hb 0573

CHAPTER 184

HB 573 - FINAL VERSION

AN ACT relative to the role of certain advanced registered nurse practitioners in the state mental health services system.

SPONSORS: Rep. Bickford, Straf 1; Sen. Wheeler, Dist 21

This bill authorizes certain advanced registered nurse practitioners to conduct examinations for the purposes of admitting persons to the state mental health services system on an emergency basis.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

AN ACT relative to the role of certain advanced registered nurse practitioners in the state mental health services system.

Be it Enacted by the Senate and House of Representatives in General Court convened:

184:1 Emergency Treatment. Amend the introductory paragraph and paragraph I of RSA 135:21-b to read as follows:

135:21-b Emergency Treatment. A physician licensed in the state, a psychiatric mental health advanced registered nurse practitioner, or a person acting under [~~his~~] such physician's or advanced registered nurse practitioner's direction may administer a recognized and approved form of medical or psychiatric treatment which the physician or the psychiatric mental health advanced registered nurse practitioner reasonably believes will tend to promote the physical and mental health of a patient of the New Hampshire hospital, Laconia developmental services, Glencliff home for the elderly, any community mental health or mental retardation program or treatment facility receiving state grants under [~~RSA 126-B or~~] RSA 171-A, or any other treatment facility designated as a receiving facility under RSA 135-C, when:

I. The physician or psychiatric mental health advanced registered nurse practitioner reasonably believes that a medical or psychiatric emergency exists; and

184:2 New Paragraph; Definition Added; Advanced Registered Nurse Practitioner. Amend RSA 135-C:2 by inserting after paragraph II the following new paragraph:

II-a. "Advanced registered nurse practitioner" or "A.R.N.P." means an advanced registered nurse practitioner licensed by the board of nursing who is a psychiatric mental health specialist and who has at least 2 years' experience as an advanced registered nurse practitioner working with individuals who have mental illness, as defined in paragraph X of this section, and who meets any other criteria specified in rules adopted by the department.

184:3 Involuntary Emergency Admission; Advanced Registered Nurse Practitioners. Amend RSA 135-C:28 to read as follows:

I. The involuntary emergency admission of a person shall be to the state mental health services system under the supervision of the commissioner. The admission may be ordered upon the certificate of a physician or A.R.N.P., as defined in RSA 135-C:2, II-a, who is approved by either a designated receiving facility or a community mental health program approved by the commissioner, provided that within 3 days of the completion of the petition the physician or A.R.N.P. has conducted, or has caused to be conducted, a physical examination if indicated and circumstances permit, and a mental examination. The physician or A.R.N.P. must find that the person to be admitted meets the criteria of RSA 135-C:27. The certificate shall state the time and, in detail, the nature of the examinations conducted. The certificate shall also state a specific act or actions the physician or A.R.N.P. has actually observed or which have been reported to him or her by the petitioner or a reliable witness who shall be identified in the certificate, and which in the physician's or A.R.N.P.'s opinion satisfy the criteria set forth in RSA 135-C:27. The physician or A.R.N.P. shall identify in the certificate the facility in the state mental health services system to which the person shall be admitted. The admission shall be made to the facility which can best provide the degree of security and treatment required by the person and shall be consistent with the placement principles set forth in RSA 135-C:15. As used in RSA 135-C:27-33, "petitioner" means any individual, including a physician or A.R.N.P. completing a certificate, who has requested that a physician or A.R.N.P. conduct or who has conducted an examination for purposes of involuntary emergency admission. Every certificate shall be accompanied by a written petition signed by a petitioner.

II. Upon request for involuntary emergency admission by a petitioner, if the person sought to be admitted refuses to consent to a mental examination, a petitioner or a law enforcement officer may sign a complaint which shall be sworn to before a justice of the peace. The complaint shall be submitted to the justice of the peace with the petition. The petition shall state in detail the acts or actions of the person sought to be admitted which the petitioner has personally observed or which have been personally reported to [~~him~~] the petitioner and in his or her opinion require a compulsory mental examination. If the justice of the peace finds that a compulsory mental examination is necessary, the justice may order the examination.

III. When a peace officer observes a person engaging in behavior which gives the peace officer reasonable suspicion to believe that the person may be suffering from a mental illness and probable cause to believe that unless the person is placed in protective custody the person poses an immediate danger of bodily injury to himself or others, the police officer may place the person in protective custody. Any person taken into protective custody under this paragraph shall be transported directly to an emergency room of a licensed general hospital or to another site designated by the community mental health program serving the area, for the purpose of determining if an involuntary emergency admission shall be ordered in accordance with RSA 135-C:28, I. The period of protective custody shall end when a physician or A.R.N.P. makes a determination as to whether involuntary emergency admission shall be ordered or at the end of 6 hours, whichever event occurs first.

184:4 Involuntary Admission; Advanced Registered Nurse Practitioners. Amend RSA 135-C:32 to read as follows:

135-C:32 Ten-Day Limitation; Petition for Involuntary Admission. No person shall be admitted for an involuntary emergency admission under RSA 135-C:27-33 for longer than a 10-day period, unless a subsequent petition for involuntary emergency admission which contains allegations of specific acts or actions which occurred subsequent to the initial involuntary emergency admission is completed and the admission is ordered by a physician or A.R.N.P., as defined in RSA 135-C:2, II-a, in accordance with RSA 135-C:28, or unless a petition requesting a judicial hearing on the issue of involuntary admission under RSA 135-C:34-54 has been filed with the appropriate probate court within the involuntary admission period. Upon the filing of the petition with the probate court, the period of involuntary emergency admission may be extended until the issuance of the order of the probate court pursuant to RSA 135-C:45.