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Amend the bill in section 1 by striking out all of the first line (page 1, line 2 in L.D.) and inserting the following:
‘Sec. 1. 15 MRSA §§106, 107 and 108 are enacted to read:’
Amend the bill in section 1 in §106 in subsection 2 in the 6th line (page 1, line 11 in L.D.) by striking out the following: "antipsychotic" and inserting the following: 'psychiatric'
Amend the bill in section 1 in §106 in subsection 3 in paragraph B in subparagraph (2) in division (a) in the first line (page 2, line 1 in L.D.) by striking out the following: "stand trial" and inserting the following: 'proceed'
Amend the bill in section 1 in §106 in subsection 3 in paragraph B in subparagraph (4) in the first line (page 2, line 7 in L.D.) by striking out the following: "likely" and inserting the following: 'unlikely'
Amend the bill in section 1 in §106 by striking out all of subsection 4 (page 2, lines 12 to 15 in L.D.)
Amend the bill in section 1 in §106 in subsection 5 in the 2nd line (page 2, line 17 in L.D.) by striking out the following: "antipsychotic" and inserting the following: 'psychiatric'
Amend the bill in section 1 in §106 in subsection 5 in the 5th line (page 2, line 20 in L.D.) by striking out the following: "antipsychotic" and inserting the following: 'psychiatric'
Amend the bill in section 1 in §106 by renumbering the subsections to read consecutively.
Amend the bill in section 1 in §107 in subsection 1 by striking out all of paragraphs A to E (page 2, lines 31 to 37 in L.D.) and inserting the following:
 
‘A.  "Commissioner" means the Commissioner of Health and Human Services or the commissioner's designee.
 
B.  "Department" means the Department of Health and Human Services.
 
C.  "Patient" means a person held in a hospital under section 101-D or 103.
 
D. "Psychiatrist" includes a physician assistant working under the supervision of a psychiatrist and a psychiatric nurse practitioner.’
Amend the bill in section 1 in §107 in subsection 3 by striking out all of paragraph B (page 3, lines 14 to 16 in L.D.) and inserting the following:
 
‘B. A psychiatrist has determined that, as a result of the patient's mental illness or disorder, the patient poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury;’
Amend the bill in section 1 in §107 in subsection 3 in paragraph H by striking out all of subparagraph (2) (page 4, lines 15 to 17 in L.D.) and inserting the following:
‘
 
(2) As a result of that illness or disorder the patient poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury if not medicated;
Amend the bill in section 1 in §107 in subsection 3 by striking out all of paragraph K (page 4, lines 29 to 33 in L.D.) and inserting the following:
 
‘K. The historical course of the patient's mental illness or disorder, as determined by available relevant information about the course of the patient's mental illness or disorder, is considered when it has direct bearing on the determination of whether the patient, as the result of a mental illness or disorder, poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury.’
Amend the bill in section 1 in §107 in subsection 7 in paragraph A in the next to the last line (page 5, line 23 in L.D.) by striking out the following: "acts need be" and inserting the following: 'acts necessarily need to be'
Amend the bill in section 1 in §107 in subsection 7 by striking out all of paragraph B (page 5, lines 25 to 32 in L.D.) and inserting the following:
 
‘B.  The commissioner may order an extension of an authorization under this subsection. An order extending an authorization that is in effect must be granted based on clear and convincing evidence that:
 
(1) The patient has a mental illness or disorder;
 
(2) As a result of that illness or disorder the patient poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury if not medicated;
 
(3) There is no less intrusive alternative to involuntary medication; and
’
 
(4) The need for treatment outweighs the risks and side effects.
Amend the bill in section 1 in §107 in subsection 8 in the 5th line (page 5, line 39 in L.D.) by inserting after the following: "change to the" the following: 'conditions leading to the original order or the'
Amend the bill in section 1 in §107 in subsection 8 in the 8th line (page 5, line 42 in L.D.) by inserting after the following: "change in" the following: 'the conditions leading to the original order or the patient's'
Amend the bill in section 1 in §107 in subsection 8 in paragraph C in the last line (page 6, line 17 in L.D.) by inserting after the following: "proceeding." the following: 'If the hearing officer determines that a hearing is warranted, the patient must be provided counsel at the department's expense at least 7 days prior to the hearing.'
Amend the bill in section 1 in §107 in subsection 8 in paragraph D by striking out all of the last sentence (page 6, lines 21 and 22 in L.D.) and inserting the following: 'The decision whether to terminate the authorization of involuntary treatment rests with the commissioner, who shall act within 48 hours upon the hearing officer's recommendation.'
Amend the bill in section 1 by inserting at the end the following:
‘§ 108. Court-ordered independent examinations
Before making a determination under section 106 or 107, a court may order an independent psychiatric or medical examination of the patient. The Department of Health and Human Services, within 30 days after receiving a request from the Administrative Office of the Courts, shall reimburse the Judicial Department for the full amount of fees paid by the Judicial Department to providers of psychiatric and medical examinations of forensic patients ordered by the court.’
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section number to read consecutively.
 
SUMMARY
This amendment changes the references to "antipsychotic" medication to "psychiatric" medication to more accurately describe the type of medication that may be administered.
The amendment changes the terminology from competency "to stand trial" to competency "to proceed" to be consistent throughout the bill.
The amendment revises the definition of "Commissioner of Health and Human Services" to include the commissioner’s designee.
The amendment deletes the definition of "gravely disabled" and replaces it with the standard that the patient poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury if not medicated.
The amendment revises the factors that the commissioner must consider in order to continue the extension of the order allowing treatment without the patient’s consent. The commissioner must find by clear and convincing evidence that:
1. The patient has a mental illness or disorder;
2. As a result of that illness or disorder the patient poses a substantial risk of harm to self or others or there is a reasonable certainty that the patient will suffer severe physical or mental harm as manifested by recent behavior demonstrating an inability to avoid risk or to protect the patient adequately from impairment or injury if not medicated;
3. There is no less intrusive alternative to involuntary medication; and
4. The need for treatment outweighs the risks and side effects.
The amendment clarifies that the patient or the patient’s designated representative may request that the treatment authorization be terminated early by filing a request with the department that demonstrates that there is a significant change to the conditions that led to the original order or the patient’s medical condition. If the hearing officer determines that a hearing on the request is warranted, then the patient must be provided counsel at the Department of Health and Human Services' expense at least 7 days before the hearing. If the hearing officer recommends termination of the treatment authorization to the commissioner, the commissioner must either order the termination or deny the request for termination within 48 hours of the recommendation.
This amendment adds a new section that clarifies that the court may order an independent psychiatric or medical examination to make a determination under the bill. The Administrative Office of the Courts is directed to request that the Department of Health and Human Services reimburse the full amount of fees paid to the providers of the examinations. The Department of Health and Human Services is directed to reimburse the Judicial Department within 30 days after the request.
FISCAL NOTE REQUIRED
(See attached)