Connecticut 2013 Regular Session

Connecticut House Bill HB05298 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	General Assembly Substitute Bill No. 5298
2		-	January Session, 2013 _____HB05298PH_JUD040313____
	1	+	General Assembly Committee Bill No. 5298
	2	+	January Session, 2013 LCO No. 4945
	3	+	04945HB05298PH_
	4	+	Referred to Committee on PUBLIC HEALTH
	5	+	Introduced by:
	6	+	(PH)
3	7
4	8		General Assembly
5	9
6		-	~~Substitute~~ Bill No. 5298
	10	+	Committee Bill No. 5298
7	11
8	12		January Session, 2013
9	13
10		-	_____HB05298PH_JUD040313____
	14	+	LCO No. 4945
	15	+
	16	+	04945HB05298PH_
	17	+
	18	+	Referred to Committee on PUBLIC HEALTH
	19	+
	20	+	Introduced by:
	21	+
	22	+	(PH)
11	23
12	24		AN ACT CONCERNING ELECTROCONVULSIVE THERAPY.
13	25
14	26		Be it enacted by the Senate and House of Representatives in General Assembly convened:
15	27
16	28		Section 1. Subsection (c) of section 17a-543 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2013):
17	29
18	30		(c) (1) No psychosurgery or [shock] electroconvulsive therapy shall be administered to any patient without the patient's written informed consent, except as provided in this subsection. Such consent shall be for a maximum period of thirty days and may be revoked at any time. If it is determined by the head of the hospital and two qualified physicians that the patient has become incapable of giving informed consent, [shock] electroconvulsive therapy may be administered upon order of the Probate Court if, after hearing in accordance with this section, such court finds that the patient is incapable of informed consent and there is no other, less intrusive beneficial treatment. An order of the Probate Court authorizing the administration of [shock] electroconvulsive therapy pursuant to this subsection shall be effective for not more than forty-five days.
19	31
20		-	(2) Upon an application for the administration of electroconvulsive therapy being filed in the Probate Court, such court shall assign a time, not later than ten business days thereafter, and a place for hearing such application, and shall cause reasonable notice thereof to be given to the respondent and to such relative or relatives and other persons as it deems advisable. ~~Such~~ notice shall inform such respondent (A) that he or she has a right to be present at the hearing; (B) that he or she has a right to counsel; (C) that he or she, if indigent, has a right to have counsel appointed to represent him or her; and (D) that he or she has a right to cross-examine witnesses testifying at any hearing upon such application.
	32	+	(2) Upon an application for the administration of electroconvulsive therapy being filed in the Probate Court, such court shall assign a time, not later than ten business days thereafter, and a place for hearing such application, and shall cause reasonable notice thereof to be given to the respondent and to such relative or relatives and other persons as it deems advisable. Said notice shall inform such respondent (A) that he or she has a right to be present at the hearing; (B) that he or she has a right to counsel; (C) that he or she, if indigent, has a right to have counsel appointed to represent him or her; and (D) that he or she has a right to cross-examine witnesses testifying at any hearing upon such application.
21	33
22		-	(3) If the court finds such respondent is indigent or otherwise unable to pay for counsel, the court shall appoint counsel for such respondent, unless such respondent refuses counsel and the court finds that the respondent understands the nature of his or her refusal. The court shall provide such respondent a reasonable opportunity to select his or her own counsel to be appointed by the court. If the respondent does not select counsel or if counsel selected by the respondent refuses to represent such respondent or is not available for such representation, the court shall appoint counsel for the respondent from a panel of attorneys admitted to practice in this state provided by the Probate Court Administrator in accordance with regulations promulgated by the Probate Court Administrator in accordance with section 45a-77. The reasonable compensation of appointed counsel shall be established by, and paid from funds appropriated to, the Judicial Department; however, if funds have not been included in the budget of the Judicial Department for such purposes, such compensation shall be established by the Probate Court Administrator and paid from the Probate Court Administration Fund. Prior to such hearing, such respondent or his or her counsel, in accordance with the provisions of sections 52-146d to 52-146i, inclusive, shall be afforded access to all records including, without limitation, hospital records if such respondent is hospitalized, and shall be entitled to take notes therefrom. If such respondent is hospitalized at the time of the hearing, the hospital shall make available at such hearing for use by ~~such respondent~~ or his or her counsel all records in its possession relating to the condition of the respondent. Notwithstanding the provisions of sections 52-146d to 52-146i, inclusive, all such hospital records directly relating to ~~such respondent~~ shall be admissible at the request of any party or the Court of Probate in any proceeding relating to the administration of electroconvulsive therapy. Nothing in this subsection shall prevent timely objection to the admissibility of evidence in accordance with the rules of civil procedure.
	34	+	(3) If the court finds such respondent is indigent or otherwise unable to pay for counsel, the court shall appoint counsel for such respondent, unless such respondent refuses counsel and the court finds that the respondent understands the nature of his or her refusal. The court shall provide such respondent a reasonable opportunity to select his or her own counsel to be appointed by the court. If the respondent does not select counsel or if counsel selected by the respondent refuses to represent such respondent or is not available for such representation, the court shall appoint counsel for the respondent from a panel of attorneys admitted to practice in this state provided by the Probate Court Administrator in accordance with regulations promulgated by the Probate Court Administrator in accordance with section 45a-77. The reasonable compensation of appointed counsel shall be established by, and paid from funds appropriated to, the Judicial Department; however, if funds have not been included in the budget of the Judicial Department for such purposes, such compensation shall be established by the Probate Court Administrator and paid from the Probate Court Administration Fund. Prior to such hearing, such respondent or his or her counsel, in accordance with the provisions of sections 52-146d to 52-146i, inclusive, shall be afforded access to all records including, without limitation, hospital records if such respondent is hospitalized, and shall be entitled to take notes therefrom. If such respondent is hospitalized at the time of the hearing, the hospital shall make available at such hearing for use by the patient or his or her counsel all records in its possession relating to the condition of the respondent. Notwithstanding the provisions of sections 52-146d to 52-146i, inclusive, all such hospital records directly relating to the patient shall be admissible at the request of any party or the Court of Probate in any proceeding relating to the administration of electroconvulsive therapy. Nothing in this subsection shall prevent timely objection to the admissibility of evidence in accordance with the rules of civil procedure.
23	35
24		-	(4) The court shall require the certificates, signed under penalty of false statement, of at least two impartial physicians selected by the court, one of whom shall be a practicing psychiatrist, both of whom shall be licensed to practice medicine in the state and shall have been practitioners of medicine at least one year and shall not be connected with the hospital for psychiatric disabilities from which the application is being made, or related by blood or marriage to the applicant, or to the respondent. Such certificates shall indicate that they have personally examined such respondent within ten days before such hearing. The court shall appoint such physicians from a list of physicians and psychiatrists provided by the Commissioner of Mental Health and Addiction Services and such appointments shall be made in accordance with regulations promulgated by the Probate Court Administrator in accordance with section 45a-77. Each such physician shall make a report on a separate form provided for that purpose by the Department of Mental Health and Addiction Services and shall answer such questions as may be set forth on such form as fully and completely as reasonably possible. Such form shall include, but not be limited to, questions relating to the specific psychiatric disabilities alleged, whether or not the respondent is dangerous to himself or herself or others, whether or not such illness has resulted or will result in serious disruption of the respondent's mental and behavioral functioning, whether or not less intrusive treatment is recommended and available and whether or not ~~the~~ respondent is incapable of understanding the need to accept the recommended electroconvulsive therapy on a voluntary basis. Any such physician shall state upon the form the reasons for his or her opinions. Such respondent or his or her counsel shall have the right to present evidence and cross-examine witnesses who testify at any hearing on the application. If such respondent notifies the court not less than three days before the hearing that he or she wishes to cross-examine the examining physicians, the court shall order such physicians to appear. The court shall cause a recording of the testimony of such hearing to be made, to be transcribed only in the event of an appeal from the decree rendered hereunder. A copy of such transcript shall be furnished without charge to any appellant whom the Court of Probate finds unable to pay for the same. The cost of such transcript shall be paid from funds appropriated to the Judicial Department. If, on such hearing, the court finds by clear and convincing evidence that the person complained of is incapable of giving informed consent and there is no other, less intrusive beneficial treatment, it shall make an order for the administration of electroconvulsive therapy. Notice of any action taken by the court shall be given to the respondent and his or her attorney, if any, in such manner as the court concludes would be appropriate under the circumstances.
	36	+	(4) The court shall require the certificates, signed under penalty of false statement, of at least two impartial physicians selected by the court, one of whom shall be a practicing psychiatrist, both of whom shall be licensed to practice medicine in the state and shall have been practitioners of medicine at least one year and shall not be connected with the hospital for psychiatric disabilities from which the application is being made, or related by blood or marriage to the applicant, or to the respondent. Such certificates shall indicate that they have personally examined such respondent within ten days before such hearing. The court shall appoint such physicians from a list of physicians and psychiatrists provided by the Commissioner of Mental Health and Addiction Services and such appointments shall be made in accordance with regulations promulgated by the Probate Court Administrator in accordance with section 45a-77. Each such physician shall make a report on a separate form provided for that purpose by the Department of Mental Health and Addiction Services and shall answer such questions as may be set forth on such form as fully and completely as reasonably possible. Such form shall include, but not be limited to, questions relating to the specific psychiatric disabilities alleged, whether or not the respondent is dangerous to himself or herself or others, whether or not such illness has resulted or will result in serious disruption of the respondent's mental and behavioral functioning, whether or not less intrusive treatment is recommended and available and whether or not respondent is incapable of understanding the need to accept the recommended electroconvulsive therapy on a voluntary basis. Any such physician shall state upon the form the reasons for his or her opinions. Such respondent or his or her counsel shall have the right to present evidence and cross-examine witnesses who testify at any hearing on the application. If such respondent notifies the court not less than three days before the hearing that he or she wishes to cross-examine the examining physicians, the court shall order such physicians to appear. The court shall cause a recording of the testimony of such hearing to be made, to be transcribed only in the event of an appeal from the decree rendered hereunder. A copy of such transcript shall be furnished without charge to any appellant whom the Court of Probate finds unable to pay for the same. The cost of such transcript shall be paid from funds appropriated to the Judicial Department. If, on such hearing, the court finds by clear and convincing evidence that the person complained of is incapable of giving informed consent and there is no other, less intrusive beneficial treatment, it shall make an order for the administration of electroconvulsive therapy. Notice of any action taken by the court shall be given to the respondent and his or her attorney, if any, in such manner as the court concludes would be appropriate under the circumstances.
25	37
26	38		(5) The respondent shall be present at any hearing for the administration of electroconvulsive therapy to him or her under this section. If the respondent is medicated at that time, the court shall be notified by the hospital in writing of such fact and of the common effects of such medication.
27	39
28	40		Sec. 2. Subdivision (11) of section 17a-540 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2013):
29	41
30		-	(11) ["Shock therapy"] "Electroconvulsive therapy" means a form of psychiatric treatment in which electric current [, insulin, carbon dioxide or indoklon, or other similar agent,] is administered to the patient and results in a loss of consciousness or a convulsive or comatose reaction;
	42	+	(11) ["Shock therapy"] "Electroconvulsive therapy" means a form of psychiatric treatment in which electric current, insulin, carbon dioxide or indoklon, or other similar agent, is administered to the patient and results in a loss of consciousness or a convulsive or comatose reaction;
31	43
32	44		Sec. 3. Section 19a-575a of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2013):
33	45
34	46		(a) Any person eighteen years of age or older may execute a document that contains health care instructions, the appointment of a health care representative, the designation of a conservator of the person for future incapacity and a document of anatomical gift. Any such document shall be signed and dated by the maker with at least two witnesses and may be in the substantially following form:
35	47
36	48		THESE ARE MY HEALTH CARE INSTRUCTIONS.
37	49
38	50		MY APPOINTMENT OF A HEALTH CARE REPRESENTATIVE,
39	51
40	52		THE DESIGNATION OF MY CONSERVATOR OF THE PERSON
41	53
42	54		FOR MY FUTURE INCAPACITY
43	55
44	56		AND
45	57
46	58		MY DOCUMENT OF ANATOMICAL GIFT
47	59
48	60		To any physician who is treating me: These are my health care instructions including those concerning the withholding or withdrawal of life support systems, together with the appointment of my health care representative, the designation of my conservator of the person for future incapacity and my document of anatomical gift. As my physician, you may rely on these health care instructions and any decision made by my health care representative or conservator of my person, if I am incapacitated to the point when I can no longer actively take part in decisions for my own life, and am unable to direct my physician as to my own medical care.
49	61
50	62		I, ...., the author of this document, request that, if my condition is deemed terminal or if I am determined to be permanently unconscious, I be allowed to die and not be kept alive through life support systems. By terminal condition, I mean that I have an incurable or irreversible medical condition which, without the administration of life support systems, will, in the opinion of my attending physician, result in death within a relatively short time. By permanently unconscious I mean that I am in a permanent coma or persistent vegetative state which is an irreversible condition in which I am at no time aware of myself or the environment and show no behavioral response to the environment. The life support systems which I do not want include, but are not limited to: Artificial respiration, cardiopulmonary resuscitation and artificial means of providing nutrition and hydration. I do want sufficient pain medication to maintain my physical comfort. I do not intend any direct taking of my life, but only that my dying not be unreasonably prolonged.
51	63
52	64		I appoint .... to be my health care representative. If my attending physician determines that I am unable to understand and appreciate the nature and consequences of health care decisions and unable to reach and communicate an informed decision regarding treatment, my health care representative is authorized to make any and all health care decisions for me, including (1) the decision to accept or refuse any treatment, service or procedure used to diagnose or treat my physical or mental condition, except as otherwise provided by law such as for psychosurgery or [shock] electroconvulsive therapy, as defined in section 17a-540, as amended by this act, and (2) the decision to provide, withhold or withdraw life support systems. I direct my health care representative to make decisions on my behalf in accordance with my wishes, as stated in this document or as otherwise known to my health care representative. In the event my wishes are not clear or a situation arises that I did not anticipate, my health care representative may make a decision in my best interests, based upon what is known of my wishes.
53	65
54	66		If .... is unwilling or unable to serve as my health care representative, I appoint .... to be my alternative health care representative.
55	67
56	68		If a conservator of my person should need to be appointed, I designate .... be appointed my conservator. If .... is unwilling or unable to serve as my conservator, I designate ..... No bond shall be required of either of them in any jurisdiction.
57	69
58	70		I hereby make this anatomical gift, if medically acceptable, to take effect upon my death.
59	71
60	72		I give: (check one)
61	73
62	74
63	75
64	76		T1 .... (1) any needed organs or parts
65	77		T2 .... (2) only the following organs or parts ….
66	78
67	79		T1
68	80
69	81		.... (1) any needed organs or parts
70	82
71	83		T2
72	84
73	85		.... (2) only the following organs or parts ….
74	86
75	87		to be donated for: (check one)
76	88
77	89
78	90
79	91		T3 (1) .... any of the purposes stated in subsection (a) of section 19a-289j
80	92		T4 (2) .... these limited purposes ....
81	93
82	94		T3
83	95
84	96		(1) .... any of the purposes stated in subsection (a) of section 19a-289j
85	97
86	98		T4
87	99
88	100		(2) .... these limited purposes ....
89	101
90	102		These requests, appointments, and designations are made after careful reflection, while I am of sound mind. Any party receiving a duly executed copy or facsimile of this document may rely upon it unless such party has received actual notice of my revocation of it.
91	103
92	104
93	105
94	106		T5 Date ...., 20..
95	107		T6 .... L.S.
96	108
97	109		T5
98	110
99	111		Date ...., 20..
100	112
101	113		T6
102	114
103	115		.... L.S.
104	116
105	117		This document was signed in our presence by .... the author of this document, who appeared to be eighteen years of age or older, of sound mind and able to understand the nature and consequences of health care decisions at the time this document was signed. The author appeared to be under no improper influence. We have subscribed this document in the author's presence and at the author's request and in the presence of each other.
106	118
107	119
108	120
109	121		T7 .... ....
110	122		T8 (Witness) (Witness)
111	123		T9 .... ....
112	124		T10 (Number and Street) (Number and Street)
113	125		T11 .... ....
114	126		T12 (City, State and Zip Code) (City, State and Zip Code)
115	127
116	128		T7
117	129
118	130		....
119	131
120	132		....
121	133
122	134		T8
123	135
124	136		(Witness)
125	137
126	138		(Witness)
127	139
128	140		T9
129	141
130	142		....
131	143
132	144		....
133	145
134	146		T10
135	147
136	148		(Number and Street)
137	149
138	150		(Number and Street)
139	151
140	152		T11
141	153
142	154		....
143	155
144	156		....
145	157
146	158		T12
147	159
148	160		(City, State and Zip Code)
149	161
150	162		(City, State and Zip Code)
151	163
152	164
153	165
154	166		T13 T14 STATE OF CONNECTICUT }
155	167		T15 ss. ....
156	168		T16 COUNTY OF ....
157	169
158	170		T13
159	171
160	172		T14
161	173
162	174		STATE OF CONNECTICUT
163	175
164	176		}
165	177
166	178		T15
167	179
168	180		ss. ....
169	181
170	182		T16
171	183
172	184		COUNTY OF ....
173	185
174	186		We, the subscribing witnesses, being duly sworn, say that we witnessed the execution of these health care instructions, the appointments of a health care representative, the designation of a conservator for future incapacity and a document of anatomical gift by the author of this document; that the author subscribed, published and declared the same to be the author's instructions, appointments and designation in our presence; that we thereafter subscribed the document as witnesses in the author's presence, at the author's request, and in the presence of each other; that at the time of the execution of said document the author appeared to us to be eighteen years of age or older, of sound mind, able to understand the nature and consequences of said document, and under no improper influence, and we make this affidavit at the author's request this .... day of .... 20...
175	187
176	188
177	189
178	190		T17 .... ....
179	191		T18 (Witness) (Witness)
180	192
181	193		T17
182	194
183	195		....
184	196
185	197		....
186	198
187	199		T18
188	200
189	201		(Witness)
190	202
191	203		(Witness)
192	204
193	205		Subscribed and sworn to before me this .... day of .... 20..
194	206
195	207
196	208
197	209		T19 ....
198	210		T20 Commissioner of the Superior Court
199	211		T21 Notary Public
200	212		T22 My commission expires: ....
201	213
202	214		T19
203	215
204	216		....
205	217
206	218		T20
207	219
208	220		Commissioner of the Superior Court
209	221
210	222		T21
211	223
212	224		Notary Public
213	225
214	226		T22
215	227
216	228		My commission expires: ....
217	229
218	230		(Print or type name of all persons signing under all signatures)
219	231
220	232		(b) Except as provided in section 19a-579b, an appointment of health care representative may only be revoked by the declarant, in writing, and the writing shall be signed by the declarant and two witnesses.
221	233
222	234		(c) The attending physician or other health care provider shall make the revocation of an appointment of health care representative a part of the declarant's medical record.
223	235
224	236		(d) In the absence of knowledge of the revocation of an appointment of health care representative, a person who carries out an advance directive pursuant to the provisions of this chapter shall not be subject to civil or criminal liability or discipline for unprofessional conduct for carrying out such advance directive.
225	237
226	238		(e) The revocation of an appointment of health care representative does not, of itself, revoke the living will of the declarant.
227	239
228	240		Sec. 4. Section 19a-577 of the general statutes is repealed and the following is substituted in lieu thereof (Effective July 1, 2013):
229	241
230	242		Any person eighteen years of age or older may execute a document that may, but need not be, in substantially the following form:
231	243
232	244		DOCUMENT CONCERNING THE APPOINTMENT
233	245
234	246		OF HEALTH CARE REPRESENTATIVE
235	247
236	248		"I understand that, as a competent adult, I have the right to make decisions about my health care. There may come a time when I am unable, due to incapacity, to make my own health care decisions. In these circumstances, those caring for me will need direction and will turn to someone who knows my values and health care wishes. By signing this appointment of health care representative, I appoint a health care representative with legal authority to make health care decisions on my behalf in such case or at such time.
237	249
238	250		I appoint .... (Name) to be my health care representative. If my attending physician determines that I am unable to understand and appreciate the nature and consequences of health care decisions and to reach and communicate an informed decision regarding treatment, my health care representative is authorized to (1) accept or refuse any treatment, service or procedure used to diagnose or treat my physical or mental condition, except as otherwise provided by law, such as for psychosurgery or [shock] electroconvulsive therapy, as defined in section 17a-540, as amended by this act, and (2) make the decision to provide, withhold or withdraw life support systems. I direct my health care representative to make decisions on my behalf in accordance with my wishes as stated in a living will, or as otherwise known to my health care representative. In the event my wishes are not clear or a situation arises that I did not anticipate, my health care representative may make a decision in my best interests, based upon what is known of my wishes.
239	251
240	252		If this person is unwilling or unable to serve as my health care representative, I appoint .... (Name) to be my alternative health care representative."
241	253
242	254		"This request is made, after careful reflection, while I am of sound mind."
243	255
244	256
245	257
246	258		T23 .... (Signature)
247	259		T24 .... (Date)
248	260
249	261		T23
250	262
251	263		.... (Signature)
252	264
253	265		T24
254	266
255	267		.... (Date)
256	268
257	269		This document was signed in our presence, by the above-named .... (Name) who appeared to be eighteen years of age or older, of sound mind and able to understand the nature and consequences of health care decisions at the time the document was signed.
258	270
259	271
260	272
261	273		T25 .... (Witness)
262	274		T26 .... (Address)
263	275		T27 .... (Witness)
264	276		T28 .... (Address)
265	277
266	278		T25
267	279
268	280		.... (Witness)
269	281
270	282		T26
271	283
272	284		.... (Address)
273	285
274	286		T27
275	287
276	288		.... (Witness)
277	289
278	290		T28
279	291
280	292		.... (Address)
281	293
282	294
283	295
284	296
	297	+
	298	+
285	299		This act shall take effect as follows and shall amend the following sections:
286	300		Section 1 July 1, 2013 17a-543(c)
287	301		Sec. 2 July 1, 2013 17a-540(11)
288	302		Sec. 3 July 1, 2013 19a-575a
289	303		Sec. 4 July 1, 2013 19a-577
290	304
291	305		This act shall take effect as follows and shall amend the following sections:
292	306
293	307		Section 1
294	308
295	309		July 1, 2013
296	310
297	311		17a-543(c)
298	312
299	313		Sec. 2
300	314
301	315		July 1, 2013
302	316
303	317		17a-540(11)
304	318
305	319		Sec. 3
306	320
307	321		July 1, 2013
308	322
309	323		19a-575a
310	324
311	325		Sec. 4
312	326
313	327		July 1, 2013
314	328
315	329		19a-577
316	330
317		-	Statement of ~~Legislative Commissioners~~:
	331	+	Statement of Purpose:
318	332
319		-	~~In section 1(c)(2),~~ the ~~phrase "Said notice" was changed~~ to ~~"Such notice",~~ for ~~consistency~~ with the drafting conventions of the general statutes; in section 1(c)(3), the phrase "for use by the patient" was changed to "for use by such respondent", the phrase "condition of the respondent" was changed to "condition of such respondent", and the phrase "relating to the patient" was changed to "relating to such respondent", for internal consistency; and in section 1(c)(4), the phrase "whether or not respondent" was changed to "whether or not the respondent", for clarity.
	333	+	To require the probate court to follow certain procedures before issuing an order for involuntary electroconvulsive therapy and to replace the term "shock therapy" with "electroconvulsive therapy".
320	334
321	335
322	336
323		-	~~PH Joint Favorable Subst~~. ~~C/R JUD~~
	337	+	Co-Sponsors: REP. NAFIS, 27th Dist.; SEN. DOYLE, 9th Dist.
324	338
325		-	PH
	339	+	Co-Sponsors:
326	340
327		-	~~Joint Favorable Subst~~. ~~C/R~~
	341	+	REP. NAFIS, 27th Dist.; SEN. DOYLE, 9th Dist.
328	342
329		-	~~JUD~~
	343	+	H.B. 5298