Current through Register 1531, September 27, 2024
(1)
Discharge
Procedures.
(a) A facility shall
arrange for necessary post-discharge support and clinical services. Such
measures shall be documented in the medical record.
(b) A facility shall make every effort to
avoid discharge to a shelter or the street. The facility shall take steps to
identify and offer alternative options to a patient and shall document such
measures, including the competent refusal of alternative options by a patient,
in the medical record. In the case of such discharge, the facility shall
nonetheless arrange for or, in the case of a competent refusal, identify
post-discharge support and clinical services. The facility shall keep a record
of all discharges to a shelter or the street, in a form approved by the
Department, and submit such information to the Department on a quarterly
basis.
(c) When a patient in a
facility operated by or under contract to the Department is a client of the
Department pursuant to
104 CMR 29.00:
Application for DMH Services, Referral, Service Planning and
Appeals, the service planning process outlined in
104 CMR 29.00 shall be
undertaken prior to discharge.
(d)
A facility shall keep a record of all patients discharged therefrom, and shall
provide such information to the Department upon request.
(2)
Voluntary Admission
Status. A patient voluntarily admitted to a facility under
104 CMR
27.06 shall be discharged upon his or her
request, or upon the request of the patient's legally authorized representative
who applied for the admission of such patient, without a requirement of a
three-day notice.
(3)
Discharge Initiated by Facility Director. The facility
director may discharge any patient admitted as a voluntary or conditional
voluntary patient at any time he or she deems such discharge in the best
interest of such patient; provided however, that if a legally authorized
representative made the application for admission, 14 days notice shall be
given to such legally authorized representative prior to such discharge, in
accordance with M.G.L. c. 123, § 10(a). With the consent of such legally
authorized representative, the facility director may discharge the patient at
any time.
(4)
Conditional Voluntary Admission Status. A patient
admitted to a facility on conditional voluntary status under
104 CMR
27.06 shall be discharged by the facility
upon his or her request; provided however, he or she shall give three days
written notice of his or her intent to leave the facility to the facility
director, and may be retained at the facility for such three-day notice period,
during which time the facility director may require an examination of such
patient to determine his or her suitability for discharge. Such patients may be
retained at the facility beyond the expiration of the three-day notice period
if, prior to the expiration of the said three-day notice period, the facility
director files with a court of competent jurisdiction, a petition for the
commitment of such patient at the s facility.
(5)
Discharge at Request of
Legally Authorized Representative. A patient admitted by his or
her legally authorized representative may be discharged at the request of such
legally authorized representative consistent with procedures for discharge of a
patient admitted upon his or her own authority.
(6)
Patients 16 or 17 Years of
Age. A patient who is 16 or 17 years of age, or who turns 16 years
old during the course of hospitalization, and who has been admitted to a
facility as a voluntary or conditional voluntary patient by application of a
legally authorized representative, shall have the same rights pertaining to
release, withdrawal and discharge as those patients 16 years of age or older
who have applied for and been admitted on a voluntary or conditional voluntary
status to the facility on their own behalf.
(7)
Involuntary Commitment
Status.
(a)
Three-day
Commitment. A patient admitted to a facility under M.G.L. c. 123,
§ 12, may be discharged by the facility director at any time during such
period of hospitalization if the facility director determines that such patient
is not in need of care and treatment in the facility. The three-day
hospitalization period authorized under M.G.L. c. 123, § 12 shall not be
extended and, at the end of such period, a patient so hospitalized shall be
discharged by the facility unless, prior to expiration, such patient has
applied for, and has been admitted on voluntary or conditional voluntary status
to the facility, or the facility director has filed a petition for an order of
commitment.
(b)
Prolonged Commitment. A patient committed to a
facility by order of a court of competent jurisdiction shall be discharged by
the facility upon the expiration of the order, unless the commitment order is
renewed under the procedures established in M.G.L. c. 123, §§ 7 and
8.
(c) Except as provided in 104
CMR 27.09(8), at any time during the period of hospitalization, the facility
director may discharge such patient if he or she determines that such patient
is no longer in need of care and treatment.
(8)
Forensic Commitment
Status.
(a) A patient committed
to facility under M.G.L. c. 123, § 15 shall not be discharged, except to
the committing court, or upon other court order.
(b) A patient committed to a facility under
M.G.L. c. 123, § 16 shall not be discharged, unless appropriate notice has
been given by the facility director to the court and district attorney which
has or had jurisdiction of the relevant criminal case. If within 30 days of the
receipt of such communication the district attorney has not filed a petition
for further commitment of such patient, the patient may be discharged. The
patient shall be held at the facility for such 30-day period, unless the
district attorney provides written notice that he does not intend to petition
for further commitment.
(c) In the
event the facility director intends to remove or modify any court ordered
restrictions on such a patient's movements, he or she shall communicate the
intention to remove or modify such restriction in writing to the court which
ordered the commitment and the district attorney who has or had jurisdiction of
the relevant criminal case. If within 14 days neither the court nor district
attorney makes written objection thereto, such restrictions may be removed or
modified.
(d) The requirements of
104 CMR 27.09(8)(b) and (c) shall not apply to patients originally committed
after a finding of incompetence to stand trial whose criminal charges have been
dismissed.
(e) A patient on
commitment status under M.G.L. c. 123, § 16 who was found incompetent to
stand trial and whose charges are dismissed may be discharged at any time if
the facility director determines that such patient is no longer in need of care
and treatment. The dismissal of criminal charges shall not, however, terminate
the underlying commitment order. Any subsequent commitment proceedings for such
a patient shall be under M.G.L. c. 123, §§ 7 and 8.
(f) A patient hospitalized at a facility
pursuant to M.G.L. c. 123, § 18 shall not be discharged, except to the
custody of the place of detention from which the patient was hospitalized,
unless such patient's sentence, or other authority under which the patient is
being held in custody, has expired.
