitment under this chapter is not warranted and that the subject individual is a fit subject for guardianship and protective placement or services, the court may, without further notice, appoint a temporary guardian for the subject individual and order temporary protective placement or services under ch. 55 for a period not to exceed 30 days. Temporary protective placement for an individual in a center for the developmentally disabled is subject to s. 51.06 (3). Any interested party may then file a petition for permanent guardianship or protective placement or services, including medication, under ch. 55. If the individual is in a treatment facility, and the individual does not have or, based on observation and currently available information, appear to have dementia, the individual may remain in the facility during the period of temporary protective placement if no other appropriate facility is available. If the individual is in a treatment facility and the individual has or, based on currently available information, appears to have dementia, the individual may remain in the facility during the period of temporary protective placement only if the facility is designated by a county as a dementia crisis unit under s. 55.55 and the facility provides an environment that is appropriate for the individual. For an individual who has or, based on currently available information, appears to have dementia, the court may order psychotropic medication as an emergency protective service under this section only as provided in s. 55.70. The court may order psychotropic medication as a temporary protective service under this section for an individual who does not have or appear to have dementia if it finds that there is probable cause to believe the individual is not competent to refuse psychotropic medication and that the medication ordered will have therapeutic value and will not unreasonably impair the ability of the individual to prepare for and participate in subsequent legal proceedings. An individual is not competent to refuse psychotropic medication if, because of serious and persistent mental illness, and after the advantages and disadvantages of and alternatives to accepting the particular psychotropic medication have been explained to the individual, one of the following is true:

AB575,11 Section 11. Subchapter I (title) of chapter 55 [precedes 55.001] of the statutes is created to read:

AB575,17,20 CHapter 55

AB575,17,22 subchapter I protective serviceS; generally

AB575,12 Section 12. 55.01 (1v) of the statutes is amended to read:

AB575,18,3 55.01 (1v) "Degenerative brain disorder" means the loss or dysfunction of brain cells to the extent that the individual is substantially impaired in his or her ability to provide adequately for his or her own care or custody or to manage adequately his or her property or financial affairs. "Degenerative brain disorder" includes dementia.

AB575,13 Section 13. 55.01 (1x) of the statutes is created to read:

AB575,18,9 55.01 (1x) "Dementia" means 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 Alzheimer's disease.

AB575,14 Section 14. 55.01 (1y) of the statutes is created to read:

AB575,18,16 55.01 (1y) "Dementia crisis unit" means a unit or part of a unit of a public or private facility that has been designated by a county department under s. 55.55 as 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 that provides a therapeutic environment that is appropriate for and designed to prevent harm to individuals who have dementia.

Note: Creates a definition of "dementia crisis unit" for the purpose of ch. 55.

AB575,15 Section 15. 55.02 (3) of the statutes is renumbered 55.02 (3) (intro.) and amended to read:

AB575,18,22 55.02 (3) Corporation counsel. (intro.) The corporation counsel of the county in which the petition is brought may or, if requested by the court, shall assist in conducting proceedings under this chapter. The corporation counsel shall assist in conducting any proceedings under this chapter in which all of the following are true:

AB575,16 Section 16. 55.02 (3) (a) and (b) of the statutes are created to read:

AB575,18,24 55.02 (3) (a) The proceedings are initiated under s. 51.20 (7) (d) 1. or 51.67.

AB575,19,1 (b) The subject individual has or appears to have dementia.

AB575,17 Section 17. 55.10 (1) of the statutes is amended to read:

AB575,19,16 55.10 (1) Time limits. A petition for protective placement or protective services shall be heard within 60 days after it is filed unless an extension of this time is requested by the petitioner, the individual sought to be protected or the individual's guardian ad litem, or the county department, in which case the court may extend the date for hearing by up to 45 days. The court shall hear a petition for protective placement that is filed under s. 55.59 (6) in conjunction with an emergency protective placement in a dementia crisis unit within 45 days after it is filed. The court may not extend the time for hearing a petition for protective placement that is filed under s. 55.59 (6) in conjunction with an emergency protective placement in a dementia crisis unit. If an individual under s. 50.06 (3) alleges that another individual is making a health care decision under s. 50.06 (5) (a) that is not in the best interests of the incapacitated individual or if the incapacitated individual verbally objects to or otherwise actively protests the admission, the petition shall be heard as soon as possible within the 60-day period.

AB575,18 Section 18. 55.12 (2) of the statutes is amended to read:

AB575,20,14 55.12 (2) Subject to s. 46.279, protective placement may be made to nursing homes, public medical institutions, centers for the developmentally disabled under the requirements of s. 51.06 (3), foster care services or other home placements, or to other appropriate facilities, but. Protective placement may not be made to units a unit for the acutely mentally ill unless the unit is designated as a dementia crisis unit under s. 55.55 and appropriate procedures under subch. II are followed. A protective placement that is otherwise permissible under subch. I is not prohibited solely because the placement facility has one or more units or locations designated under s. 55.55 or is associated with a facility that is designated under s. 55.55. An individual, other than an individual who has or, based on observation and currently available information, appears to have dementia, who is subject to an order for protective placement or protective services may be detained on an emergency basis under s. 51.15 or involuntarily committed under s. 51.20 or . An individual who is subject to an order for protective placement or protective services may be voluntarily admitted to a treatment facility or a dementia crisis unit for inpatient care under s. 51.10 (8). No individual who is subject to an order for protective placement or services may be involuntarily transferred to, detained in, or committed to a treatment facility for care except under s. 51.15 or 51.20. This subsection does not prohibit the placement or transfer of an individual who has or, based on currently available information, appears to have dementia in or to a dementia crisis unit as provided in s. 55.59 or 55.65. Protective placement in a locked unit shall require a specific finding of the court as to the need for the action.

AB575,19 Section 19. 55.13 (6) of the statutes is created to read:

AB575,20,19 55.13 (6) For an individual who has or, based on observation and currently available information, appears to have dementia, involuntary administration of psychotropic medications may be provided as an emergency protective service only as provided under s. 55.70.

AB575,20 Section 20. 55.135 (1) of the statutes is amended to read:

AB575,21,19 55.135 (1) If, from personal observation of, 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 it 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 developmental disability, degenerative brain disorder, serious and persistent mental illness, or other like incapacities if not immediately placed, the individual who personally made the observation or to whom the report is made may take into custody and transport the individual to an appropriate medical or protective placement facility. An individual may be transported to a dementia crisis unit for emergency protective placement only if the individual has or, based on observation and currently available information, appears to have dementia and only as provided under s. 55.59. The person making emergency protective placement shall prepare 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 emergency placement. The statement shall be filed with the director of the facility and with any petition under s. 55.075. At the time of emergency protective placement the individual shall be informed by the director of the facility or the director's designee, 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 also provide the individual with a copy of the statement by the person making emergency protective placement.

AB575,21 Section 21. 55.14 (1) (b) 2. of the statutes is amended to read:

AB575,21,24 55.14 (1) (b) 2. The individual is substantially incapable of applying an understanding of the advantages, and disadvantages of accepting treatment and the alternatives to accepting treatment to his or her condition in order to make an informed choice as to whether to accept or refuse psychotropic medication.

AB575,22 Section 22. 55.14 (3) (e) (intro.) and (4) of the statutes are amended to read:

AB575,22,6 55.14 (3) (e) (intro.) Unless psychotropic medication is administered involuntarily, 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 Except as provided in par. (em), the substantial probability of physical harm, impairment, injury, or debilitation shall be evidenced by one of the following:

AB575,22,16 (4) A petition under this section must shall include a written statement signed by a physician who has personal knowledge of the individual that provides general clinical information regarding the appropriate use of psychotropic medication for the individual's condition and specific data that indicates that the individual's current condition necessitates the use of psychotropic medication. If the individual has or appears to have dementia, the statement shall state that the physician has determined and documented in writing that there is a reasonable probability that the behavior for which treatment with psychotropic medication is sought is not caused by a physical condition or illness that could be treated successfully by means other than psychotropic medication.

AB575,23 Section 23. 55.14 (3) (em) and (4m) of the statutes are created to read:

AB575,22,24 55.14 (3) (em) In the case of an individual who has or appears to have dementia, the substantial probability of physical harm, impairment, injury, or debilitation under par. (e) 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.

AB575,23,8 (4m) In the case of an individual who has or appears to have dementia, and who resides in a nursing home, as defined in s. 50.01 (3), a community-based residential facility, as defined in s. 50.01 (1g), an adult family home, as defined in s. 50.01 (1), or a residential care apartment complex, as defined in s. 50.01 (6d), the petition shall also allege that reasonable efforts have been made to address or accommodate the behavior or condition for which treatment with psychotropic medication is sought. Evidence of the facility's response to the individual's behavior or condition, as documented in records maintained by the facility, shall be attached to the petition.

AB575,24 Section 24. 55.15 (1) of the statutes is amended to read:

AB575,23,17 55.15 (1) Transfers authorized. An individual under a protective placement order may be transferred between protective placement units, between protective placement facilities, or from a protective placement unit to a medical facility. The individual may not be transferred, under the protective placement order, to any facility for which commitment procedures are required under ch. 51. This provision does not prohibit temporary transfer of an individual who has or, based on currently available information, appears to have dementia, to a dementia crisis unit as provided in s. 55.65.

AB575,25 Section 25. 55.18 (1) (b) of the statutes is amended to read:

AB575,24,6 55.18 (1) (b) If, following an annual review of an individual's status under par. (a), the individual or the individual's guardian or guardian ad litem requests modification or termination of the individual's protective placement and a hearing under the requirements of s. 55.10 (2) to (4) is provided, or if a hearing under the requirements of s. 55.10 (2) to (4) is provided pursuant to a petition for modification or termination of the protective placement, the county is not required to initiate a subsequent review of the individual's status under par. (a) until the first day of the 11th month after the date that the court issues a final order after the hearing. A petition under s. 55.61, 55.65, or 55.67 is not a request for modification or termination of an individual's protective placement for purposes of this paragraph, and the fact that a hearing has been held at any time under any of those sections with respect to an individual does not affect the duty of the county to perform an annual review of the individual's protective placement as required under par. (a).

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.