Substitute Senate Bill No. 1048

Public Act No. 99-234

An Act Concerning Technical Revisions to the Department of Mental Health and Addiction Services Statutes and Borrowings by District Departments of Health.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Subsection (b) of section 17a-450 of the general statutes is repealed and the following is substituted in lieu thereof:

(b) For the purposes of chapter 50, the Department of Mental Health and Addiction Services shall be a single budgeted agency. It shall consist of two divisions, the Division of Mental Health Services and the Division of Substance Abuse Services, that shall be organized to promote comprehensive, client-based services in the areas of mental health treatment and substance abuse treatment and to ensure the programmatic integrity and clinical identity of services in each area. The department shall perform the functions of: Centralized administration, planning and program development; prevention and treatment programs and facilities, both inpatient and outpatient, for persons with psychiatric disabilities or persons with substance abuse disabilities, or both; community mental health centers and community or regional programs and facilities providing services for persons with psychiatric disabilities or persons with substance abuse disabilities, or both; training and education; and research and evaluation of programs and facilities providing services for persons with psychiatric disabilities or persons with substance abuse disabilities, or both. The department shall include, but not be limited to, the following divisions and facilities or their successor facilities: The office of the Commissioner of Mental Health and Addiction Services; Capitol Region Mental Health Center; Connecticut Valley Hospital; the Connecticut Mental Health Center; the Whiting Forensic Division; Ribicoff Research Center; Cedarcrest Hospital; the Southwest Connecticut Mental Health System, including the Franklin S. DuBois Center [;] and the Greater Bridgeport Community Mental Health Center; the Southeastern Mental Health Authority; River Valley Services; the Western Connecticut Mental Health Network; and any other state-operated facility for the treatment of persons with psychiatric disabilities or persons with substance abuse disabilities, or both, but shall not include those portions of such facilities transferred to the Department of Children and Families for the purpose of consolidation of children's services.

Sec. 2. Subsection (t) of section 17a-451 of the general statutes is repealed and the following is substituted in lieu thereof:

(t) The commissioner shall adopt regulations to establish a fair hearing process which provides the right to appeal final determinations [of the Mental Health Division] of the Department of Mental Health and Addiction Services or of [said division's] its grantee agencies as determined by the commissioner regarding: The nature of denial, involuntary reduction or termination of services. Such hearings shall be conducted in accordance with the provisions of chapter 54, after a person has exhausted the department's established grievance procedure. Any matter which falls within the jurisdiction of the Psychiatric Security Review Board under sections 17a-580 to 17a-603, inclusive, shall not be subject to the provisions of this section. Any person receiving services from a Department of Mental Health and Addiction Services facility or a grantee agency determined by the commissioner to be subject to this subsection and who is aggrieved by a violation of sections 17a-540 to 17a-549, inclusive, may elect to either use the procedure specified in this subsection or file for remedies under section 17a-550.

Sec. 3. Subsection (b) of section 17a-473 of the general statutes is repealed and the following is substituted in lieu thereof:

(b) Subject to the standards established by the Commissioner of Mental Health and Addiction Services for the operation of state-operated facilities constituting the Department of Mental Health and Addiction Services for the treatment of [the mentally disordered] persons with psychiatric disabilities or persons with substance abuse disabilities, or both, each superintendent or director of such a facility shall be in charge of its day-to-day operations.

Sec. 4. Section 17a-679 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) The Department of Mental Health and Addiction Services shall pay the expenses of necessary transportation for any alcohol-dependent person admitted to a treatment facility pursuant to the provisions of section 17a-682 or 17a-684 or to any program funded by the department pursuant to section 17a-675, provided such program has given prior approval to the transportation provider and so certifies to the department, or for any person intoxicated by alcohol transported to a hospital for treatment, which expenses are certified by such hospital to the department, unless the Department of Administrative Services determines after investigation that such person is able to pay. The department may pay such expense pending the investigation provided if the department determines that the person is able to pay, the transportation provider shall reimburse the department. The department shall not pay expenses for the transport of any person who is able to pay, has private insurance, or is receiving Title XIX [or general assistance benefits which] Medicaid benefits that cover the transportation services provided.

(b) The Office of Emergency Medical Services within the Department of Public Health shall be responsible for developing and implementing dispatch and field triage protocols to provide a mechanism for local response systems to utilize the least costly most appropriate form of transport for alcohol-dependent persons. Such dispatch and field protocols shall be developed on or before January 1, 1995.

(c) The department may adopt regulations, in accordance with provisions of chapter 54, concerning the payment of transportation expenses under this section.

Sec. 5. Section 17a-688 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) All records maintained by the court of cases coming before it under the provisions of sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, shall be sealed and available only to the respondent or his counsel unless the court, after hearing held with notice to the respondent, determines such record should be disclosed for cause shown.

(b) Medical treatment facilities shall keep and submit such records of all persons examined, admitted or treated pursuant to sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, as may be required by the [Department of Public Health] department.

(c) No person, hospital, treatment facility or the department may disclose or permit the disclosure of the identity, diagnosis, prognosis or treatment of any such patient that would constitute a violation of federal statutes concerning confidentiality of alcohol or drug patient records and any regulations pursuant thereto, or as they may be amended from time to time. The department shall adopt regulations to protect the confidentiality of information obtained by it.

(d) If the person seeking treatment or rehabilitation for alcohol dependence or drug dependence is a minor, the fact that the minor sought such treatment or rehabilitation or that he is receiving such treatment or rehabilitation, shall not be reported or disclosed to the parents or legal guardian of the minor without his consent. The minor may give legal consent to receipt of such treatment and rehabilitation. A minor shall be personally liable for all costs and expenses for alcohol and drug dependency treatment afforded him at his request under section 17a-682.

(e) The [Commissioner of Public Health] commissioner may use or make available to authorized persons information from patients' records for purposes of conducting scientific research, management audits, financial audits, or program evaluation, provided such information shall not be utilized in a manner that discloses a patient's name or other identifying information.

Sec. 6. Subsection (c) of section 17a-673 of the general statutes is repealed and the following is substituted in lieu thereof:

(c) The department shall provide for adequate and appropriate treatment for alcohol-dependent persons, drug-dependent persons and intoxicated persons admitted under sections 17a-465a [, 17a-677] and 17a-680 to 17a-690, inclusive. Treatment may not be provided at a correctional institution except for inmates.

Sec. 7. Section 17a-680 of the general statutes is repealed and the following is substituted in lieu thereof:

For purposes of sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, and subsection (d) of section 17a-484:

(1) "Alcohol-dependent person" means a person who has a psychoactive substance dependence on alcohol as that condition is defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders";

(2) "Business day" means Monday to Friday, inclusive, except when a legal holiday falls on any such day;

(3) "Department" means the Department of Mental Health and Addiction Services;

(4) "Dangerous to himself" means there is a substantial risk that physical harm will be inflicted by a person on himself;

(5) "Dangerous to others" means there is a substantial risk that physical harm will be inflicted by a person on another person;

(6) "Drug or drugs" means a controlled drug as defined in section 21a-240;

(7) "Drug-dependent person" means a person who has a psychoactive substance dependence on drugs as that condition is defined in the most recent edition of the American Psychiatric Association's "Diagnostic and Statistical Manual of Mental Disorders";

(8) "Commissioner" means the Commissioner of Mental Health and Addiction Services;

(9) "Gravely disabled" means a condition in which a person, as a result of the use of alcohol or drugs on a periodic or continuous basis, is in danger of serious physical harm because (A) he is not providing for his essential needs such as food, clothing, shelter, vital medical care, or safety, (B) he needs, but is not receiving, inpatient treatment for alcohol dependency or drug dependency and (C) he is incapable of determining whether to accept such treatment because his judgment is impaired;

(10) "Hospital" means an establishment licensed under the provisions of sections 19a-490 to 19a-503, inclusive, for the lodging, care and treatment of persons suffering from disease or other abnormal physical or mental conditions, and includes inpatient psychiatric services in general hospitals;

(11) "Incapacitated by alcohol" means a condition in which a person as a result of the use of alcohol has his judgment so impaired that he is incapable of realizing and making a rational decision with respect to his need for treatment;

(12) "Incompetent person" means a person who has been adjudged incompetent by a court of competent jurisdiction;

(13) "Intoxicated person" means a person whose mental or physical functioning is substantially impaired as a result of the use of alcohol or drugs;

(14) "Medical officer" means a licensed physician in attendance at a treatment facility or hospital;

(15) "Respondent" means a person who is alleged to be alcohol-dependent or drug-dependent and for whom a petition for commitment or recommitment to an inpatient treatment facility has been filed;

(16) "Treatment" means any emergency, outpatient, intermediate and inpatient services and care, including diagnostic evaluation, medical, psychiatric, psychological and social services, vocational and social rehabilitation and other appropriate services, which may be extended to alcohol-dependent persons, drug-dependent persons and intoxicated persons;

(17) "Treatment facility" means (A) a facility providing treatment and operating under the direction and control of the department or (B) a private facility providing treatment and licensed under the provisions of sections 19a-490 to 19a-503, inclusive.

Sec. 8. Section 17a-689 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) No medical officer or staff member of a treatment facility or hospital who submits any report or files any petition required or authorized by sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, shall be held to have violated any otherwise confidential relationship.

(b) Any medical officer or staff member of a treatment facility or hospital acting in compliance with sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, shall be deemed to be acting in the course of his official duty and shall not be criminally or civilly liable therefor.

(c) Any police officer acting in compliance with sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, shall be deemed to be acting in the course of official duty and shall not be criminally or civilly liable therefor.

(d) Any person who is lawfully designated to assist in protective custody and transport under the provisions of section 17a-683 shall be deemed to be acting in the course of official duty and shall not be criminally or civilly liable therefor.

(e) Any person who wilfully and knowingly causes or attempts to cause any person not an alcohol-dependent person or not a drug-dependent person to be committed pursuant to section 17a-684, or section 17a-685, or any person who knowingly makes a false statement of fact or belief in any petition, certificate or report required by sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, or any person who wilfully and knowingly reports falsely to any court, judge, prosecutor or law enforcement officer that any person is an alcohol-dependent person or a drug-dependent person, may be imprisoned not more than one year or fined not more than one thousand dollars or both.

(f) Any person who fraudulently makes application for treatment as a drug-dependent person, or who makes more than one application for such treatment with the intent of obtaining controlled drugs in excess of that provided for a patient in treatment or to conceal or thwart a prior treatment program at another or the same treatment facility, shall be fined not more than five hundred dollars or imprisoned not more than one year, or both.

Sec. 9. Subsection (c) of section 17a-690 of the general statutes is repealed and the following is substituted in lieu thereof:

(c) Nothing in sections 17a-465a, 17a-673 [, 17a-677] and 17a-680 to 17a-690, inclusive, shall affect any law against driving under the influence of alcoholic liquor, or other similar offense involving the operation of a vehicle, aircraft, boat, machinery or other equipment, or regarding the sale, purchase, dispensing, possessing or use of alcoholic beverages at stated times and places or by a particular class of persons.

Sec. 10. Subsection (a) of section 19a-241 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Towns, cities and boroughs, by vote of their respective legislative bodies, after a public hearing, may unite to form district departments of health, which shall be instrumentalities of their constituent municipalities. The affairs of any such district department of health shall be managed by a board, which shall have all the duties exercised or performed immediately prior to the effective date of the creation of such district by directors of health or boards of health of the municipalities and which shall exercise all the authority as to public health required of or conferred upon the constituent municipalities by law and shall have the powers of the district set forth in section 19a-243, as amended by this act. Towns, cities and boroughs may, in like manner, join a district department of health previously formed with the approval of the board of such district.

Sec. 11. Section 19a-243 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Each such board may make and [promulgate] adopt reasonable rules and regulations for the promotion of general health within the district not in conflict with law or with the Public Health Code. The powers of [the board] each district shall include but not be limited to the following enumerated powers: To sue and be sued; to make and execute contracts and other instruments necessary or convenient to the exercise of the powers of the health district; to make and from time to time amend and repeal bylaws, rules and regulations; to acquire real estate; to provide for the financing of the programs, projects or other functions of the district in the manner described in subsection (b) of this section; and to have whatever other powers are necessary to properly carry out their powers as an independent entity of government.

(b) A district may, without limiting its authority under other provisions of law, borrow money for the purpose of carrying out or administering a district project, program or other function authorized under chapter 368f, or for the purpose of refinancing existing indebtedness, or temporarily in anticipation of receipt of current revenues, and provided the board shall hold a public hearing on any such proposed borrowing which is estimated by the board to increase the annual apportionment of district expenses made pursuant to subsection (c) of this section by more than seven per cent over levels currently established. The board shall give one week's notice of such hearing in a newspaper having a circulation in each constituent municipality of the district. The district may enter into note, loan or other agreements providing that such borrowings shall be payable from or secured by one or more of the following: (1) A pledge, lien, mortgage or other security interest in any or all of the income, proceeds, revenues and property, real or personal, of its projects, assets, programs or other functions, including the proceeds of payments, grants, loans, advances, guarantees or contributions from the federal government, the state of Connecticut, the constituent municipalities of the district or any other source; or (2) a pledge, lien, mortgage or other security interest in the property, real or personal, of projects to be financed by the borrowing. Such borrowings and obligations shall not constitute an indebtedness within the meaning of any debt limitation or restrictions on, and shall not be obligations of, the state of Connecticut or any municipality. No constituent municipality of a district shall be liable for any such borrowing or obligation of the district upon default. Neither members of the board nor any person executing on behalf of the district any note, mortgage, pledge, loan, security or other agreement in connection with the borrowing of money by a district shall be personally liable on the obligations thereunder or be subject to any personal liability or accountability by reason of the entrance into such agreements. Each pledge, agreement or assignment made for the benefit or security of any such borrowing entered into pursuant to this subsection shall be in effect until the principal and interest on such borrowing for the benefit of which the same were made have been fully paid, or until provision is made for the payment in the manner provided therein. Any pledge or assignment made in respect of such borrowing secured thereby shall be valid and binding from the time when the pledge or assignment is made; any income, proceeds, revenues or property so pledged or assigned and thereafter received by the district shall immediately be subject to the lien of such pledge, without any physical delivery thereof or further act; and the lien of any such pledge or assignment shall be valid and binding as against parties having claims of any kind in tort, contract or otherwise against the district irrespective of whether such parties have notice thereof. Neither the resolution, trust indenture, agreement, assignment or other instrument by which a pledge is created need be recorded or filed, except for the recording of any mortgage or lien on real property or on any interest in real property.

[(b)] (c) The board shall meet at least quarterly and at other times determined by the [chairman] chairperson. At its September meeting it shall elect a [chairman] chairperson and it shall furnish the necessary offices and equipment to enable it to carry out its duties. The board may elect an executive committee, consisting of the [chairman] chairperson and two other members, and the director of health, who shall serve without a vote, and such executive committee shall have power to act when the board is not in session. The fiscal year of each district department of health shall be from July first to June thirtieth, and, by June thirtieth in each year, the board shall estimate the amount of money required to pay the costs and expenses of the district during the ensuing fiscal year, provided, if any municipality within the district has a fiscal year which begins on July first, such estimate shall be made by April thirtieth of each year. Such board shall hold a public hearing on its proposed budget, two weeks' notice of which shall be given in a newspaper having a circulation in each constituent municipality of such district. From time to time the board shall draw upon the treasurer of each town, city or borough within the district a proportionate share of the expenses of such district, from such funds as may have been appropriated by each, to pay the cost of operating the district, including debt service on borrowings of the district, such apportionment to be made equitable on a per capita basis as established by the last annual population estimate by the Department of Public Health for each participating town, city or borough.

Sec. 12. Section 19a-246 of the general statutes is repealed and the following is substituted in lieu thereof:

(a) Any constituent town, city or borough may, by vote passed prior to January first in any year, withdraw from the district, such withdrawal to become effective on the first day of July following, provided such city, town or borough shall have been a member of the district for at least twenty-four months prior to such vote of withdrawal. A city, town or borough on withdrawal shall at once resume such status with respect to the appointment of its director of health, employees and board of health as it held prior to becoming a member of the district as provided in section 19a-244. Employees shall not lose any benefits or civil services status as a result of the withdrawal from the district.

(b) Notwithstanding the provisions of subsection (a) of this section, no withdrawal or termination of participation by any constituent municipality shall affect any pledge, agreement, assignment or mortgage of any income, revenue proceeds or property of a district made for the benefit or security of any borrowing of the district entered into pursuant to subsection (b) of section 19a-243, as amended by this act.

(c) Notwithstanding any other provision of the general statutes, no district shall cease to exist until such time as payment or provision for payment of the outstanding balance of borrowings of such district entered into pursuant to subsection (b) of section 19a-243, as amended by this act, is made.

Sec. 13. Section 17a-677 of the general statutes is repealed.

Sec. 14. This act shall take effect from its passage, except that sections 1 to 9, inclusive, and section 13 shall take effect October 1, 1999.

Approved June 29, 1999

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