“It seems counterintuitive that a physician is the expert needed to release patients with mental illness, but a physician can’t initiate a mental health hold.”


the organizations worried the bill could inadvertently create a liability for phy- sicians or facilities. TMA asked Senator West to add language clarifying that no new liability would exist for a physician regardless of whether he or she placed a hold on a patient. Senator West’s office worked closely with TMA and addressed most of the as- sociation’s concerns. The bill passed the Senate but stalled in the House Commit- tee on Public Health. SB 937 coauthor Sen. Judith Zaffirini


(D-Laredo) says the legislature focused increasingly on mental health in general and on physician-initiated mental health holds in particular. “I believe this reflects a greater aware-


to hold a patient pending an evaluation,” he said.


The 2013 session of the Texas Legisla-


ture did not pass legislation that would have authorized physician-initiated men- tal health holds. TMA, the Texas College of Emergency Physicians (TCEP), the Texas Hospital Association (THA), the Texas Police Chiefs Association, and the Texas Emergency Nurses Association supported the concept. It became clear, however, that lawmakers needed to fur- ther consider legal, financial, and practi- cal matters before passing such a law. TMA, TCEP, and THA will form a


workgroup to weigh those consider- ations. At press time, the workgroup’s membership hadn’t been finalized. The group plans to meet regularly to develop a consensus on legislation for the 2015 legislative session.


Dr. Greenberg Les Secrest, MD


introduced a reso- lution on physician- initiated mental health holds to the TMA House of Del- egates at TexMed 2013 in San Anto- nio. The house ad- opted a policy that says the association


30 TEXAS MEDICINE November 2013


“supports activities, including legislation, that give a physician the authority to hold, until such time a judge or justice of the peace can hear the case, a per- son who is suffering from mental illness and exhibits a substantial risk of seri- ous harm to himself or others in order to evaluate and coordinate care for that patient.” The policy also says TMA will


“work with interested parties, including patient advocacy groups, other medical care organizations, law enforcement, the mental health community, and the legal community, to ensure that there is no increased medical liability exposure or criminal exposure to the physician who places a patient in a mental health hold when the physician’s professional judg- ment is in the patient’s best interest.”


Legislators consider mental health holds


Senate Bill 937 by Sen. Royce West (D- Dallas) would have allowed a physician to detain a patient with mental illness for up to four hours when it was in the patient’s best interest and until an eval- uation and appropriate treatment plan could be developed. TMA and TCEP sup- ported the bill’s goals at a Senate Health and Human Services Committee hearing, but cited some concerns. For instance,


ness of mental health issues, not only among legislators, but also among the general public. It is important that we address complex issues related to physi- cian-initiated holds to enhance the safety of Texans who have mental illnesses and to ensure they receive the care they need in appropriate clinical settings,” she said. Senator Zaffirini says she intends to collaborate with Senator West to file the bill again next session. Two other bills died due to concerns


from lawmakers and rural hospitals. House Bill 245 by Rep. Jose Menen-


dez (D-San Antonio) would have permit- ted an attending physician to initiate a hold of up to 24 hours on patients with mental illness who exhibit substantial risk of serious harm to themselves or others. House Bill 2186 by Rep. Paul Workman (R-Austin) would have al- lowed hospitals, mental health facilities, and freestanding emergency centers to hold a person with mental illness for up to four hours.


Colorado’s law on involuntary mental health holds may be a model that works in the best interest of patients and physi- cians, according to Dr. Greenberg. Colo- rado authorizes licensed medical doctors, therapists, and clinical social workers, as well as law enforcement officers, to hold people who are suicidal, homicidal, or incapacitated for up to 72 hours. Dur- ing that time, patients can be evaluated and treated. Only a doctor can rescind or vacate an involuntary hold before 72 hours pass.


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