§ 28:53 — Admission by emergency certificate; extension; payment for services rendered
This text of Louisiana § 28:53 (Admission by emergency certificate; extension; payment for services rendered) is published on Counsel Stack Legal Research, covering Louisiana primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
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§53. Admission by emergency certificate; extension; payment for services rendered A.
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§53. Admission by emergency certificate; extension; payment for services rendered
A.(1) A person who has a mental illness or a person who is suffering from a
substance-related or addictive disorder may be admitted and detained at a treatment facility
for observation, diagnosis, and treatment for a period not to exceed fifteen days under an
emergency certificate.
(2) A person suffering from a substance-related or addictive disorder may be
detained at a treatment facility for one additional period, not to exceed fifteen days, provided
that a second emergency certificate is executed. A second certificate may be executed only
if and when a physician at the treatment facility and any other physician have examined the
detained person within seventy-two hours prior to the termination of the initial fifteen-day
period and certified in writing on the second certificate that the person remains dangerous
to himself or others or gravely disabled, and that his condition is likely to improve during the
extended period. The director shall inform the patient of the execution of the second
certificate, the length of the extended period, and the specific reasons therefor, and shall also
give notice of the same to the patient's nearest relative or other designated responsible party
initially notified pursuant to Subsection F of this Section.
B.(1) Any physician licensed or permitted by the Louisiana State Board of Medical
Examiners, physician assistant when acting in accordance with his respective clinical practice
guidelines, psychiatric mental health nurse practitioner, other nurse practitioner who acts in
accordance with a collaborative practice agreement and receives verbal approval for
executing the certificate from his collaborating physician, or psychologist may execute an
emergency certificate only after an actual examination of a person alleged to have a mental
illness or be suffering from a substance-related or addictive disorder who is determined to
be in need of immediate care and treatment in a treatment facility because the examining
physician, physician assistant when acting in accordance with his respective clinical practice
guidelines, psychiatric mental health nurse practitioner, other nurse practitioner who acts in
accordance with a collaborative practice agreement and receives verbal approval for
executing the certificate from his collaborating physician, or psychologist determines the
person to be dangerous to self or others or to be gravely disabled. The actual examination
of the person by a psychiatrist, psychologist, medical psychologist, or psychiatric mental
health nurse practitioner may be conducted by telehealth utilizing video conferencing
technology, provided that a licensed healthcare professional who can adequately and
accurately assist with obtaining any necessary information including but not limited to the
information listed in Paragraph (4) of this Subsection shall be in the examination room with
the patient at the time of the video conference. A patient examined in such a manner shall
be medically cleared prior to admission to a mental health treatment facility. Failure to
conduct an examination prior to the execution of the certificate will be evidence of gross
negligence.
(2) The certificate shall state:
(a) The date of the physician's, physician assistant's, psychiatric mental health nurse
practitioner's, other nurse practitioner's or psychologist's examination of the person, which
shall not be more than seventy-two hours prior to the date of the signature of the certificate.
(b) The objective findings of the physician, physician assistant when acting in
accordance with their respective clinical practice guidelines, psychiatric mental health nurse
practitioner, other nurse practitioner who acts in accordance with a collaborative practice
agreement and receives verbal approval for executing the certificate from his collaborating
physician, or psychologist relative to the physical or mental condition of the person, leading
to the conclusion that the person is dangerous to self or others or is gravely disabled as a
result of a substance-related or addictive disorder or mental illness.
(c) The history of the case, if known.
(d) The determination of whether the person examined is in need of immediate care
and treatment in a treatment facility because the patient is any of the following:
(i) Dangerous to himself.
(ii) Dangerous to others.
(iii) Gravely disabled.
(e) That the person is unwilling or unable to seek voluntary admission or is willing
to seek voluntary admission upon arrival at the treating facility.
(3) The certificate shall be dated and executed under the penalty of perjury, but need
not be notarized. The certificate shall be valid for seventy-two hours and shall be delivered
to the director of the treatment facility where the person is to be further evaluated and treated.
(4) In the case of an emergency certificate issued pursuant to an examination
conducted by telehealth pursuant to Paragraph (1) of this Subsection and Paragraph (J)(1) of
this Section, the licensed healthcare professional present during the actual examination shall
be responsible for obtaining, recording, and attaching to the emergency certificate the
following information regarding the video conference:
(a) The date.
(b) The starting and ending times.
(c) The names of all persons who were in the room and the type of license issued to
the health care professional.
(d) The physical address of both the examining psychiatrist and the patient when the
video conference was conducted.
(5) If the certificate states that the person is willing to seek voluntary admission upon
arrival at the treating facility, the person shall be assessed pursuant to the provisions of R.S.
28:52 or 52.2, as applicable, at the time of the initial psychiatric evaluation at the treating
facility.
C. A patient may request the director of the treatment facility to advise the executive
director of the mental health advocacy service of his admission and may request
representation.
D. Prior to or during confinement, under the provisions of this Title, any person or
his attorney shall have the right to demand a judicial hearing to determine if probable cause
exists for his continued confinement under an emergency certificate. The hearing shall be
held within five days of the filing of the petition. The petition shall be filed in the court of
the jurisdiction in which the patient is confined. The hearing shall be held in that court and
no other except for good cause shown. If the person is confined, the judge of the court where
the petition was filed may hold the hearing at the treatment facility where the person is
confined if, in the opinion of the director of the treatment facility, it will be detrimental to
the patient's health, welfare, or dignity to travel to the court where the petition was filed.
Pending the decision of the court, the patient shall remain confined unless the court orders
release or a less restrictive status.
E. The attorney of any patient in a treatment facility may review his client's medical
record. If deemed essential by the attorney, portions of the record specifically required for
proper representation pursuant to this Title, may be copied and given to the patient's attorney.
The attorney shall return all copies of his client's medical record to the treatment facility
upon completion of their use.
F. An emergency certificate shall constitute legal authority to transport a patient to
a treatment facility and shall permit the director of the treatment facility to detain the patient
for diagnosis and treatment for a period not to exceed fifteen days and to return the patient
to the facility if the patient is absent with or without permission during authorized periods
of detention. If necessary, peace officers shall apprehend and transport, or ambulance
services, under appropriate circumstances, may locate and transport, a patient on whom an
emergency certificate has been completed to a treatment facility at the request of either the
director of the facility, the certifying physician, physician assistant when acting in accordance
with their respective clinical practice guidelines, psychiatric mental health nurse practitioner,
other nurse practitioner who acts in accordance with a collaborative practice agreement and
receives verbal approval for executing the certificate from his collaborating physician, or
psychologist, the patient's next of kin, the patient's curator, or the agency legally responsible
for his welfare. In the case of an emergency certificate issued pursuant to an examination
conducted by telehealth pursuant to Paragraph (B)(1) of this Section, or where the valid
original is not provided to the transporter, a copy transmitted by facsimile or other electronic
device shall be sufficient authority for the peace officer or ambulance worker to transport the
patient to a treatment facility and for the director to accept the patient. The psychiatrist shall
cause the original certificate to be deposited in the United States mail properly addressed to
the director of the treatment facility by the next business day following the date of
examination. The director of the treatment facility shall notify the patient's nearest relative,
if known, or designated responsible party, if any, in writing of the patient's admission by
emergency certificate as soon as reasonably possible.
G.(1) Upon admission of any person by emergency certificate to a treatment facility,
the director of the treatment facility shall immediately notify the coroner of the parish in
which the treatment facility is located of the admission, giving the following information if
known:
(a) The person's name.
(b) Address.
(c) Date of birth.
(d) Name of certifying physician, psychiatric mental health nurse practitioner, or
psychologist.
(e) Date and time of admission.
(f) The name and address of the treatment facility.
(2)(a) Within seventy-two hours of admission, the person shall be independently
examined by the coroner or his deputy who shall execute an emergency certificate, pursuant
to Subsection B of this Section, which shall be a necessary precondition to the person's
continued confinement.
(b) Except as provided in Subparagraph (c) of this Paragraph, a coroner who is a
physician, or his deputy who is a physician, may utilize telehealth to conduct the
seventy-two-hour independent examination pursuant to this Paragraph.
(c) Except as provided in Paragraph (7) of this Subsection, if the actual examination
provided for in Paragraph (B)(1) of this Section is conducted utilizing telehealth, the
seventy-two-hour independent examination by the coroner or his deputy shall be conducted
in person.
(3) However, in the event that the coroner has made the initial examination and
executed the first emergency commitment certificate then a second examination shall be
made within the seventy-two hour period set forth in this Part by any physician at the
treatment facility where the person is confined.
(4) In making either the initial examination or the second examination, when the
coroner or his deputy examines the person and executes an emergency certificate and a
reexamination of the person and reexecution of a certificate is necessary for any reason to
ensure the validity of the certificate, both the first examiner and the reexaminer shall be
entitled to the fee for the service, unless they are one and the same.
(5) If, from his examination, the coroner concludes that the person is not a proper
subject for emergency admission, then the person shall not be further detained in the
treatment facility and shall be discharged by the director forthwith.
(6) When a person is confined in a treatment facility other than a state psychiatric
hospital, the examining coroner in the parish where the patient is confined shall be entitled
to the usual fee paid for this service to the coroner of the parish in which the patient is
domiciled or residing. When a person is confined in a state psychiatric hospital in a parish
other than his parish of domicile or residence, the examining coroner shall be entitled to the
fee authorized by law in his parish for the service. In either case, the fee shall be paid and
accurate records of such payments kept by the governing authority of the parish in which the
patient is domiciled or residing from parish funds designated for the purpose of payment to
the coroner. Each coroner shall keep accurate records showing the number of patients
confined in his parish pursuant to this Section.
(7) As it relates to the parish of St. Tammany, all of the following shall apply:
(a) The coroner or deputy coroner, who is a physician, preferably a psychiatrist, may
conduct an examination and execute an emergency certificate, as provided in Subparagraph
(b) of this Paragraph, by telehealth utilizing video conferencing equipment, provided that all
of the following are met:
(i) A licensed healthcare professional, who can adequately and accurately assist with
obtaining any necessary information including but not limited to that information in
Paragraph (B)(4) of this Section and where such healthcare professional will be present in
the examining room with the patient at the time of the video conferencing.
(ii) The coroner or deputy coroner who is a physician, preferably a psychiatrist, shall
comply with all of the provisions in Subsection F of this Section.
(b) The coroner or deputy coroner, who is a physician, preferably a psychiatrist, may
conduct an examination and execute an emergency certificate, as provided in Subparagraph
(a) of this Paragraph, by telehealth under all of the following circumstances:
(i) If the initial examination, pursuant to Paragraph (B)(1) of this Section, has been
made in person.
(ii) If the coroner conducted the initial examination pursuant to Paragraph (3) of this
Subsection by telehealth and has executed the first emergency commitment certificate, a
second examination shall be made in person within the seventy-two-hour period set forth in
this Part by any psychiatrist, psychiatric mental health nurse practitioner, or a psychologist
at the treatment facility where the person is confined.
(c)(i) When a patient is transferred from another parish pursuant to an emergency
certificate, a second physician's emergency certificate, when appropriate, shall be executed
by a physician at the admitting facility.
(ii) The coroner shall be notified immediately following the execution of the second
emergency certificate and shall conduct an independent examination within seventy-two
hours as provided in Paragraph (2) of this Subsection, in the manner provided in accordance
with Subparagraph (a) of this Paragraph.
(iii) Nothing herein shall be construed to authorize a period of commitment to exceed
fifteen days from the date and time the initial emergency certificate was executed in the
parish of origin.
(8) As it relates to all other parishes the following shall apply:
(a) When a patient is transferred from another parish pursuant to an emergency
certificate, a second physician's emergency certificate, when appropriate, shall be executed
by a physician at the admitting facility.
(b) The coroner shall be notified immediately following the execution of the second
emergency certificate and shall conduct an independent examination within seventy-two
hours as provided in Paragraph (2) of this Subsection, in the manner provided in accordance
with Subparagraph (G)(7)(a) of this Section.
(c) Nothing herein shall be construed to authorize a period of commitment to exceed
fifteen days from the date and time the initial emergency certificate was executed in the
parish of origin.
H. If the patient admitted to a treatment facility pursuant to this Section is a proper
candidate for judicial commitment pursuant to R.S. 28:54, the director of the treatment
facility, or any interested party, may apply for such commitment under provisions of that
Section. Such a patient, hospitalized on an emergency certificate, for whom a petition for
judicial commitment has been filed in court may continue to be detained for a further period
on order of the court.
I. Every patient admitted by emergency certificate shall be informed in writing at the
time of his admission of the procedures of requesting release from the treatment facility, the
availability of counsel, information about the mental health advocacy service, the rights
enumerated in R.S. 28:171, and the rules and regulations applicable to or concerning his
conduct while a patient in the treatment facility. If the person is illiterate or does not read
or understand English, appropriate provisions shall be made to supply this information to
him. In addition, a copy of the information mentioned in this Subsection shall be posted in
any area where patients are confined and treated.
J.(1) Upon the request of a credible person of legal age who is financially unable to
afford a private physician or who cannot immediately obtain an examination by a physician,
the parish coroner may render, or the coroner or a judge of a court of competent jurisdiction
may cause to be rendered by a physician, an actual examination of a person alleged to have
a mental illness or be suffering from a substance-related or addictive disorder and in need of
immediate medical treatment because the person is dangerous to himself or others or is
gravely disabled. The actual examination of the person by a psychiatrist may be conducted
by telehealth utilizing video conferencing technology, provided that a licensed healthcare
professional who can adequately and accurately assist with obtaining any necessary
information including but not limited to the information listed in Paragraph (B)(4) of this
Section shall be in the examination room with the patient at the time of the video conference.
If the coroner is not a physician, the coroner may deputize a physician to perform this
examination. To accomplish the examination authorized by this Subsection, if the coroner
or the judge is apprehensive that his own safety or that of the deputy or other physician may
be endangered thereby, the coroner or judge shall issue a protective custody order pursuant
to R.S. 28:53.2.
(2) If the examining physician determines that the standard provided in Paragraph
(1) of this Subsection is met, he shall execute an emergency certificate and shall transport
or cause to be transported the person named in the emergency certificate to a treatment
facility. Failure to render an actual examination prior to execution of the emergency
certificate shall be evidence of gross negligence.
(3) In any instance where the coroner or his deputy executes the first emergency
certificate, the second emergency certificate shall not be executed by the coroner or his
deputy, but the second emergency certificate may be executed by any other physician
including a physician at the treatment facility. However, if the first examination by the
coroner is conducted utilizing video conferencing technology, the second examination shall
be conducted in person.
K.(1)(a) Patients admitted by emergency certificate may receive medication and
treatment without their consent, but no major surgical procedure or electroshock therapy may
be performed without the written consent of a court of competent jurisdiction after a hearing.
With regard to the administration of medicine, if the patient objects to being medicated, prior
to making a final decision, the treating physician shall make a reasonable effort to consult
with the primary physician or primary care provider outside of the facility that has previously
treated the patient for his behavioral health condition. The treating physician shall, prior to
the administration of such medication, record in the patient's file either the date and time of
the consultation and a summary of the comments of the primary physician or primary care
provider or, if the treating physician is unable to consult with the primary physician or
primary care provider, the date and time that a consultation with the primary physician or
primary care provider was attempted.
(b) Notwithstanding the provisions of Subparagraph (a) of this Paragraph, any
licensed physician may administer medication to a patient without his consent and against
his wishes in a situation which, in the reasonable judgment of the physician who is observing
the patient during the emergency, constitutes a psychiatric or behavioral health emergency.
For purposes of this Paragraph a "psychiatric or behavioral health emergency" occurs when
a patient, as a result of mental illness, a substance-related or addictive disorder, or
intoxication engages in behavior which, in the clinical judgment of the physician, places the
patient or others at significant and imminent risk of damage to life or limb. The emergency
administration of medication may be continued until the emergency subsides, but in no event
shall it exceed forty-eight hours, except on weekends or holidays when it may be extended
for an additional twenty-four hours.
(c) The physician shall make a reasonable effort to consult with the primary
physician or primary care provider outside the facility who has previously treated the patient
for his behavioral health condition at the earliest possible time, but in no event more than
forty-eight hours after the emergency administration of medication has begun, except on
weekends or holidays, when the time period may be extended an additional twenty-four
hours. The physician shall record in the patient's file either the date and time of the
consultation and a summary of the comments of the primary physician or primary care
provider or, if the physician is unable to consult with the primary physician or primary care
provider, the date and time that a consultation with the primary physician or primary care
provider was attempted.
(2) If the director of the treatment facility, in consultation with two physicians,
determines that the condition of such a patient is of such a critical nature that it may be life-threatening unless major surgical procedures or electroshock treatment is administered, such
emergency measures may be performed without the consent otherwise provided for in this
Section.
L.(1) A peace officer or a peace officer accompanied by an emergency medical
service trained technician may take a person into protective custody and transport him to a
treatment facility for a medical evaluation when, as a result of his personal observation, the
peace officer or emergency medical service technician has reasonable grounds to believe the
person is a proper subject for involuntary admission to a treatment facility because the person
is acting in a manner dangerous to himself or dangerous to others, is gravely disabled, and
is in need of immediate hospitalization to protect such a person or others from physical harm.
The person may be transported only to a treatment facility as defined in R.S. 28:2.
(2)(a) Upon arrival at the treatment facility, the escorting peace officer shall then be
relieved of any further responsibility and the person shall be immediately examined by a
physician, preferably a psychiatrist, or a psychiatric mental health nurse practitioner who is
acting in accordance with a collaborative practice agreement who shall determine if the
person shall be voluntarily admitted, admitted by emergency certificate, or discharged.
(b) If a peace officer transports a person to a treatment facility and no emergency
certificate for that person has been issued in accordance with the provisions of this Section,
then only a psychiatrist may admit the person to the facility.
(3) In the case of a person suffering from a substance-related or addictive disorder
and where no treatment facility is available, the peace officer and emergency medical service
technician may use whatever means or facilities available to protect the health and safety of
the person suffering from a substance-related or addictive disorder until such time as a
treatment facility becomes available. In taking a person into protective custody the peace
officer and emergency medical service technician may take reasonable steps to protect
themselves. A peace officer or emergency medical service technician who acts in
compliance with this Section is acting in the course of his official duty and shall not be
subject to criminal or civil liability as a result thereof.
M. Under the provisions of this Part no person shall be placed in protective custody
for a period in excess of seventy-two hours. Any person placed in protective custody under
the provisions of this Part shall be considered as an inmate for maintenance purposes only.
N.(1) Public and private general hospitals and their personnel who provide services
in good faith for commitments defined in this Part shall not be liable for damages suffered
by the patient as a result of the commitment or damages caused by the patient during the term
of the commitment, unless the damage or injury was caused by willful or wanton negligence
or gross misconduct. This limitation of liability shall only apply to public and private general
hospital personnel who within the preceding twelve-month period have received appropriate
training in nonviolent crisis intervention and such training has been documented in their
personnel files. The training shall be provided by an instructor who has attended a course
in crisis intervention taught by a certified instructor.
(2) The provisions of this Subsection shall not affect the provisions of R.S.
40:2113.6 or the Federal Emergency Medical Treatment and Active Labor Act, 42 U.S.C.
1395dd.
O.(1) For the purposes of this Chapter, "public and private general hospital
personnel" shall mean all persons who provide services or furnish assistance to a public or
private general hospital in connection with the operations or delivery of patient care,
including employees, independent contractors, and volunteers.
(2) Notwithstanding the provisions of this Section or R.S. 28:63, "public and private
general hospital personnel" does not include a physician, psychiatric mental health nurse
practitioner, medical psychologist, or psychologist as defined in R.S. 28:2, for the purpose
of nonviolent crisis intervention training.
P.(1) Notwithstanding any provision of law to the contrary, no claim for payment for
inpatient behavioral health services provided to a person while admitted and detained in a
facility that provides mental health services under an emergency certificate, issued in
accordance with the provisions of this Section, shall be denied by Medicaid, an entity
contracted with the state for the provision of Medicaid services, or any hospital, health, or
medical expense insurance policy, hospital or medical service contract, employee welfare
benefit plan, contract or other agreement with a health maintenance organization or a
preferred provider organization, health and accident insurance policy, or any other insurance
contract of this type in this state, including a group insurance plan, a self-insurance plan, and
the Office of Group Benefits programs, on the basis of medical necessity if all of the
following conditions are met:
(a) Claims for payment for services issued in accordance with this Subsection shall
be limited to behavioral health expenditures and shall exclude payment for non-behavioral
health services or other medical expenses not directly related to the provision of behavioral
health care, treatment, or services with the exception of usual and customary laboratory
services necessary to monitor patient progress.
(b) The admitting physician or psychiatric mental health nurse practitioner who is
acting in accordance with a collaborative practice agreement and the evaluating psychiatrist
or medical psychologist shall offer the subject of the emergency certificate the opportunity
for voluntary admission pursuant to R.S. 28:53.
(c) Any patient committed under an emergency certificate to inpatient treatment by
a facility that provides mental health services shall be evaluated by a psychiatrist or medical
psychologist in the admitting facility within twenty-four hours of arrival at the admitting
facility. After the psychiatric evaluation, payment of claims shall be determined by medical
necessity. For purposes of this Subsection, "admitting facility" means a crisis receiving
center, acute treatment hospital or facility, distinct part psychiatric unit, or free-standing
psychiatric hospital or facility.
(2) Nothing in this Subsection shall be construed or interpreted to require payment
of claims in a manner other than in accordance with the terms and conditions of the health
insurance contract.
(3) In the event that funding is necessary pursuant to the provisions of this
Subsection, the utilization of available Community Development Block Grant (CDBG) funds
shall be authorized only upon the approval of the Centers for Medicare and Medicaid
Services (CMS).
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Louisiana § 28:53, Counsel Stack Legal Research, https://law.counselstack.com/statute/la/28%3A53.