Effective - 28 Aug 2019, 4 histories
630.175. Physical and chemical restraints prohibited, exceptions — requirements for collaborative practice arrangements — security escort devices and certain extraordinary measures not considered physical restraint. — 1. No person admitted on a voluntary or involuntary basis to any mental health facility or mental health program in which people are civilly detained pursuant to chapter 632 and no patient, resident or client of a residential facility or day program operated, funded or licensed by the department shall be subject to physical or chemical restraint, isolation or seclusion unless it is determined by the head of the facility, the attending licensed physician, or in the circumstances specifically set forth in this section, by an advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician that the chosen intervention is imminently necessary to protect the health and safety of the patient, resident, client or others and that it provides the least restrictive environment. An advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician may make a determination that the chosen intervention is necessary for patients, residents, or clients of facilities or programs operated by the department, in hospitals as defined in section 197.020 that only provide psychiatric care and in dedicated psychiatric units of general acute care hospitals as hospitals are defined in section 197.020. Any determination made by the advanced practice registered nurse, physician assistant, or assistant physician shall be documented as required in subsection 2 of this section and reviewed in person by the attending licensed physician if the episode of restraint is to extend beyond:
(1) Four hours duration in the case of a person under eighteen years of age;
(2) Eight hours duration in the case of a person eighteen years of age or older; or
(3) For any total length of restraint lasting more than four hours duration in a twenty-four-hour period in the case of a person under eighteen years of age or beyond eight hours duration in the case of a person eighteen years of age or older in a twenty-four-hour period.
The review shall occur prior to the time limit specified under subsection 6 of this section and shall be documented by the licensed physician under subsection 2 of this section.
2. Every use of physical or chemical restraint, isolation or seclusion and the reasons therefor shall be made a part of the clinical record of the patient, resident or client under the signature of the head of the facility, or the attending licensed physician, or the advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician.
3. Physical or chemical restraint, isolation or seclusion shall not be considered standard treatment or habilitation and shall cease as soon as the circumstances causing the need for such action have ended.
4. The use of security escort devices, including devices designed to restrict physical movement, which are used to maintain safety and security and to prevent escape during transport outside of a facility shall not be considered physical restraint within the meaning of this section. Individuals who have been civilly detained under sections 632.300 to 632.475 may be placed in security escort devices when transported outside of the facility if it is determined by the head of the facility, or the attending licensed physician, or the advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician that the use of security escort devices is necessary to protect the health and safety of the patient, resident, client, or other persons or is necessary to prevent escape. Individuals who have been civilly detained under sections 632.480 to 632.513 or committed under chapter 552 shall be placed in security escort devices when transported outside of the facility unless it is determined by the head of the facility, or the attending licensed physician, or the advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician that security escort devices are not necessary to protect the health and safety of the patient, resident, client, or other persons or is not necessary to prevent escape.
5. Extraordinary measures employed by the head of the facility to ensure the safety and security of patients, residents, clients, and other persons during times of natural or man-made disasters shall not be considered restraint, isolation, or seclusion within the meaning of this section.
6. Orders issued under this section by the advanced practice registered nurse in a collaborative practice arrangement, or a physician assistant or an assistant physician with a collaborative practice arrangement, with the attending licensed physician shall be reviewed in person by the attending licensed physician of the facility within twenty-four hours or the next regular working day of the order being issued, and such review shall be documented in the clinical record of the patient, resident, or client.
7. For purposes of this subsection, "division" shall mean the division of developmental disabilities. Restraint or seclusion shall not be used in habilitation centers or community programs that serve persons with developmental disabilities that are operated or funded by the division unless such procedure is part of an emergency intervention system approved by the division and is identified in such person's individual support plan. Direct-care staff that serve persons with developmental disabilities in habilitation centers or community programs operated or funded by the division shall be trained in an emergency intervention system approved by the division when such emergency intervention system is identified in a consumer's individual support plan.
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(L. 1980 H.B. 1724, A.L. 1996 S.B. 884 & 841, A.L. 2008 S.B. 1081, A.L. 2014 H.B. 1779, A.L. 2016 H.B. 1682 merged with H.B. 1816, A.L. 2019 S.B. 514)
Structure Missouri Revised Statutes
Title XL - Additional Executive Departments
Chapter 630 - Department of Mental Health
Section 630.005 - Definitions.
Section 630.015 - Director, appointment — duties of commission.
Section 630.020 - Departmental goals, duties.
Section 630.030 - Division directors, appointment, removal — appointment of other general personnel.
Section 630.035 - Appointment of facility heads, medical staffs.
Section 630.040 - Facility administrative officers to have general charge and control.
Section 630.045 - Appointment of persons for civil involuntary detention actions.
Section 630.050 - Rules, promulgation, procedure — public inspection — facility policies.
Section 630.053 - Mental health earnings fund — uses — rules and regulations, procedure.
Section 630.055 - Research activities by department.
Section 630.060 - Cooperation with other groups.
Section 630.065 - Planning activities by department.
Section 630.070 - Workers' compensation law extended to employees of department.
Section 630.075 - Personnel recruitment, development and training.
Section 630.085 - Annual report by director, to whom, when, contents.
Section 630.095 - Copyrights and trademarks by department.
Section 630.110 - Patient's rights — limitations.
Section 630.115 - Patient's entitlements — administrative review of violations.
Section 630.120 - No presumptions.
Section 630.125 - Explanation of rights and entitlements.
Section 630.127 - Notification protocols — rulemaking authority.
Section 630.130 - Electroconvulsive therapy, procedure — prohibitions — attorney's fees.
Section 630.133 - Psychosurgery, consent required — not to be performed by department.
Section 630.135 - Rules regarding patient's rights.
Section 630.150 - Disclosure of absence to be made, when, to whom.
Section 630.155 - Mistreatment of patient — defined — penalty.
Section 630.160 - Furnishing unfit food — defined — penalty.
Section 630.161 - Investigation of reports of vulnerable person abuse, when.
Section 630.162 - Mandatory reporters — preventing or discouraging reporting, penalty.
Section 630.163 - Mandatory reporting requirements.
Section 630.164 - Immunity from liability, when.
Section 630.168 - Suspected abuse to be reported.
Section 630.180 - Treatment by religious practice to be permitted.
Section 630.183 - Officers may authorize medical treatment for patient.
Section 630.186 - Purchase of food limited to that for use of patients.
Section 630.192 - Limitations on research activities in mental health facilities and programs.
Section 630.198 - Duties of research review committee.
Section 630.199 - Research involving persons civilly detained, sections applicable.
Section 630.200 - Discrimination prohibited.
Section 630.202 - Essential caregiver designation, procedure, requirements.
Section 630.305 - Funds of patient, control, expenditure, return, safekeeping.
Section 630.310 - Receipt of funds of patient, procedure.
Section 630.315 - Department may become payee for patient, procedure.
Section 630.320 - Disposition of unclaimed funds of patient — escheats, procedure.
Section 630.325 - Disposition of unclaimed personal property of patient.
Section 630.335 - Canteens and commissaries authorized — operation.
Section 630.340 - Sheltered workshops and activity centers authorized — operation.
Section 630.350 - Limitation on bank accounts.
Section 630.410 - Evaluation of contracts.
Section 630.415 - Terms of contracts.
Section 630.420 - Affiliation agreements from vendors required.
Section 630.425 - Incentive grants authorized — rules and regulations — duration of grants.
Section 630.430 - Commissioner of administration to make rules and regulations for incentive grants.
Section 630.435 - Affiliation agreements from grantees required.
Section 630.440 - Payment to grantees, procedure.
Section 630.445 - Records required of vendors or grantees, contents — access for inspection.
Section 630.450 - Duplication of programs to be avoided.
Section 630.455 - Attorney general to seek restitution for department.
Section 630.462 - Contractors for community psychiatric rehabilitation, reviews, how conducted.
Section 630.505 - Department to name facilities.
Section 630.510 - Inventory of facilities — plan for new facilities.
Section 630.525 - Destruction of obsolete structures — procedure.
Section 630.535 - Unneeded property may be transferred to another state agency — procedure.
Section 630.540 - Proposed transfers and conveyances to be reviewed.
Section 630.545 - Board and living quarters for employees of facilities.
Section 630.575 - Council created, members, duties, terms, meetings.
Section 630.580 - Education and awareness programs established — cooperation of state agencies.
Section 630.605 - Placement programs to be maintained.
Section 630.610 - Applications for placement — criteria to be considered.
Section 630.615 - Program standards to be considered — prior to placement.
Section 630.620 - Facilities and programs to be utilized in making placements.
Section 630.625 - Consent required for placement.
Section 630.630 - Alternative proposals to be prepared.
Section 630.640 - Costs of benefits may be paid by department — recovery.
Section 630.645 - Follow-up care.
Section 630.650 - Cooperation with department of social services.
Section 630.655 - Rules for standards for placement facilities and programs — required standards.
Section 630.656 - Waiver or exception request of administrative rule or standard, procedure.
Section 630.660 - Written contracts required.
Section 630.710 - Required standards.
Section 630.715 - Licensing of residential facilities and day programs — fee — affidavit.
Section 630.730 - Inspection by department and others, when — may be ordered, when.
Section 630.735 - License required.
Section 630.760 - Patients to have same rights as those for residents of nursing homes.
Section 630.763 - Receiver may be requested, by whom, when.
Section 630.772 - Emergency procedure.
Section 630.775 - Powers and duties of receiver.
Section 630.781 - Compensation of receiver.
Section 630.784 - Receiver may receive license.
Section 630.787 - Receivership may be terminated by court, when.
Section 630.793 - Liabilities of receivers and licensees.
Section 630.810 - Compact enacted — form.
Section 630.815 - Director of department to make rules — cooperate in administration.
Section 630.820 - Supplementary agreements authorized, when effective.
Section 630.825 - Expenses, how paid.
Section 630.830 - Transfer of patient, duty of administrator.
Section 630.835 - Copies of law furnished other states.
Section 630.850 - Compact enacted — form.
Section 630.855 - Contracts authorized, limitations.
Section 630.925 - Mental health fatality review panel established, members, duties.
Section 630.927 - Rulemaking authority.
Section 630.950 - Immunity from liability, when.
Section 630.975 - Rulemaking authority — disclosure of records, when.