Amends TCA Title 33, Chapter 6, Part 4.

Present law provides the following concerning involuntary admission of a detainee: (1) A hospital or treatment resource that receives a detainee transported for treatment must have a licensed physician examine the person to determine whether the person is subject to admission; (2) If the person is subject to admission, then the physician must complete a certificate of need for the emergency diagnosis, evaluation, and treatment showing the factual foundation for any conclusions, and the sheriff or transportation agent may then apply for the admission for the purpose of emergency diagnosis, evaluation and treatment; (3) If the person is not subject to admission and the sheriff or transportation agent is under a duty to remain at the hospital or treatment resource with the detainee, the sheriff or transportation agent must return the person to the county; (4) If the person is not subject to admission and the sheriff or transportation agent is not under a duty to remain at the hospital or treatment resource, then the hospital or treatment resource must return the detainee to the county; and (5) A hospital, treatment resource, or healthcare provider is immune from civil liability and has an affirmative defense to any criminal liability arising either from a determination relative to admission of a person to a facility or treatment resource or from the transportation of a person to and from the hospital or treatment resource. This bill authorizes a qualified advanced practice provider to do the actions that a physician does in (1) and (2) above. A "qualified advanced practice provider" is defined as an individual working under the supervision of a licensed physician and who is either a licensed advanced practice nurse with certification from a national certifying organization as a psychiatric-mental health advanced practice nurse or a physician assistant with certification from a national certifying organization as having additional qualifications in psychiatry. CERTIFICATION Present law provides if a person who is not a licensed physician executes the first certificate of need in support of hospitalization, then only a licensed physician may execute the second certificate of need in support of hospitalization for the detainee’s treatment. This bill adds to present law by providing that, if a person who is a licensed physician and board-certified as a psychiatrist by the American Board of Psychiatry and Neurology executes the first certificate of need in support of hospitalization, the detainee may be subject to admission without the execution of a second certificate of need in support of the hospitalization. However, this provision does not apply to a state-owned or operated hospital or treatment resource. ON MARCH 6, 2023, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 672, AS AMENDED. AMENDMENT #1 rewrites this bill to require a hospital or treatment resource that receives a detainee transported for treatment to have a licensed physician or a qualified advanced practice provider examine the person to determine whether the person is subject to admission. This amendment also provides that if a detainee is subject to admission, then a qualified practice provider must complete a certificate of need for the emergency diagnosis, evaluation, and treatment showing the factual foundation for any conclusions, and then the person who took the service recipient to the hospital or treatment resource may apply for the admission for the purpose of emergency diagnosis, evaluation, and treatment. A “qualified advanced practice provider” is defined as an individual working in collaboration with a licensed physician, and who is either a licensed advanced practice nurse with a current certification from a national certifying organization as a psychiatric-mental health advanced practice nurse; or a physician assistant with a current certification from a national certifying organization as having additional qualifications in psychiatry. DUTY TO RETURN The amendment clarifies the shifting duty to return the detainee transferred for treatment in case the detainee is not subject to admission. If the sheriff or transportation agent is under a duty to remain at the hospital or treatment resource, then the duty to return remains with the sheriff or the transportation agent, who must return the detainee to the county. If the sheriff or the transportation agent is not under a duty to remain at the hospital or treatment resource, then the duty to return transfers to the hospital or treatment resource, who now must return the detainee to the county. However, a hospital, treatment resource, or healthcare provider is immune from civil liability and has an affirmative defense to criminal liability arising either from a determination relative to admission of a person to a facility or treatment resource or from the transportation of a person to and from the hospital or treatment resource. CERTIFICATION This amendment provides that, if a person who is not a licensed physician executes the first certificate of need in support of hospitalization, then only a licensed physician may execute the second certificate of need in support of hospitalization. If, however, a person who is a licensed physician and board certified as a psychiatrist by the American Board of Psychiatry and Neurology executes the first certificate of need in support of hospitalization, then the patient may be subject to admission without the execution of a second certificate of need in support of hospitalization. INVALIDATION OF A CERTIFICATE OF NEED This amendment provides that the initial certificate of need in support of hospitalization issued by a board-certified psychiatrist is deemed invalid under the following conditions: (1) It is made by a professional who is a relative by blood, marriage, or adoption, or the legal guardian, conservator, or legal custodian of the person who is the subject of the petition, application, or certificate; (2) It is made by a professional who has an ownership interest in a private facility in which the person is to be admitted; or (3) It is made by a professional who is employed by or contracts with the admitting hospital or treatment resource. In addition, the issuance of a certificate of need in support of hospitalization executed by a board-certified psychiatrist does not relieve the hospital or treatment resource’s chief officer from filing with the court, by the time of the probable cause hearing, the required certificates of need. The admitting hospital or treatment resource also may rescind said certificate of need, if a licensed physician or other qualified professional in examining the patient determines that the patient no longer meets the admission criteria required by law. These provisions do not apply to a state-owned or state-operated or treatment resource or a hospital or treatment resource that contracts with the department of mental health and substance abuse services for in-patient psychiatric services. ADMISSION OF DETAINEE ALREADY AT TREATMENT FACILITY Present law provides that, if the person has been certified as subject to admission and is already at the hospital or treatment resource at which the person is proposed to be admitted, then the person who took the service recipient to the hospital or treatment resource may then apply for the admission for the purpose of emergency diagnosis, evaluation and treatment. The application must be accompanied by the two certificates of need and must state the reasons and circumstances under which the person was taken into custody. This amendment requires that the application be accompanied by either the two certificates of need mentioned in present law or the one certificate of need executed in support of hospitalization issued by a board-certified psychiatrist now authorized by this amendment. ADMISSION OF DETAINEE TO OTHER PRIVATE OR LOCAL FACILITY Present law provides that if the chief officer of a licensed private or local public hospital or treatment resource determines that the person is subject to admission and has the required certificates of need and a parent, legal guardian, legal custodian, conservator, spouse, or an adult relative of the person, or any other person has made arrangements to pay the cost of care and treatment in a hospital, or treatment resource, or the facility chooses to accept the person when no third person has made arrangements to pay the cost, then the facility may admit and detain the person for emergency diagnosis, evaluation and treatment. This amendment revises this provision to allow the initial certificate of need issued by a board-certified psychiatrist mentioned above to meet the chief officer’s duty to obtain the two initial certificates of need that supported hospitalization. NOTICE OF ADMISSION TO GENERAL SESSIONS COURT Present law requires the chief officer, upon admission of the person, to notify the judge of the general sessions court where the hospital or treatment resource is located, by telephone or in person, and provide the information from the certificates of need and such other information as the court may desire, that is in the possession of the hospital or treatment resource, bearing on the condition of the person. If the general sessions court finds that there is probable cause to believe that the defendant is subject to admission to a hospital or treatment resource, the court may order the defendant admitted for no more than five days from the date of the order, excluding Saturdays, Sundays and holidays, for emergency diagnosis, evaluation and treatment pending a probable cause hearing. If the court does not order the defendant admitted, the defendant must be released. This amendment revises the present law to require the chief officer to also notify the judge of general sessions if hospitalization proceedings were initiated by only one certificate of need issued by a board-certified psychiatrist.