DEPARTMENT OF COMMUNITY HEALTH

                   MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES

                               
(By authority conferred on the department of mental health by  sections  1
to 4 of Act No. 80 of the Public Acts of 1905, as amended, section  33  of
Act No. 306 of the Public Acts of 1969, as amended, and sections 114, 130,
136, 157, 206, 244, 498n, 498r, 842, 844, 908, and 1002a of Act No. 258 of
the Public Acts of 1974, as amended,  being  sections  19.141  to  19.144,
24.233,  330.1114,  330.1130,  330.1136,  330.1206,  330.1244,  330.1498n,
330.1498r, 330.1842, 330.1844, 330.1908, and  330.2002a  of  the  Michigan
Compiled Laws)


          PART 4. ADMINISTRATIVE ACTION FOR MENTALLY ILL PERSONS 

                    SUBPART 2. TRANSFER REQUIREMENTS

R  330.4011   Transfer between state hospitals.
  Rule 4011. (1) A patient may be transferred between hospitals, including
the university of Michigan neuropsychiatric institute or other  facilities
of the department which are not hospitals, for administrative  reasons  or
for good and sufficient clinical reasons when approved by the  department.
Approval by the department shall be expressed by an order of  transfer,  a
copy of which  shall  be  forwarded  to  the  director  of  each  hospital
involved. Prior to approval or denial  of  the  transfer,  the  department
shall consult with the contractually responsible county  community  mental
health program. A request for a transfer may be submitted  by  a  hospital
director, a patient, or other interested person.
  (2) Before an approved transfer is  acted  upon,  the  director  of  the
hospital in which the  patient  is  currently  residing  shall  notify  in
writing, not less than 7 days prior  to  transfer,  the  patient  and  his
guardian or his nearest relative and up to 2 other persons  designated  by
the patient, except if the transfer is necessitated  by  an  emergency  as
determined by the hospital director and documented  in  hospital  records.
Under emergency  circumstances,  the  hospital  director  shall  effect  a
transfer as soon as necessary and issue the appropriate notices  not  more
than 24 hours after transfer.
  (3) The notification period of not more than 7 days  prior  to  transfer
may be reduced if the patient or his guardian or nearest relative approves
the transfer in person, by telephone, or in writing, and this approval  is
documented. Written approval shall be obtained as soon as administratively
possible.
  (4) Notice of transfer by a hospital director shall inform  the  patient
and his guardian or nearest  relative  of  the  right  to  object  to  the
transfer. Upon receipt of a written objection, an appeal hearing shall  be
held promptly, under procedures  established  by  the  department.  If  an
objection is made, transfer shall be delayed until a ruling of the  appeal
hearing indorses it, unless an emergency as determined and  documented  by
the hospital director necessitates an  immediate  transfer.  An  emergency
transfer is revocable by decision of the director of the department or  by
order of the appeal referee.
  (5) Administrative transfer of a patient to another department  hospital
for purposes of supervision in connection with convalescent leave or other
community placement may be appealed if it is alleged that the  supervision
or administrative control of the leave or placement, by  the  hospital  to
which the administrative transfer is made, and not the leave or  placement
itself, would be detrimental to the patient.
  (6) Each hospital shall establish  procedures  through  which  patients,
guardians, or responsible relatives may participate  in  the  planning  or
selection of a leave or placement.

  History:  1979 AC; 1986 AACS.


R  330.4013   Transfer to a facility other than a state hospital.
  Rule  4013.  (1)  A  patient  may  be  temporarily  transferred   to   a
non-department hospital or other facility for emergency medical reasons as
determined and documented by a hospital director.
  (2) With the written consent of an adult patient or the parent,  legally
authorized guardian, or person in loco parentis of a patient under the age
of 18, a patient may be transferred from  a  departmental  hospital  to  a
hospital  or  facility  in  this  state  which  is  not  operated  by  the
department. If a patient objects to a transfer that has been consented  to
by a person in loco parentis, transfer will be  delayed  until  an  appeal
hearing established by the department has made a determination.
  (3) Transfer of a patient to or from a hospital or facility that is  not
a department designated hospital shall not constitute a discharge from  an
order of hospitalization from a probate court.
  (4) Transfer of an involuntary patient out of state shall be governed by
interstate compact agreements.

  History:  1979 AC; 1986 AACS.


                      SUBPART 3. ADMISSION CONDITIONS


R  330.4031   Voluntary admission.
  Rule 4031. (1) An application  for  voluntary  admission  shall  not  be
considered as lacking voluntariness because an individual  has  agreed  to
that action as a result of a probate court proceeding.
  (2) The hospital director or his designee shall evaluate an individual's
clinical suitability for informal or formal voluntary admission and  shall
include the following criteria in making the determination.
  (a) The individual has a condition that the hospital director determines
can benefit from the inpatient treatment that is provided by the hospital.
  (b) Appropriate alternatives to hospitalization have been considered  by
the hospital, and with the consent of the individual, the community mental
health program in the individual's county of residence.
  (c) Adequate alternative treatment is not available or suitable  at  the
time of admission as determined by the hospital, and with the  consent  of
the individual, the community mental health program  in  the  individual's
county of residence.

  History:  1979 AC.


R  330.4039   Denial by director of voluntary admission.
  Rule 4039. (1) If the hospital director, or his or  her  designee,  does
not deem an individual clinically suitable for full hospitalization as  an
informal or formal voluntary patient, he or she shall deny the request and
shall refer the individual to an appropriate community  mental  health  or
other service. The reason or reasons for denial shall be made known to the
applicant, shall be documented, and a copy of the document shall be  given
to the applicant. If the individual consents, the community mental  health
or other service shall be notified of the referral.
  (2) If the hospital director denies  admission,  he  or  she  may  offer
partial admission on a day, night, or weekend  basis  if  the  service  is
available and if the individual is deemed suitable for partial  admission.
The criteria for suitability for partial admission shall parallel that  of
other forms of voluntary admission.

  History:  1979 AC; 1981 AACS.


R  330.4045   Involuntary admissions.
  Rule 4045. (1) For the  purpose  of  establishing  the  point  at  which
hospitalization begins, 1 of the following conditions shall be met:
  (a) An individual arrives at or is at a hospital and an application  for
hospitalization is completed and given to a hospital staff member  with  a
completed certificate.
  (b) An individual arrives at or is at a hospital under a court order for
immediate hospitalization, other than an order to undergo an  examination,
after a petition has been filed with the court.
  (c) An individual is at a hospital after giving  written  notice  of  an
intention to terminate formal voluntary hospitalization and  the  director
of the hospital or  his  or  her  designee  has  filed  with  a  court  an
application for admission by certification and the required  certificates.
  (2) For the purpose of establishing when an individual  may  complete  a
reasonable number of telephone calls and when a preliminary hearing  shall
be convened if the person is not  released,  the  time  an  individual  is
received for hospitalization by certification, or court-ordered  immediate
hospitalization, is any time the individual arrives  at  the  hospital.  A
formal voluntary patient who is being admitted as an  involuntary  patient
by  application  of  a  hospital  director  is  considered  received   for
hospitalization at the time application and certificates are filed with  a
probate court.
  (3) When an individual is presented to a hospital, the hospital shall do
all of the following:
  (a) Require that the application for hospitalization, if any,  meet  the
requirements of section 424 of the act.
  (b) Require that the certificate accompanying the application,  if  any,
meet the requirements of section 400(K) of the act.
  (c) Determine if the individual presented  is  clinically  suitable  for
informal or formal voluntary hospitalization.  If  this  determination  is
affirmative, immediately offer the individual the opportunity to apply for
hospitalization as an informal or formal voluntary patient,  and  as  many
times thereafter as deemed appropriate by the hospital director  until  an
order of hospitalization, alternative treatment, or discharge is received.
If the individual is hospitalized as a  voluntary  patient,  the  hospital
director shall inform the court and recommend whether dismissal of pending
proceedings would or would not be in the best interest of  the  individual
or the public.
  (d) Allow the individual to complete not less than 2 phone calls. If the
individual does not have sufficient funds on  his  or  her  person,  calls
shall be made at hospital expense with the condition that they be  limited
to persons who are willing to receive the calls. The hospital director  or
his or her designee may determine the appropriateness of a call  or  calls
that are at hospital expense and may limit their length  to  a  reasonable
duration, but a call shall not be limited to less than 5 minutes.  If  the
hospital director or his or her designee restricts the  call,  appropriate
written documentation of the reasons for the restriction shall be noted in
the case record. Under circumstances in which the individual cannot make a
call, or if it is  necessary  to  restrict  calls  that  are  at  hospital
expense, the hospital shall place the  calls  for  the  individual  if  so
requested.
  (e)  Provide  to  the  individual,  not  more  than   12   hours   after
hospitalization, a copy of the application for  admission  asserting  that
the individual is a person requiring treatment, a written  statement  that
the individual will be examined by a psychiatrist within 24 hours  of  the
hospitalization, and a written statement, in simple terms, explaining  the
right of the individual to request a preliminary hearing, to be present at
the preliminary hearing, and to be represented by legal  counsel,  if  the
individual is  certified  as  a  person  requiring  treatment;  a  written
statement, in simple terms, explaining the right of the  individual  to  a
full court hearing, to be present at the hearing,  to  be  represented  by
legal counsel, to a jury trial, and to an independent  evaluation;  and  a
copy of each certificate executed  in  connection  with  the  individual's
hospitalization if available. Each certificate shall be delivered  to  the
individual within 24 hours of either a certificate's completion or receipt
of a certificate by the hospital from a source outside the hospital.
  (f) If the individual is  unable  to  read  or  understand  the  written
materials, every effort shall be made to explain them to him or her  in  a
language he or she understands, and a note of the explanation and by  whom
made shall be entered in the case record.
  (g) The admission officer, as soon as  administratively  possible  after
receiving an individual by certification  who  has  been  certified  as  a
person requiring treatment, shall do all of the following:
  (i) Notify the probate court by phone.
  (ii) Obtain, when available, the tentative date of  the  preliminary  or
full court hearing and the name and address of counsel  appointed  by  the
court.
  (iii) Notify the patient of this information.

  History:  1979 AC; 1986 AACS.


R  330.4047   Admission by certification.
  Rule 4047. (1) A state hospital, as  designated  in  R  330.4005,  shall
receive and detain  for  examination  by  a  psychiatrist  any  individual
presented to the hospital who is  accompanied  by  a  certificate  and  an
executed application. A psychiatrist, either from the  hospital  staff  or
from outside the hospital, shall examine an individual not  more  than  24
hours after admission. The hospital director  shall  provide  a  room  and
other equipment necessary to provide a complete examination.
  (2) A psychologist or physician who has  examined  a  patient  shall  be
permitted, by the hospital director, adequate time to  be  deposed  or  to
testify, if so required at a probate court hearing regarding that patient.

  History:  1979 AC; 1983 AACS; 1986 AACS.


R  330.4049   Examination upon  application  by  peace  officer  or  court
order.
  Rule 4049. (1) A state hospital, as  designated  in  R  330.4005,  shall
receive and detain an individual for examination  if  that  individual  is
presented to  the  hospital  by  a  peace  officer  who  has  executed  an
application for admission. The hospital shall also receive and detain  for
examination any  individual  ordered  by  the  court  to  be  examined.  A
psychologist or physician, either from the hospital staff or from  outside
the  hospital,  shall  examine  the  individual   within   24   hours.   A
psychiatrist, either from the hospital staff or from outside the hospital,
shall examine the  individual,  if  necessary,  within  24  hours  of  the
completion of the first certificate. The hospital director shall provide a
room and other equipment necessary to provide a complete examination.
  (2) A psychologist or physician who has examined an individual presented
shall be permitted by the hospital director adequate time to be deposed or
to testify, if so required, at a probate court hearing.

  History:  1979 AC; 1986 AACS.


R  330.4051   Admission by petition.
  Rule 4051. An individual shall be admitted to a hospital on  a  petition
pending a hearing only  upon  order  of  immediate  hospitalization  by  a
probate court. The hospital director shall have  the  individual  examined
within 24 hours of hospitalization. If the required  examination  has  not
been accomplished within 24 hours, the hospital director shall release the
individual and document in the records the reasons the examination was not
completed. The hospital shall notify the probate court.

  History:  1979 AC.


R  330.4055   Probate court hearings at hospital.
  Rule 4055. (1) It shall be the  hospital  director's  responsibility  to
provide adequate facilities on the hospital grounds in  which  to  conduct
probate court hearings on petitions for hospitalization, discharge, and to
hear objections to voluntary admissions and appeals of returns.
  (2) The hospital director shall provide prompt access to the patient  by
his attorney upon proper notice,  and  shall  provide  a  room  where  the
patient and his attorney may confer in private.
  (3)  The  hospital  director  shall   develop   rules   and   procedures
establishing visiting rights by  attorneys  and  requirements  for  proper
notice.

  History:  1979 AC.


                     SUBPART 5. RELEASE AND DISCHARGE


R  330.4077   Discharge of voluntary patients.
  Rule 4077. (1) An informal, voluntary patient shall be discharged either
during normal day shift hours or immediately, at  the  discretion  of  the
hospital director, after either of the following:
  (a) A request is made by the patient to terminate hospitalization.
  (b) The hospital director deems it clinically suitable.
  (2) A formal, voluntary patient shall be discharged as soon as possible,
but not later than 3 days, excluding Sundays and holidays, after either of
the following:
  (a) Written notice of intent to terminate hospitalization  is  given  by
the patient.
  (b) The hospital director deems that it would be clinically suitable.
  (3) Even if a guardian has  been  appointed  for  a  patient,  only  the
patient  may  give  written  notice   of   an   intention   to   terminate
hospitalization.

  History:  1979 AC; 1986 AACS; 1990 AACS.


R  330.4083   Unauthorized leave by voluntary patients.
  Rule 4083. (1) A patient who has been admitted as an informal, voluntary
patient and who leaves a hospital without proper notification of intention
to terminate shall be placed on unauthorized leave status  for  24  hours.
After this period,  the  hospital  shall  administratively  discharge  the
patient.
  (2) A patient who has been admitted as a formal, voluntary  patient  and
who leaves a hospital without permission shall be placed  on  unauthorized
leave status for not more than 3 days and shall be readmitted during  that
period without signing a new application for  admission.  If  the  patient
does not return within 3 days, he or she shall be discharged.
  (3) A patient who  is  absent  from  a  hospital  without  having  given
notification of intention to terminate shall be designated  as  a  missing
person. Prompt and vigorous measures shall be taken to find  the  patient,
including an immediate  search  by  hospital  employees  as  warranted  by
circumstances and notification, pursuant to section 748(6)(c) of the  act,
of other public agencies if there is a substantial probability of harm  to
the patient or other persons. Relatives or other interested parties  shall
be notified if the patient had given prior authorization to  notify  those
persons in the event of an emergency. A record shall be  kept  of  persons
notified and the time of notification. Upon locating  a  missing  patient,
the hospital shall inform those notified  and  determine  if  any  of  the
following provisions apply to the patient:
  (a) He or she desires to return voluntarily.
  (b) He or she desires to terminate hospitalization.
  (c) He or she meets other statutory provisions for treatment.

  History:  1979 AC; 1990 AACS.


R  330.4089   Discharge of involuntary patient.
  Rule 4089. (1) Discharge shall constitute  release  of  a  patient  from
jurisdiction of a hospital, by action of the hospital director or by court
order, or if the court rejects an application or petition or fails to hold
a requested preliminary hearing or final hearing within the required  time
or a continuance was not granted. A patient discharged may not be returned
to the hospital without a new  order  for  admission  or  application  for
voluntary admission.
  (2) When a patient is discharged, the hospital director shall report the
change in status to the probate court which ordered admission and indicate
in this report which of the following  factors  have  brought  about  this
discharge:
  (a) Patient legally transferred out of state.
  (b) Patient, in the opinion of the hospital director, not mentally  ill.
  (c) Patient not  reasonably  expected  to  seriously  physically  injure
himself or others.
  (d)  Patient  no  longer  clinically   suitable   for   this   form   of
hospitalization.
  (e) Death of patient.
  (f) Patient, on an order of continuing hospitalization, after 1 year  of
continuous leave.
  (g) Any other reason acceptable under  the  act  or  procedures  of  the
department.

  History:  1979 AC.