Franklin County CIT Pink Slip Training

This presentation is meant for Crisis Intervention Team (CIT) training.

1. Emergency Hospitalization and the Pink Slip Process September 14, 2020 Franklin County CIT TRAINING Presented by: Christina Shaynak-Diaz, ATTORNEY **The content of this presentation is for general informational purposes only and does not constitute legal advice. Contact your legal counsel with specific questions. **

2. Ohio Revised Code Chapter 5122 CC BY-NC-ND

3. Key Definition: “Mentally Ill Person Subject To Court Order” A mentally ill person who, because of the person's illness: Represents a substantial risk of physical harm to self as manifested by evidence of threats of, or attempts at, suicide or serious self-inflicted bodily harm; Represents a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior, evidence of recent threats that place another in reasonable fear of violent behavior and serious physical harm, or other evidence of present dangerousness;

4. Key Definition: “Mentally Ill Person Subject To Court Order” Represents a substantial and immediate risk of serious physical impairment or injury to self as manifested by evidence that the person is unable to provide for and is not providing for the person's basic physical needs because of the person's mental illness and that appropriate provision for those needs cannot be made immediately available in the community; Would benefit from treatment for the person's mental illness and is in need of such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of others or the person; or

5. Key Definition: “Mentally Ill Person Subject To Court Order” Would benefit from treatment as manifested by evidence of behavior that indicates ALL of the following : Person unlikely to survive safely in the community without supervision, based on a clinical determination. Person has history of lack of compliance with treatment for mental illness and one of the following applies: At least twice within the thirty-six months prior to the filing of an affidavit seeking court-ordered treatment of the person under section  5122.111  of the Revised Code, the lack of compliance has been a significant factor in necessitating hospitalization in a hospital or receipt of services in a forensic or other mental health unit of a correctional facility Within the forty-eight months prior to the filing of an affidavit seeking court-ordered treatment of the person under section  5122.111  of the Revised Code, the lack of compliance resulted in one or more acts of serious violent behavior toward self or others or threats of, or attempts at, serious physical harm to self or others The person, as a result of the person's mental illness, is unlikely to voluntarily participate in necessary treatment. In view of the person's treatment history and current behavior, the person is in need of treatment in order to prevent a relapse or deterioration that would be likely to result in substantial risk of serious harm to the person or others. **Court-Ordered Outpatient Treatment Criteria**

6. Emergency Hospitalization Process (Pink Slip Process)

7. Purposes Protect person and others from risk of harm Get person to safe environment where they can receive treatment Designate persons authorized to carry out process Provide information to receiving facility to assist in making determinations Initiate civil commitment process Require specific due process protections

8. Emergency Procedure - O.R.C. 5122.10 Certain professionals with reason to believe a person is: A “mentally ill person subject to court order”; AND represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination; May take into custody and immediately transport the person to a: Hospital (OhioMHAS licensed or State Hospital); OR non OhioMHAS-licensed general hospital

9. Categories of Professionals Police officer Sheriff Parole officer Psychiatrist Licensed physician Licensed clinical psychologist Health officer Clinical nurse specialist certified as a psychiatric-mental health (NEW category) Certified nurse practitioner certified as a psychiatric-mental health NP (NEW category) Probation officer (for parolees and certain other offenders)

10. “Written Statement” Requirements A.K.A. “Application for Emergency Admission”& “Pink Slip” Professional must provide “written statement” to the hospital. Statement must: specify the circumstances under which person was taken into custody; and reasons for belief that person is a mentally ill person subject to court order and represents a substantial risk of physical harm to self or others if allowed to remain at liberty pending examination

11. Completing the Form Must be completely filled out Exception: “Statement of Observation” will not always be included Must list name of hospital to which person is being transported Cannot be altered unless mistake made on original Interim stop for medical clearance should not be/is not required to be listed on form Date and time approved by hospital CCO = important! “Statement of Belief” must be based on belief of professional taking custody

12. Additional Responsibilities of Professional Written statement must be made available to the person upon request Must explain the following to the person: name and professional designation and affiliation of the person taking custody the custody-taking is not a criminal arrest the person is being taken for examination by mental health professionals at a specified mental health facility identified by name.

13. Additional Responsibilities of Professional Must make every reasonable and appropriate effort to take person into custody in the least conspicuous manner possible Person has right at all times to be treated with consideration and respect for the patient's privacy and dignity Must take reasonable precautions to preserve and safeguard the personal property in the possession of or on the premises occupied by person

14. Facility Options OhioMHAS-Licensed Hospital or Inpatient Unit Public/State Hospital/RPH General Hospital (not Ohio-MHAS licensed) * Note: Statute later refers to a person transported to a “Community Mental Health Services Provider” but not listed as an option to transport on pink slip

15. Transported to a Ohio-MHAS Licensed Hospital or Inpatient Unit Chief clinical officer (CCO) of a hospital may receive for observation, diagnosis, care, and treatment any person whose admission is applied for under emergency or judicial procedure O.R.C. 5122.05

16. Transported to a Public/State Hospital CCO of a public hospital, in all cases of psychiatric medical emergencies, shall receive for observation, diagnosis, care, and treatment any person whose admission is applied for under emergency or judicial procedure. O.R.C. 5122.05

17. Transported to a GENERAL HOSPITAL (not OhioMHAS-licensed) MAY admit the person or provide care and treatment MUST transfer to an OhioMHAS-licensed hospital by the end of twenty-four hours after arrival O.R.C. 5122.10(D)

18. Person must immediately be informed and provided with written statement that person may do any of the following: Immediately make reasonable number of phone calls or use other reasonable means to contact an attorney, a licensed physician, or a licensed clinical psychologist, to contact any other person or persons to secure representation by counsel, or to obtain medical or psychological assistance, and be provided assistance in making calls if the assistance is needed and requested; Retain counsel and have independent expert evaluation of person's mental condition and, if person is unable to obtain an attorney or independent expert evaluation, be represented by court-appointed counsel or have independent expert evaluation of person's mental condition, or both, at public expense if person is indigent; Have hearing to determine whether or not person is mentally ill person subject to court order Written Notice of Rights

19. Required Licensed/State Hospital Notification CCO of hospital must immediately notify: Person's legal guardian, spouse or next of kin, and legal counsel (if can be determined through exercise of reasonable diligence) and ADAMH Board (or the provider designated by Board) of the patient's county of residence

20. Board-Designated Provider Assessment (Prescreen) ADAMH Board (or designated provider) must promptly assess the patient unless: the Board or designated provider has already performed the assessment; or the commitment is of a NGRI or incompetent person

21. Purpose of the Assessment Purpose of assessment by ADAMH Board (or designated provider): “to assist the hospital in determining whether the patient is subject to involuntary hospitalization and whether alternative services are available”

22. Required Licensed/State Hospital Examination Must be examined within 24 hours after arrival If conducting of examination requires that person to remain overnight, the person must be admitted in an unclassified status until making a disposition

23. Initial Determination After Required Examination If CCO believes the person is not a mentally ill person subject to court order, must release or discharge the person immediately unless a court has issued a temporary order of detention applicable to the person If the CCO believes the person is a mentally ill person subject to court order, may detain the person for not more than three court days following the day of the examination

24. 3-Day Hold Period By end of 3-day period, CCO must either: admit the person as a voluntary patient; file an affidavit with the probate court to initiate proceedings for a mentally ill person subject to court order; OR discharge the person unless court has issued a TOD; or person has been sentenced to DRC and has not been released from the person's sentence (returned to DRC)

25. 3-Day Period Requirements May not detain person for “more than three court days following the day of the examination ” 1 st “court day” is day after examination occurs (exam must be within 24 hours of arrival) Court days => no holidays and weekends Example: Arrives at hospital on Tuesday at 4pm Examination occurs on Wednesday at 3pm 1 st court day is Thursday 2 nd court day is Friday 3 rd court day is Monday Disposition must be made by end of court day on Monday!

26. Important to note! During 3 day period, person may be transferred to another hospital if the one to which they were pink-slipped is full, cannot address the person’s needs, etc. A new pink slip is not required for this purpose.

27. Due Process Statutory requirements must be followed to provide adequate protection of due process rights: Follow process Provide completed written statement to hospital Ensure rights of involuntary patients Hearing and representation

28. Common Issues & Concerns Application of the Law

29.   Can the statements of others be relied on in making the decision to pink slip a person? Professional taking custody and transporting must have “reason to believe” Must form own reason to believe In making determination, may rely on statements made by others who observed actions of person

30. Is law enforcement required to transport individuals for purposes of emergency hospitalization? No, law enforcement has authority but is not required to take person into custody and transport for purposes of emergency hospitalization (unless TOD issued)

31. Can a state/public hospital require interim stop at different facility for medical examination before being transported to the public hospital? No. AG Opinion states public hospital has no authority to require interim stop.

32. If making an interim stop for medical clearance, does the stop need to be listed on the pink slip? No, AG Opinion says it is permissible to first transport to general hospital for medical exam or treatment or CMH agency responsible for assessment. Law allows “Reasonable exercise of discretion in determining where to transport”

33.   Can hospital to which person pink-slipped choose to pink slip the person to another hospital? No “serial” pink-slipping not authorized. No longer “at liberty” once at hospital. Law provides other mechanisms to transport/transfer to another hospital when necessary

34. Can facility name on pink slip be left blank or changed? No, pink slip is a legal document, akin to an affidavit and providing due process, and must be completed in its entirety. The law provides options for transferring/transporting to another hospital when necessary.

35. What options are available for transfer when a general hospital (not OhioMHAS licensed) is utilized? 1. Pink slip to licensed or state hospital and make “interim stop” for medical clearance Pink slip essentially on hold until cleared and transported to licensed/state hospital 24 hours for exam and 3-day hold begins when pink slip approved/signed/dates by licensed/state hospital 2. Pink slip to general medical hospital for medical clearance or other reasons General hospital must transfer to licensed/state hospital within 24 hours 24 hours for exam and 3-day hold begins when pink slip approved/signed/dates by licensed/state hospital

36. Can hospital emergency department pink slip person to a psychiatric hospital if person brought to ER by family member (not pink-slipped to the ED)? Yes, if no psych facilities at hospital Not initially pink-slipped to ED so not “serial” pink-slipping

37.   What are the options when person absent without leave? Within 5 days of unauthorized absence, Hospital or OhioMHAS may issue verbal or written order for any health officer, police officer or sheriff to take custody and transport person back to hospital

38. Can a facility require that a person requesting voluntary admission be pink-slipped for transportation or other purposes? Can only be pink-slipped if criteria for emergency hospitalization apply Voluntary admission should always be favored over involuntary admissions

39. Can a Minor be pink-slipped? Statute says “any person” No distinction between adults and minors

40. Questions?

41. Thank you!