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HB 256 - Temp Hlth Care Placement Decision Maker for an Adult Act; enact

Martin, Jim (47th)	Bordeaux, Tom (151st)	Allen, Ben (117th)

Status Summary	HC:	Judy	SC:	C Aff	FR:	01/27/99	LA:	03/24/99	S - Conf Comm Appointed (CS ) (FA )

First Reader Summary

A BILL to amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to provide for consent to admission to or discharge from a health care facility or placement or transfer to another health care facility or placement for adults unable to consent; and for other purposes.

Code Sections - 31-36A-1/ 31-36A-2/ 31-36A-3/ 31-36A-4/ 31-36A-5/ 31-36A-6/ 31-36A-7

HB 256                                            LC 22 3451S 
 
 
                _________________________ offers the following 
      substitute to HB 256: 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Title 31 of the Official Code of Georgia Annotated, 
  1- 2  relating to health, so as to provide for consent to 
  1- 3  admission to or discharge from a health care facility or 
  1- 4  placement or transfer to another health care facility or 
  1- 5  placement for adults unable to consent; to provide a short 
  1- 6  title; to provide for legislative findings and definitions; 
  1- 7  to provide that the Act does not apply to involuntary 
  1- 8  examination and hospitalization for treatment of mental 
  1- 9  illness; to provide for a physician's certification that an 
  1-10  adult is unable to consent; to authorize enumerated persons 
  1-11  to consent; to provide for limitation and expiration of 
  1-12  authorization to consent; to provide for immunity; to 
  1-13  provide for petition to the probate court for an order 
  1-14  authorizing transfer, admission, or discharge; to provide 
  1-15  for the contents of the petition, venue, and jurisdiction; 
  1-16  to provide for affidavits by a physician and designated 
  1-17  personnel of the discharging facility or placement; to 
  1-18  provide for orders and copies of such orders to the 
  1-19  commissioner of human resources; to provide for expiration 
  1-20  and limitation of such orders; to provide for related 
  1-21  matters; to repeal conflicting laws; and for other purposes. 
 
  1-22       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-23                           SECTION 1. 
 
  1-24  Title 31 of the Official Code of Georgia Annotated, relating 
  1-25  to health, is amended by inserting a new chapter to be 
  1-26  designated Chapter 36A to read as follows: 
 
 
 
  1-27    31-36A-1. 
 
  1-28    This chapter shall be known and may be cited as the 
  1-29    'Temporary Health Care Placement Decision Maker for an 
  1-30    Adult Act.' 
 
 
 
 
 
                                 -1- 
 
 
 
  2- 1    31-36A-2. 
 
  2- 2    (a) The General Assembly recognizes that there may be 
  2- 3    occasions when an adult has not made advance arrangements 
  2- 4    for a situation when he or she is unable to consent to his 
  2- 5    or her own admission to or discharge from one health care 
  2- 6    facility or placement or transfer to another health care 
  2- 7    facility or placement.  Under these circumstances, the 
  2- 8    General Assembly further recognizes that it may be 
  2- 9    necessary and in the adult's best interest to be admitted 
  2-10    to or discharged from one health care facility or 
  2-11    placement or transferred to an alternative facility or 
  2-12    placement. 
 
  2-13    (b) In recognition of the findings in subsection (a) of 
  2-14    this Code section, the General Assembly declares that the 
  2-15    laws of the State of Georgia shall provide for the most 
  2-16    appropriate placement available for these individuals and 
  2-17    shall declare an order of priority for those persons who 
  2-18    may make the decision to transfer, admit, or discharge 
  2-19    such adults at the appointed times and a procedure for 
  2-20    obtaining authorization from the court in the absence of a 
  2-21    person authorized to consent. 
 
  2-22    31-36A-3. 
 
  2-23    As used in this chapter, the term: 
 
  2-24      (1) 'Absence of a person authorized to consent' means 
  2-25      that: 
 
  2-26        (A) After diligent efforts for a reasonable period of 
  2-27        time,  no person authorized to consent under the 
  2-28        provisions of Code Section 31-36A-6 has been located; 
  2-29        or 
 
  2-30        (B) All such authorized persons located have 
  2-31        affirmatively waived their authority to consent or 
  2-32        dissent to admission to or discharge from a health 
  2-33        care facility or placement or transfer to an 
  2-34        alternative health care facility or placement, 
  2-35        provided that dissent by an authorized person to a 
  2-36        proposed admission, discharge, or transfer shall not 
  2-37        be deemed waiver of authority. 
 
  2-38      (2) 'Unable to consent' means that an adult is unable 
  2-39      to: 
 
 
 
 
 
                                 -2- 
 
 
 
  3- 1        (A) Make rational and competent decisions regarding 
  3- 2        his or her placement options for health or personal 
  3- 3        care; or 
 
  3- 4        (B) Communicate such decisions by any means. 
 
  3- 5    31-36A-4. 
 
  3- 6    This chapter shall not apply to involuntary examination 
  3- 7    and hospitalization for treatment of mental illness, which 
  3- 8    shall continue to be governed by Title 37. 
 
  3- 9    31-36A-5. 
 
  3-10    An attending physician, treating physician, or other 
  3-11    physician licensed according to the laws of the State of 
  3-12    Georgia, after having personally examined an adult, may 
  3-13    certify in the adult's medical records the following: 
 
  3-14      (1) The adult is unable to consent for himself or 
  3-15      herself; and 
 
  3-16      (2) It is the physician's belief that it is in the 
  3-17      adult's best interest to be discharged from a hospital, 
  3-18      institution, medical center, or other health care 
  3-19      institution providing health or personal care for 
  3-20      treatment of any type of physical or mental condition 
  3-21      and to be transferred to or admitted to an alternative 
  3-22      facility or placement, including, but not limited to, 
  3-23      nursing facilities, personal care homes, rehabilitation 
  3-24      facilities, and home and community based programs. 
 
  3-25    31-36A-6. 
 
  3-26    (a) Upon a physician's certification pursuant to Code 
  3-27    Section 31-36A-5, and in addition to such other persons as 
  3-28    may be otherwise authorized and empowered, any one of the 
  3-29    following persons is authorized and empowered to consent, 
  3-30    in the priority order listed below, either orally or 
  3-31    otherwise, to such transfer, admission, or discharge: 
 
  3-32      (1) Any adult, for himself or herself; 
 
  3-33      (2) Any person authorized to give such consent for the 
  3-34      adult under a health care agency complying with Chapter 
  3-35      36 of this title, the 'Durable Power of Attorney for 
  3-36      Health Care Act'; 
 
  3-37      (3) Any guardian of the person for his or her ward; 
 
  3-38      (4) Any spouse for his or her spouse; 
 
  3-39      (5) Any adult child for such person's parent; 
 
 
                                 -3- 
 
 
 
  4- 1      (6) Any parent for such person's adult child; 
 
  4- 2      (7) Any adult for such person's adult brother or sister; 
 
  4- 3      (8) Any grandparent for such person's adult grandchild; 
 
  4- 4      (9) Any adult grandchild for such person's grandparent; 
 
  4- 5      (10) Any adult uncle or aunt for such person's adult 
  4- 6      nephew or niece; or 
 
  4- 7      (11) Any adult nephew or niece for such person's adult 
  4- 8      uncle or aunt. 
 
  4- 9    (b) Any person authorized and empowered to consent under 
  4-10    subsection (a) of this Code section shall, after being 
  4-11    informed of the provisions of this Code section, act in 
  4-12    good faith to consent to a transfer, admission, or 
  4-13    discharge which the patient would have wanted had the 
  4-14    patient been able to consent in the circumstances under 
  4-15    which such transfer, admission, or discharge is considered 
  4-16    or, if the patient's preferences are unknown, which such 
  4-17    person believes the patient would have wanted had the 
  4-18    patient been able to consent in the circumstances under 
  4-19    which such transfer, admission, or discharge is 
  4-20    considered. The current health care facility's discharge 
  4-21    planner, social worker, or other designated personnel 
  4-22    shall assist the person authorized to consent under 
  4-23    subsection (a) of this Code section with identifying the 
  4-24    most appropriate, least restrictive level of care 
  4-25    available, including home and community based services and 
  4-26    available placements, if any, in reasonable proximity to 
  4-27    the patient's residence. 
 
  4-28    (c) The authorization to consent to such transfer, 
  4-29    admission, or discharge shall expire upon the earliest of 
  4-30    the following: 
 
  4-31      (1) The completion of the transfer, admission, or 
  4-32      discharge and such responsibilities associated with such 
  4-33      transfer, admission, or discharge, including, but not 
  4-34      limited to, assisting with applications for financial 
  4-35      coverage and insurance benefits for health or personal 
  4-36      care; 
 
  4-37      (2) Upon a physician's certification that the adult is 
  4-38      able to consent to decisions regarding his or her 
  4-39      placements for health or personal care; or 
 
  4-40      (3) Upon discovery that another person authorized under 
  4-41      subsection (a) of this Code section of a higher priority 
 
 
                                 -4- 
 
 
 
  5- 1      is available who has not affirmatively waived his or her 
  5- 2      authority to consent or dissent to admission to or 
  5- 3      discharge from a health care facility or placement or 
  5- 4      transfer to an alternative health care facility or 
  5- 5      placement, provided that dissent by such authorized 
  5- 6      person to a proposed admission, discharge, or transfer 
  5- 7      shall not be deemed waiver of authority. 
 
  5- 8    (d) The authorization to give consent for transfer, 
  5- 9    admission, or discharge is limited solely to said 
  5-10    transfer, admission, or discharge decision and 
  5-11    responsibilities associated with such decision, including 
  5-12    providing assistance with financial assistance 
  5-13    applications.  It does not include the power or authority 
  5-14    to perform any other acts on behalf of the adult not 
  5-15    expressly authorized in this Code section. 
 
  5-16    (e) This Code section shall not repeal, abrogate, or 
  5-17    impair the operation of any other laws, either federal or 
  5-18    state, governing the transfer, admission, or discharge of 
  5-19    a person to or from a health care facility or placement. 
  5-20    Further, the adult retains all rights provided under laws, 
  5-21    both federal and state, as a result of an involuntary 
  5-22    transfer, admission, or discharge. 
 
  5-23    (f) Each certifying physician, discharge planner, social 
  5-24    worker, or other hospital personnel or authorized person 
  5-25    who acts in good faith pursuant to the authority of this 
  5-26    Code section shall not be subject to any civil or criminal 
  5-27    liability or discipline for unprofessional conduct. 
 
  5-28    31-36A-7. 
 
  5-29    (a) In the absence of a person authorized to consent under 
  5-30    the provisions of Code Section 31-36A-6, any interested 
  5-31    person or persons, including, but not limited to, any 
  5-32    authority, corporation, partnership, or other entity 
  5-33    operating the health care facility where the adult who is 
  5-34    unable to consent is then present, with or without the 
  5-35    assistance of legal counsel, may petition the probate 
  5-36    court for a health care placement transfer, admission, or 
  5-37    discharge order. The petition must be verified and filed 
  5-38    in the county where the adult requiring an alternative 
  5-39    placement or transfer, admission, or discharge resides or 
  5-40    is found, provided that the probate court of the county 
  5-41    where the adult is found shall not have jurisdiction to 
  5-42    grant the order if it appears that the adult was removed 
 
 
 
 
                                 -5- 
 
 
 
  6- 1    to that county solely for purposes of filing such a 
  6- 2    petition.  The petition shall set forth: 
 
  6- 3      (1) The name, age, address, and county of the residence 
  6- 4      of the adult, if known; 
 
  6- 5      (2) The name, address, and county of residence of the 
  6- 6      petitioner; 
 
  6- 7      (3) The relationship of the petitioner to the adult; 
 
  6- 8      (4) The current location of the adult; 
 
  6- 9      (5) A physician's certification pursuant to Code Section 
  6-10      31-36A-5; 
 
  6-11      (6) The absence of any person to consent to such 
  6-12      transfer, admission, or discharge as authorized by the 
  6-13      provisions of Code Section 31-36A-6; 
 
  6-14      (7) Name and address of the recommended alternative 
  6-15      health care facility or placement; and 
 
  6-16      (8) A statement of the reasons for such transfer, 
  6-17      admission, or discharge as required by subsections (b) 
  6-18      and (c) of this Code section. 
 
  6-19    (b) The petition shall be supported by the affidavit of an 
  6-20    attending physician, treating physician, or other 
  6-21    physician licensed according to the laws of the State of 
  6-22    Georgia, attesting the following: 
 
  6-23      (1) The adult is unable to consent for himself or 
  6-24      herself; 
 
  6-25      (2) It is the physician's belief that it is in the 
  6-26      adult's best interest to be admitted to or discharged 
  6-27      from a hospital, institution, medical center, or other 
  6-28      health care institution  providing health or personal 
  6-29      care for treatment of any type of physical or mental 
  6-30      condition or to be transferred to an alternative 
  6-31      facility or placement, including, but not limited to, 
  6-32      nursing facilities, personal care homes, rehabilitation 
  6-33      facilities, and home and community based programs; and 
 
  6-34      (3) The identified type of health care facility or 
  6-35      placement will provide the adult with the recommended 
  6-36      services to meet the needs of the adult and is the most 
  6-37      appropriate, least restrictive level of care available. 
 
  6-38    (c) The petition shall also be supported by the affidavit 
  6-39    of the discharging health care facility's discharge 
 
 
 
                                 -6- 
 
 
 
  7- 1    planner, social worker, or other designated personnel 
  7- 2    attesting to and explaining the following: 
 
  7- 3      (1) There is an absence of a person to consent to such 
  7- 4      transfer, admission, or discharge as authorized in Code 
  7- 5      Section 31-36A-6; 
 
  7- 6      (2) The recommended alternative facility or placement is 
  7- 7      the most appropriate facility or placement available 
  7- 8      that provides the least restrictive and most appropriate 
  7- 9      level of care and reasons therefor; and 
 
  7-10      (3) Alternative facilities or placements were 
  7-11      considered, including home and community based 
  7-12      placements and available placements, if any, that were 
  7-13      in reasonable proximity to the adult's  residence. 
 
  7-14    (d) The court shall review the petition and accompanying 
  7-15    affidavits and other information to determine if all the 
  7-16    necessary information is provided to the court as required 
  7-17    in subsections (a), (b), and (c) of this Code section. The 
  7-18    court shall enter an instanter order if the following 
  7-19    information is provided: 
 
  7-20      (1) The adult  is unable to consent for himself or 
  7-21      herself; 
 
  7-22      (2) There is an absence of any person to consent to such 
  7-23      transfer, admission, or discharge as authorized in Code 
  7-24      Section 31-36A-6; 
 
  7-25      (3) It is in the adult's best interest to be discharged 
  7-26      from a hospital, institution, medical center, or other 
  7-27      health care institution or placement providing health or 
  7-28      personal care for treatment for any type of physical or 
  7-29      mental condition and to be admitted or transferred to an 
  7-30      alternative facility or placement; 
 
  7-31      (4) The recommended alternative facility or placement is 
  7-32      the most appropriate facility or placement available 
  7-33      that provides the least restrictive and most appropriate 
  7-34      level of care; and 
 
  7-35      (5) Alternative facilities or placements were 
  7-36      considered, including home and community based 
  7-37      placements and available placements, if any, in 
  7-38      reasonable proximity to the adult's residence. 
 
  7-39    The order shall authorize the petitioner or the 
  7-40    petitioner's designee to do all things necessary to 
  7-41    accomplish the discharge from a hospital, institution, 
 
 
                                 -7- 
 
 
 
  8- 1    medical center, or other health care institution and the 
  8- 2    transfer to or admission to the recommended facility or 
  8- 3    placement. 
 
  8- 4    (e) At the same time as issuing the order, the court shall 
  8- 5    provide a copy of said order to the commissioner of human 
  8- 6    resources. 
 
  8- 7    (f) The order authorizing such transfer, admission, or 
  8- 8    discharge shall expire upon the earliest of the following: 
 
  8- 9      (1) The completion of the transfer, admission, or 
  8-10      discharge and such responsibilities associated with such 
  8-11      transfer, admission, or discharge, including, but not 
  8-12      limited to, assisting with the completion of 
  8-13      applications for financial coverage and insurance 
  8-14      benefits for the health or personal care; 
 
  8-15      (2) Upon a physician's certification that the adult is 
  8-16      able to understand and make decisions regarding his or 
  8-17      her placements for health or personal care and can 
  8-18      communicate such decisions by any means; or 
 
  8-19      (3) At a time specified by the court not to exceed 30 
  8-20      days from the date of the order. 
 
  8-21    (g) The order is limited to authorizing the transfer, 
  8-22    admission, or discharge and other responsibilities 
  8-23    associated with such decision, such as authorizing the 
  8-24    application for financial coverage and  insurance 
  8-25    benefits.  It does not include the authority to perform 
  8-26    any other acts on behalf of the adult not expressly 
  8-27    authorized in this Code section. 
 
  8-28    (h) This Code section shall not repeal, abrogate, or 
  8-29    impair the operation of any other laws, either federal or 
  8-30    state, governing the transfer, admission, or discharge of 
  8-31    a person to or from a health care facility or placement. 
  8-32    Further, such person retains all rights provided under 
  8-33    laws, both federal and state, as a result of an 
  8-34    involuntary transfer, admission, or discharge. 
 
  8-35    (i) Each certifying physician, discharge planner, social 
  8-36    worker, or other hospital personnel or authorized person 
  8-37    who acts in good faith pursuant to the authority of this 
  8-38    Code section shall not be subject to any civil or criminal 
  8-39    liability or discipline for unprofessional conduct." 
 
 
 
 
 
                                 -8- 
 
 
 
  9- 1                           SECTION 2. 
 
  9- 2  All laws and parts of laws in conflict with this Act are 
  9- 3  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 -9-