Involuntary Hospitalization and Treatment of Involuntary Patients

The procedure commonly referred to as a “1013” is governed by O.C.G.A. Title 37, Chapter 3 (§ 37-3-41 et seq).* The procedure applies to individuals who present a substantial risk of imminent harm to himself, herself or others, as manifested by either recent overt acts or recent expressed threats of violence which present a probability of physical injury to that person or other persons; or Who is so unable to care for that person’s own physical health and safety as to create an imminently life-endangering crisis; and Who is in need of involuntary inpatient treatment. It authorizes a 72 hour involuntary hold so it is also known as the 72 hour hold rule.

Any physician (or psychologist, clinical social worker, licensed professional counselor, or clinical nurse specialist in psychiatric/mental health) within Georgia may execute a certificate stating that he or she has personally examined a person within the preceding 48 hours and found that, based upon observations set forth in the certificate, the examined person appears to be a mentally ill person requiring involuntary treatment. This certificate is the 1013. A physician’s certificate shall expire seven days after it is executed. Any peace officer, within 72 hours after receiving such certificate, shall make diligent efforts to take into custody the person named in the certificate and to deliver him forthwith to the nearest available emergency receiving facility serving the county in which the patient is found, where he shall be received for examination. A court may also issue an order to deliver an individual for examination, and a peace officer may deliver an individual who has committed a crime for examination.

Unless a physician examines the patient and determines that the patient is mentally ill and requires hospitalization, he or she must be discharged within 48 hours. If the examining physician certifies (on Form 1014) that the patient may be mentally ill, requiring involuntary treatment, and that treatment is consistent with good medical practice, then the patient may be transported to an evaluating facility. Notice must be given to the patient and his representative and the patient is informed of his or her rights on Form 1015. Involuntary hospitalization may only continue for five days (excluding Saturdays and Sundays) without a court order, although the patient may transfer to voluntary status and remain (on Form 1012). Commitment is initiated when:

The treating physician finds that the individual meets or continues to meet the criteria for involuntary hospitalization and/or mandated outpatient treatment; AND The recommendation of the treating physician is supported by an additional physician or a psychologist who has personally examined the individual within the preceding five (5) days; AND The Chief Medical Officer/Clinical Director supports the commitment recommendation. See Legal Status for DBHDD Hospitals.

A Commitment petition (Including Form 1021), verified by the chief medical officer and supported by two physicians must be filed if involuntary hospitalization continues. A hearing on the petition for involuntary hospitalization beyond the initial five day period must take place no sooner than seven and not later than 12 days after the petition is filed with the court. If the court at a hearing concludes that the patient is a mentally ill person requiring involuntary treatment, it shall make findings of fact and conclusions of law in support of that conclusion as part of its final order. The court may order involuntary hospitalization for a period of up to six months.

Georgia Rules and Regulations, Rule 111-8-40-.37 applies to psychiatric and substance abuse services. In addition to the rights afforded all patients at a hospital , a psychiatric hospital must In addition to the rights afforded all patients at the hospital, the hospital shall ensure that patients served by the psychiatric and substance abuse services shall have the right to: (1) Receive treatment in the hospital using the least restrictive methods possible; and (2) Participate to the extent possible in the development, implementation, and review of their individualized service plan. At the time of development of the patient’s treatment plan and with the participation of the patient, a discharge plan shall be developed for each inpatient or an aftercare plan for each outpatient. The discharge/aftercare plan shall be re-evaluated periodically during treatment to identify any need for revision. Significantly, in addition to discharge planning rights available to Medicare recipients, post-discharge needs of all Georgia patients must be considered as part of the discharge plan. See Discharge Planning for Crisis Stabilization Units and Behavioral Health Crisis Centers, 01-352, Section E(1)(d).

Involuntary administration of psychotropic medication is governed by O.C.G.A. § 37-3-163. A guardian does not have the legal authority to override the person’s refusal to take psychotropic medications and thus may not consent to the involuntary administration of psychotropic medication to a person with a mental illness. O.C.G.A. § 37-3-163(b). Only physicians are granted legal authority to administer medication against the will of a person with a mental illness. See Section 6010, Refusal of Pyschotropic Medications, Georgia Division of Aging Services.

With regard to nursing home residents, federal quality of care regulations require:

• Giving psychotropic medications only when necessary to treat a specific diagnosed and documented condition;
• Implementing GDR and other non-pharmacologic interventions for residents who receive psychotropic medications, unless contraindicated; and
• Limiting the timeframe for PRN psychotropic medications, which are not antipsychotic medications, to 14 days, unless a longer timeframe is deemed appropriate by the attending physician or the prescribing practitioner.
• Limiting PRN psychotropic medications, which are antipsychotic medications, to 14 days and not entering a new order without first evaluating the resident.

Guidance relating to F758 indicates:

As clarified in the section on Indication for Use, residents must not receive any medications which are not clinically indicated to treat a specific condition. The medical record must show documentation of the diagnosed condition for which a medication is prescribed. This requirement is especially important when prescribing psychotropic medications which, as defined in this guidance, include, but are not limited to, the categories of anti-psychotic, anti-depressant, anti-anxiety, and hypnotic medications. All medications included in the psychotropic medication definition may affect brain activities associated with mental processes and behavior. Use of psychotropic medications, other than antipsychotics, should not increase when efforts to decrease antipsychotic medications are being implemented, unless the other types of psychotropic medications are clinically indicated. Other medications which may affect brain activity such as central nervous system agents, mood stabilizers, anticonvulsants, muscle relaxants,  anticholinergic medications, antihistamines, NMDA receptor modulators, and over the counter natural or herbal products must also only be given with a documented clinical indication consistent with accepted clinical standards of practice. Residents who take these medications must be monitored for any adverse consequences, specifically increased confusion or over-sedation. The regulations and guidance concerning psychotropic medications are not intended to to supplant the judgment of a physician or prescribing practitioner in consultation with facility staff, the resident and his/her representatives and in accordance with appropriate standards of practice. Rather, the regulations and guidance are intended to ensure psychotropic medications are used only when the medication(s) is appropriate to treat a resident’s specific, diagnosed, and documented condition and the medication(s) is beneficial to the resident, as demonstrated by monitoring and documentation of the resident’s response to the medication(s).