An Act To Correct Errors and Inconsistencies in the Laws of Maine
Maine Legislature, Session 123, LD 2252
House Amendment HA_C_H1044 (House)
Amends: 34-B MRSA §3861

HOUSE AMENDMENT "(!,.,, to H.P. 1615, LD. 2252, Bill, "An Act To Correct 
Errors and Inconsistencies in the Laws of Maine" 
Amend the bill by inserting after Part B the following: 
'PARTC 
Sec. C-l. 34-B MRSA §3861, sub-§3, as enacted by PL 2007, c. 580, §2, IS 
amended to read: 
3. Involuntary treatment. Except for involuntary treatment ordered pursuant to the 
provisions of section 3864, subsection 7-A, involuntary treatment of a patient at a 
designated nonstate mental health institution or a state mental health institute who is an 
involuntarily committed patient under the provisions of this subchapter may be ordered 
and administered only in conformance with the provisions of this subsection. For the 
purposes of this subsection, involuntary treatment is limited to medication for the 
treatment of mental illness and laboratory testing and medication for the monitoring and 
management of side effects. 
A. If the patient's primary treating physician proposes a treatment that the physician, 
in the exercise of professional judgment, bel ieves is in the best interest of the patient 
and if the patient lacks clinical capacity to give informed consent to the proposed 
treatment and the patient is unwilling or unable to comply with the proposed 
treatment, the patient's primary treating physician shall request in writing a clinical 
review of the proposed treatment by a clinical review panel. For a patient at a state 
mental health institute, the request must be made to the superintendent of the institute 
or the designee of the superintendent. For a patient at a designated nonstate mental 
health institution, the request must be made to the chief administrative officer or the 
designee of the chief administrative officer. The request must include the following 
information: 
(I) The name of the patient, the patient's diagnosis and the unit on which the 
patient is hospitalized; 
(2) The date that the patient was committed to the institution or institute and the 
period of the court-ordered commitment; 
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HOUSE AMENDMENT "c"to H.P. 1615, L.D. 2252 
(3) A statement by the primary treating physician that the patient lacks capacity 
to give informed consent to the proposed treatment. The statement must include 
documentation of a 2nd opinion that the patient lacks that capacity, given by a 
professional qualified to issue such an opinion who does not provide direct care 
to the patient but who may work for the institute or institution; 
(4) 
A description of the proposed course of treatment, including specific 
medications, routes of administration and dose ranges, proposed alternative 
medications or routes of administration, if any, and the circumstances under 
which any proposed alternative would be used; 
(5) A description of how the proposed treatment will benefit the patient and 
ameliorate identified signs and symptoms of the patient's psychiatric illness; 
(6) A listing of the known or anticipated risks and side effects of the proposed 
treatment and how the prescribing physician will monitor, manage and minimize 
the risks and side effects; 
(7) Documentation of consideration of any underlying medical condition of the 
patient that contraindicates the proposed treatment; and 
(8) Documentation of consideration of any advance health-care directive given 
in accordance with Title 18-A, section 5-802 and any declaration regarding 
medical treatment of psychotic disorders executed in accordance with section 
11001. 
B. The provisions of this paragraph apply to the appointment, duties and procedures 
of the clinical review panel under paragraph A. 
(1) Within one business day of receiving a request under paragraph A, the 
superintendent of a state mental health institute or chief administrative officer of 
a designated nonstate mental health institution or that person's designee shall 
appoint a clinical review panel of 2 or more licensed professional staff who do 
not provide direct care to the patient. At least one person must be a professional 
icensed to prescribe medication relevant to the patient's care and treatment. At 
the time of appointment of the clinical review panel, the superintendent of a state 
mental health institute or chief administrative officer of a designated nonstate 
mental health institution or that person's designee shall notify the following 
persons in writing that the clinical review panel will be convened: 
(a) The primary treating physician; 
(b) The director of the Office of Adult Mental Health Services within the 
department or that person's designee; 
(c) The patient's designated representative or attorney, if any; 
(d) The State's designated federal protection and advocacy agency; and 
(e) The patient. Notice to the patient must inform the patient that the clinical 
review panel will be convened and of the right to assistance from a lay 
advisor, at no expense to the patient, and the right to obtain an attorney at the 
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patient's expense. The notice must include contact information for requesting 
assistance from a lay advisor, who may be employed by the institute or 
institution, and access to a telephone to contact a lay advisor must be 
provided to the patient. 
(2) Within 4 days of receiving a request under paragraph A and no less than 24 
hours before the meeting of the clinical review panel, the superintendent of a 
state mental health institute or chief administrative officer of a designated 
nonstate mental health institution or that person's designee shall provide notice of 
the date, time and location of the meeting to the patient's primary treating 
physician, the patient and any lay advisor or attorney. 
(3) The clinical review panel shall hold the meeting and any additional meetings 
as necessary, reach a final determination and render a written decision ordering 
or denying involuntary treatment. 
(a) 
At the meeting, the clinical review panel shall receive information 
relevant to the determination of the patient's capacity to give informed 
consent to treatment and the need for treatment, review relevant portions of 
the patient's medical records, consult with the physician requesting the 
treatment, review with the patient that patient's reasons for refusing 
treatment, provide the patient and any lay advisor or attorney an opportunity 
to ask questions of anyone presenting information to the clinical review panel 
at the meeting and determine whether the requirements for ordering 
involuntary treatment have been met. 
(b) All meetings of the clinical review panel must be open to the patient and 
any lay advisor or attorney, except that any meetings held for the purposes of 
deliberating, making findings and reaching final conclusions are confidential 
and not open to the patient and any lay advisor or attorney. 
(c) The clinical review panel shall conduct its review in a manner that is 
consistent with the patient's rights. 
(d) Involuntary treatment may not be approved and ordered if the patient 
affirmatively demonstrates to the clinical review panel that if that patient 
possessed capacity, the patient would have refused the treatment on religious 
grounds or on the basis of other previously expressed convictions or beliefs. 
(4) The clinical review panel may approve a request for involuntary treatment 
and order the treatment ifthe clinical review panel finds, at a minimum: 
(a) 
That the patient lacks the capacity to make an informed decision 
regarding treatment; 
(b) . That the patient is unable or unwilling to comply with the proposed 
treatment; 
(c) That the need for the treatment outweighs the risks and side effects; and 
(d) That the proposed treatment is the least intrusive appropriate treatment 
option. 
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c. 
, " 
I 
IO 
II 
HOUSE AMENDMENT .v 
to H.P. 1615, L.D. 2252 
(5) The clinical review panel may make additional findings, including but not 
limited to findings that: 
(a) Failure to treat the illness is likely to produce lasting or irreparable harm 
to the patient; or 
(b) 
Without the proposed treatment the patient's illness or involuntary 
commitment may be significantly extended without addressing the symptoms 
that cause the patient to pose a likelihood of serious harm. 
(6) 
The clinical review panel shall document its findings and conclusions, 
including whether the potential benefits of the proposed treatment outweigh the 
potential risks. 
C. The provisions of this paragraph govern the rights of a patient who is the subject 
of a clinical review panel under paragraph A. 
(1) The patient is entitled to the assistance of a lay advisor without expense to 
the patient. The patient is entitled to representation by an attorney at the patient's 
expense. 
(2) The patient may review any records or documents considered by the clinical 
review panel. 
(3) The patient may provide information orally and in writing to the clinical 
review panel and may present witnesses. 
(4) The patient may ask questions of any person who provides information to the 
clinical review panel. 
(5) The patient and any lay advisor or attorney may attend all meetings of the 
clinical review panel except for any private meetings authorized under paragraph 
B, subparagraph 3, division (b). 
D. 
If the clinical review panel under paragraph A approves the request for 
involuntary treatment, the clinical review panel shall enter an order for the treatment 
in the patient's medical records and immediately notifY the superintendent of a state 
mental health institute or ch ief administrative officer of a designated nonstate mental 
health institution. The order takes effect: 
(1) For a patient at a state mental health institute, one business day from the date 
of entry of the order; or 
(2) For a patient at a designated nonstate mental health institution, one business 
day from the date of entry of the order, except that if the patient has requested 
review of the order by the director of the Office of Adult Mental Health Services 
within the department under paragraph F, subparagraph (2), the order takes effect 
one business day from the day on which the director issues a written decision. 
E. The order for treatment under this subsection remains in effect for 120 days or 
until the end of the period of commitment, whichever is sooner, unless altered by: 
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HOUSE AMENDMENT 'V' to H.P. 1615, L.D. 2252 
(1) 
An agreement to a different course of treatment by the primary treating 
physician and patient; 
(2) For a patient at a designated nonstate mental health institution, modification 
or vacation of the order by the director of the Office of Adult Mental Health 
Services within the department; or 
(3) 
An alteration or stay of the order entered by the Superior Court after 
reviewing the entry of the order by the clinical review panel on appeal under 
paragraph F. 
F. The provisions of this paragraph apply to the review and appeal of an order of the 
clinical review panel entered under paragraph B. 
(1) The order of the clinical review panel at a state mental health institute is final 
agency action that may be appealed to the Superior Court in accordance with 
Rule 80C of the Maine Rules of Civil Procedure. 
(2) The order of the clinical review panel at a designated nonstate mental health 
institution may be reviewed by the director of the Office of Adult Mental Health 
Services within the department or the designee of the director upon receipt of a 
written request from the patient submitted no later than one day after the patient 
receives the order of the clinical review panel. Within 3 business days of receipt 
of the request for review, the director or designee shall review the full clinical 
review panel record and issue a written decision. The decision of the director or 
designee may affirm the order, modifY the order or vacate the order. 
The 
decision of the director or designee takes effect one business day after the 
director or designee issues a written decision. The decision of the director or 
designee is final agency action that may be appealed to the Superior Court in 
accordance with Rule 80C ofthe Maine Rules of Civil Procedure.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
The involuntary treatment law enacted in Public Law 2007, chapter 580 addresses 
medication but does not address the laboratory testing that is necessary to monitor and 
manage the possible side effects. This amendment authorizes laboratory testing for the 
management and monitoring ft e ossible side effects of medication. 
SPONSORED BY: -~¥.-=..L.::::.....JL:---~~RI,L---lL.. __ 
_ 
(Representative SIMPSON) 
TOWN: Auburn 
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