Are any of you involved in the "dust-up" concerning GA-0753. This is an AG opinion concerning medical evaluation prior to transport to a mental health facility. Rather than go into my own rant I will take the liberty of pasting in an email from my County Judge that sets out some (but not all ) the issues concerning this. You will note that the input of the TDCAA is evidently going to be requested pretty soon.
John L. Hutchison
C.A. Hansford County



John:
Maybe we will learn something from this after they sift through it.


Benny D. Wilson
Hansford County Judge
16 NW Court
Spearman, Tx 79081
806-659-4100




Subject: Medical Clearance Issues
Date: Fri, 22 Jan 2010 12:45:16 -0600
From: Jim.Womack@TPMHMR.org
To: hansfordco@hotmail.com

Hi Judge,

Below you will find information from our state council on their meeting about medical clearance issues


Jim Womack
Director of Planning and Public Information
Texas Panhandle MHMR
806-351-3326
806-351-3346 Fax

From: Joe Lovelace
Sent: Thursday, January 21, 2010 4:46 PM

Subject: Medical Clearance Workgroup - Notes and Next Meeting

Thanks to all who were able to attend the very interactive meeting of our Medical Clearance Workgroup on January 19, 2010.

The workgroup members reported the responses from their membership on the % of patients required to be transported for medical clearance and the average waiting time in the emergency room:

A. Sheriff Kirk reported that 104 out of 254 sheriffs responded. 90%-100% of the patients under emergency detention required medical clearance. The range in wait time in the ER was 2 to 12 hours (avg. 6). Respondents experienced a 30% diversion from the state hospital in their catchment area to hospital in another area of the state (data soon to be provided).
B. Meredith McKinney reported for the Texas Municipal Police Association – Nearly 50% of the police experience 10 or more transports to mental health facilities in a year. In transports to State Hospitals, medical clearance is required 63% of the time. Waiting time varied from 15 minutes to 10 hours depending upon the priority given to medical clearance of mental health patients (see attached report).
C. Texas Council reported that 18 out of 37 LMHAs responded. Respondents varied in size from major urban, suburban, rural and frontier. Required medical clearance appears relatively low in communities with existing resources. However, in rural and frontier areas medical clearance is directed for 80% to 90% of patients transported under emergency detention (see attached survey).
D. Department of State Health Services – State Hospitals take the position that their medical exclusionary criteria are simply guidelines. Relatively few patients are required to have routine medical screening prior to admission only when warranted or required by the LMHA.

Our law enforcement stakeholders indicated the AG Opinion is being read by their members that the person apprehended under Chapter 573 shall be transported to the nearest appropriate inpatient mental health facility or a mental health facility deemed suitable by the local mental health authority.

The workgroup agreed this interpretation leaves no room for distinct factual scenarios that law enforcement, using good judgment, should use in deviating to an emergency room for medical treatment or medical clearance and decided to gather the following information:

1. Law enforcement members of our stakeholder group will consult with legal council to determine: if the AG opinion prohibits an emergency room visit for persons under emergency detention in need of immediate physical medical care; whether existing or future agreements for transport for medical clearance would be invalid; and for consideration of the exposure a peace officer would have to a law suit or a civil rights action if facts justifying medical clearance or treatment were ignored.

2. State Hospitals will again review their medical clearance policy to determine if it is being consistently applied by the physicians in the facilities or are persons required to have medical clearance even though they have no obvious signs of illness or injury and/or are known patients to an LMHA that reports no physical concerns.

3. LMHAs will submit MOU(s) with law enforcement which contain guidelines and standard operating procedures to safely handle persons in a mental health crisis under the provisions of Chapter 573, Health and Safety Code.

Texas Council will contact other key stakeholders that may be considered for addition to the workgroup – Texas Association of Counties and District and County Attorney Association.


Joe Lovelace
Associate Director Behavioral Health
Texas Council of Community MHMR Centers
8140 N. Mopac, Westpark Bldg. 3, Ste. 240
Austin, Texas 78758
512/794-9268
512/799-6294 (c)
jlovelace@txcouncil.com


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Ilse Bailey is the Acting County Attorney for Kerr County, which requested the opinion. Contact her for more information.