101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1702

 

Introduced 2/15/2019, by Sen. Julie A. Morrison

 

SYNOPSIS AS INTRODUCED:
 
405 ILCS 5/1-101.3 new
405 ILCS 5/2-108  from Ch. 91 1/2, par. 2-108
405 ILCS 5/2-109  from Ch. 91 1/2, par. 2-109
405 ILCS 5/3-602  from Ch. 91 1/2, par. 3-602
405 ILCS 5/3-603  from Ch. 91 1/2, par. 3-603
405 ILCS 5/3-610  from Ch. 91 1/2, par. 3-610
405 ILCS 5/3-702  from Ch. 91 1/2, par. 3-702
405 ILCS 5/3-703  from Ch. 91 1/2, par. 3-703
405 ILCS 5/3-752
405 ILCS 5/3-753
405 ILCS 5/3-807  from Ch. 91 1/2, par. 3-807

    Amends the Mental Health and Developmental Disabilities Code. Permits an advanced practice psychiatric nurse to order restraints or seclusion for a recipient of treatment. Provides that an advanced practice psychiatric nurse may examine a respondent and execute a certificate which states that the respondent is subject to involuntary admission on an inpatient basis and requires immediate hospitalization. Defines "advanced practice psychiatric nurse" as a nurse who is licensed to practice as an advanced practice registered nurse under the Nurse Practice Act and has been certified by the American Nurses Credentialing Center as a psychiatric mental health clinical nurse specialist or a psychiatric mental health nurse practitioner.


LRB101 06196 RLC 51220 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1702LRB101 06196 RLC 51220 b

1    AN ACT concerning health.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Mental Health and Developmental
5Disabilities Code is amended by changing Sections 2-108, 2-109,
63-602, 3-603, 3-610, 3-702, 3-703, 3-752, 3-753, and 3-807 and
7by adding Section 1-101.3 as follows:
 
8    (405 ILCS 5/1-101.3 new)
9    Sec. 1-101.3. Advanced practice psychiatric nurse.
10"Advanced practice psychiatric nurse" means a nurse who is
11licensed to practice as an advanced practice registered nurse
12under Section 65-5 of the Nurse Practice Act and has been
13certified by the American Nurses Credentialing Center as a
14psychiatric mental health clinical nurse specialist or a
15psychiatric mental health nurse practitioner.
 
16    (405 ILCS 5/2-108)  (from Ch. 91 1/2, par. 2-108)
17    Sec. 2-108. Use of restraint. Restraint may be used only as
18a therapeutic measure to prevent a recipient from causing
19physical harm to himself or physical abuse to others. Restraint
20may only be applied by a person who has been trained in the
21application of the particular type of restraint to be utilized.
22In no event shall restraint be utilized to punish or discipline

 

 

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1a recipient, nor is restraint to be used as a convenience for
2the staff.
3    (a) Except as provided in this Section, restraint shall be
4employed only upon the written order of a physician, clinical
5psychologist, clinical social worker, clinical professional
6counselor, advanced practice psychiatric nurse, or registered
7nurse with supervisory responsibilities. No restraint shall be
8ordered unless the physician, clinical psychologist, clinical
9social worker, clinical professional counselor, advanced
10practice psychiatric nurse, or registered nurse with
11supervisory responsibilities, after personally observing and
12examining the recipient, is clinically satisfied that the use
13of restraint is justified to prevent the recipient from causing
14physical harm to himself or others. In no event may restraint
15continue for longer than 2 hours unless within that time period
16a nurse with supervisory responsibilities, advanced practice
17psychiatric nurse, or a physician confirms, in writing,
18following a personal examination of the recipient, that the
19restraint does not pose an undue risk to the recipient's health
20in light of the recipient's physical or medical condition. The
21order shall state the events leading up to the need for
22restraint and the purposes for which restraint is employed. The
23order shall also state the length of time restraint is to be
24employed and the clinical justification for that length of
25time. No order for restraint shall be valid for more than 16
26hours. If further restraint is required, a new order must be

 

 

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1issued pursuant to the requirements provided in this Section.
2    (b) In the event there is an emergency requiring the
3immediate use of restraint, it may be ordered temporarily by a
4qualified person only where a physician, clinical
5psychologist, clinical social worker, clinical professional
6counselor, advanced practice psychiatric nurse, or registered
7nurse with supervisory responsibilities is not immediately
8available. In that event, an order by a nurse, clinical
9psychologist, clinical social worker, clinical professional
10counselor, advanced practice psychiatric nurse, or physician
11shall be obtained pursuant to the requirements of this Section
12as quickly as possible, and the recipient shall be examined by
13a physician or supervisory nurse within 2 hours after the
14initial employment of the emergency restraint. Whoever orders
15restraint in emergency situations shall document its necessity
16and place that documentation in the recipient's record.
17    (c) The person who orders restraint shall inform the
18facility director or his designee in writing of the use of
19restraint within 24 hours.
20    (d) The facility director shall review all restraint orders
21daily and shall inquire into the reasons for the orders for
22restraint by any person who routinely orders them.
23    (e) Restraint may be employed during all or part of one 24
24hour period, the period commencing with the initial application
25of the restraint. However, once restraint has been employed
26during one 24 hour period, it shall not be used again on the

 

 

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1same recipient during the next 48 hours without the prior
2written authorization of the facility director.
3    (f) Restraint shall be employed in a humane and therapeutic
4manner and the person being restrained shall be observed by a
5qualified person as often as is clinically appropriate but in
6no event less than once every 15 minutes. The qualified person
7shall maintain a record of the observations. Specifically,
8unless there is an immediate danger that the recipient will
9physically harm himself or others, restraint shall be loosely
10applied to permit freedom of movement. Further, the recipient
11shall be permitted to have regular meals and toilet privileges
12free from the restraint, except when freedom of action may
13result in physical harm to the recipient or others.
14    (g) Every facility that employs restraint shall provide
15training in the safe and humane application of each type of
16restraint employed. The facility shall not authorize the use of
17any type of restraint by an employee who has not received
18training in the safe and humane application of that type of
19restraint. Each facility in which restraint is used shall
20maintain records detailing which employees have been trained
21and are authorized to apply restraint, the date of the training
22and the type of restraint that the employee was trained to use.
23    (h) Whenever restraint is imposed upon any recipient whose
24primary mode of communication is sign language, the recipient
25shall be permitted to have his hands free from restraint for
26brief periods each hour, except when freedom may result in

 

 

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1physical harm to the recipient or others.
2    (i) A recipient who is restrained may only be secluded at
3the same time pursuant to an explicit written authorization as
4provided in Section 2-109 of this Code. Whenever a recipient is
5restrained, a member of the facility staff shall remain with
6the recipient at all times unless the recipient has been
7secluded. A recipient who is restrained and secluded shall be
8observed by a qualified person as often as is clinically
9appropriate but in no event less than every 15 minutes.
10    (j) Whenever restraint is used, the recipient shall be
11advised of his right, pursuant to Sections 2-200 and 2-201 of
12this Code, to have any person of his choosing, including the
13Guardianship and Advocacy Commission or the agency designated
14pursuant to the Protection and Advocacy for Persons with
15Developmental Disabilities Act notified of the restraint. A
16recipient who is under guardianship may request that any person
17of his choosing be notified of the restraint whether or not the
18guardian approves of the notice. Whenever the Guardianship and
19Advocacy Commission is notified that a recipient has been
20restrained, it shall contact that recipient to determine the
21circumstances of the restraint and whether further action is
22warranted.
23(Source: P.A. 98-137, eff. 8-2-13; 99-143, eff. 7-27-15.)
 
24    (405 ILCS 5/2-109)  (from Ch. 91 1/2, par. 2-109)
25    Sec. 2-109. Seclusion. Seclusion may be used only as a

 

 

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1therapeutic measure to prevent a recipient from causing
2physical harm to himself or physical abuse to others. In no
3event shall seclusion be utilized to punish or discipline a
4recipient, nor is seclusion to be used as a convenience for the
5staff.
6    (a) Seclusion shall be employed only upon the written order
7of a physician, clinical psychologist, clinical social worker,
8clinical professional counselor, advanced practice psychiatric
9nurse, or registered nurse with supervisory responsibilities.
10No seclusion shall be ordered unless the physician, clinical
11psychologist, clinical social worker, clinical professional
12counselor, advanced practice psychiatric nurse, or registered
13nurse with supervisory responsibilities, after personally
14observing and examining the recipient, is clinically satisfied
15that the use of seclusion is justified to prevent the recipient
16from causing physical harm to himself or others. In no event
17may seclusion continue for longer than 2 hours unless within
18that time period a nurse with supervisory responsibilities,
19advanced practice psychiatric nurse, or a physician confirms in
20writing, following a personal examination of the recipient,
21that the seclusion does not pose an undue risk to the
22recipient's health in light of the recipient's physical or
23medical condition. The order shall state the events leading up
24to the need for seclusion and the purposes for which seclusion
25is employed. The order shall also state the length of time
26seclusion is to be employed and the clinical justification for

 

 

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1the length of time. No order for seclusion shall be valid for
2more than 16 hours. If further seclusion is required, a new
3order must be issued pursuant to the requirements provided in
4this Section.
5    (b) The person who orders seclusion shall inform the
6facility director or his designee in writing of the use of
7seclusion within 24 hours.
8    (c) The facility director shall review all seclusion orders
9daily and shall inquire into the reasons for the orders for
10seclusion by any person who routinely orders them.
11    (d) Seclusion may be employed during all or part of one 16
12hour period, that period commencing with the initial
13application of the seclusion. However, once seclusion has been
14employed during one 16 hour period, it shall not be used again
15on the same recipient during the next 48 hours without the
16prior written authorization of the facility director.
17    (e) The person who ordered the seclusion shall assign a
18qualified person to observe the recipient at all times. A
19recipient who is restrained and secluded shall be observed by a
20qualified person as often as is clinically appropriate but in
21no event less than once every 15 minutes.
22    (f) Safety precautions shall be followed to prevent
23injuries to the recipient in the seclusion room. Seclusion
24rooms shall be adequately lighted, heated, and furnished. If a
25door is locked, someone with a key shall be in constant
26attendance nearby.

 

 

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1    (g) Whenever seclusion is used, the recipient shall be
2advised of his right, pursuant to Sections 2-200 and 2-201 of
3this Code, to have any person of his choosing, including the
4Guardianship and Advocacy Commission notified of the
5seclusion. A person who is under guardianship may request that
6any person of his choosing be notified of the seclusion whether
7or not the guardian approves of the notice. Whenever the
8Guardianship and Advocacy Commission is notified that a
9recipient has been secluded, it shall contact that recipient to
10determine the circumstances of the seclusion and whether
11further action is warranted.
12(Source: P.A. 98-137, eff. 8-2-13.)
 
13    (405 ILCS 5/3-602)  (from Ch. 91 1/2, par. 3-602)
14    Sec. 3-602. The petition shall be accompanied by a
15certificate executed by a physician, qualified examiner,
16psychiatrist, advanced practice psychiatric nurse, or clinical
17psychologist which states that the respondent is subject to
18involuntary admission on an inpatient basis and requires
19immediate hospitalization. The certificate shall indicate that
20the physician, qualified examiner, psychiatrist, advanced
21practice psychiatric nurse, or clinical psychologist
22personally examined the respondent not more than 72 hours prior
23to admission. It shall also contain the physician's, qualified
24examiner's, psychiatrist's, advanced practice psychiatric
25nurse's, or clinical psychologist's clinical observations,

 

 

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1other factual information relied upon in reaching a diagnosis,
2and a statement as to whether the respondent was advised of his
3rights under Section 3-208.
4(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
5    (405 ILCS 5/3-603)  (from Ch. 91 1/2, par. 3-603)
6    Sec. 3-603. (a) If no physician, qualified examiner,
7psychiatrist, advanced practice psychiatric nurse, or clinical
8psychologist is immediately available or it is not possible
9after a diligent effort to obtain the certificate provided for
10in Section 3-602, the respondent may be detained for
11examination in a mental health facility upon presentation of
12the petition alone pending the obtaining of such a certificate.
13    (b) In such instance the petition shall conform to the
14requirements of Section 3-601 and further specify that:
15        1. the petitioner believes, as a result of his personal
16    observation, that the respondent is subject to involuntary
17    admission on an inpatient basis;
18        2. a diligent effort was made to obtain a certificate;
19        3. no physician, qualified examiner, psychiatrist, or
20    clinical psychologist could be found who has examined or
21    could examine the respondent; and
22        4. a diligent effort has been made to convince the
23    respondent to appear voluntarily for examination by a
24    physician, qualified examiner, psychiatrist, or clinical
25    psychologist, unless the petitioner reasonably believes

 

 

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1    that effort would impose a risk of harm to the respondent
2    or others.
3(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
4    (405 ILCS 5/3-610)  (from Ch. 91 1/2, par. 3-610)
5    Sec. 3-610. As soon as possible but not later than 24
6hours, excluding Saturdays, Sundays and holidays, after
7admission of a respondent pursuant to this Article, the
8respondent shall be examined by a psychiatrist. The
9psychiatrist may be a member of the staff of the facility but
10shall not be the person who executed the first certificate. If
11a certificate has already been completed by a psychiatrist
12following the respondent's admission, the respondent shall be
13examined by another psychiatrist or by a physician, clinical
14psychologist, advanced practice psychiatric nurse, or
15qualified examiner. If, as a result of this second examination,
16a certificate is executed, the certificate shall be promptly
17filed with the court. If the certificate states that the
18respondent is subject to involuntary admission but not in need
19of immediate hospitalization, the respondent may remain in his
20or her place of residence pending a hearing on the petition
21unless he or she voluntarily agrees to inpatient treatment. If
22the respondent is not examined or if the psychiatrist,
23physician, clinical psychologist, advanced practice
24psychiatric nurse, or qualified examiner does not execute a
25certificate pursuant to Section 3-602, the respondent shall be

 

 

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1released forthwith.
2(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
3    (405 ILCS 5/3-702)  (from Ch. 91 1/2, par. 3-702)
4    Sec. 3-702. (a) The petition may be accompanied by the
5certificate of a physician, qualified examiner, psychiatrist,
6advanced practice psychiatric nurse, or clinical psychologist
7which certifies that the respondent is subject to involuntary
8admission on an inpatient basis and which contains the other
9information specified in Section 3-602.
10    (b) Upon receipt of the petition either with or without a
11certificate, if the court finds the documents are in order, it
12may make such orders pursuant to Section 3-703 as are necessary
13to provide for examination of the respondent. If the petition
14is not accompanied by 2 certificates executed pursuant to
15Section 3-703, the court may order the respondent to present
16himself for examination at a time and place designated by the
17court. If the petition is accompanied by 2 certificates
18executed pursuant to Section 3-703 and the court finds the
19documents are in order, it shall set the matter for hearing.
20(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
21    (405 ILCS 5/3-703)  (from Ch. 91 1/2, par. 3-703)
22    Sec. 3-703. If no certificate was filed, the respondent
23shall be examined separately by a physician, or clinical
24psychologist, advanced practice psychiatric nurse, or

 

 

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1qualified examiner and by a psychiatrist. If a certificate
2executed by a psychiatrist was filed, the respondent shall be
3examined by a physician, clinical psychologist, qualified
4examiner, advanced practice psychiatric nurse, or
5psychiatrist. If a certificate executed by a qualified
6examiner, clinical psychologist, advanced practice psychiatric
7nurse, or a physician who is not a psychiatrist was filed, the
8respondent shall be examined by a psychiatrist. The examining
9physician, clinical psychologist, qualified examiner, advanced
10practice psychiatric nurse, or psychiatrist may interview by
11telephone or in person any witnesses or other persons listed in
12the petition for involuntary admission. If, as a result of an
13examination, a certificate is executed, the certificate shall
14be promptly filed with the court. If a certificate is executed,
15the examining physician, clinical psychologist, qualified
16examiner, advanced practice psychiatric nurse, or psychiatrist
17may also submit for filing with the court a report in which his
18findings are described in detail, and may rely upon such
19findings for his opinion that the respondent is subject to
20involuntary admission on an inpatient basis. Copies of the
21certificates shall be made available to the attorneys for the
22parties upon request prior to the hearing. A certificate
23prepared in compliance with this Article shall state whether or
24not the respondent is in need of immediate hospitalization.
25However, if both the certificates state that the respondent is
26not in need of immediate hospitalization, the respondent may

 

 

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1remain in his or her place of residence pending a hearing on
2the petition unless he or she voluntarily agrees to inpatient
3treatment.
4(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
5    (405 ILCS 5/3-752)
6    Sec. 3-752. Certificate.
7    (a) The petition may be accompanied by the certificate of a
8physician, qualified examiner, psychiatrist, advanced practice
9psychiatric nurse, or clinical psychologist which certifies
10that the respondent is subject to involuntary admission on an
11outpatient basis. The certificate shall indicate that the
12physician, qualified examiner, advanced practice psychiatric
13nurse, or clinical psychologist personally examined the
14respondent not more than 72 hours prior to the completion of
15the certificate. It shall also contain the physician's,
16qualified examiner's, advanced practice psychiatric nurse's,
17or clinical psychologist's clinical observations, other
18factual information relied upon in reaching a diagnosis, and a
19statement as to whether the respondent was advised of his or
20her rights under Section 3-208.
21    (b) Upon receipt of the petition either with or without a
22certificate, if the court finds the documents are in order, it
23may make such orders pursuant to Section 3-753 as are necessary
24to provide for examination of the respondent. If the petition
25is not accompanied by 2 certificates executed pursuant to

 

 

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1Section 3-753, the court may order the respondent to present
2himself or herself for examination at a time and place
3designated by the court. If the petition is accompanied by 2
4certificates executed pursuant to Section 3-753 and the court
5finds the documents are in order, the court shall set the
6matter for hearing.
7(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
8    (405 ILCS 5/3-753)
9    Sec. 3-753. Examination. If no certificate was filed, the
10respondent shall be examined separately by a physician, or
11clinical psychologist, advanced practice psychiatric nurse, or
12qualified examiner and by a psychiatrist. If a certificate
13executed by a psychiatrist was filed, the respondent shall be
14examined by a physician, clinical psychologist, qualified
15examiner, advanced practice psychiatric nurse, or
16psychiatrist. If a certificate executed by a qualified
17examiner, clinical psychologist, advanced practice psychiatric
18nurse, or a physician who is not a psychiatrist was filed, the
19respondent shall be examined by a psychiatrist. The examining
20physician, clinical psychologist, qualified examiner, advanced
21practice psychiatric nurse, or psychiatrist may interview by
22telephone or in person any witnesses or other persons listed in
23the petition for involuntary admission. If, as a result of an
24examination, a certificate is executed, the certificate shall
25be promptly filed with the court. If a certificate is executed,

 

 

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1the examining physician, clinical psychologist, qualified
2examiner, advanced practice psychiatric nurse, or psychiatrist
3may also submit for filing with the court a report in which his
4or her findings are described in detail, and may rely upon such
5findings for his opinion that the respondent is subject to
6involuntary admission. Copies of the certificates shall be made
7available to the attorneys for the parties upon request prior
8to the hearing.
9(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
10    (405 ILCS 5/3-807)  (from Ch. 91 1/2, par. 3-807)
11    Sec. 3-807. No respondent may be found subject to
12involuntary admission on an inpatient or outpatient basis
13unless at least one psychiatrist, clinical social worker,
14clinical psychologist, advanced practice psychiatric nurse, or
15qualified examiner who has examined the respondent testifies in
16person at the hearing. The respondent may waive the requirement
17of the testimony subject to the approval of the court.
18(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10;
1997-121, eff. 7-14-11.)