First Regular Session
Seventy-fourth General Assembly
STATE OF COLORADO
REENGROSSED
This Version Includes All Amendments
Adopted in the House of Introduction
LLS NO. 23-0162.03 Jacob Baus x2173
HOUSE BILL 23-1013
House Committees Senate Committees
Judiciary
Appropriations
A BILL FOR AN ACT
C
ONCERNING MEASURES TO REGULA TE THE USE OF RESTRICTIVE101
PRACTICES ON INDIVIDUALS IN CORRECTIONAL FACILITIES .102
Bill Summary
(Note: This summary applies to this bill as introduced and does
not reflect any amendments that may be subsequently adopted. If this bill
passes third reading in the house of introduction, a bill summary that
applies to the reengrossed version of this bill will be available at
http://leg.colorado.gov/
.)
Legislative Oversight Committee Concerning the Treatment
of Persons with Behavioral Health Disorders in the Criminal and
Juvenile Justice Systems. The bill prohibits the use of a clinical restraint
on an individual, unless:
! The use is to prevent the individual from committing
imminent and serious harm to the individual's self or
HOUSE
3rd Reading Unamended
April 24, 2023
HOUSE
Amended 2nd Reading
April 21, 2023
HOUSE SPONSORSHIP
Amabile, Bacon, Bird, Boesenecker, Brown, deGruy Kennedy, Dickson, Froelich, Gonzales-
Gutierrez, Herod, Jodeh, Lindsay, Lindstedt, Mabrey, Michaelson Jenet, Ortiz, Parenti,
Sharbini, Sirota, Snyder, Story, Velasco, Weissman, Willford, Woodrow, Young
SENATE SPONSORSHIP
Fields and Rodriguez,
Shading denotes HOUSE amendment. Double underlining denotes SENATE amendment.
Capital letters or bold & italic numbers indicate new material to be added to existing law.
Dashes through the words or numbers indicate deletions from existing law. another person, based on immediately present evidence and
circumstances;
! All less restrictive interventions have been exhausted; and
! The clinical restraint is ordered by a licensed mental health
provider.
The bill requires facilities that utilize clinical restraints to
implement procedures to ensure frequent and consistent monitoring for
the individual subjected to the clinical restraint and uniform
documentation procedures concerning the use of the clinical restraint.
The bill limits the amount of time an individual may be subjected
to a clinical restraint per each restraint episode and within a calendar year.
The bill prohibits the use of an involuntary medication on an
individual, unless:
! The individual is determined to be dangerous to the
individual's self or another person and the treatment is in
the individual's medical interest;
! All less restrictive alternative interventions have been
exhausted; and
! The involuntary medication is administered after
exhaustion of procedural requirements that ensure a
hearing, opportunity for review, and right to counsel.
The bill requires the department of corrections (department) to
submit an annual report to the judiciary committees of the senate and
house of representatives with data concerning the use of clinical restraints
and involuntary medication in the preceding calendar year.
The bill requires the department to include specific data
concerning the placement of individuals in settings with heightened
restrictions in its annual administrative segregation report.
Be it enacted by the General Assembly of the State of Colorado:1
SECTION 1. In Colorado Revised Statutes, add 17-1-167 as2
follows:3
17-1-167. Use of restraints for state inmates - criteria -4
documentation - intake assessment - report - rules - definitions.5
(1) BY JULY 1, 2027, THE DEPARTMENT SHALL IMPLEMENT POLICIES AND6
PRACTICES THAT CONFORM TO THE MINIMUM STANDARDS PRESCRIBED BY7
THE MOST UPDATED RESTRAINT AND SECLUSION STANDARDS OF THE8
NATIONAL COMMISSION ON CORRECTIONAL HEALTH CARE. THE9
1013-2- DEPARTMENT SHALL CONTINUOUSLY AMEND ITS PRACTICES AND POLICIES1
TO COMPLY, AT A MINIMUM, WITH THE THOSE MINIMUM STANDARDS .2
(2) (a) A FACILITY OR QUALIFIED FACILITY SHALL ENSURE THAT3
THE USE OF RESTRAINT IS DOCUMENTED AND MAINTAINED IN THE4
ELECTRONIC HEALTH RECORD OF THE INDIVIDUAL WHO WAS RESTRAINED.5
AT A MINIMUM, THE FACILITY OR QUALIFIED FACILITY SHALL DOCUMENT:6
(I) THE ORDER FOR CLINICAL RESTRAINT, THE DATE AND TIME OF7
THE ORDER, AND THE SIGNATURE OF THE LICENSED OR LICENSE-ELIGIBLE8
MENTAL HEALTH PROVIDER WHO ISSUED THE CLINICAL RESTRAINT ORDER.9
IF THE ORDER IS AUTHORIZED BY TELEPHONE, THE ORDER MUST BE10
TRANSCRIBED AND SIGNED AT THE TIME OF ISSUANCE BY A PERSON WITH11
AUTHORITY TO ACCEPT ORDERS. THE ORDERING LICENSED OR LICENSE-12
ELIGIBLE MENTAL HEALTH PROVIDER SHALL SIGN THE ORDER AS SOON AS13
PRACTICABLE.14
(II) A CLEAR EXPLANATION OF THE CLINICAL BASIS FOR USE OF THE15
CLINICAL RESTRAINT, INCLUDING THE LESS-INTRUSIVE INTERVENTIONS16
THAT WERE EMPLOYED AND FAILED , AND EVIDENCE OF THE IMMEDIATE17
CIRCUMSTANCES JUSTIFYING THE BELIEF THAT THE USE OF RESTRAINT WAS18
TO PREVENT THE INDIVIDUAL FROM COMMITTING IMMINENT AND SERIOUS19
HARM TO THE INDIVIDUAL'S SELF OR ANOTHER PERSON;20
(III) THE SPECIFIC BEHAVIORAL CRITERIA THE INDIVIDUAL MUST21
EXHIBIT FOR THE CLINICAL RESTRAINT EPISODE TO BE TERMINATED ;22
(IV) ANY MODIFICATIONS TO THE ORDER, AND THE TIME AND23
DATE, AND THE SIGNATURE OF THE LICENSED OR LICENSE -ELIGIBLE24
MENTAL HEALTH PROVIDER, OR MENTAL HEALTH CLINICIAN AS DEFINED BY25
DEPARTMENT RULE OR DESIGNATED BY THE DEPARTMENT, WHO MODIFIES26
THE ORDER;27
1013
-3- (V) THE DATE AND TIME OF AN ORDER MODIFICATION , THE DATE1
AND TIME OF THE MODIFICATION, AND THE SIGNATURE OF THE LICENSED2
OR LICENSE-ELIGIBLE MENTAL HEALTH PROVIDER, OR MENTAL HEALTH3
CLINICIAN AS DEFINED BY DEPARTMENT RULE OR DESIGNATED BY THE4
DEPARTMENT, WHO ISSUED THE CLINICAL RESTRAINT ORDER. IF THE ORDER5
IS MODIFIED BY TELEPHONE, THE MODIFICATION MUST BE TRANSCRIBED6
AND SIGNED AT THE TIME OF ISSUANCE BY A PERSON WITH AUTHORITY TO7
ACCEPT THE MODIFICATION . THE ORDERING LICENSED OR8
LICENSE-ELIGIBLE MENTAL HEALTH PROVIDER , OR MENTAL HEALTH9
CLINICIAN AS DEFINED BY DEPARTMENT RULE OR DESIGNATED BY THE10
DEPARTMENT, SHALL SIGN THE ORDER AS SOON AS PRACTICABLE ; AND11
(VI) THE DATE AND TIME OF THE TERMINATION OF THE ORDER, THE12
SIGNATURE OF THE PERSON WHO TERMINATED THE ORDER, THE13
OBSERVATIONS, AND EVIDENCE THAT THE INDIVI DUAL EXHIBITED14
BEHAVIOR JUSTIFYING THE TERMINATION OF THE ORDER .15
(b) THE FACILITY OR QUALIFIED FACILITY SHALL ENSURE THE16
DOCUMENTATION AND RETENTION REQUIRED PURSUANT TO THIS SECTION17
ARE CONDUCTED PURSUANT TO ALL APPLICABLE STATE AND FEDERAL18
LAWS REGARDING THE CONFIDENTIALITY OF THE INDIVIDUAL 'S19
INFORMATION AND SHALL ENSURE AN INDIVIDUAL MAY ACCESS THE20
INFORMATION OR DEMAND RELEASE OF THE INFORMATION TO A THIRD21
PARTY.22
(3) A QUALIFIED FACILITY SHALL PERFORM AN EVALUATION UPON23
EVERY INDIVIDUAL'S INTAKE TO THE RESPECTIVE FACILITY FOR THE24
PURPOSE OF ASSESSING THE INDIVIDUAL'S RISK OF SELF-HARM BEHAVIORS25
AND WHETHER THE INDIVI DUAL HAS BEEN PREVIOUSLY SUBJECTED TO26
CLINICAL FOUR-POINT RESTRAINTS. A LICENSED OR LICENSE-ELIGIBLE27
1013
-4- MENTAL HEALTH PROVIDER, MENTAL HEALTH CLINICIAN AS DEFINED BY1
DEPARTMENT RULE OR DESIGNATED BY THE DEPARTMENT , QUALIFIED2
HEALTH-CARE PROVIDER, OR MENTAL HEALTH ADMINISTRATOR SHALL3
INITIATE APPROPRIATE SAFETY PLANNING TO ADDRESS CONCERNS AND4
ATTEMPT TO AVOID THE USE OF CLINICAL RESTRAINTS , IF POSSIBLE.5
(4) (a) SUBJECT TO THE PROVISIONS OF THIS SECTION, A QUALIFIED6
FACILITY SHALL NOT USE AN INVOLUNTARY MEDICATION ON AN7
INDIVIDUAL UNLESS:8
(I) THE INDIVIDUAL IS DETERMINED TO BE DANGEROUS TO THE9
INDIVIDUAL'S SELF OR ANOTHER PERSON, AND THE TREATMENT IS IN THE10
INDIVIDUAL'S MEDICAL INTEREST;11
(II) THE QUALIFIED FACILITY HAS EXHAUSTED ALL12
LESS-RESTRICTIVE ALTERNATIVE INTERVENTIONS ;13
(III) THE INVOLUNTARY MEDICATION IS ADMINISTERED AFTER14
EXHAUSTION OF PROCEDURAL REQUIREMENTS ESTABLISHED PURSUANT TO15
THIS SECTION; AND16
(IV) THE MAJORITY OF THE INVOLUNTARY MEDICATION17
COMMITTEE DESCRIBED IN SUBSECTION (4)(b) OF THIS SECTION APPROVES18
OF THE INVOLUNTARY MEDICATION .19
(b) THE QUALIFIED FACILITY SHALL CONVENE AN INVOLUNTARY20
MEDICATION COMMITTEE, COMPRISED OF A LICENSED PSYCHIATRIST, A21
LICENSED PSYCHOLOGIST, A LICENSED OR LICENSE-ELIGIBLE MENTAL22
HEALTH PROVIDER, AND THE SUPERINTENDENT OF THE QUALIFIED FACILITY23
OR THE SUPERINTENDENT'S DESIGNEE.24
(c) AN ORDER FOR AN INVOLUNTARY MEDICATION MUST NOT :25
(I) EXCEED ONE HUNDRED EIGHTY DAYS FROM THE DATE OF THE26
ORDER; AND27
1013
-5- (II) PERMIT THE USE OF MORE THAN TEN DIFFERENT PSYCHOTROPIC1
MEDICATIONS DURING THE ONE HUNDRED EIGHTY-DAY PERIOD. THIS DOES2
NOT LIMIT THE AMOUNT OF DOSES OF THE MEDICATIONS TO BE3
ADMINISTERED, AS MEDICALLY APPROPRIATE.4
(d) A QUALIFIED FACILITY SHALL ENSURE THAT THE USE OF5
INVOLUNTARY MEDICATION IS DOCUMENTED AND MAINTAINED IN THE6
INDIVIDUAL'S ELECTRONIC HEALTH RECORD. AT A MINIMUM, THE 7
QUALIFIED FACILITY SHALL DOCUMENT :8
(I) THE ORDER FOR INVOLUNTARY MEDICATION ;9
(II) THE DATE AND TIME OF THE ORDER; AND10
(III) A CLEAR EXPLANATION OF THE CLINICAL BASIS FOR USE OF11
THE INVOLUNTARY MEDICATION , INCLUDING THE LESS-INTRUSIVE12
INTERVENTIONS THAT WERE EMPLOYED AND FAILED AND EVIDENCE OF THE13
IMMEDIATE CIRCUMSTANCES JUSTIFYING THE DETERMINATION THAT THE14
INDIVIDUAL IS DANGEROUS TO THE INDIVIDUAL'S SELF OR ANOTHER15
PERSON AND THAT THE TREATMENT IS IN THE INDIVIDUAL'S MEDICAL16
INTEREST.17
(e) THE FACILITY OR QUALIFIED FACILITY SHALL ENSURE THE18
DOCUMENTATION AND MAINTENANCE REQUIRED PURSUANT TO THIS19
SECTION ARE CONDUCTED PURSUANT TO ALL APPLICABLE STATE AND20
FEDERAL LAWS REGARDING THE CONFIDENTIALITY OF THE INFORMATION.21
(f) THIS SUBSECTION (4) DOES NOT APPLY TO EMERGENCY22
MEDICINE ADMINISTERED PURSUANT TO DEPARTMENT POLICY .23
(5) (a) ON OR BEFORE JANUARY 1, 2024 AND ON OR BEFORE24
JANUARY 1 EACH YEAR THEREAFTER, THE EXECUTIVE DIRECTOR OF THE25
DEPARTMENT SHALL SUBMIT A REPORT TO THE JUDICIARY COMMITTEES OF26
THE SENATE AND HOUSE OF REPRESENTATIVES, OR ANY SUCCESSOR27
1013
-6- COMMITTEES, CONCERNING THE USE OF CLINICAL RESTRAINTS AND1
INVOLUNTARY MEDICATION IN THE PRECEDING CALENDAR YEAR. AT A2
MINIMUM, THE REPORT MUST INCLUDE:3
(I) THE TOTAL NUMBER OF CLINICAL AMBULATORY RESTRAINT4
EPISODES AND CLINICAL FOUR-POINT RESTRAINT EPISODES;5
(II) THE TOTAL NUMBER OF INVOLUNTARY MEDICATION ORDERS6
ISSUED;7
(III) THE AVERAGE AMOUNT OF TIME OF A CLINICAL AMBULATORY8
RESTRAINT EPISODE AND CLINICAL FOUR -POINT RESTRAINT EPISODE;9
(IV) THE AVERAGE DURATION OF INVOLUNTARY MEDICATION10
ORDERS ISSUED;11
(V) THE LONGEST CLINICAL AMBULATORY RESTRAINT EPISODE12
AND THE LONGEST CLINICAL FOUR-POINT RESTRAINT EPISODE;13
(VI) THE PERCENTAGE OF TOTAL CLINICAL AMBULATORY14
RESTRAINT EPISODES THAT EXCEEDED TWO HOURS, AND THE PERCENTAGE15
OF TOTAL CLINICAL FOUR-POINT RESTRAINT EPISODES THAT EXCEEDED16
TWO HOURS;17
(VII) THE PERCENTAGE OF TOTAL CLINICAL AMBULATORY18
RESTRAINT EPISODES THAT INVOLVED AN INDIVIDUAL DIAGNOSED WITH A19
BEHAVIORAL HEALTH DISORDER OR INTELLECTUAL OR DEVELOPMENTAL20
DISABILITY, AND THE PERCENTAGE OF TOTAL CLINICAL FOUR-POINT21
RESTRAINT EPISODES THAT INVOLVED AN INDIVIDUAL DIAGNOSED WITH A22
BEHAVIORAL HEALTH DISORDER OR INTELLECTUAL OR DEVELOPMENTAL23
DISABILITY;24
(VIII) THE PERCENTAGE OF TOTAL INVOLUNTARY MEDICATION25
ORDERS THAT INVOLVED AN INDIVIDUAL DIAGNOSED WITH A BEHAVIORAL26
HEALTH DISORDER OR INTELLECTUAL OR DEVELOPMENTAL DISABILITY ,27
1013
-7- AND THE PERCENTAGE OF TOTAL CLINICAL FOUR-POINT RESTRAINT1
EPISODES THAT INVOLVED AN INDIVIDUAL DIAGNOSED WITH A2
BEHAVIORAL HEALTH DISORDER OR INTELLECTUAL OR DEVELOPMENTAL3
DISABILITY;4
(IX) THE PERCENTAGE OF TOTAL CLINICAL AMBULATORY5
RESTRAINT EPISODES THAT INVOLVED AN INDIVIDUAL WHO WAS6
SUBJECTED TO THE RESTRAINT FOR A SECOND OR SUBSEQUENT EPISODE7
WITHIN THE YEAR, AND THE PERCENTAGE OF TOTAL CLINICAL FOUR-POINT8
RESTRAINT EPISODES THAT INVOLVED AN INDIVIDUAL WHO WAS9
SUBJECTED TO THE RESTRAINT FOR A SECOND OR SUBSEQUENT EPISODE10
WITHIN THE YEAR;11
(X) THE PERCENTAGE OF TOTAL INVOLUNTARY MEDICATION12
ORDERS THAT INVOLVED AN INDIVIDUAL WHO WAS SUBJECTED TO A13
SECOND OR SUBSEQUENT ORDER WITHIN THE YEAR ;14
(XI) THE TOTAL NUMBER OF INVOLUNTARY MEDICATION ORDERS15
THAT EXCEEDED ONE HUNDRED EIGHTY DAYS ; AND16
(XII) AN IMPLEMENTATION PLAN TO CONFORM WITH THE17
REQUIREMENTS PURSUANT TO SUBSECTION (1) OF THIS SECTION,18
INCLUDING TIME LINES, A SUMMARY OF PROGRESS , AND A COMPLIANCE19
REPORT.20
(b) BEGINNING IN 2024 AND EACH YEAR THEREAFTER, THE21
DEPARTMENT SHALL PRESENT FINDINGS FROM THE REPORT DESCRIBED BY22
THIS SECTION TO THE HOUSE OF REPRESENTATIVES AND SENATE JUDICIARY23
COMMITTEES, OR ANY SUCCESSOR COMMITTEES, DURING THE HEARINGS24
HELD PURSUANT TO THE "SMART ACT", PART 2 OF ARTICLE 7 OF TITLE 2.25
(c) NOTWITHSTANDING THE REQUIREMENT IN SECTION 24-1-13626
(11)(a)(I), THE REQUIREMENT TO SUBMIT THE REPORT REQUIRED IN THIS27
1013
-8- SUBSECTION (5) CONTINUES INDEFINITELY.1
(d) THE DEPARTMENT SHALL ENSURE THE REPORT REQUIRED IN2
THIS SUBSECTION (5) DOES NOT DISCLOSE ANY INFORMATION IN VIOLATION3
OF APPLICABLE STATE AND FEDERAL LAWS REGARDING THE4
CONFIDENTIALITY OF INDIVIDUALS' INFORMATION.5
(6) AS USED IN THIS SECTION, UNLESS THE CONTEXT OTHERWISE6
REQUIRES:7
(a) "CLINICAL AMBULATORY RESTRAINT " MEANS A DEVICE USED8
TO INVOLUNTARILY LIMIT AN INDIVIDUAL'S FREEDOM OF MOVEMENT, BUT9
STILL PERMITS THE ABILITY OF THE INDIVIDUAL TO WALK AND MOVE10
WHILE SUBJECTED TO THE DEVICE.11
(b) "CLINICAL FOUR-POINT RESTRAINT" MEANS A DEVICE USED TO12
INVOLUNTARILY LIMIT AN INDIVIDUAL'S FREEDOM OF MOVEMENT BY13
SECURING THE INDIVIDUAL'S ARMS AND LEGS.14
(c) "CLINICAL RESTRAINT" MEANS A DEVICE USED TO15
INVOLUNTARILY LIMIT AN INDIVIDUAL'S FREEDOM OF MOVEMENT.16
"CLINICAL RESTRAINT" INCLUDES CLINICAL AMBULATORY RESTRAINTS17
AND CLINICAL FOUR-POINT RESTRAINTS.18
(d) "CORRECTIONAL FACILITY" HAS THE SAME MEANING AS SET19
FORTH IN SECTION 17-1-102 (1.7).20
(e) "DEPARTMENT" MEANS THE DEPARTMENT OF CORRECTIONS,21
CREATED AND EXISTING PURSUANT TO SECTION 24-1-128.5.22
(f) "FACILITY" MEANS A CORRECTIONAL FACILITY OR A PRIVATE23
CONTRACT PRISON.24
(g) "INVOLUNTARY MEDICATION" MEANS GIVING AN INDIVIDUAL25
MEDICATION INVOLUNTARILY; EXCEPT THAT "INVOLUNTARY MEDICATION"26
DOES NOT INCLUDE THE INVOLUNTARY ADMINISTRATION OF MEDICATION27
1013
-9- OR ADMINISTRATION OF MEDICATION FOR VOLUNTARY LIFE -SAVING1
MEDICAL PROCEDURES.2
(h) "LICENSED OR LICENSE-ELIGIBLE MENTAL HEALTH PROVIDER"3
HAS THE SAME MEANING AS DEFINED IN SECTION 27-60-108 (2)(a), OR4
MEANS A PERSON WHO HAS COMPLETED THE EDUCATION REQUIREMENTS5
TO BE A LICENSED MENTAL HEALTH PROVIDER AS DEFINED IN SECTION6
27-60-108 (2)(a), BUT IS IN THE PROCESS OF COMPLETING THE EXPERIENCE7
AND EXAMINATION REQUIREMENTS TO BECOMING LICENSED .8
(i) "PRIVATE CONTRACT PRISON" HAS THE SAME MEANING AS SET9
FORTH IN SECTION 17-1-102 (7.3).10
(j) "QUALIFIED FACILITY" MEANS:11
(I) A CORRECTIONAL FACILITY INFIRMARY ;12
(II) THE SAN CARLOS CORRECTIONAL FACILITY; AND13
(III) THE DENVER WOMEN'S CORRECTIONAL FACILITY.14
(k) "QUALIFIED HEALTH-CARE PROVIDER" MEANS A LICENSED15
PHYSICIAN, A LICENSED ADVANCED PRACTICE REGISTERED NURSE , OR A16
LICENSED REGISTERED NURSE.17
SECTION 2. In Colorado Revised Statutes, 17-1-113.9, amend18
(1) as follows:19
17-1-113.9. Use of administrative segregation for state inmates20
- reporting. (1) Notwithstanding section 24-1-136 (11)(a)(I), on or21
before January 1, 2012, and each January 1 thereafter, the executive22
director shall provide a written report to the judiciary committees of the23
senate and house of representatives, or any successor committees,24
concerning the status of administrative segregation; reclassification25
efforts for offenders INDIVIDUALS DIAGNOSED with mental BEHAVIORAL26
health disorders or intellectual and developmental disabilities, including27
1013
-10- duration of stay, reason for placement, and number and percentage1
discharged; and any internal reform efforts since July 1, 2011. THE2
REPORT MUST INCLUDE DATA CONCERNING THE PLACEMENT OF3
INDIVIDUALS IN ALL SETTINGS WITH HEIGHTENED RESTRICTIONS,4
INCLUDING THE TOTAL NUMBER OF PLACEMENTS IN EACH SETTING , THE5
TOTAL NUMBER OF PLACEMENTS IN EACH SETTING INVOLVING AN6
INDIVIDUAL DIAGNOSED WITH A BEHAVIORAL HEALTH DISORDER OR7
INTELLECTUAL OR DEVELOPMENTAL DISABILITY, THE AVERAGE DURATION8
OF STAY OF AN INDIVIDUAL IN EACH SETTING, THE REASONS FOR9
PLACEMENT IN EACH SETTING, AND THE TOTAL NUMBER OF INDIVIDUALS10
DISCHARGED FROM EACH SETTING .11
SECTION 3. Safety clause. The general assembly hereby finds,12
determines, and declares that this act is necessary for the immediate13
preservation of the public peace, health, or safety.14
1013
-11-