2023 Hawaii Revised Statutes › Title 19. Health › 334. Mental Health, Mental Illness, Drug Addiction, and Alcoholism › 334-59 Emergency examination and hospitalization.

§334-59 Emergency examination and hospitalization.
(a) Initiation of proceedings. An emergency admission may be initiated as follows:
(1) If a law enforcement officer has reason to believe that a person is imminently dangerous to self or others, the officer shall call for assistance from the mental health emergency workers designated by the director. Upon determination by the mental health emergency workers that the person is imminently dangerous to self or others, the person shall be transported by ambulance or other suitable means, to a licensed psychiatric facility for further evaluation and possible emergency hospitalization. A law enforcement officer may also take into custody and transport to any facility designated by the director any person threatening or attempting suicide. The officer shall make application for the examination, observation, and diagnosis of the person in custody. The application shall state or shall be accompanied by a statement of the circumstances under which the person was taken into custody and the reasons therefor which shall be transmitted with the person to a physician, advanced practice registered nurse, or psychologist at the facility.
(2) Upon written or oral application of any licensed physician, advanced practice registered nurse, psychologist, attorney, member of the clergy, health or social service professional, or any state or county employee in the course of employment, a judge may issue an ex parte order orally, but shall reduce the order to writing by the close of the next court day following the application, stating that there is probable cause to believe the person is mentally ill or suffering from substance abuse, is imminently dangerous to self or others and in need of care or treatment, or both, giving the findings upon which the conclusion is based. The order shall direct that a law enforcement officer or other suitable individual take the person into custody and deliver the person to a designated mental health program, if subject to an assisted community treatment order issued pursuant to part VIII of this chapter, or to the nearest facility designated by the director for emergency examination and treatment, or both. The ex parte order shall be made a part of the patient's clinical record. If the application is oral, the person making the application shall reduce the application to writing and shall submit the same by noon of the next court day to the judge who issued the oral ex parte order. The written application shall be executed subject to the penalties of perjury but need not be sworn to before a notary public.
(3) Any licensed physician, advanced practice registered nurse, physician assistant, or psychologist who has examined a person and has reason to believe the person is:
(A) Mentally ill or suffering from substance abuse;
(B) Imminently dangerous to self or others; and
(C) In need of care or treatment;
may direct transportation, by ambulance or other suitable means, to a licensed psychiatric facility for further evaluation and possible emergency hospitalization. A licensed physician, an advanced practice registered nurse, or physician assistant may administer treatment as is medically necessary, for the person's safe transportation. A licensed psychologist may administer treatment as is psychologically necessary.
(b) Emergency examination. A patient who is delivered for emergency examination and treatment to a psychiatric facility or a behavioral health crisis center shall be provided an examination, which shall include a screening to determine whether the criteria for involuntary hospitalization listed in section 334-60.2 persists, by a licensed physician, medical resident under the supervision of a licensed physician, or advanced practice registered nurse without unnecessary delay, and shall be provided such treatment as is indicated by good medical practice. If, after the examination, screening, and treatment, the licensed physician, medical resident under the supervision of a licensed physician, or advanced practice registered nurse determines that the involuntary hospitalization criteria persist, then a psychiatrist or advanced practice registered nurse who has prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization shall further examine the patient to diagnose the presence or absence of a mental illness or substance use disorder, further assess the risk that the patient may be dangerous to self or others, and assess whether or not the patient needs to be hospitalized. If it is determined that hospitalization is not needed, an examination pursuant to section 334-121.5 shall be completed.
(c) Release from emergency examination. If, after examination, the licensed physician, psychiatrist, or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization determines that the involuntary hospitalization criteria set forth in section 334-60.2 are not met or do not persist and the examination pursuant to section 334-121.5, where required, has been completed, the patient shall be discharged expediently, unless the patient is under criminal charges, in which case the patient shall be returned to the custody of a law enforcement officer.
(d) Emergency hospitalization. If the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization who performs the emergency examination has reason to believe that the patient is:
(1) Mentally ill or suffering from substance abuse;
(2) Imminently dangerous to self or others; and
(3) In need of care or treatment, or both;
the psychiatrist or advanced practice registered nurse with prescriptive authority and who holds an accredited national certification in an advanced practice registered nurse psychiatric specialization shall direct that the patient be hospitalized on an emergency basis or cause the patient to be transferred to another psychiatric facility for emergency hospitalization, or both. The patient shall have the right immediately upon admission to telephone the patient's guardian or a family member including a reciprocal beneficiary, or an adult friend and an attorney. If the patient declines to exercise that right, the staff of the facility shall inform the adult patient of the right to waive notification to the family, including a reciprocal beneficiary, and shall make reasonable efforts to ensure that the patient's guardian or family, including a reciprocal beneficiary, is notified of the emergency admission but the patient's family, including a reciprocal beneficiary, need not be notified if the patient is an adult and requests that there be no notification. The patient shall be allowed to confer with an attorney in private.
(e) Release from emergency hospitalization. If at any time during the period of emergency hospitalization the treating physician determines that the patient no longer meets the criteria for emergency hospitalization and the examination pursuant to section 334-121.5 has been completed, the physician shall expediently discharge the patient. If the patient is under criminal charges, the patient shall be returned to the custody of a law enforcement officer. In any event, the patient shall be released within forty-eight hours of the patient's admission to a psychiatric facility, unless the patient voluntarily agrees to further hospitalization, or a proceeding for court-ordered evaluation or hospitalization, or both, is initiated as provided in section 334-60.3. If that time expires on a Saturday, Sunday, or holiday, the time for initiation is extended to the close of the next court day. Upon initiation of the proceedings, the facility shall be authorized to detain the patient until further order of the court. [L 1976, c 130, pt of §4; am L 1977, c 76, pt of §3; am L 1984, c 188, §1; am L 1985, c 68, §6; am L 1986, c 335, § §2, 3; am L 1992, c 138, §1; gen ch 1993; am L 1994, c 58, §1; am L 1997, c 383, §45; am L 2009, c 151, §15; am L 2013, c 221, § §4, 24 and c 232, §3; am L 2015, c 27, §2; am L 2016, c 55, §51, c 114, § §2, 6, and c 183, §3; am L 2020, c 28, §3]
Attorney General Opinions
Regarding the meaning and functioning of this chapter and the assisted community treatment provisions under part VIII: (1) to be deemed "imminently dangerous to self or others", the individual does not need to be currently dangerous to self or others; (2) determinations surrounding whether a person is "dangerous to self" or "imminently dangerous to self or others" are mixed questions of fact and law; (3) if an individual is not "imminently dangerous to self or others", the individual may be placed under an assisted community treatment order, if appropriate; and (4) an individual may be forcibly medicated under an assisted community treatment order if the individual is within an emergency department or admitted to a hospital, it is determined there that the individual is "imminently dangerous to self or others", and the administration of medication pursuant to the assisted community treatment order is indicated by good medical practice. Att. Gen. Op. 23-01.
Case Notes
Several provisions of section held to violate Fourteenth Amendment due process rights. 438 F. Supp. 1106 (1977).
Defendant hospital's renewed motion for judgment as a matter of law denied, where the court found that there was clear and convincing evidence to support the jury's conclusion that the administration of one hundred milligrams of Haldol, which remained in plaintiff's system for thirty days, was not medically necessary for plaintiff's safe transport to a psychiatric facility nine miles from defendant hospital and, therefore, did not fall within the authority of this section. 403 F. Supp. 3d 868 (2019).