Dear Friends,
Persons attending the panel discussion for the Virginia Civil Commitment Training Symposium on April 27, 2005, in Newport News, Virginia, jointly sponsored by the Virginia Attorney General and The Institute of Law, Psychiatry and Public Policy at the University of Virginia, were asked to submit suggestions for the one change in the law that would most improve the civil commitment process.
Written suggestions were collected and collated by the undersigned according to the type of hearing (juvenile, adult, or both) and the phase in the process to which the suggestion most specifically occurred: before detention, after detention but before the hearing, in the hearing, and after the hearing.
The results are printed below. I hope that they will be instructive to those who face the challenge of assisting the Virginia legislative and executive branches in policy making to discharge our legal responsibility - and moral privilege - of providing health, and hope, for our mentally ill brothers and sisters in Virginia.
R. Shawn Majette, VSB 19372
Thompson and McMullan P.C.
100 Shockoe Slip
Richmond, Virginia 23219
804/698-6233 (V) 804/780-1813 (F)
[email protected]
http://majette.net
Adult Hearings
Before TDO Issued
The ECO period should be extended from four hours.
Name: ? ?
Adult Hearings
Before TDO Issued
Extend ECO four hour limit (or eliminate such limit?) to the time required to locate a willing institution.
Name: Anonymous
Adult Hearings
Before TDO Issued
The ECO period of four hours should be flexible once it is determined that a bed is required, but not available, or that medical clearance is incomplete.
Name: Jane Bolle'
[email protected] (804) 819-4100
Adult Hearings
Before TDO Issued
Define what constitutes "unavailability" for a psychiatrist or psychologist in conducting evaluations as a "qualified evaluator."
Name: Stephanie J. Eppinger
[email protected]
(757) 253-4239
Adult Hearings
Before TDO Issued
Increase the 4 hour ECO limit to the number of hours necessary to obtain a bed from a willing institution.
Name: Karen Stark
[email protected]
All
After Hearing
Authorize serial outpatient commitment order to follow release after inpatient commitment hearing.
Name: Yvonne Evans
[email protected]
703-771-5100
General
Adult Hearings
More specific criteria to determine "substantial inability to care for self" is required in the law.
Name: ? ? [Illegible]
[email protected] (Email returned as undeliverable)
General
Adult Process
Given increasing TDO's of geriatric patients, include a focus on the geriatric patient and specific clinical/ legal / transportation issues.
Name: Courtney Christie
[email protected]
General
Both Juvenile And Adult Hearings
Eliminate dementia and Alzheimer's diagnoses from statutory definition of mental illness.
Name: Nancy Wood
[email protected]
(N.B.: HB 2551, captioned, "Mental illness; definition not to include dementia or Alzheimer's disease for certain purposes," a bill to achieve this result, died in the 2005 General Assembly. See http://leg1.state.va.us/cgi-bin/legp504.exe?051+sum+HB2551.)
Adult Process
In the Hearing
Clarify that a volunteer at the hearing must remain in the hospital involuntarily if he changes his mind within the period of required voluntary treatment (presently limited to 72 hours).
Name: Anonymous
Adult Process
In the Hearing
Better integration of forced medications under Va. Code Sec. 37.1-134.21 and commitment hearings.
Name: Shawn Majette
[email protected]
All Hearings
Before TDO issued
Magistrates should be required to order medical evaluation or clearance if a doctor (physician? Ph.D.?) finds such evaluation necessary.
Name: Anonymous
All Hearings
Before TDO issued
Eliminate requirement that the magistrate specify the receiving hospital in the TDO when the bed is not available to the prescreener at the time of the TDO issuance.
Name: Anonymous
All Hearings
Before TDO issued
Extend ECO four hour limit (or eliminate such limit?) to the time required to locate a willing institution.
Name: Anonymous
All Hearings
Before TDO issued
Allow magistrate to issue TDO while search for hospital bed continues.
Name: Anonymous
All Hearings
Before TDO issued
Allow transfer of custody from officer executing ECO to hospital security staff whether "sworn peace officer" on staff or not.
Name: Paul J. Barnett
All Hearings
Before TDO issued
Include specific requirement and specification that a designated sheriff's office will be responsible for transfers of a committed patient from a state hospital to a private hospital, or vice versa.
Name: Ruth Ann Bates
[email protected]
(804) 524-7291
All Hearings
Before TDO issued
Employ actuarial data to decide bed needs for inpatient treatment, to provide enough acute beds as needed, either by private or public facilities in a particular district to prevent the current logjam of bed space.
Name: Stephanie J. Eppinger
[email protected]
(757) 253-4239
All Hearings
Before TDO issued
Add provision of medical clearance as part of admission process [prescreening form?] like Dr. Jaabpour's presentation, referring to the Massachusetts College of Emergency Physicians. Use less ambiguous language of medical clearance than is use in the draft proposal addressing medical screening.
Name: Stephanie J. Eppinger
[email protected]
All Hearings
Before TDO issued
Suggests that a hospital be required to accept a patient pending medical clearance, so that the TDO can be issued before medical clearance or evaluation
Name: J[Illegible] Ferrell
[email protected]
Adult Process Hearings
Before TDO issued
Least restrictive alternative back in TDO and Civil Commitment Code - Adults.
Name: Sarah P. Fuller
[email protected]
Adult Process Hearings
Before TDO issued
Agents for elderly should be able to make treatment decisions when there is a power of attorney (health care power of attorney?); elderly persons with interested family members should not be subjected to the TDO process.
Name: Joann H. Grayson
[email protected]
(540) 568-6771
All Hearings
After Detention
ECO 37.2-808 "Time frame [illegible] of four hours continuance once determine hospitalization is necessary. TDO beds can't be found under four hours window therefore released."
Name: David E. Millward
[email protected]
All Hearings
After Detention
Increase detention period under ECO from 4 hours to between 6 and 8 hours.
Name: Paul J. Barnett
All Hearings
After Detention
Delays in transportation have impact on consumers clinically. 37.2-829: Sheriff of jurisdiction where person resides transports unless his office more than 50 road miles (versus 100). 37.2-810: Nearest boundary of jurisdiction in which person resides is more than 30 miles (versus 50).
Name: Brinda Fowlkes
[email protected]
All Hearings
After Detention
Levels of dangerousness for patients subject to ECO's and TDO's should be defined to avoid unnecessary restraints (handcuffs, shackles) during transportation.
Name: Kathy McDonald
[email protected]
All Hearings
After Detention
Grant immunity to facility and others for family or private transportation after involuntary admission order is entered.
Name: Paul M. Barnett
All Hearings
After Detention / During Hearing
Require special justices to hold a hearing for every case, not just those cases which are certified.
Name: Joann Grayson
[email protected]
All Hearings
After Detention / During Hearing
Write statutes as power points or bullets so they can be understood by all who read them.
Name: Anonymous
All Hearings
After Detention / During Hearing
Increase use of alternatives to commitment by the special justice / court by utilization of "least restrictive" alternatives in the community setting.
Name: Clayton Neal
[email protected]
Juvenile
Before Detention
The identity of the judicial officer to conduct hearings when minors are transported on a TDO from one jurisdiction (e.g., Richmond) to CCCA (in Staunton?) should be clarified. It is not clear to this professional who is required to do this.
Name: Anonymous
Juvenile
During Hearing
Allow special justices to perform both juvenile and adult commitment proceedings.
Name: Paul M. Barnett
Juvenile
During Hearing
In juvenile commitment proceedings (Va. Code Sec. 16.1-335 through 348, according to the writer), include a specific right for the juvenile patient to volunteer.
Name: Stacie Fisher
[email protected]