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	SUMMARY OF STATE OUTPATIENT ASSISTED TREATMENT COMPLIANCE MECHANISMS (Excerpted from REPORT OF THE BELLEVUE HOSPITAL CENTER OUTPATIENT COMMITMENT PILOT PROGRAM prepared by:Howard Telson, M.D. Richard Glickstein, Esq. Manuel Trujillo, M.D., MARCH 1, 1999 Bellevue Hospital Center, Department of Psychiatry, 462 First Avenue, New York, NY 10016) Approximately 35 states have statutes that provide for outpatient commitment. Many of these statutes have provisions that address patient non-compliance before the point of dangerousness is reached. 1. Provision that the court shall have continuing authority to modify an order for outpatient treatment if the patient fails to comply with the order or is otherwise found unsuitable for outpatient treatment. The responsible treatment provider (or the hospital, agency in charge, etc.) has the right to ask for a hearing on compliance, and at the hearing the court can continue or modify the order or, if appropriate, require a hospital examination. Failure of the patient to appear at the hearing is grounds for a court-issued custody order. In an emergency, the court or the examining physician can order the patient retained for an examination and treatment pending the hearing. It appears that in some states the court may be able to review and modify the outpatient order ex parte upon application by the treatment provider. Examples of states that have such a procedure: (provisions for emergency detention or hospitalization that are part of the compliance provision are noted below, but in one way or another, every state has an emergency hospitalization procedure): Alabama (court sets hearing after report of material non-compliance); Arizona (court, without hearing, can alter plan or order inpatient treatment if warranted; emergency detention procedure); Hawaii (provider can petition court for involuntary hospitalization which requires dangerousness, grave disability, or obvious illness and no alternative to hospitalization); Illinois (patient shall have opportunity to respond when modification is being considered); Indiana (court at hearing can issue order requiring law enforcement officers to transport patient to clinic for treatment upon provider notification of non-compliance with treatment; also certain transfers can be made administratively subject to judicial review); Iowa (following non-compliance, court may have respondent taken into custody and following notice and hearing, hospitalized for treatment); Kansas (hearing on compliance; provision for emergency custody order); Kentucky (court can order immediate detention and reconvene the proceedings); Michigan (on an ex parte basis, court can modify or change outpatient order; or order hospitalization or combined hospitalization and alternative treatment with, if the court chooses, a provision that if the individual refuses to comply with the psychiatrist’s order to return to the hospital, a peace officer shall take the individual to the hospital); Minnesota (case manager may petition for reopening of commitment hearing); Nebraska (hearing before mental health board; emergency custody provision); New Hampshire (hearing on compliance); North Carolina (hearing on compliance, also see procedure below for having patient brought to treatment center); North Dakota (hearing required; emergency custody and examination provision); Oklahoma (hearing required); Oregon (hearing required); Pennsylvania (hearing required for change in status from outpatient to inpatient); South Carolina (hearing required); South Dakota (hearing by board of mental illness); Texas (hearing required; provision for temporary detention pending hearing); Vermont (hearing required); Virginia (hearing required for commitment for hospital treatment); West Virginia (hearing required for commitment for hospital treatment). 2. Provision that in the event of material non-compliance (after efforts to solicit compliance), responsible treatment provider can petition court for an ex parte order authorizing a peace officer to take the patient to the provider or an emergency room for an evaluation and such other emergency or other medical treatment as is indicated by good medical practice. Examples of states that have such a procedure: Georgia (patient must be released from community mental health center within 4 hours or from emergency facility within 48 hours unless examining physician executes certificate of hospitalization); Indiana (after hearing on non-compliance, court can issue order requiring law enforcement officers to respond to facility requests to bring patient in for treatment); Michigan (in its initial order for alternative treatment, or combined hospitalization and alternative treatment, or in the event of noncompliance, the court may provide in its order that if an individual refuses to comply with a psychiatrist’s order to return to the hospital, a peace officer shall take the individual to the hospital) ; North Carolina (if patient fails to comply, but does not clearly refuse to comply with court ordered treatment, upon request to court, clerk shall issue order for peace officer to take patient to designated physician or center for examination; officer may wait and take patient home; no forced medication or forcible detention for treatment unless dangerousness exists in which case inpatient proceedings shall be initiated). 3. Provision that in the event of non-compliance, responsible provider can on its own request peace officer to take patient to provider or hospital for an examination or treatment. Usually subsequent notice to court and/or right to hearing if admitted. Examples of states that have such a procedure: Arkansas; District of Columbia (summary hospitalization for brief period in appropriate circumstances if authorized in initial court order and accompanied by appropriate due process safeguards); Indiana (provides for certain administrative transfers subject to judicial review); Mississippi (affidavit must be first filed with court); Utah; Washington. 4. If medication is part of the court order, provision that the court may direct in order that if individual has failed to take medication or to report for evaluations as required, then, in such event, the responsible treatment provider may request that a peace officer take the individual into custody and bring him/her to the provider or emergency room for the administration of medication; medication can then be administered involuntarily if necessary (subject to rights under law for patient to refuse medication). Examples of states that have such a procedure: Wisconsin. NOTES . Ala. Code Sec. 22-52-10.3(f) (1998). . Ariz. Rev. Stat. Secs. 36-540(E)(4),(E)(5) (1998). . Hawaii Rev. Stat. Ann. Secs. 334-129(c), 334-60.2 (1997). . 405 ILCS Sec. 5/3-812 (1998). . Burns Ind. Code Ann. Sec. 12-26-14-4, 14-5 (1998). . Iowa Code Sec. 229.14 (1997). . Kansas Stat. Ann. Sec. 59-2967 (1997). . Ky Rev. Stat. Ann. Sec. 202A.081 (Michie 1996). . Mich. Stat. Ann. Sec. 14.800(475)(2) (1998). . Minn. Stat. Sec. 253B.097(5) (1998). . R.R.S. Neb. Sec. 83-1045.02 (1998). .N.H.R.S.A. Sec. 135-C:47 (1998). .N.C. Gen. Stat. Sec. 122C-273 (1997). .N.D. Cent. Code Sec. 25-03.1-21 (1998). .43A Okl. St. Sec. 5-416B (1998). .ORS Sec. 426.275 (1997). .50 P.S. Sec. 7306(c) (1998). .S.C. Code Ann. Sec. 44-17-580 (1997). . S.D. Codified Laws Secs. 27A-11A-21, 22 (1998). .Tex. Health & Safety Code Secs. 574.062,.063 (1998). .18 V.S.A. Sec. 7618 (1998). .Va. Code Ann. Sec. 37.1-67.3 (1998). 23 . Op. Att’y Gen. May 29, 1981. .O.C.G.A. Sec. 37-3-82(b) (1998). .Burns Ind. Code Ann. Sec. 12-26-14-5 (1998). 26 . Mich. Stat. Ann. Sec 14.800(469a)(2), (475)(2)(b)(1998) (not clear from statutory language whether this provision applies only in case of combined order for hospitalization and alternative treatment). . N.C. Gen. Stat. Sec. 122C-273 (1997). . Ark. Stat. Ann. Sec. 20-47-219 (1997). . United States v. Ellerbee, App. D.C., 481 A.2d 473 (1984). . Burns Ind. Code Ann. Sec. 12-26-14-4 (1998). . Miss. Code Ann. Sec. 41-21-74 (1998). . Utah Code Ann. Sec. 62A-12-241 (1998). . Rev. Code Wash. (ARCW) Secs. 71.05.340(3),(4),(5) 1998). 34 . Wis. Stat. Sec. 51.20 (13) (dm) (1997).

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