Chapter 82a

10 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 1 CHAPTER 82A ASSISTED OUTPATIENT TREATMENT SOURCE: Entire chapter added by P.L. 33-071:1 (Sept. 15, 20 15). Article 1. Legislative Findings and Intent. Article 2. Definitions. Article 3. Voluntary Treatment. Article 4. Petition for Assisted Treatment. Article 5. Assisted Treatment Hearing Procedures. Article 6. Assisted Treatment Hearing Disposition. Article 7. Appeals. Article 8. Safeguards. Article 9. Assisted Outpatient Treatment. Article 10. Review of Status. Article 11. Renewals. Article 12. Procedures for Discharge. Article 13. Emergency Treatment/Observation - Certi fication. Article 14. Accountability. Article 15. Patient Bill of Rights. ARTICLE 1 LEGISLATIVE INTENT § 82A101. Legislative Findings and Intent. § 82A102. [Baby Alexya Law.] § 82A101. Legislative Findings and Intent. I Liheslaturan Guåhan finds that Assisted Outpatient Treatment (AOT) is practiced in forty-five (45) states as an extens ion of inpatient treatment, while allowing the qualified patient with a treatab le mental illness or condition to receive court ordered treatment on an outpatient basis.

five (45) states as an extens ion of inpatient treatment, while allowing the qualified patient with a treatab le mental illness or condition to receive court ordered treatment on an outpatient basis. It is also known in some states as outpatient commitment. A d etailed six (6)-month study of New York’s Kendra’s Law documented a strik ing decline in the rate of hospitalization among participants. AOT recipie nts were hospitalized at less than half the rate they were hospitalized in t he six (6) months prior to receiving AOT (i.e., the hospitalization rate dropp ed from seventy-four (74) percent to thirty-six (36) percent). Further, when they were hospitalized, the COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 2 length of the stay was greatly reduced. Studies in other states have demonstrated similar benefits. The continued treatment and management of the patie nt’s condition on an outpatient basis has also been determined to gre atly reduce incidents of violence and arrests. Without AOT, the patient’s c ondition often deteriorates directly due to a lack of treatment co mpliance and the continuing exhibition of 'good' adherence to their medication treatment

e and arrests. Without AOT, the patient’s c ondition often deteriorates directly due to a lack of treatment co mpliance and the continuing exhibition of 'good' adherence to their medication treatment plan. Another tragic consequence for many individuals wit h untreated mental illnesses is homelessness. At any given time, there are more people with untreated severe psychiatric illnesses living on Am erica’s streets than are receiving care in hospitals. In New York, when com pared to the three (3) years prior to their participation in the program, seventy-four (74) percent fewer AOT recipients experienced homelessness (New York State Office of Mental Health 2005). New York and other states hav e incurred enormous costs in the provision of public assistance for hou sing assistance and re- hospitalization. I Liheslaturan Guåhan further finds that the consequences of untreated mental illness are as apparent as they are devastat ing: homelessness, criminalization, suicide, violence, victimization, lost productivity, permanently decreased medication responses, and the incalculable costs of unnecessary suffering.

are devastat ing: homelessness, criminalization, suicide, violence, victimization, lost productivity, permanently decreased medication responses, and the incalculable costs of unnecessary suffering. Due to advances in recent ye ars, treatment is now available that can eliminate or substantially allev iate the symptoms of mental illness for most who suffer from it. People with tr eated mental illness can now reclaim their lives. But first, there must be t reatment. Treatment voluntarily embraced is always preferable . However, mental illness is a biologically based disease that attack s the brain. As a result, mental illness renders many people incapable of vol untarily entering treatment because they are unable to make rational decisions or unaware that they are ill. When this occurs, such people may req uire assisted treatment to protect their lives, as well as to avoid tragic per sonal and societal consequences. This Act is designed to be the legal framework for the provision of care to individuals who, due to the symptoms of severe m ental illness, become either dangerous or incapable of making informed me dical decisions concerning their treatment.

ork for the provision of care to individuals who, due to the symptoms of severe m ental illness, become either dangerous or incapable of making informed me dical decisions concerning their treatment. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 3 The procedural components of this Act are intended to create a flexible mechanism that can be used to secure treatment for those who most need it while still distinguishing those for whom intervent ion is inappropriate. Paramount are the strict and plentiful safeguards w hich this Act establishes to protect both the rights and well-being of those subject to it. It is the intent of I Liheslaturan Guåhan to provide for a missing but necessary treatment component in our mental healthc are system. As was the case in New York City in the establishment of Kendr a’s Law, it took the tragic death of Ms. Kendra Webdale, a young woman w ho died in January 1999 after being pushed in front of a New York City subway train by a person who was living in the community at the time, but was not receiving treatment for his mental illness.

w ho died in January 1999 after being pushed in front of a New York City subway train by a person who was living in the community at the time, but was not receiving treatment for his mental illness. On Guam, we had the recent case of ten (10) month old baby Alexya being punched in the fac e while in the arms of her mother under similar circumstances by a person not receiving treatment for her mental illness. § 82A102. This Act shall be cited as the 'Baby Alexya Law.' ---------- ARTICLE 2 DEFINITIONS § 82A201. Definitions. § 82A201. Definitions. As used in this Chapter, unless the context require s otherwise: (a) Assisted treatment means the provision of treatment, in accordance with this Act, to individuals who are ei ther dangerous or incapable of making informed medical decisions beca use of the effects of severe mental illness. (b) Assisted outpatient treatment (AOT) means assisted treatment on an outpatient basis. (c) Certificate means a form filed with the court by a psychiatris t or other physician to request an assisted treatment hearing for an individual currently in emergency treatment/observa tion. COL62201610 GCA HEALTH AND SAFETY CH.

ed with the court by a psychiatris t or other physician to request an assisted treatment hearing for an individual currently in emergency treatment/observa tion. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 4 (d) Chronically disabled may be shown by establishing that the person is incapable of making an informed medical d ecision and, based on the person’s psychiatric history, the person is unlikely to comply with treatment and, as a consequence, the person’s current condition is likely to deteriorate until his or her psychiatric disorder significantly impairs the person’s judgment, reason, behavior or capacity to recognize reality and has a substantial probability of causing him or her to suffer or continue to suffer severe psychiatric, emotional or physical harm. (e) Court means the Superior Court of Guam, which shall be the court of judicial review designated to accept petit ions and certificates for assisted treatment and related filings, decide on preliminary and ex parte motions, and all other functions assigned to it pursuant to this Act. (f) Danger to himself or herself may be shown by establishing that, by his or her behavior, a person is, in

liminary and ex parte motions, and all other functions assigned to it pursuant to this Act. (f) Danger to himself or herself may be shown by establishing that, by his or her behavior, a person is, in the r easonably foreseeable future, likely to either attempt suicide, to inflic t bodily harm on himself or herself or, because of his or her actions or ina ction, to suffer serious physical harm in the near future. The person’s past behavior may be considered. (g) Danger to others may be shown by establishing that, by his or her behavior, a person is in the reasonably foresee able future likely to cause or attempt to cause harm to another. Evidence that a person is a danger to others may include, but is not limited to: (1) that he or she has inflicted, or attempted or t hreatened in an objectively serious manner to inflict, bodily ha rm on another; (2) that by his or her actions or inactions, he or she has presented a danger to a person in his or her care; or (3) that he or she has recently and intentionally c aused significant damage to the substantial property of o thers. (h) Gravely disabled , as defined in § 82101(c) of Chapter 82, may be shown by establishing that a person is

ently and intentionally c aused significant damage to the substantial property of o thers. (h) Gravely disabled , as defined in § 82101(c) of Chapter 82, may be shown by establishing that a person is incap able of making an informed medical decision and has behaved in such a manner as to indicate that he or she is unlikely, without superv ision and the assistance of others, to satisfy his or her need fo r either nourishment, personal or medical care, shelter, or self-protecti on and safety so that it COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 5 is probable that substantial bodily harm, significa nt psychiatric deterioration or debilitation, or serious illness w ill result unless adequate treatment is afforded. (i) Incapable of making an informed medical decision means that a person is unaware of the effects of his or h er psychiatric disorder or that the person lacks the capacity to make a wel l-reasoned, willful, and knowing decision concerning his or her medical or psychiatric treatment. Any history of the person’s non-complian ce with treatment or of criminal acts related to his or her mental il lness shall , if available, be considered.

his or her medical or psychiatric treatment. Any history of the person’s non-complian ce with treatment or of criminal acts related to his or her mental il lness shall , if available, be considered. (j) Petition means a form filed with a court to request an assi sted treatment hearing based on the good faith belief of the petitioner that the subject of the petition is eligible for assiste d treatment pursuant to the provisions of this Act. (k) Petitioner shall only mean the Director of the Guam Behavioral Health and Wellness Center or his or her designee, in conjunction with the treating psychiatrist or physi cian who has examined the respondent, and who shall file the petition. (l) Respondent means the person who is the subject of a petition or certificate. (m) Severe psychiatric disorder means a substantial impairment of a person’s thought processes (e.g., delusions), sensory input (e.g., hallucinations), mood balance (e.g., mania or sever e depression), memory (e.g., dementia), or ability to reason that substantially interferes with a person’s ability to meet the ordinary demand s of living.

ations), mood balance (e.g., mania or sever e depression), memory (e.g., dementia), or ability to reason that substantially interferes with a person’s ability to meet the ordinary demand s of living. Severe psychiatric disorders are distinguished from: (1) conditions that are primarily due to drug abuse or alcoholism, although severe psychiatric disorders m ay co-exist with these disorders; (2) other known neurological disorders such as epil epsy, multiple sclerosis, Parkinson’s disease, or Alzheim er’s disease, although such neurological disorders may also have psychotic features similar to those found in severe psychiatr ic disorders; (3) normal age-related changes in the brain; (4) brain changes related to terminal medical cond itions; COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 6 (5) personality disorders as defined by the Americ an Psychiatric Association’s 'Diagnostic and Statistic al Manual of Mental Disorders' (APA-DSM); (6) moderate, severe and profound mental retardati on as defined by the APA-DSM; and (7) pervasive developmental disorders, including a utistic disorder, Rett’s disorder and Asperger’s disorder a s defined by the APA-DSM.

nd profound mental retardati on as defined by the APA-DSM; and (7) pervasive developmental disorders, including a utistic disorder, Rett’s disorder and Asperger’s disorder a s defined by the APA-DSM. (n) Treating professional, professional staff, professi onal person or qualified mental health professional shall mean a licensed professional qualified by training or experience in the diagnosis of mental or related illness. The following licensed professionals shall be so designated: (1) a psychiatrist; (2) a clinical psychologist; (3) a certified psychiatric nurse at the Master’s l evel; or (4) a physician. (o) Guam Behavioral Health and Wellness Center (GBH WC) is the public agency designated by the government of G uam to diagnose or treat persons with mental health disorders. ---------- ARTICLE 3 VOLUNTARY TREATMENT § 82A301. Admission to Voluntary Treatment. § 82A302. Discharge From Voluntary Treatment. § 82A301. Admission to Voluntary Treatment. A person in need of psychiatric care should be admi tted into treatment voluntarily whenever possible. § 82A302. Discharge From Voluntary Treatment. COL62201610 GCA HEALTH AND SAFETY CH.

y Treatment. A person in need of psychiatric care should be admi tted into treatment voluntarily whenever possible. § 82A302. Discharge From Voluntary Treatment. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 7 A voluntary patient may seek discharge at any time. Unless properly invoking the provisions of this Act allowing for th eir retention, the psychiatric treatment facility must release volunta ry patients who request to be discharged within forty-eight (48) hours, not in cluding Saturdays, Sundays or holidays. ---------- ARTICLE 4 PETITION FOR ASSISTED TREATMENT § 82A401. Criteria. § 82A401. Criteria. (a) A person may be ordered to receive assisted out patient treatment (AOT) if the court finds that such person: (1) is eighteen (18) years of age or older; and (2) is suffering from mental illness; and (3) is an inpatient client or a client transitioning ou t of Mental Health Court; or (4) is an outpatient client or was a former client who is being treated or has been treated for mental illness at t he GBHWC; and (5) is unlikely to survive safely in the community with out supervision, based on clinical determination; and (6) has a history of poor

eated or has been treated for mental illness at t he GBHWC; and (5) is unlikely to survive safely in the community with out supervision, based on clinical determination; and (6) has a history of poor treatment compliance for ment al illness that has: (A) been a significant factor in his or her being in a hospital, prison or jail at least twice within the last thirt y-six (36) months for inflicting serious bodily injury upon others or upon himself; or (B) resulted in one or more acts, attempts or threats o f serious bodily injury toward self or others within the last forty- eight (48) months; and COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 8 (7) as a result of mental illness, is unlikely to volun tarily participate in outpatient treatment that would enab le him or her to live safely in the community; and (8) be, in view of his or her treatment and current beh avior, in need of assisted outpatient treatment in order to p revent relapse or deterioration which would likely result in: (A) a substantial risk of physical harm to the cons umer as manifested by threats or attempts at suicide or ser ious bodily injury or conduct demonstrating that the consumer i

would likely result in: (A) a substantial risk of physical harm to the cons umer as manifested by threats or attempts at suicide or ser ious bodily injury or conduct demonstrating that the consumer i s dangerous to himself or herself, or (B) a substantial risk of physical harm to other pe rsons as manifested by homicidal or other violent behavior b y which others are placed in reasonable fear of serious bodily inj ury; and (9) be likely to benefit from assisted outpatient treat ment. (b) A petition for an AOT order may be sought withi n the seventy-two (72) hour hold as provided when initiated pursuant to § 82201(h) of Chapter 82. ---------- ARTICLE 5 ASSISTED TREATMENT HEARING PROCEDURES § 82A501. Continuance. § 82A502. Location of Assisted Treatment Hearing. § 82A503. Attendance at Hearing. § 82A504. Expert Testimony Required at Hearing. § 82A505. Evidence Admissible at Hearing. § 82A506. Record of Hearing. § 82A507. Rights of Family Members. § 82A501. Continuance. The court may, for good cause, order a continuance of up to forty-eight (48) hours or, if this period ends on a Saturday, S unday or holiday, to the end of the next day on which the court is open.

e. The court may, for good cause, order a continuance of up to forty-eight (48) hours or, if this period ends on a Saturday, S unday or holiday, to the end of the next day on which the court is open. The continuance shall extend COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 9 the emergency treatment/observation period or any t emporary treatment order until the time of the hearing. § 82A502. Location of Assisted Treatment Hearing. For those currently admitted to an inpatient facili ty operated by the Guam Behavioral Health and Wellness Center, or its designee, assisted treatment hearings shall be held at the court. § 82A503. Attendance at Hearing. The hearing shall be open to anyone unless the respondent requests that it be closed, at which point only parties and their counsels, witnesses, members and staff of the GBHWC, and court personnel may be present. However, the court may approve a motion of an indiv idual to attend the trial upon a showing that the person has a substantial in terest in the proceeding. § 82A504. Expert Testimony Required at Hearing. (a) For a hearing on a certificate, a treating pro fessional who has examined the respondent since

erson has a substantial in terest in the proceeding. § 82A504. Expert Testimony Required at Hearing. (a) For a hearing on a certificate, a treating pro fessional who has examined the respondent since he or she was placed under emergency treatment/observation shall testify. (b) For a hearing on a petition, the testimony of a treating professional who has examined the respondent more recently than seven (7) calendar days before the petition was filed is required. (1) Such testimony may be presented by affidavit, unless respondent’s counsel requests of the petitioner or petitioner’s counsel, in writing, the presence of such a treating profess ional at the assisted treatment hearing. (2) A copy of this request must be filed with the court and made at least seventy-two (72) hours, excluding Saturdays, Sundays and holidays, prior to the hearing. (3) If planning to present the examining treating professional’s testimony by affidavit, counsel for the petitioner must present a copy of the affidavit either to respondent’s counsel or at the office of respondent’s counsel at least twenty-four (24) hour s, excluding Saturdays, Sundays and holidays, prior to the heari ng.

ent a copy of the affidavit either to respondent’s counsel or at the office of respondent’s counsel at least twenty-four (24) hour s, excluding Saturdays, Sundays and holidays, prior to the heari ng. (d) The procedures applicable when the respondent has not been examined prior to the hearing are delineated in § 8 2A601. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 10 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A505. Evidence Admissible at Hearing. The court may review any information it finds relev ant, material, and reliable, even if normally excluded under rules of evidence. § 82A506. Record of Hearing. No transcript is required to be kept of hearings be fore the court. § 82A507. Rights of Family Members. (a) A family member may file a motion for particip ation in the hearing. (b) The court may approve the preliminary motion o f such an individual to participate in the hearing upon a sho wing that the person has a substantial interest in the proceeding. (c) If the psychiatrist or physician so approves, the fami ly member may have the right to representation by counsel at his or her own expense, present

n has a substantial interest in the proceeding. (c) If the psychiatrist or physician so approves, the fami ly member may have the right to representation by counsel at his or her own expense, present evidence, cross-examine witnesses, and appeal. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 6 ASSISTED TREATMENT HEARING DISPOSITION § 82A601. Procedure After Failure to Comply With Or dered Evaluation. § 82A602. Consent Order. § 82A603. Assisted Treatment Order. § 82A604. Services Included in Order for Assisted O utpatient Treatment. § 82A605. Effect of Assisted Treatment Determinatio n on Other Rights. § 82A601. Procedure After Failure to Comply With Or dered Evaluation. (a) If the respondent presents good and credible c ause why he or she was not present for an ordered evaluation, the cour t shall continue the proceeding and issue another order for examination. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 11 (b) A hearing concerning an individual who fails t o comply, without good cause, with a court’s evaluation order shall still proceed.

10 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 11 (b) A hearing concerning an individual who fails t o comply, without good cause, with a court’s evaluation order shall still proceed. (c) An individual’s refusal, without good cause, t o comply with an evaluation order may be used as evidence of his or her need for treatment and incapability of making an informed medical deci sion. (d) If a continuance is ordered, the respondent shall be placed in a designated psychiatric facility and evaluated by a treating professional. (e) The continuance shall be for no more than seventy-two (72) hours or, if this period ends on a Saturday, Sunday or holiday, until the end of the next day on which the court is open. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A602. Consent Order. (a) At the hearing, the petitioner and respondent may proffer a mutually agreed upon proposed assisted treatment or der, known as a consent order. (1) The terms of the order must be consistent with those of an initial order for assisted treatment made pursuant to this Act.

greed upon proposed assisted treatment or der, known as a consent order. (1) The terms of the order must be consistent with those of an initial order for assisted treatment made pursuant to this Act. (2) The consent order must be accompanied by the t estimony, which may be by affidavit, of a treating profession al qualifying under § 82A201 that the suggested order is clinically appro priate for the respondent. (b) At its discretion, the court may enter the con sent order without a full hearing. Once entered, the consent order has t he same effect as an assisted treatment order issued pursuant to § 82A60 3. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A603. Assisted Treatment Order. (a) An order for assisted treatment, for its durat ion, subordinates the individual’s right to refuse the administration of medication or other minor medical treatment to the GBHWC, its designee, or an y other medical provider obligated to care for the person by the co urt in its order. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 12 (b) The treatment setting shall be the least restrictive possible and appropriate alternative.

n by the co urt in its order. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 12 (b) The treatment setting shall be the least restrictive possible and appropriate alternative. (c) An initial order for assisted treatment on an outpatient basis may be for up to one hundred eighty (180) calendar days. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A604. Services Included in Order for Assisted O utpatient Treatment. (a) An initial assisted treatment order directing care on an outpatient basis must include provisions for intensive case ma nagement. (b) The order may also require the patient to make use of and care providers to supply any or all of the following cat egories of services to the individual: (1) medication; (2) periodic blood tests or urinalysis to determine compliance with treatment; (3) individual or group therapy; (4) day or partial day programming activities; (5) educational and vocational training or activiti es; (6) alcohol or substance abuse treatment and counse ling, and periodic tests for the presence of alcohol or illeg al drugs for persons with a history of alcohol or substance abuse; (7)

r activiti es; (6) alcohol or substance abuse treatment and counse ling, and periodic tests for the presence of alcohol or illeg al drugs for persons with a history of alcohol or substance abuse; (7) supervision of living arrangements; and (8) any other services prescribed to treat the pers on’s mental illness and to assist the person in living and func tioning in the community, or to attempt to prevent a relapse or de terioration. (c) Any material modifications of the provisions o f the assisted treatment order to which the patient does not agree must be approved by the court. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 13 § 82A605. Effect of Assisted Treatment Determinatio n on Other Rights. The determination that a person is in need of assis ted treatment as an outpatient is not a determination that the patient is legally incomp etent or incapacitated for any purpose other than those set out in this Act. ---------- ARTICLE APPEALS § 82A701. Appeal or Review of Assisted Treatment De cision or Status. § 82A701.

legally incomp etent or incapacitated for any purpose other than those set out in this Act. ---------- ARTICLE APPEALS § 82A701. Appeal or Review of Assisted Treatment De cision or Status. § 82A701. Appeal or Review of Assisted Treatment De cision or Status. (a) Except where specifically prohibited by this Act, a decisi on of the psychiatrist or physician may be appealed to an app ropriate court of record within ten (10) calendar days of being entered. (b) The hearing of an appeal is de novo and must be held within seven (7) calendar days of the filing of the appeal. (c) The subject of the assisted treatment decision , the petitioner, and family members allowed as parties pursuant to § 82A 507 have the right to appeal. (d) The court of record may review any information it finds relevant, material, and reliable, even if normally excluded u nder rules of evidence. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 8 SAFEGUARDS § 82A801. Thirty (30)-Day Review for Medication Sid e Effects. § 82A802. Recommendation for Alternative Appropriat e Treatment. § 82A803. Grievance Procedure. § 82A804. Appeal of Grievance.

AFEGUARDS § 82A801. Thirty (30)-Day Review for Medication Sid e Effects. § 82A802. Recommendation for Alternative Appropriat e Treatment. § 82A803. Grievance Procedure. § 82A804. Appeal of Grievance. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 14 § 82A801. Thirty (30)-Day Review for Medication Sid e Effects. Each patient receiving medication pursuant to an as sisted treatment order shall be examined every thirty (30) days for serious side effects by his or her treating professional. § 82A802. Recommendation for Alternative Appropriat e Treatment. After an examination described in § 82A801 determin es, in his or her clinical judgment, that the patient has serious sid e effects from his or her current medication, the treating professional shall suggest, if available, an alternative appropriate treatment that will have fe wer side effects. § 82A803. Grievance Procedure. (a) There shall be a one-step grievance procedure made available t o patients on assisted outpatient treatment status. (b) Grievances concerning treatment may be made to the medical director of each inpatient facility.

a one-step grievance procedure made available t o patients on assisted outpatient treatment status. (b) Grievances concerning treatment may be made to the medical director of each inpatient facility. (c) Grievances about a patient’s treatment regimen may be brought by (1) the patient or on the patient’s behalf by his or her legal guardian or conservator; (2) his or her patient advocate; (3) any party at a hearing for the institution of or renewal of assisted treatment; or (4) his or her spouse, parent, adult child or, (5) if there is no relative of such degree, his or her closest living relative. (d) The grievance of a patient whose treating psyc hiatrist is the facility’s medical director shall be ruled on by a medical professional generally appointed for this purpose by the GBHWC o r its designee. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A804. Appeal of Grievance. (a) Grievances that are disallowed may be appealed to the court, which shall hear the appeal within fourteen (14) calendar days. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 15 (b) All rulings on appeals of grievances by the co urt are

, which shall hear the appeal within fourteen (14) calendar days. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 15 (b) All rulings on appeals of grievances by the co urt are final. (c) If the appeal of a grievance is denied, the pa tient it was brought either by or for is barred from appealing, and othe rs from doing so on his or her behalf, any other grievances to the court for a period of ninety (90) days. (d) This limitation of appeal does not otherwise alter the patient’s right to bring grievances in accordance with the provisio ns of § 82A803. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 9 ASSISTED OUTPATIENT TREATMENT § 82A901. Enforcement of Assisted Outpatient Treatm ent Order. § 82A902. Transfer to Inpatient Care. § 82A901. Enforcement of Assisted Outpatient Treatm ent Order. (a) An assisted outpatient treatment order’s requi rement to maintain treatment can be enforced for non-compliance. (b) On the signature of a supervising psychiatrist , the order may be enforced either at the patient’s residence or at a treatment center designated by the GBHWC or its designee, whichever the

iance. (b) On the signature of a supervising psychiatrist , the order may be enforced either at the patient’s residence or at a treatment center designated by the GBHWC or its designee, whichever the patient chooses. (c) Patients who physically resist or fail to sele ct a treatment location shall be treated at a treatment center designated by GBH WC. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A902. Transfer to Inpatient Care. (a) The procedures used to determine whether a pat ient under an assisted treatment order who is on outpatient statu s should be placed in inpatient care are the same as those for initial pl acement in assisted treatment. (b) A patient who meets the criteria for emergency treatment shall immediately be given care in an inpatient facility, but a hearing is still necessary to confirm this transfer to inpatient sta tus. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 16 (c) At the hearing, the court shall order the patient’s transfer to or continued placement in inpatient care, depending on his or her status pending the hearing, if such treatment setting is t he least restrictive form

the court shall order the patient’s transfer to or continued placement in inpatient care, depending on his or her status pending the hearing, if such treatment setting is t he least restrictive form that will meet the patient’s clinical needs. (d) A patient’s failure to comply with an order fo r assisted treatment while in the community may be used as evidence that outpatient placement is not an appropriate treatment setting for that individu al. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 10 REVIEW OF STATUS § 82A1001. Request for Review of Assisted Treatment Status. § 82A1002. Notice of Status Review Hearing. § 82A1001. Request for Review of Assisted Treatment Status. (a) If the time for appeal of his or her most rece nt assisted treatment order or renewal has expired, a patient may request a review of his or her assisted treatment status by the treating psychiatr ist or qualified mental health professional. (b) The psychiatrist or qualified mental health pr ofessional shall review the request within fourteen (14) calendar days.

tatus by the treating psychiatr ist or qualified mental health professional. (b) The psychiatrist or qualified mental health pr ofessional shall review the request within fourteen (14) calendar days. (c) A patient may request a review of status heari ng no more than once every one hundred eighty (180) days. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1002. Notice of Status Review Hearing. (a) Notice of the status review hearing shall be mailed at least seven (7) calendar days in advance to the patient; the patien t’s legal guardian or conservator, if known; the patient’s counsel, if known; an adult me mber of the patient’s household, if known; and anyone recognized as a party at the initial assisted treatment hearing or any subsequen t renewal hearings. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 17 (b) Timely actual notice shall fulfill the notice requirement for any given individual. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 11 RENEWALS § 82A1101. Renewal of Assisted Treatment Order. § 82A1102. Duration of Renewal Period. § 82A1101.

ion designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 11 RENEWALS § 82A1101. Renewal of Assisted Treatment Order. § 82A1102. Duration of Renewal Period. § 82A1101. Renewal of Assisted Treatment Order. The process for renewing an assisted treatment orde r is the same as for the application for an original assisted treatment order by petition, except that notice of the renewal hearing, as provided in § 82A504, shall also be sent to anyone recognized as a party at the initial assisted treatment hearing or any subsequent renewal hearings. § 82A1102. Duration of Renewal Period. (a) The first renewal for an assisted outpatient t reatment period may last up to one hundred eighty (180) days and subseq uent renewals up to three hundred sixty (360) days thereafter. (b) A subsequent renewal for an assisted outpatien t treatment period may last up to three hundred sixty (360) days. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 12 PROCEDURES FOR DISCHARGE § 82A1201. Discharge Prior to the Expiration of Ass isted Treatment Period. § 82A1202. Notice of Discharge. § 82A1203.

thori ty granted by 1 GCA § 1606. ---------- ARTICLE 12 PROCEDURES FOR DISCHARGE § 82A1201. Discharge Prior to the Expiration of Ass isted Treatment Period. § 82A1202. Notice of Discharge. § 82A1203. Discharge Plan Requirement. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 18 § 82A1204. Early Discharge Hearing. § 82A1201. Discharge Prior to the Expiration of Ass isted Treatment Period. (a) A patient in assisted outpatient treatment may be discharged on the signature of both the treating medical professional and the medical director of the facility. (b) A patient under an assisted treatment order wh o is on outpatient status may be discharged on the signature of the tr eating medical professional and the director of the outpatient pro gram. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1202. Notice of Discharge. Notice of discharge from an assisted treatment orde r shall be mailed at least seventy-two (72) hours before the planned dis charge to (a) the petitioner; (b) the patient’s legal guardian or conservator, i f known; (c) the patient’s counsel, if known; (d) an adult member of the patient’s household,

s before the planned dis charge to (a) the petitioner; (b) the patient’s legal guardian or conservator, i f known; (c) the patient’s counsel, if known; (d) an adult member of the patient’s household, if known; and (e) anyone recognized as a party at the initial as sisted treatment hearing or any subsequent renewal hearings. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1203. Discharge Plan Requirement. (a) Any patient placed on assisted outpatient trea tment must be given a treatment plan at the time of discharge from inpati ent care and placement on an assisted outpatient treatment program for a peri od anticipated being greater than seventy-two (72) hours. (b) An outpatient treatment plan may include, but is not limited to, (1) suggested medication; (2) individual or group therapy; (3) day or partial day programming activities; COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 19 (4) services and training, including educational a nd vocational activities; (5) residential supervision; (6) intensive case management services; and (7) living arrangements.

OUTPATIENT TREATMENT 19 (4) services and training, including educational a nd vocational activities; (5) residential supervision; (6) intensive case management services; and (7) living arrangements. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1204. Early Discharge Hearing. A hearing before the court to determine the appropr iateness of the discharge of a patient prior to the expiration of h is or her assisted treatment period may be demanded as a matter of right by (a) the petitioner; (b) the patient’s legal guardian or conservator, i f known; (c) an adult member of the patient’s household, if known; and (d) anyone recognized as a party at the initial as sisted treatment hearing or any subsequent renewal hearings. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. ---------- ARTICLE 13 EMERGENCY TREATMENT /O BSERVATION - CERTIFICATION § 82A1301. Emergency Treatment Initiated by Law Enf orcement Officers. § 82A1302. Emergency Treatment Initiated by Others. § 82A1303. Transportation to Emergency Facility. § 82A1304. Evaluation. § 82A1305. Immediate Release. § 82A1306. Certification.

orcement Officers. § 82A1302. Emergency Treatment Initiated by Others. § 82A1303. Transportation to Emergency Facility. § 82A1304. Evaluation. § 82A1305. Immediate Release. § 82A1306. Certification. § 82A1307. Requirements of Certificate. § 82A1308. Criminal Penalty. § 82A1309. Initial Responsibilities of Court After Certificate is Filed. § 82A1310. Notice of Hearing on Certificate. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 20 § 82A1311. Duration of Emergency Treatment/Observat ion. § 82A1312. Treatment During Emergency Treatment/ Ob servation. § 82A1301. Emergency Treatment Initiated by Law Enf orcement Officers. (a) At the request of the treating physician, or a t the discretion of any law enforcement officer with the power of arrest, a ny person generally designated to do so by the government of Guam may b ring to a designated facility for evaluation any person on assisted outp atient treatment that the officer has reasonable cause to believe has a sever e psychiatric disorder and, because of the disorder, is a danger to himself, he rself or to others or is gravely disabled.

tient treatment that the officer has reasonable cause to believe has a sever e psychiatric disorder and, because of the disorder, is a danger to himself, he rself or to others or is gravely disabled. (b) If a physician determines that someone under a n AOT order is non- compliant with the court order and may need involun tary hospitalization, the physician may arrange for the individual to be tran sported to a hospital and retained for an evaluation not to exceed seventy-tw o (72) hours to determine if inpatient care and treatment are necessary. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1302. Emergency Treatment Initiated by Others. (a) Any psychiatrist, other physician, or qualifie d mental health professional as designated pursuant to § 82101(g) o f Chapter 82, who has been generally designated to do so by the governmen t of Guam or GBHWC may initiate emergency treatment/observation based on a good faith belief that because of a severe psychiatric disorder a per son is either a danger to himself or herself, a danger to others, or gravely disabled.

emergency treatment/observation based on a good faith belief that because of a severe psychiatric disorder a per son is either a danger to himself or herself, a danger to others, or gravely disabled. (b) Any such person who determines the need for em ergency treatment/observation but who is not authorized to transport such individuals to a psychiatric facility may direct any person enu merated in § 82A1303 to do so. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1303. Transportation to Emergency Facility. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 21 Protesting individuals may only be transported by law enforcement officers with the power of arrest, the Guam Fire De partment, or others who have been designated to perform this function by th e government of Guam. § 82A1304. Evaluation. A psychiatrist or other physician shall evaluate an individual in emergency treatment/observation within twenty-four (24) hours of the individual’s placement in a designated psychiatric facility. § 82A1305. Immediate Release. An individual shall be released from emergency treatment/observation unless the psychiatrist or

hours of the individual’s placement in a designated psychiatric facility. § 82A1305. Immediate Release. An individual shall be released from emergency treatment/observation unless the psychiatrist or other physician who performs t he evaluation determines that the individual is either a danger t o himself, herself or others or is gravely disabled. § 82A1306. Certification. (a) If the examining psychiatrist or other physici an who performs the evaluation determines, in his or her clinical opini on, that the individual is a danger to himself, herself or to others or is grave ly disabled, he or she must file, or cause to be filed by another psychiatrist or other physician who has also examined the individual, a certificate with th e court. (b) The certificate shall be filed with the court within twenty-four (24) hours of the initial examination, not including Sat urdays, Sundays or holidays. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1307. Requirements of Certificate. The certificate shall be in writing, executed under oath, and shall include the following information: (a) the name and address, if known, of the responde nt; (b) the

07. Requirements of Certificate. The certificate shall be in writing, executed under oath, and shall include the following information: (a) the name and address, if known, of the responde nt; (b) the name and address, if known, of the respondent’s spouse, legal counsel, conservator or guardian, and next-of -kin; (c) the name and address, if known, of anyone curre ntly providing psychiatric care to the respondent; COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 22 (d) the names and addresses, if known, of other per sons with knowledge of the respondent’s mental illness who ma y be called as witnesses at the assisted treatment hearing; (e) the name and work address of the certifying psy chiatrist or other physician; (f) the name and address of the facility in which t he respondent is undergoing emergency treatment/observation; (g) the certifying psychiatrist or other physician’ s statement that he or she has examined the respondent since the res pondent was placed in emergency treatment/observation; and (h) the certifying psychiatrist or other physician’ s statement that, in his or her clinical opinion, the respondent is a danger to himself, herself or to

aced in emergency treatment/observation; and (h) the certifying psychiatrist or other physician’ s statement that, in his or her clinical opinion, the respondent is a danger to himself, herself or to others, or gravely disabled, and the clinical basis for this opinion. § 82A1308. Criminal Penalty. It shall be a crime to knowingly file, or cause to be filed, a certificate that contains a false material statement or informa tion. § 82A1309. Initial Responsibilities of Court After Certificate is Filed. After the filing of the certificate, the court shall : (a) schedule a hearing on the certificate that will occur no more than seventy-two (72) hours, not including Saturday s, Sundays and holidays, after the initial examination; and (b) designate counsel for the respondent no less th an twenty-four (24) hours prior to the hearing. § 82A1310. Notice of Hearing on Certificate. (a) The court shall notify (1) the certifying psychiatrist or other physician , (2) respondent, and (3) the respondent’s legal guardian or conservator , if known, of the scheduled hearing on the certificate at leas t twenty-four (24) hours in advance. COL62201610 GCA HEALTH AND SAFETY CH.

dent, and (3) the respondent’s legal guardian or conservator , if known, of the scheduled hearing on the certificate at leas t twenty-four (24) hours in advance. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 23 (b) The court must also attempt to notify of the p ending hearing, at least twenty-four (24) hours in advance, (1) an adult member of respondent’s household , if known, and (2) up to five (5) individuals of the respondent’s choice. (c) Notice may be either by mail, personal deliver y, telephone, or reliable electronic means. (d) Timely actual notice shall fulfill the notice requirement for any given individual. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1311. Duration of Emergency Treatment/Observat ion. (a) Absent the exercise of other applicable provis ions of this Act, the period of emergency treatment/observation may last no more than seventy- two (72) hours after the initial examination, not i ncluding Saturdays, Sundays or holidays. (b) Anyone who is determined by the examining or a treating physician not to be a danger to himself, herself, or others, or gravely disabled, must be released

ncluding Saturdays, Sundays or holidays. (b) Anyone who is determined by the examining or a treating physician not to be a danger to himself, herself, or others, or gravely disabled, must be released from emergency treatment/observation. (c) The initial assisted treatment hearing shall take place before the end of the treatment/observation period. 2015 SOURCE: Subsection designations added pursuant to authori ty granted by 1 GCA § 1606. § 82A1312. Treatment During Emergency Treatment/ Ob servation. During the emergency treatment/observation period, treatment may be administered if the person is, in the clinical opin ion of a treating professional, a danger to himself, herself or other s, or is gravely disabled. ---------- ARTICLE 14 ACCOUNTABILITY § 82A1401. Treatment Provider Liability. COL62201610 GCA HEALTH AND SAFETY CH. 82A ASSISTED OUTPATIENT TREATMENT 24 § 82A1401. Treatment Provider Liability. In addition to other limitations on liability set o ut elsewhere in this Chapter or applicable law, persons providing care t o patients placed in assisted treatment pursuant to this Chapter shall only be liable for harm subsequently caused by or to individuals who are di scharged

or applicable law, persons providing care t o patients placed in assisted treatment pursuant to this Chapter shall only be liable for harm subsequently caused by or to individuals who are di scharged from assisted outpatient treatment if the discharge of the indivi dual was reckless or grossly negligent. ---------- ARTICLE 15 PATIENT BILL OF RIGHTS § 82A1501. Rights of All Individuals in Assisted Tr eatment. § 82A1501. Rights of All Individuals in Assisted Tr eatment. All patients placed in assisted treatment pursuant to this Chapter have the following rights: (a) the right to appointed counsel at the initial a ssisted treatment hearing, reviews of status, subsequent renewal hear ings of orders for assisted treatment, and appeals of these proceeding s; (b) the right for the patient and his or her legal guardian or conservator, if known, to receive a written list of all rights enumerated in this Chapter; (c) the right to appropriate treatment, which shall be administered skillfully, safely, and humanely. Each patient placed in assisted treatment pursuant to this Chapter shall receive treatment suited to his or her needs, which shall include such medical, vocational, social,

lly, safely, and humanely. Each patient placed in assisted treatment pursuant to this Chapter shall receive treatment suited to his or her needs, which shall include such medical, vocational, social, educational, and rehabilitative services as the patient’s condition requires; and (d) the right at all times to be treated with consi deration and respect for his or her privacy and dignity. ---------- COL622016 COL622016