Rep. Robyn Gabel

Filed: 5/26/2019

 

 


 

 


 
10100SB1702ham001LRB101 06196 KTG 61238 a

1
AMENDMENT TO SENATE BILL 1702

2    AMENDMENT NO. ______. Amend Senate Bill 1702 by replacing
3everything after the enacting clause with the following:
 
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.
 

 

 

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1    (405 ILCS 5/2-108)  (from Ch. 91 1/2, par. 2-108)
2    Sec. 2-108. Use of restraint. Restraint may be used only as
3a therapeutic measure to prevent a recipient from causing
4physical harm to himself or physical abuse to others. Restraint
5may only be applied by a person who has been trained in the
6application of the particular type of restraint to be utilized.
7In no event shall restraint be utilized to punish or discipline
8a recipient, nor is restraint to be used as a convenience for
9the staff.
10    (a) Except as provided in this Section, restraint shall be
11employed only upon the written order of a physician, clinical
12psychologist, clinical social worker, clinical professional
13counselor, advanced practice psychiatric nurse, or registered
14nurse with supervisory responsibilities. No restraint shall be
15ordered unless the physician, clinical psychologist, clinical
16social worker, clinical professional counselor, advanced
17practice psychiatric nurse, or registered nurse with
18supervisory responsibilities, after personally observing and
19examining the recipient, is clinically satisfied that the use
20of restraint is justified to prevent the recipient from causing
21physical harm to himself or others. In no event may restraint
22continue for longer than 2 hours unless within that time period
23a nurse with supervisory responsibilities, advanced practice
24psychiatric nurse, or a physician confirms, in writing,
25following a personal examination of the recipient, that the
26restraint does not pose an undue risk to the recipient's health

 

 

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1in light of the recipient's physical or medical condition. The
2order shall state the events leading up to the need for
3restraint and the purposes for which restraint is employed. The
4order shall also state the length of time restraint is to be
5employed and the clinical justification for that length of
6time. No order for restraint shall be valid for more than 16
7hours. If further restraint is required, a new order must be
8issued pursuant to the requirements provided in this Section.
9    (b) In the event there is an emergency requiring the
10immediate use of restraint, it may be ordered temporarily by a
11qualified person only where a physician, clinical
12psychologist, clinical social worker, clinical professional
13counselor, advanced practice psychiatric nurse, or registered
14nurse with supervisory responsibilities is not immediately
15available. In that event, an order by a nurse, clinical
16psychologist, clinical social worker, clinical professional
17counselor, advanced practice psychiatric nurse, or physician
18shall be obtained pursuant to the requirements of this Section
19as quickly as possible, and the recipient shall be examined by
20a physician or supervisory nurse within 2 hours after the
21initial employment of the emergency restraint. Whoever orders
22restraint in emergency situations shall document its necessity
23and place that documentation in the recipient's record.
24    (c) The person who orders restraint shall inform the
25facility director or his designee in writing of the use of
26restraint within 24 hours.

 

 

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1    (d) The facility director shall review all restraint orders
2daily and shall inquire into the reasons for the orders for
3restraint by any person who routinely orders them.
4    (e) Restraint may be employed during all or part of one 24
5hour period, the period commencing with the initial application
6of the restraint. However, once restraint has been employed
7during one 24 hour period, it shall not be used again on the
8same recipient during the next 48 hours without the prior
9written authorization of the facility director.
10    (f) Restraint shall be employed in a humane and therapeutic
11manner and the person being restrained shall be observed by a
12qualified person as often as is clinically appropriate but in
13no event less than once every 15 minutes. The qualified person
14shall maintain a record of the observations. Specifically,
15unless there is an immediate danger that the recipient will
16physically harm himself or others, restraint shall be loosely
17applied to permit freedom of movement. Further, the recipient
18shall be permitted to have regular meals and toilet privileges
19free from the restraint, except when freedom of action may
20result in physical harm to the recipient or others.
21    (g) Every facility that employs restraint shall provide
22training in the safe and humane application of each type of
23restraint employed. The facility shall not authorize the use of
24any type of restraint by an employee who has not received
25training in the safe and humane application of that type of
26restraint. Each facility in which restraint is used shall

 

 

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1maintain records detailing which employees have been trained
2and are authorized to apply restraint, the date of the training
3and the type of restraint that the employee was trained to use.
4    (h) Whenever restraint is imposed upon any recipient whose
5primary mode of communication is sign language, the recipient
6shall be permitted to have his hands free from restraint for
7brief periods each hour, except when freedom may result in
8physical harm to the recipient or others.
9    (i) A recipient who is restrained may only be secluded at
10the same time pursuant to an explicit written authorization as
11provided in Section 2-109 of this Code. Whenever a recipient is
12restrained, a member of the facility staff shall remain with
13the recipient at all times unless the recipient has been
14secluded. A recipient who is restrained and secluded shall be
15observed by a qualified person as often as is clinically
16appropriate but in no event less than every 15 minutes.
17    (j) Whenever restraint is used, the recipient shall be
18advised of his right, pursuant to Sections 2-200 and 2-201 of
19this Code, to have any person of his choosing, including the
20Guardianship and Advocacy Commission or the agency designated
21pursuant to the Protection and Advocacy for Persons with
22Developmental Disabilities Act notified of the restraint. A
23recipient who is under guardianship may request that any person
24of his choosing be notified of the restraint whether or not the
25guardian approves of the notice. Whenever the Guardianship and
26Advocacy Commission is notified that a recipient has been

 

 

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1restrained, it shall contact that recipient to determine the
2circumstances of the restraint and whether further action is
3warranted.
4(Source: P.A. 98-137, eff. 8-2-13; 99-143, eff. 7-27-15.)
 
5    (405 ILCS 5/2-109)  (from Ch. 91 1/2, par. 2-109)
6    Sec. 2-109. Seclusion. Seclusion may be used only as a
7therapeutic measure to prevent a recipient from causing
8physical harm to himself or physical abuse to others. In no
9event shall seclusion be utilized to punish or discipline a
10recipient, nor is seclusion to be used as a convenience for the
11staff.
12    (a) Seclusion shall be employed only upon the written order
13of a physician, clinical psychologist, clinical social worker,
14clinical professional counselor, advanced practice psychiatric
15nurse, or registered nurse with supervisory responsibilities.
16No seclusion shall be ordered unless the physician, clinical
17psychologist, clinical social worker, clinical professional
18counselor, advanced practice psychiatric nurse, or registered
19nurse with supervisory responsibilities, after personally
20observing and examining the recipient, is clinically satisfied
21that the use of seclusion is justified to prevent the recipient
22from causing physical harm to himself or others. In no event
23may seclusion continue for longer than 2 hours unless within
24that time period a nurse with supervisory responsibilities,
25advanced practice psychiatric nurse, or a physician confirms in

 

 

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1writing, following a personal examination of the recipient,
2that the seclusion does not pose an undue risk to the
3recipient's health in light of the recipient's physical or
4medical condition. The order shall state the events leading up
5to the need for seclusion and the purposes for which seclusion
6is employed. The order shall also state the length of time
7seclusion is to be employed and the clinical justification for
8the length of time. No order for seclusion shall be valid for
9more than 16 hours. If further seclusion is required, a new
10order must be issued pursuant to the requirements provided in
11this Section.
12    (b) The person who orders seclusion shall inform the
13facility director or his designee in writing of the use of
14seclusion within 24 hours.
15    (c) The facility director shall review all seclusion orders
16daily and shall inquire into the reasons for the orders for
17seclusion by any person who routinely orders them.
18    (d) Seclusion may be employed during all or part of one 16
19hour period, that period commencing with the initial
20application of the seclusion. However, once seclusion has been
21employed during one 16 hour period, it shall not be used again
22on the same recipient during the next 48 hours without the
23prior written authorization of the facility director.
24    (e) The person who ordered the seclusion shall assign a
25qualified person to observe the recipient at all times. A
26recipient who is restrained and secluded shall be observed by a

 

 

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1qualified person as often as is clinically appropriate but in
2no event less than once every 15 minutes.
3    (f) Safety precautions shall be followed to prevent
4injuries to the recipient in the seclusion room. Seclusion
5rooms shall be adequately lighted, heated, and furnished. If a
6door is locked, someone with a key shall be in constant
7attendance nearby.
8    (g) Whenever seclusion is used, the recipient shall be
9advised of his right, pursuant to Sections 2-200 and 2-201 of
10this Code, to have any person of his choosing, including the
11Guardianship and Advocacy Commission notified of the
12seclusion. A person who is under guardianship may request that
13any person of his choosing be notified of the seclusion whether
14or not the guardian approves of the notice. Whenever the
15Guardianship and Advocacy Commission is notified that a
16recipient has been secluded, it shall contact that recipient to
17determine the circumstances of the seclusion and whether
18further action is warranted.
19(Source: P.A. 98-137, eff. 8-2-13.)
 
20    (405 ILCS 5/3-602)  (from Ch. 91 1/2, par. 3-602)
21    Sec. 3-602. The petition shall be accompanied by a
22certificate executed by a physician, qualified examiner,
23psychiatrist, advanced practice psychiatric nurse, or clinical
24psychologist which states that the respondent is subject to
25involuntary admission on an inpatient basis and requires

 

 

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1immediate hospitalization. The certificate shall indicate that
2the physician, qualified examiner, psychiatrist, advanced
3practice psychiatric nurse, or clinical psychologist
4personally examined the respondent not more than 72 hours prior
5to admission. It shall also contain the physician's, qualified
6examiner's, psychiatrist's, advanced practice psychiatric
7nurse's, or clinical psychologist's clinical observations,
8other factual information relied upon in reaching a diagnosis,
9and a statement as to whether the respondent was advised of his
10rights under Section 3-208.
11(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
12    (405 ILCS 5/3-603)  (from Ch. 91 1/2, par. 3-603)
13    Sec. 3-603. (a) If no physician, qualified examiner,
14psychiatrist, advanced practice psychiatric nurse, or clinical
15psychologist is immediately available or it is not possible
16after a diligent effort to obtain the certificate provided for
17in Section 3-602, the respondent may be detained for
18examination in a mental health facility upon presentation of
19the petition alone pending the obtaining of such a certificate.
20    (b) In such instance the petition shall conform to the
21requirements of Section 3-601 and further specify that:
22        1. the petitioner believes, as a result of his personal
23    observation, that the respondent is subject to involuntary
24    admission on an inpatient basis;
25        2. a diligent effort was made to obtain a certificate;

 

 

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1        3. no physician, qualified examiner, psychiatrist, or
2    clinical psychologist could be found who has examined or
3    could examine the respondent; and
4        4. a diligent effort has been made to convince the
5    respondent to appear voluntarily for examination by a
6    physician, qualified examiner, psychiatrist, or clinical
7    psychologist, unless the petitioner reasonably believes
8    that effort would impose a risk of harm to the respondent
9    or others.
10(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
11    (405 ILCS 5/3-610)  (from Ch. 91 1/2, par. 3-610)
12    Sec. 3-610. As soon as possible but not later than 24
13hours, excluding Saturdays, Sundays and holidays, after
14admission of a respondent pursuant to this Article, the
15respondent shall be personally examined by a psychiatrist. The
16psychiatrist may be a member of the staff of the facility but
17shall not be the person who executed the first certificate. If
18a certificate has already been completed by a psychiatrist
19following the respondent's admission, the respondent shall be
20examined by another psychiatrist or by a physician, clinical
21psychologist, advanced practice psychiatric nurse, or
22qualified examiner. If, as a result of this second examination,
23a certificate is executed, the certificate shall be promptly
24filed with the court. If the certificate states that the
25respondent is subject to involuntary admission but not in need

 

 

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1of immediate hospitalization, the respondent may remain in his
2or her place of residence pending a hearing on the petition
3unless he or she voluntarily agrees to inpatient treatment. If
4the respondent is not examined or if the psychiatrist,
5physician, clinical psychologist, advanced practice
6psychiatric nurse, or qualified examiner does not execute a
7certificate pursuant to Section 3-602, the respondent shall be
8released forthwith. For the purpose of this Section, a personal
9examination includes an examination performed in real time
10(synchronous examination) via an Interactive Telecommunication
11System as defined in 89 Ill. Adm. Code 140.403(a)(5). An
12examination via an Interactive Telecommunication System may
13only be used for certification under this Section when a
14psychiatrist is not on-site within the time period set forth in
15this Section. If the examination is performed via an
16Interactive Communication System, that fact shall be noted on
17the certificate.
18(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
19    (405 ILCS 5/3-702)  (from Ch. 91 1/2, par. 3-702)
20    Sec. 3-702. (a) The petition may be accompanied by the
21certificate of a physician, qualified examiner, psychiatrist,
22advanced practice psychiatric nurse, or clinical psychologist
23which certifies that the respondent is subject to involuntary
24admission on an inpatient basis and which contains the other
25information specified in Section 3-602.

 

 

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1    (b) Upon receipt of the petition either with or without a
2certificate, if the court finds the documents are in order, it
3may make such orders pursuant to Section 3-703 as are necessary
4to provide for examination of the respondent. If the petition
5is not accompanied by 2 certificates executed pursuant to
6Section 3-703, the court may order the respondent to present
7himself for examination at a time and place designated by the
8court. If the petition is accompanied by 2 certificates
9executed pursuant to Section 3-703 and the court finds the
10documents are in order, it shall set the matter for hearing.
11(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
12    (405 ILCS 5/3-703)  (from Ch. 91 1/2, par. 3-703)
13    Sec. 3-703. If no certificate was filed, the respondent
14shall be examined separately by a physician, or clinical
15psychologist, advanced practice psychiatric nurse, or
16qualified examiner and by a psychiatrist. If a certificate
17executed by a psychiatrist was filed, the respondent shall be
18examined by a physician, clinical psychologist, qualified
19examiner, advanced practice psychiatric nurse, or
20psychiatrist. If a certificate executed by a qualified
21examiner, clinical psychologist, advanced practice psychiatric
22nurse, or a physician who is not a psychiatrist was filed, the
23respondent shall be examined by a psychiatrist. The examining
24physician, clinical psychologist, qualified examiner, advanced
25practice psychiatric nurse, or psychiatrist may interview by

 

 

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1telephone or in person any witnesses or other persons listed in
2the petition for involuntary admission. If, as a result of an
3examination, a certificate is executed, the certificate shall
4be promptly filed with the court. If a certificate is executed,
5the examining physician, clinical psychologist, qualified
6examiner, advanced practice psychiatric nurse, or psychiatrist
7may also submit for filing with the court a report in which his
8findings are described in detail, and may rely upon such
9findings for his opinion that the respondent is subject to
10involuntary admission on an inpatient basis. Copies of the
11certificates shall be made available to the attorneys for the
12parties upon request prior to the hearing. A certificate
13prepared in compliance with this Article shall state whether or
14not the respondent is in need of immediate hospitalization.
15However, if both the certificates state that the respondent is
16not in need of immediate hospitalization, the respondent may
17remain in his or her place of residence pending a hearing on
18the petition unless he or she voluntarily agrees to inpatient
19treatment.
20(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
21    (405 ILCS 5/3-752)
22    Sec. 3-752. Certificate.
23    (a) The petition may be accompanied by the certificate of a
24physician, qualified examiner, psychiatrist, advanced practice
25psychiatric nurse, or clinical psychologist which certifies

 

 

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1that the respondent is subject to involuntary admission on an
2outpatient basis. The certificate shall indicate that the
3physician, qualified examiner, advanced practice psychiatric
4nurse, or clinical psychologist personally examined the
5respondent not more than 72 hours prior to the completion of
6the certificate. It shall also contain the physician's,
7qualified examiner's, advanced practice psychiatric nurse's,
8or clinical psychologist's clinical observations, other
9factual information relied upon in reaching a diagnosis, and a
10statement as to whether the respondent was advised of his or
11her rights under Section 3-208.
12    (b) Upon receipt of the petition either with or without a
13certificate, if the court finds the documents are in order, it
14may make such orders pursuant to Section 3-753 as are necessary
15to provide for examination of the respondent. If the petition
16is not accompanied by 2 certificates executed pursuant to
17Section 3-753, the court may order the respondent to present
18himself or herself for examination at a time and place
19designated by the court. If the petition is accompanied by 2
20certificates executed pursuant to Section 3-753 and the court
21finds the documents are in order, the court shall set the
22matter for hearing.
23(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 
24    (405 ILCS 5/3-753)
25    Sec. 3-753. Examination. If no certificate was filed, the

 

 

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1respondent shall be examined separately by a physician, or
2clinical psychologist, advanced practice psychiatric nurse, or
3qualified examiner and by a psychiatrist. If a certificate
4executed by a psychiatrist was filed, the respondent shall be
5examined by a physician, clinical psychologist, qualified
6examiner, advanced practice psychiatric nurse, or
7psychiatrist. If a certificate executed by a qualified
8examiner, clinical psychologist, advanced practice psychiatric
9nurse, or a physician who is not a psychiatrist was filed, the
10respondent shall be examined by a psychiatrist. The examining
11physician, clinical psychologist, qualified examiner, advanced
12practice psychiatric nurse, or psychiatrist may interview by
13telephone or in person any witnesses or other persons listed in
14the petition for involuntary admission. If, as a result of an
15examination, a certificate is executed, the certificate shall
16be promptly filed with the court. If a certificate is executed,
17the examining physician, clinical psychologist, qualified
18examiner, advanced practice psychiatric nurse, or psychiatrist
19may also submit for filing with the court a report in which his
20or her findings are described in detail, and may rely upon such
21findings for his opinion that the respondent is subject to
22involuntary admission. Copies of the certificates shall be made
23available to the attorneys for the parties upon request prior
24to the hearing.
25(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10.)
 

 

 

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1    (405 ILCS 5/3-807)  (from Ch. 91 1/2, par. 3-807)
2    Sec. 3-807. No respondent may be found subject to
3involuntary admission on an inpatient or outpatient basis
4unless at least one psychiatrist, clinical social worker,
5clinical psychologist, advanced practice psychiatric nurse, or
6qualified examiner who has examined the respondent testifies in
7person at the hearing. The respondent may waive the requirement
8of the testimony subject to the approval of the court.
9(Source: P.A. 96-1399, eff. 7-29-10; 96-1453, eff. 8-20-10;
1097-121, eff. 7-14-11.)".