House committee reviews bill to expand who can certify emergency mental-health exams

The House Health Care committee on Feb. 18 heard testimony on H573, a bill that would broaden which professionals may complete the certification that allows a person to be held for an emergency mental-health exam under the state's involuntary-commitment process.

Katie McLean of the Legislative Council told members the measure would change statutory language in Title 18 to replace the term "licensed physician" with the broader term "health care professional." McLean said the bill's draft defines that term to include physicians and advanced practice registered nurses (APRN) — both already authorized — and would add physician assistants, master's-level social workers, clinical mental health counselors (master's or greater) and marriage and family therapists.

"This is really the focus of the bill you're gonna be looking at today," McLean said, explaining that the application plus a certificate together authorize transport and admission to a hospital for an emergency exam to determine whether a person is a "person in need of treatment." She outlined the statutory sequence: an initial medical-level certification and transport, a psychiatrist's exam as soon as practicable and no later than 24 hours, and potential 72-hour holding or court petition for involuntary treatment.

Proponents and some witnesses told the committee the change could increase capacity and speed evaluations, particularly during busy emergency-room shifts when physicians are occupied. Trish, a witness who identified herself in the transcript as "representing 1 VA," said she had no objection to adding physician assistants but raised concerns about nonmedical master's-level clinicians performing the first certification.

"The additional mental-health personnel give me concerns simply because they're not medical personnel," Trish said, noting that in her experience emergency-room medical staff perform medical clearance and the certifying clinician confirms the behavior is not caused by an underlying medical condition. "I think it's important that is said by a medical personnel."

Committee members also signaled an intent to narrow the proposal; one committee member (identified in the transcript as Unidentified Speaker 4) said stakeholders were likely to recommend pairing the expansion back to adding only physician assistants as a starting point.

McLean noted the bill also makes conforming edits to a later paragraph that governs who may be the hospital official admitting the person; current law prohibits the certifier from being the same person who makes admission or discharge decisions, and the draft would apply the broader "health care professional" language to that restriction.

The draft bill text as discussed in the hearing cross-references Title 71 definitions and, as provided in committee materials, shows an effective date listed in the text (07/01/1926). The committee and witnesses treated that date as part of the draft language under review; the date appears in the circulated draft and may be a drafting error in the submitted text.

No formal votes were taken at the Feb. 18 first hearing. The committee called for additional witnesses to testify and took a brief recess to allow more testimony to assemble.

What's next: the committee will hear further testimony and stakeholder recommendations, with at least one member indicating a proposal to narrow the bill to add physician assistants first rather than all listed master's-level clinicians.