GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1995

S	1 

SENATE BILL 859

Short Title:  MH Commitment Law.	(Public)

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Sponsors: Senators Martin of Guilford, Conder, and Warren.

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Referred to:  Children and Human Resources

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April 26, 1995

A BILL TO BE ENTITLED
AN ACT TO AMEND THE MENTAL HEALTH COMMITMENT LAW.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 122C-3 is amended by inserting a new subdivision to read: 
"(30b)	'Qualified crisis services professional' means an individual trained and privileged by the area authority to evaluate the circumstances of a crisis and the characteristics of a person with mental illness who may be in need of commitment, and to issue custody orders."
Sec. 2.  G.S. 122C-132 reads as rewritten:
"§ 122C-132.  Single portal of entry and exit designation for mental health and substance abuse facilities.
(a)	The public system should provide for a single portal of entry and exit policy for State and area mental health and substance abuse facilities. In order to accomplish this objective, an area authority desiring designation as a single portal area shall present to the Secretary a single portal of entry and exit plan approved by the area board. The decision as to whether to choose to submit a plan is in the discretion of the area authority after weighing the policy goal stated in this subsection and in G.S. 122C-101.  The single portal of entry and exit policy for State and area mental health and substance abuse facilities does not preclude those individuals whose cost of care will not be paid in full or in part with public funds from making use of the procedures to be followed in areas without a single portal plan.
(b)	In order for a single portal area to be designated, the single portal of entry and exit plan shall be subject to approval by the Secretary. Once an area is designated by the Secretary as a single portal area, any changes to the plan shall be subject to approval by the Secretary. In order for a single portal plan approved before July 1, 1995, to remain in force, it shall be reviewed by the area authority, show evidence of renewal of the agreements provided for in subdivision (c)(5) below, and be reapproved by the Secretary after July 1, 1995.
(c)	The plan shall include but not be limited to:
(1)	A specific listing of facilities to be covered by the single portal of entry and exit plan;
(2)	Procedures for review of individuals to be admitted to or discharged from State and area facilities;
(3)	Procedures for shared responsibility when individuals are admitted directly to a State facility;
(3a)	Procedures for treatment of mentally retarded individuals with mental illness who are committed to the area authority pursuant to Part 7A of Article 5 of this Chapter;
(4)	Evidence of incorporation of these plans within the contracts between the area authority and the State facilities as required by G.S. 122C-143(c) and with other public and private agencies as required in G.S. 122C-141;
(5)	Evidence of cooperative arrangements with local law enforcement, local courts, and the local medical society; 
(6)	Procedures for review of citizen complaints; and
(7)	Criteria for the designation of two or more persons to act as qualified crisis services professionals.
(d)	Residents of a county in a designated single portal area whose cost of care will be paid in full or in part with public funds shall be admitted to or discharged from State and area facilities through the area authority as described in the area's single portal of entry and exit policy."
Sec. 3.  G.S. 122C-201 reads as rewritten:
"§ 122C-201.  Declaration of policy.
It is State policy to encourage voluntary admissions to facilities. It is further State policy that no individual shall be involuntarily committed to a 24-hour facility unless that individual is mentally ill or a substance abuser and dangerous to self or others.  All admissions and commitments shall be accomplished under conditions that protect the dignity and constitutional rights of the individual.
It is further State policy that, except as provided in G.S. 122C-212(b), individuals who have been voluntarily admitted shall be discharged upon application and that involuntarily committed individuals shall be discharged as soon as a less restrictive mode of treatment is appropriate."
Sec. 4.  (a) G.S. 122C-204 reads as rewritten:
"§ 122C-204.  Liability for corruptly attempting admission or commitment.
(a)	Nothing in this Article relieves from liability in any suit instituted in the courts of this State any individual who unlawfully, maliciously, and corruptly attempts to admit or commit any individual to any facility under this Article.
(b)	Knowingly providing false information in an attempt to admit or commit an individual to any facility under this Article or that results in a person being taken into custody pursuant to the provisions of this Article is a Class 2 misdemeanor."
(b) This section becomes effective December 1, 1995, and applies to offenses committed on or after that date.
Sec. 5.  Article 5 of Chapter 122C of the General Statutes reads as rewritten:
"§ 122C-209.1.  Review of advance instruction for mental health treatment required.
Whenever the area authority is contacted regarding an individual under consideration for the issuance of a custody order or whenever an individual is considered for voluntary admission or involuntary commitment to a facility, the physician, eligible psychologist, qualified crisis services professional, or another designated person shall determine whether the individual has presented an advance instruction for mental health treatment executed pursuant to Article 3, Part 2 of this Chapter.  If there is an advance instruction on file, it shall be considered in accordance with the provisions of Article 3, Part 2 of this Chapter, prior to making a decision regarding custody, admission, or commitment."
Sec. 6.  G.S. 122C-210.1 reads as rewritten:
"§ 122C-210.1.  Immunity from liability.
No facility or any of its officials, staff, or employees, or any physician or other individual who is responsible for the custody, examination, management, supervision, treatment, or release of a client and who follows accepted professional judgment, practice, and standards is civilly liable, personally or otherwise, for actions arising from these responsibilities or for actions of the client. This immunity is in addition to any other legal immunity from liability to which these facilities or individuals may be entitled."
Sec. 7.  G.S. 122C-251(c) reads as rewritten:
"(c)	Transportation of a respondent may be by city- or county-owned vehicles or by private vehicle by contract with the city or county.  To the extent feasible, law enforcement officers transporting respondents shall dress in plain clothes and shall travel in unmarked vehicles.  Further, law enforcement officers, to the extent possible, shall advise respondents when taking them into custody that they are not under arrest and have not committed a crime, but are being transported to receive treatment and for their own safety and that of others."
Sec. 8.  G.S. 122C-252 reads as rewritten:
"§ 122C-252.  Twenty-four hour facilities for custody and treatment of involuntary clients.
State facilities, 24-hour facilities licensed under this Chapter, or hospitals licensed under Chapter 131E may be designated by the Secretary as facilities for the custody and treatment of involuntary clients. Designation of these facilities shall be made in accordance with rules of the Secretary that assure the protection of the client and the general public. Facilities so designated may detain a client under the procedures of Parts 7, 7A, and 8 of this Article both before a district court hearing and after commitment of the respondent."
Sec. 9. The title of Part 7 of Article 5 of Chapter 122C of the General Statutes reads as rewritten: 
"Part 7.  Involuntary Commitment of the Mentally Ill
;
Facilities for the Mentally Ill."
Sec. 10.  G.S. 122C-261 reads as rewritten:
"§ 122C-261.  In areas without a single portal plan for mental health facilities; affidavit and petition before clerk or magistrate when immediate hospitalization is not necessary; custody order.
(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone who has knowledge of an individual who is mentally ill and either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, may appear before a clerk or assistant or deputy clerk of superior court or a magistrate and execute an affidavit to this effect, and petition the clerk or magistrate for issuance of an order to take the respondent into custody for examination by a physician or eligible psychologist. The affidavit shall include the facts on which the affiant's opinion is based.  If, based on the affidavit or based on information provided by the area authority, the clerk or magistrate has reason to believe that the respondent is mentally retarded, the clerk or magistrate shall proceed according to the provisions of Part 7A of this Article.  Jurisdiction under this subsection is in the clerk or magistrate in the county where the respondent resides or is found.  In an area with a single portal plan, if anyone contacts a clerk, assistant or deputy clerk, or a magistrate about an individual described in this subsection, the clerk, assistant or deputy clerk, or magistrate shall proceed in accordance with G.S. 122C-261.1, unless no public funds will be used to pay for the cost of the individual's care.
(b)	If the clerk or magistrate finds reasonable grounds to believe that the facts alleged in the affidavit are true and that the respondent is probably mentally ill and either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, the clerk or magistrate shall issue an order to a law enforcement officer or any other person authorized under G.S. 122C-251 to take the respondent into custody for examination by a physician or eligible psychologist.  The clerk or magistrate shall provide the petitioner and the respondent, if present, with specific information regarding the next steps that will occur for the respondent or, if no custody order was issued, information regarding whom to contact in order to protest this determination.
(c)	If the clerk or magistrate issues a custody order, the clerk or magistrate shall also make inquiry in any reliable way as to whether the respondent is indigent within the meaning of G.S. 7A-450. A magistrate shall report the result of this inquiry to the clerk.
(d)	If the affiant is a physician or eligible psychologist, the affiant may execute the affidavit before any official authorized to administer oaths. This affiant is not required to appear before the clerk or magistrate for this purpose. This affiant's examination shall comply with the requirements of the initial examination as provided in G.S. 122C-263(c). If the physician or eligible psychologist recommends outpatient commitment and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for outpatient commitment, the clerk or magistrate shall issue an order that a hearing before a district court judge be held to determine whether the respondent will be involuntarily committed. If a physician or eligible psychologist recommends outpatient commitment, the clerk or magistrate shall provide the respondent with written notice of any scheduled appointment and the name, address, and telephone number of the proposed outpatient treatment physician or center. If the physician or eligible psychologist recommends inpatient commitment and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for inpatient commitment, the clerk or magistrate shall issue an order for transportation to or custody at a 24-hour facility described in G.S. 122C-252. If a physician or eligible psychologist executes an affidavit for inpatient commitment of a respondent, a second physician shall be required to perform the examination required by G.S. 122C-266.
(e)	Upon receipt of the custody order of the clerk or magistrate or a custody order issued by the court pursuant to G.S. 15A-1003, a law enforcement officer or other person designated in the order shall take the respondent into custody within 24 hours after the order is signed, and proceed according to G.S. 122C-263.
	."
Sec. 11.  Part 7 of Article V of Chapter 122C of the General Statutes is amended by adding a new section to read:
"§ 122C-261.1.  In areas with a single portal plan for mental health facilities; custody and examination.
(a)	In an area with a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone, including a law enforcement officer, who has knowledge of an individual who is subject to commitment according to the criteria of G.S. 122C-261(a) and who requires immediate treatment to prevent harm to self or others, may transport the individual directly to a facility in accordance with the single portal plan, for examination by a physician or eligible psychologist, in accordance with G.S. 122C-263(c).
(b)	Anyone who has knowledge of an individual who is subject to commitment according to the criteria of G.S. 122C-261(a), but is unable to transport the individual, may describe the behavior of the individual to a qualified crisis services professional.
(1)	If the person requesting commitment contacts the qualified crisis services professional by telephone and the qualified crisis services professional is satisfied that the information provided is an adequate basis on which to issue a custody order, that professional shall fill out a statement containing the facts on which the request for commitment is based and containing an acknowledgement that the person signing is aware of the penalty pursuant to G.S. 122C-204(b) for giving false information.  The qualified crisis services professional shall provide to the clerk or assistant or deputy clerk or magistrate a copy of the unsigned statement and the signed recommendation of the qualified crises services professional that the clerk or magistrate issue a custody order.  The clerk or magistrate shall give the unsigned statement to the person to whom the clerk or magistrate gives the custody order and that person shall contact the person requesting commitment and obtain the signature of the person requesting commitment before taking the respondent into custody, unless doing so would place any person in danger, in which case that person may take action to ensure the safety of those present prior to obtaining the signature.  If the person requesting commitment refuses to sign the statement, the person to whom the clerk or magistrate has given the custody order shall determine whether to take the respondent into custody pursuant to the criteria of subsection (a) of this section.
(2)	If the person requesting commitment contacts the qualified crisis services professional by telephone, but the qualified crisis services professional is not satisfied that the information provided is an adequate basis on which to issue a custody order, the qualified crisis services professional may require the person to appear in person and make a written statement before determining whether to recommend that the clerk or magistrate issue a custody order.
(3)	If the person requesting commitment appears in person before the qualified crisis services professional, the person shall sign a statement containing the facts on which the request for commitment is based and containing an acknowledgment that the person is aware of the penalty pursuant to G.S. 122C-204(b) for giving false information.
(4)	If the qualified crisis services professional is able to form a reasonable belief, based on the information, that the individual is subject to commitment according to the criteria of G.S. 122C-261(a), the professional shall provide to the clerk or magistrate a copy of the statement, whether signed or unsigned, and a written and signed recommendation that a custody order should be issued.  The statement and recommendation may be transmitted to the clerk or magistrate by facsimile.  If the statement is signed, the original shall be forwarded to the clerk within 48 hours.
(5)	The qualified crisis services professional shall provide the person requesting commitment with specific information regarding the next steps that will occur for the respondent or, if no custody order is issued, information regarding whom to contact in order to protest this determination.  At first contact with the individual subject to commitment, the qualified crisis services professional shall provide the person subject to commitment with specific information regarding the next steps that may occur.
(6)	Anyone who has knowledge of an individual who is mentally ill and either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, may appear before a clerk or assistant or deputy clerk of superior court or a magistrate and execute an affidavit to this effect, and petition the clerk or magistrate for issuance of an order to take the respondent into custody for examination by a physician or eligible psychologist.  The affidavit shall include the facts on which the affiant's opinion is based.  If, based on the affidavit or based on information provided by the area authority, the clerk or magistrate has reason to believe that the respondent is mentally retarded, the clerk or magistrate shall proceed according to the provisions of Part 7A.  Jurisdiction under this subsection is in the clerk or magistrate in the county where the respondent resides or is found.  Before making a determination to issue a custody order, the clerk or magistrate shall contact the area authority to determine if there are more appropriate resources available through the area authority to assist the person requesting commitment or the person who may be in need of treatment.
(7)	If the clerk or magistrate finds reasonable grounds to believe that the facts alleged in the affidavit or statement are true and that the respondent is probably mentally ill and either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, and that more appropriate resources are not available through the area authority to assist the person requesting commitment or the person who may be in need of treatment, the clerk or magistrate shall issue an order to a law enforcement officer or any other person authorized under G.S. 122C-251 to take the respondent into custody for examination by a physician or eligible psychologist, in accordance with the single portal plan and with G.S. 122C-263(c).
(c)	Upon examination by the physician or eligible psychologist, if the individual meets the criteria required in G.S. 112C-261(a), the physician or eligible psychologist shall so certify in writing.  The certificate shall also include the facts on which the physician's or eligible psychologist's opinion is based and shall state whether the individual meets the criteria of G.S. 122C-263(d)(1) for outpatient commitment or meets the criteria of G.S. 122C-263(d)(2) for inpatient commitment.  If the physician or eligible psychologist has reason to believe that the individual is mentally retarded, the physician or psychologist shall continue according to the provisions of Part 7A.
(d)	A representative of the area authority shall inquire in any reliable way as to whether the respondent is indigent within the meaning of G.S. 7A-450.  The physician or eligible psychologist shall send the result of this inquiry and a copy of the certificate to the clerk of superior court by the most reliable and expeditious means.  If it cannot be reasonably anticipated that the clerk will receive the copy within 24 hours, excluding Saturday, Sunday, and holidays, of the time that it was signed, the physician or eligible psychologist shall also communicate the findings to the clerk by telephone.
(e)	The physician's or eligible psychologist's certificate, if it indicates that the individual meets the criteria for inpatient commitment, shall serve as the custody order, and the law enforcement officer or other designated person shall provide transportation in accordance with G.S. 122C-251 to a 24-hour facility designated in the single portal plan or to a private facility that has agreed to admit the respondent, if no public funds will be used to pay for the respondent's care.  If the physician or eligible psychologist determines that the individual meets the criteria for outpatient commitment, the physician or eligible psychologist shall provide the respondent with written notice of any scheduled appointment and the name, address, and telephone number of the proposed outpatient treatment facility.
(f)	Respondents received at a 24-hour facility under the provisions of this section shall be examined by a second physician in accordance with G.S. 122C-266.  After receipt of notification that the district court has determined reasonable grounds for the commitment, further proceedings shall be carried out in the same way as for all other respondents under this Part."
Sec. 12.  G.S. 122C-262 reads as rewritten:
"§ 122C-262.  In areas without a single portal plan for mental health facilities; procedure for individuals needing immediate hospitalization.
(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone, including a law enforcement officer, who has knowledge of an individual who is subject to inpatient commitment according to the criteria of G.S. 122C-261(a) and who requires immediate hospitalization to prevent harm to self or others, may transport the individual directly to an area facility or other place, including a State facility for the mentally ill, for examination by a physician or eligible psychologist, in accordance with G.S. 122C-263(a).
(b)	Upon examination by the physician or eligible psychologist, if the individual meets the criteria required in G.S. 122C-261(a), the physician or eligible psychologist shall so certify in writing before any official authorized to administer oaths.  The certificate shall also state the reason that the individual requires immediate hospitalization.  If the physician or eligible psychologist has reason to believe that the individual is mentally retarded, the physician or eligible psychologist shall continue according to the provisions of Part 7A of this Article.
(c)	If the physician or eligible psychologist executes the oath, appearance before a magistrate shall be waived.  The physician or eligible psychologist shall send a copy of the certificate to the clerk of superior court by the most reliable and expeditious means.  If it cannot be reasonably anticipated that the clerk will receive the copy within 24 hours, excluding Saturday, Sunday, and holidays, of the time that it was signed, the physician or eligible psychologist shall also communicate the findings to the clerk by telephone.
(d)	Anyone, including a law enforcement officer if necessary, may transport the individual to a 24-hour facility described in G.S. 122C-252 for examination and treatment pending a district court hearing.  If there is no area 24-hour facility and if the respondent is indigent and unable to pay for care at a private 24-hour facility, the law enforcement officer or other designated person providing transportation shall take the respondent to a State facility for the mentally ill designated by the Commission in accordance with G.S. 143B-147(a)(1)a and immediately notify the clerk of superior court of this action.  The physician's or eligible psychologist's certificate shall serve as the custody order and the law enforcement officer or other designated person shall provide transportation in accordance with the provisions of G.S. 122C-251.
(e)	Respondents received at a 24-hour facility under the provisions of this section shall be examined by a second physician in accordance with G.S. 122C-266.  After receipt of notification that the district court has determined reasonable grounds for the commitment, further proceedings shall be carried out in the same way as for all other respondents under this Part."
Sec. 13.  (a)	G.S. 122C-263(a) reads as rewritten:
"(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, without unnecessary delay after assuming custody, the law enforcement officer or the individual designated by the clerk or magistrate under G.S. 122C-251(g) to provide transportation shall take the respondent to an area facility for examination by a physician or eligible psychologist; if a physician or eligible psychologist is not available in the area facility, the person designated to provide transportation shall take the respondent to any physician or eligible psychologist locally available. If a physician or eligible psychologist is not immediately available, the respondent may be temporarily detained in an area facility, if one is available; if an area facility is not available, the respondent may be detained under appropriate supervision in the respondent's home, in a private hospital or a clinic, in a general hospital, or in a State facility for the mentally ill, but not in a jail or other penal facility."
(b)	G.S. 122C-263(c) reads as rewritten:
"(c)	The physician or eligible psychologist described in subsection (a) of this section shall examine the respondent as soon as possible, and in any event within 24 hours, after the respondent is presented for examination. The examination shall include but is not limited to an assessment of the respondent's:
(1)	Current and previous mental illness including, if available, previous treatment history;
(2)	Dangerousness to self, as defined in G.S. 122C-3(11)a. or others, as defined in G.S. 122C-3(11)b.;
(3)	Ability to survive safely without inpatient commitment, including the availability of supervision from family, friends or others; and
(4)	Capacity to make an informed decision concerning treatment."
(c)	G.S. 122C-263(d) reads as rewritten:
"(d)	After the conclusion of the examination the physician or eligible psychologist shall make the following determinations:
(1)	If the physician or eligible psychologist finds that:
a.	The respondent is mentally ill;
b.	The respondent is capable of surviving safely in the community with available supervision from family, friends, or others;
c.	Based on the respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined by G.S. 122C-3(11); and
d.	The respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision to seek voluntarily or comply with recommended treatment;
	The physician or eligible psychologist shall so show on the examination report and shall recommend outpatient commitment.  In addition the examining physician or eligible psychologist shall show the name, address, and telephone number of the proposed outpatient treatment physician or center.  The person designated in the order to provide transportation shall return the respondent to the respondent's regular residence or to the home of a consenting individual, and the respondent shall be released from custody.
(2)	If the physician or eligible psychologist finds that the respondent is mentally ill and is dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., the physician or eligible psychologist shall recommend inpatient commitment, and shall so show on the examination report.  The law enforcement officer or other designated person shall take the respondent to a 24-hour facility described in G.S. 122C-252 pending a district court hearing.  If there is no area 24-hour facility and if the respondent is indigent and unable to pay for care at a private 24-hour facility, the law enforcement officer or other designated person shall take the respondent to a State facility for the mentally ill designated by the Commission in accordance with G.S. 143B-147(a)(1)a. for custody, observation, and treatment and immediately notify the clerk of superior court of this action.
(3)	If the physician or eligible psychologist finds that neither condition described in subdivisions (1) or (2) of this subsection exists, the respondent shall be released and the proceedings terminated.
(4)	If the physician or eligible psychologist has reason to believe that the respondent is mentally retarded, the physician or eligible psychologist shall proceed according to the provisions of Part 7A, unless the respondent is being evalulated for commitment pursuant to the provisions of G.S. 15A-1003 or G.S. 15A-1321."
(d)	G.S. 122C-263 is amended by adding a new subsection to read:
"( g)	The physician or eligible psychologist, at the completion of the examination, shall provide the individual who initiated the involuntary action with specific information regarding the next steps that will occur for the respondent and information regarding whom to contact in order to protest the outcome of the examination."
Sec. 14.  G.S. 122C-264(b1) reads as rewritten:
"(b1)	Upon receipt of a physician's or eligible psychologist's certificate that a respondent meets the criteria of G.S. 122C-261(a) and that immediate hospitalization is needed pursuant to G.S. 122C-262, or that the respondent meets the criteria of G.S. 122C-261(a) pursuant to G.S. 122C-261.1, the clerk of superior court of the county where the treatment facility is located shall submit the certificate to the Chief District Court Judge.  The court shall review the certificate within 24 hours, excluding Saturday, Sunday, and holidays, for a finding of reasonable grounds in accordance with 122C-261(b).  The clerk shall notify the treatment facility of the court's findings by telephone and shall proceed as set forth in subsections (b), (c), and (f) of this section."
Sec. 15.  (a) G.S. 122C-266(a) reads as rewritten:
"(a)	Except as provided in subsections (b) and (e), within 24 hours of arrival at a 24-hour facility described in G.S. 122C-252, the respondent shall be examined by a physician.  This physician shall not be the same physician who completed the certificate or examination under the provisions of G.S. 122C-261.1 or G.S. 122C-263(a).  The examination shall include but is not limited to the assessment specified in G.S. 122C-263(c).
(1)	If the physician finds that the respondent is mentally ill and is dangerous to self, as defined by G.S. 122C-3(11)a., or others, as defined by G.S. 122C-3(11)b., the physician shall hold the respondent at the facility pending the district court hearing.
(2)	If the physician finds that the respondent meets the criteria for outpatient commitment under G.S. 122C-263(d)(1), the physician shall show these findings on the physician's examination report, release the respondent pending the district court hearing, and notify the clerk of superior court of the county where the petition was initiated of these findings. In addition, the examining physician shall show on the examination report the name, address, and telephone number of the proposed outpatient treatment physician or center. The physician shall give the respondent a written notice listing the name, address, and telephone number of the proposed outpatient treatment physician or center and directing the respondent to appear at that address at a specified date and time. The examining physician before the appointment shall notify by telephone and shall send a copy of the notice and the examination report to the proposed outpatient treatment physician or center.
(3)	If the physician finds that the respondent does not meet the criteria for commitment under either G.S. 122C-263(d)(1) or G.S. 122C-263(d)(2), the physician shall release the respondent and the proceedings shall be terminated.
(4)	If the respondent is released under subdivisions (2) or (3) of this subsection, the law enforcement officer or other person designated to provide transportation shall return the respondent to the originating county.
(5)	If the physician or eligible psychologist has reason to believe that the respondent is mentally retarded, the physician or eligible psychologist shall proceed according to the provisions of Part 7A of this Article unless the respondent was sent to the 24-hour facility pursuant to the provisions of G.S. 15A-1003 or G.S. 15A-1321."
(b) G.S 122C-266(e) reads as rewritten:
"(e)	If the 24-hour facility described in G.S. 122C-252 or G.S. 122C-262 is the facility in which the first examination by a physician or eligible psychologist occurred and is the same facility in which the respondent is held, the second examination shall occur not later than the following regular working day."
Sec. 16. (a) G.S. 122C-268(a) reads as rewritten:
"(a)	A hearing shall be held in district court within 10 days of the day the respondent is taken into law enforcement custody pursuant to G.S. 122C-261(e), 122C-261.1, or 122C-262.  A continuance of not more than five days may be granted upon motion of:
(1)	The court;
(2)	Respondent's counsel; or
(3)	The State, sufficiently in advance to avoid movement of the respondent."
(b)	G.S. 122C-268(j) reads as rewritten:
"(j)	To support an inpatient commitment order, the court shall find by clear, cogent, and convincing evidence that the respondent is mentally ill and dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b. The court shall record the facts that support its findings."
Sec. 17. (a) G.S. 122C-270(a) reads as rewritten: 
"(a)	The senior regular resident superior court judge of a superior court district or set of districts as defined in G.S. 7A-41.1 in which a State facility for the mentally ill is located shall appoint an attorney licensed to practice in North Carolina as special counsel for indigent respondents who are mentally ill.  This special counsel shall serve at the pleasure of the appointing judge, may not privately practice law, and shall receive annual compensation within the salary range for assistant district attorneys as fixed by the Administrative Officer of the Courts. The special counsel shall represent all indigent respondents at all hearings, rehearings, and supplemental hearings held at the State facility and on appeals held under this Article. Special counsel shall determine indigency in accordance with G.S. 7A-450(a). Indigency is subject to redetermination by the presiding judge."
(b)	G.S. 122C-270(f) reads as rewritten:
"(f)	The Attorney General may employ four attorneys, one to be assigned by him full-time to each of the State facilities for the mentally ill, to represent the State's interest at commitment hearings, rehearings and supplemental hearings held under this Article at the State facilities for respondents admitted to those facilities pursuant to Part 3, 4, 7, 7A, or 8 of this Article or G.S. 15A-1321 and to provide liaison and consultation services concerning these matters.  These attorneys are subject to Chapter 126 of the General Statutes and shall also perform additional duties as may be assigned by the Attorney General. The attorney employed by the Attorney General in accordance with G.S. 114-4.2B shall represent the State's interest at commitment hearings, rehearings and supplemental hearings held for respondents admitted to the University of North Carolina Hospitals at Chapel Hill pursuant to Part 3, 4, 7, 7A, or 8 of this Article or G.S. 15A-1321."
Sec. 18.  G.S. 122C-271(b) reads as rewritten: 
"(b)	If the respondent has been held in a 24-hour facility pending the district court hearing pursuant to G.S. 122C-268, the court may make one of the following dispositions:
(1)	If the court finds by clear, cogent, and convincing evidence that the respondent is mentally ill; that the respondent is capable of surviving safely in the community with available supervision from family, friends, or others; that based on respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined by G.S. 122C-3(11); and that the respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision voluntarily to seek or comply with recommended treatment, it may order outpatient commitment for a period not in excess of 90 days. If the commitment proceedings were initiated as the result of the respondent's being charged with a violent crime, including a crime involving an assault with a deadly weapon, and the respondent was found incapable of proceeding, the commitment order shall so show.
(2)	If the court finds by clear, cogent, and convincing evidence that the respondent is mentally ill and is dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., it may order inpatient commitment at a 24-hour facility described in G.S. 122C-252 for a period not in excess of 90 days. However, no respondent may be committed to a State, area or private facility for the mentally retarded. An individual who is mentally ill and dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., may also be committed to a combination of inpatient and outpatient commitment at both a 24-hour facility and an outpatient treatment physician or center for a period not in excess of 90 days. If the commitment proceedings were initiated as the result of the respondent's being charged with a violent crime, including a crime involving an assault with a deadly weapon, and the respondent was found incapable of proceeding, the commitment order shall so show. If the court orders inpatient commitment for a respondent who is under an outpatient commitment order, the outpatient commitment is terminated; and the clerk of the superior court of the county where the district court hearing is held shall send a notice of the inpatient commitment to the clerk of superior court where the outpatient commitment was being supervised.
(3)	If the court does not find that the respondent meets either of the commitment criteria set out in subdivisions (1) and (2) of this subsection, the respondent shall be discharged, and the facility in which the respondent was last a client so notified.
(4)	Before ordering any outpatient commitment, the court shall make findings of fact as to the availability of outpatient treatment. The court shall also show on the order the outpatient treatment physician or center who is to be responsible for the management and supervision of the respondent's outpatient commitment. When an outpatient commitment order is issued for a respondent held in a 24-hour facility, the court may order the respondent held at the facility for no more than 72 hours in order for the facility to notify the designated outpatient treatment physician or center of the treatment needs of the respondent. The clerk of court in the county where the facility is located shall send a copy of the outpatient commitment order to the designated outpatient treatment physician or center. If the outpatient commitment will be supervised in a county other than the county where the commitment originated, the court shall order venue for further court proceedings to be transferred to the county where the outpatient commitment will be supervised. Upon an order changing venue, the clerk of superior court in the county where the commitment originated shall transfer the file to the clerk of superior court in the county where the outpatient commitment is to be supervised."
Sec. 19.  Article 5 of Chapter 122C of the General Statutes is amended by inserting a new Part to read:
"Part 7A.  Involuntary Commitment of the Mentally Retarded With Mental Illness.
"§ 122C-280.1.  In areas without a single portal plan for mental health facilities; affidavit and petition before clerk or magistrate when immediate hospitalization is not necessary; custody order.
(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone who has knowledge of an individual who is mentally retarded and because of mental illness, either dangerous to self, as defined in G.S. 122C-3(11)a., or others as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, may appear before a clerk or assistant or deputy clerk of superior court or a magistrate and execute an affidavit to this effect, and petition the clerk or magistrate for issuance of an order to take the respondent into custody for examination by a physician or eligible psychologist.  The affidavit shall include the facts on which the affiant's opinion is based.  Jurisdiction under this subsection is in the clerk or magistrate in the county where the respondent resides or is found.  In an area with a single portal plan, if anyone contacts a clerk, assistant or deputy clerk, or a magistrate about an individual described in this subsection, the clerk, assistant or deputy clerk, or magistrate shall proceed in accordance with G.S. 122C-280.2, unless no public funds will be used to pay for the person's care.
(b)	If the clerk or magistrate finds reasonable grounds to believe that the facts alleged in the affidavit are true and that the respondent is probably mentally retarded and because of mental illness is either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, the clerk or magistrate shall issue an order to a law enforcement officer or any other person authorized under G.S. 122C-251 to take the respondent into custody for examination by a physician or eligible psychologist.  The clerk or magistrate shall provide the petitioner, and the respondent, if present, with specific information regarding the next steps that will occur for the respondent or, if no custody order was issued, information regarding whom to contact in order to protest this determination.
(c)	If the clerk or magistrate issues a custody order, the clerk or magistrate shall also make inquiry in any reliable way as to whether the respondent is indigent within the meaning of G.S. 7A-450.  A magistrate shall report the result of this inquiry to the clerk.
(d)	If the affiant is a physician or eligible psychologist, the affiant may execute the affidavit before any official authorized to administer oaths and is not required to appear before the clerk or magistrate for this purpose.  The physician's or psychologist's examination shall comply with the requirements of the initial examination as provided in G.S. 122C-280.4(c).  If the physician or eligible psychologist recommends outpatient commitment and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for outpatient commitment, the clerk or magistrate shall issue an order that a hearing before a district court judge be held to determine whether the respondent will be involuntarily committed.  If a physician or eligible psychologist recommends outpatient commitment, the clerk or magistrate shall provide the respondent with written notice of any scheduled appointment and the name, address, and telephone number of the proposed outpatient treatment physician or center.  If the physician or eligible psychologist recommends inpatient commitment and the clerk or magistrate finds probable cause to believe that the respondent meets the criteria for inpatient commitment, the clerk or magistrate shall issue an order for transportation to or custody at a 24-hour facility described in G.S. 122C-252.  If a physician or eligible psychologist executes an affidavit for inpatient commitment of a respondent, a second physician shall be required to perform the examination required by G.S. 122C-280.7.
(e)	Upon receipt of the custody order of the clerk or magistrate, a law enforcement officer or other person designated in the order shall take the respondent into custody within 24 hours after the order is signed and proceed according to G.S. 122C-280.4.
"§ 122C-280.2.  In areas with single portal plans for mental health facilities; custody and examination.
(a)	In an area with a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone, including a law enforcement officer, who has knowledge of an individual who is subject to commitment according to the criteria of G.S. 122C-280.1(a) and who requires immediate treatment to prevent harm to self or others, may transport the individual directly to a facility in accordance with the single portal plan, for examination by a physician or eligible psychologist, in accordance with G.S. 122C-280.4.
(b)	Anyone who has knowledge of an individual who is subject to commitment according to the criteria of G.S. 122C-261(a), but is unable to transport the individual, may describe the behavior of the individual to a qualified crisis services professional.
(1)	If the person requesting commitment contacts the qualified crisis services professional by telephone and the qualified crisis services professional is satisfied that the information provided is an adequate basis on which to issue a custody order, the professional shall fill out a statement containing the facts on which the request for commitment is based and containing an acknowledgment that the person signing is aware of the penalty pursuant to G.S. 122C-204(b) for giving false information.  The qualified crisis services professional shall provide to the clerk or assistant or deputy clerk of superior court or magistrate a copy of the unsigned statement and the signed recommendation of the qualified crises services professional that the clerk or magistrate issue a custody order.  The clerk or magistrate shall give the unsigned statement to the person to whom the clerk or magistrate gives the custody order and that person shall contact the person requesting commitment and obtain the signature of the person requesting commitment before taking the respondent into custody, unless doing so would place any person in danger, in which case the person to whom the custody order has been given may take action to ensure the safety of those present prior to obtaining the signature.  If the person requesting commitment refuses to sign the statement, the person to whom the custody order has been given shall determine whether to take the respondent into custody pursuant to the criteria of subsection (a) of this section.
(2)	If the person requesting commitment contacts the qualified crisis services professional by telephone but the qualified services professional is not satisfied that the information provided is an adequate basis on which to issue a custody order, the qualified crisis services professional may require the person to appear in person and make a written statement before determining whether to recommend that the clerk or magistrate issue a custody order.
(3)	If the person requesting commitment appears in person before the qualified crisis services professional, the person shall sign a statement containing the facts on which the request for commitment is based and containing an acknowledgment that the person is aware of the penalty pursuant to G.S. 122C-204(b) for giving false information.
(4)	If the qualified crisis services professional is able to form a reasonable belief, based on the information, that the individual is subject to commitment according to the criteria of G.S. 122C-261(a), the qualified crisis services professional shall provide to the clerk or magistrate a copy of the statement, whether signed or unsigned, and a written and signed recommendation that a custody order should be issued. The statement and recommendation may be transmitted to the clerk or magistrate by facsimile.  If the statement is signed, the original shall be forwarded to the clerk within 48 hours.
(5)	The qualified crisis services professional shall provide the person requesting commitment with specific information regarding the next steps that will occur for the respondent or, if no custody order is issued, information regarding whom to contact in order to protest this determination.  At first contact with the individual subject to commitment, the qualified crisis services professional shall provide the person subject to commitment with specific information regarding the next steps that may occur.
(6)	Anyone who has knowledge of an individual who is mentally retarded and because of a mental illness is either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, may appear before a clerk or assistant or deputy clerk of superior court or a magistrate and execute an affidavit to this effect, and petition the clerk or magistrate for issuance of an order to take the respondent into custody for examination by a physician or eligible psychologist.  The affidavit shall include the facts on which the affiant's opinion is based.  If, based on the affidavit or based on information provided by the area authority, the clerk or magistrate has reason to believe that the respondent is not mentally retarded, the clerk or magistrate shall proceed according to the provisions of Part 7.  Jurisdiction under this subsection is in the clerk or magistrate in the county where the respondent resides or is found.  Before making a determination to issue a custody order, the clerk or magistrate shall contact the area authority to determine if there are more appropriate resources available through the area authority to assist the person requesting commitment or the person who may be in need of treatment.
(7)	If the clerk or magistrate finds reasonable grounds to believe that the facts alleged in the affidavit or statement are true and that the respondent is probably mentally retarded and because of a mental illness is either dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., or in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness, and that more appropriate resources are not available through the area authority to assist the person requesting commitment or the person who may be in need of treatment, the clerk or magistrate shall issue an order to a law enforcement officer of any other person authorized under G.S. 122C-251 to take the respondent into custody for examination by a physician or eligible psychologist, in accordance with the single portal plan and with G.S. 122C-263(c).
(c)	Upon examination, if the individual subject to commitment meets the criteria required in G.S. 122C-280.1(a), the physician or eligible psychologist shall so certify in writing.  The certificate shall also include the facts on which the physician's or eligible psychologist's opinion is based and shall state whether the individual meets the criteria of G.S. 122C-280.4(d)(1) for outpatient commitment or meets the criteria of G.S. 122C-280.4(d)(2) for inpatient commitment.  If the physician or eligible psychologist has reason to believe that the individual is not mentally retarded, the physician or psychologist shall continue according to the provisions of Part 7 of this Article.
(d)	A representative of the area authority shall inquire in any reliable way as to whether the respondent is indigent within the meaning of G.S. 7A-450.  The physician or eligible psychologist shall send the result of this inquiry and a copy of the certificate to the clerk of superior court by the most reliable and expeditious means.  If it cannot be reasonably anticipated that the clerk will receive the copy within 24 hours, excluding Saturday, Sunday, and holidays, of the time that it was signed, the physician or eligible psychologist shall also communicate these findings to the clerk by telephone.
(e)	The physician's or eligible psychologist's certificate, if it indicates that the individual meets the criteria for inpatient commitment, shall serve as the custody order and the law enforcement officer or other designated person shall provide transportation to the area 24-hour facility in accordance with the single portal plan and with the provisions of G.S. 122C-251.  If the physician or eligible psychologist determines that the individual meets the criteria for outpatient commitment, the physician or psychologist shall provide the respondent with written notice of any scheduled appointment and the name, address, and telephone number of the proposed outpatient treatment center or physician.
(f)	Respondents received at a 24-hour facility under the provisions of this section shall be examined by a second physician in accordance with G.S. 122C-280.7.  After receipt of notification that the district court has determined reasonable grounds for the commitment, further proceedings shall be carried out in the same way as for all other respondents under this Part.
"§ 122C-280.3.  In areas without a single portal plan for mental facilities; procedure for individuals needing immediate hospitalization.
(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, anyone, including a law enforcement officer, who has knowledge of an individual who is subject to inpatient commitment according to the criteria of G.S. 122C-280.1(a) and who requires immediate hospitalization to prevent harm to self or others, may transport the individual directly to an area facility or other place, including a State facility for the mentally ill, for examination by a physician or eligible psychologist, in accordance with G.S. 122C-280.4(c).
(b)	Upon examination by the physician or eligible psychologist, if the individual meets the criteria required in G.S. 122C-280.1(a), the physician or eligible psychologist shall so certify in writing before any official authorized to administer oaths.  The certificate shall also state the reason that the individual requires immediate hospitalization.  If the physician or eligible psychologist has reason to believe that the individual is not mentally retarded, the physician or psychologist shall continue according to the provisions of Part 7 of this Article.
(c)	If the physician or eligible psychologist executes the oath, appearance before a magistrate shall be waived.  The physician or eligible psychologist shall send a copy of the certificate to the clerk of superior court by the most reliable and expeditious means.  If it cannot be reasonably anticipated that the clerk will receive the copy within 24 hours, excluding Saturday, Sunday, and holidays, of the time that it was signed, the physician or eligible psychologist shall also communicate these findings to the clerk by telephone.
(d)	Anyone, including a law enforcement officer if necessary, may transport the individual to a 24-hour facility described in G.S. 122C-252 for examination and treatment pending a district court hearing.  If there is no area 24-hour facility and if the respondent is indigent and unable to pay for care at a private 24-hour facility, the law enforcement officer or other designated person providing transportation shall take the respondent to a State facility for the mentally ill designated by the Commission in accordance with G.S. 143B-147(a)(1)a. and immediately notify the clerk of superior court of this action.  The physician's or eligible psychologist's certificate shall serve as the custody order, and the law enforcement officer or other designated person shall provide transportation in accordance with the provisions of G.S. 122C-251.
(e)	Respondents received at a 24-hour facility under the provisions of this section shall be examined by a second physician in accordance with G.S. 122C-280.7.  After receipt of notification that the district court has determined reasonable grounds for the commitment, further proceedings shall be carried out in the same way as for all other respondents under this Part.
"§ 122C-280.4.  Duties of law enforcement officer; first examination by physician or eligible psychologist.
(a)	In an area without a valid single portal of entry and exit plan pursuant to G.S. 122C-132, without unnecessary delay after assuming custody, the law enforcement officer or the individual designated by the clerk or magistrate under G.S. 122C-251(g) to provide transportation shall take the respondent to an area facility for examination by a physician or eligible psychologist; if a physician or eligible psychologist is not available in the area facility, the person providing transportation shall take the respondent to any physician or eligible psychologist locally available.  If a physician or eligible psychologist is not immediately available, the respondent may be temporarily detained in an area facility, if one is available; if an area facility is not available, the respondent may be detained under appropriate supervision in the respondent's home, in a private hospital or a clinic, in a general hospital, or in a State facility for the mentally ill, but not in a jail or other penal facility.
(b)	The examination set forth in subsection (a) of this section is not required if the affiant who obtained the custody order is a physician or eligible psychologist who recommends inpatient commitment.  In this case, the law enforcement officer shall take the respondent directly to a 24-hour facility described in G.S. 122C-252.
(c)	The physician or eligible psychologist described in subsection (a) of this section shall examine the respondent as soon as possible, and in any event within 24 hours, after the respondent is presented for examination.  The examination shall include, but is not limited to, an assessment of the respondent's:
(1)	Current and previous mental illness and mental retardation including, if available, previous treatment history;
(2)	Dangerousness to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b.;
(3)	Ability to survive safely without inpatient commitment, including the availability of supervision from family, friends, or others; and
(4)	Capacity to make an informed decision concerning treatment.
(d)	After the conclusion of the examination, the physician or eligible psychologist shall make the following determinations:
(1)	If the physician or eligible psychologist finds that:
a.	The respondent is mentally retarded and mentally ill;
b.	The respondent is capable of surviving safely in the community with available supervision from family, friends, or others;
c.	Based on the respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability or deterioration which would predictably result in dangerousness as defined by G.S. 122C-3(11); and
d.	The respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision to seek voluntarily or comply with recommended treatment.
	The physician or eligible psychologist shall so show on the examination report and shall recommend outpatient commitment.  In addition, the examining physician or eligible psychologist shall show the name, address, and telephone number of the proposed outpatient treatment facility.  The person designated in the order to provide transportation shall return the respondent to the respondent's regular residence or to the home of a consenting individual and shall release the respondent from custody.
(2)	If the physician or eligible psychologist finds that the respondent is mentally retarded and because of a mental illness is dangerous to self as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., the physician or psychologist shall recommend inpatient commitment and shall so show on the examination report.  The law enforcement officer or other designated person shall take the respondent to a 24-hour facility described in G.S. 122C-252 pending a district court hearing.  If there is no area 24-hour facility and if the respondent is indigent and unable to pay for care at a private 24-hour facility, the law enforcement officer or other designated person shall take the respondent to a State facility for the mentally ill designated by the Commission in accordance with G.S. 143B-147(a)(1)a. for custody, observation, and treatment and immediately notify the clerk of superior court of this action.
(3)	If the physician or eligible psychologist finds that neither condition described in subdivision (1) or (2) of this subsection exists, the respondent shall be released and the proceedings terminated.
(4)	If the physician or eligible psychologist has reason to believe that the respondent is not mentally retarded, the physician or psychologist shall proceed according to the provisions of Part 7 of this Article.
(e)	The findings of the physician or eligible psychologist and the facts on which they are based shall be in writing in all cases.  The physician or eligible psychologist shall send a copy of the findings to the clerk of superior court by the most reliable and expeditious means.  If it cannot be reasonably anticipated that the clerk will receive the copy within 48 hours of the time that it was signed, the physician or eligible psychologist shall also communicate these findings to the clerk by telephone.
(f)	When outpatient commitment is recommended, the examining physician or eligible psychologist, if different from the proposed outpatient treatment physician or center, shall give the respondent a written notice listing the name, address, and telephone number of the proposed outpatient treatment facility and directing the respondent to appear at the address at a specified date and time.  The examining physician or eligible psychologist before the appointment shall notify by telephone the designated outpatient treatment facility and shall send a copy of the notice and the examination report to the facility.
(g)	The physician or eligible psychologist, at the completion of the examination, shall provide the individual who initiated the involuntary action with specific information regarding the next steps that will occur for the respondent, and information regarding whom to contact in order to protest the outcome of the examination.
"§ 122C-280.5.  Duties of clerk of superior court.
(a)	Upon receipt of a physician's or eligible psychologist's finding that the respondent meets the criteria of G.S. 122C-280.4(d)(1) and that outpatient commitment is recommended, the clerk of superior court of the county where the petitioner or certificate was initiated, upon direction of a district court judge, shall calendar the matter for hearing and shall notify the respondent, the proposed outpatient treatment physician or center, and the petitioner of the time and place of the hearing.  The petitioner may file a written waiver of the petitioner's right to notice under this subsection with the clerk of court.
(b)	Upon receipt of a physician's or eligible psychologist's finding that a respondent meets the criteria of G.S. 122C-280.4(d)(2) and that inpatient commitment is recommended, the clerk of superior court of the county where the 24-hour facility is located shall, after determination required by G.S. 122C-280.1(c) and upon direction of a district court judge, assign counsel if necessary, calendar the matter for hearing, and notify the respondent, respondent's counsel, and the petitioner of the time and place of the hearing.  The petitioner may file a written waiver of the right to notice under this subsection with the clerk of court.
(c)	Upon receipt of a physician's or eligible psychologist's certificate that a respondent meets the criteria of G.S. 122C-280.1(a) and that immediate hospitalization is needed pursuant to G.S. 122C-280.3, or that the respondent meets the criteria of G.S. 122C-280.1(a) pursuant to G.S. 122C-280.2, the clerk of superior court of the county where the treatment facility is located shall submit the certificate to the Chief District Court Judge.  The court shall review the certificate within 24 hours, excluding Saturday, Sunday, and holidays, for a finding of reasonable grounds in accordance with G.S. 122C-280.1(b).  The clerk shall notify the treatment facility of the court's findings by telephone and shall proceed as set forth in subsections (b), (d), and (f) of this section.
(d)	Notice to the respondent, required by subsections (a) and (b) of this section, shall be given as provided in G.S. 1A-1, Rule 4(j) at least 72 hours before the hearing.  Notice to other individuals shall be sent at least 72 hours before the hearing by first-class mail postage prepaid to the individual's last known address.  G.S. 1A-1, Rule 6 shall not apply.
(e)	The clerk of superior court of the county where outpatient commitment is to be supervised shall keep a separate list regarding outpatient commitment and shall prepare quarterly reports listing all active cases, the assigned supervisor, and the disposition of all hearings, supplemental hearings, and rehearings.
(f)	The clerk of superior court of the county where inpatient commitment hearings and rehearings are held shall provide all notices, send all records, and maintain a record of all proceedings as required by this Part; provided that if the respondent has been committed to a 24-hour facility in a county other than the respondent's county of residence and the district court hearing is held in the county of the facility, the clerk of superior court in the county of the facility shall forward the record of the proceedings to the clerk of superior court in the county of the respondent's residence, where they shall be maintained by the receiving clerk.
"§ 122C-280.6.  Outpatient commitment; examination and treatment pending hearing.
(a)	If a respondent fails to appear for examination by the area authority at the designated time, the area authority shall issue an order to a law enforcement officer or other person authorized under G.S. 122C-251 to take the respondent into custody and to take the respondent immediately to the area authority for evaluation.  The law enforcement officer may wait during the examination and return the respondent to the respondent's home after the examination.
(b)	The examining physician at the area authority may prescribe for the respondent reasonable and appropriate medication and treatment that are consistent with accepted medical standards pending the district court hearing.
(c)	In no event may a respondent released on a recommendation that the respondent meets the outpatient commitment criteria be physically forced to take medication or forcibly detained for treatment pending a district court hearing.
(d)	If at any time pending the district court hearing, the area authority determines that the respondent does not meet the criteria of G.S. 122C-280.4(d)(1), it shall release the respondent and notify the clerk of court and the proceedings shall be terminated.
(e)	If a respondent becomes dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., pending a district court hearing on outpatient commitment, new proceedings for involuntary inpatient commitment may be initiated.
(f)	If an inpatient commitment proceeding is initiated pending the hearing for outpatient commitment and the respondent is admitted to a 24-hour facility to be held for an inpatient commitment hearing, notice shall be sent by the clerk of court in the county where the respondent is being held to the clerk of court of the county where the outpatient commitment was initiated and the outpatient commitment proceeding shall be terminated.
"§ 122C-280.7.  Inpatient commitment; second examination and treatment pending hearing.
(a)	Except as provided in subsection (d) of this section, within 24 hours of arrival at a 24-hour facility described in G.S. 122C-252, the respondent shall be examined by a physician.  This physician shall not be the same physician who completed the certificate or examination under the provisions of G.S. 122C-280.2 or G.S. 122C-280.4(a).  The examination shall include, but is not limited to, the assessment specified in G.S. 122C-280.4(c).
(1)	If the physician finds that the respondent is mentally retarded and because of a mental illness is dangerous to self, as defined by G.S. 122C-3(11)a., or others, as defined by G.S. 122C-3(11)b., the physician shall hold the respondent at the facility pending the district court hearing.
(2)	If the physician finds that the respondent meets the criteria for outpatient commitment under G.S. 122C-280.4(d)(1), the physician shall show these findings on the physician's examination report, release the respondent pending the district court hearing, and notify the clerk of superior court of the county where the petition was initiated of these findings.  In addition, the examining physician shall show on the examination report the name, address, and telephone number of the proposed outpatient treatment physician or center and shall give the respondent a written notice listing the name, address, and telephone number of the proposed outpatient treatment facility and directing the respondent to appear at that address at a specified date and time.  The examining physician, before the appointment, shall notify by telephone and shall send a copy of the notice and the examination report to the proposed outpatient treatment facility.
(3)	If the physician finds that the respondent does not meet the criteria for commitment under either G.S. 122C-280.4(d)(1) or G.S. 122C-280.4(d)(2), the physician shall release the respondent and the proceedings shall be terminated.
(4)	If the respondent is released under subdivision (2) or (3) of this subsection, the law enforcement officer or other person designated to provide transportation shall return the respondent to the originating county.
(5)	If the physician or eligible psychologist has reason to believe that the respondent is not mentally retarded, the physician or eligible psychologist shall proceed according to the provisions of Part 7 of this Article.
(b)	The findings of the physician and the facts on which they are based shall be in writing, in all cases.  A copy of the findings shall be sent to the clerk of superior court by reliable and expeditious means.
(c)	Pending the district court hearing, the physician attending the respondent may administer to the respondent reasonable and appropriate medication and treatment that is consistent with accepted medical standards.  If at any time pending the district court hearing, the attending physician determines that the respondent no longer meets the criteria of either G.S. 122C-280.4(d)(1) or (d)(2), the physician shall release the respondent and notify the clerk of court and the proceedings shall be terminated.
(d)	If the 24-hour facility described in G.S. 122C-252 or G.S. 122C-280.3 is the facility in which the first examination by a physician or eligible psychologist occurred and is the same facility in which the respondent is held, the second examination shall occur not later than the following regular working day.
"§ 122C-280.8.  Outpatient commitment; district court hearing.
(a)	A hearing shall be held in district court within 10 days of the day the respondent is taken into law enforcement custody pursuant to G.S. 122C-280.1(e), 122C-280.2, or 122C-280.3.  Upon its own motion or upon motion of the proposed outpatient treatment physician or the respondent, the court may grant a continuance of not more than five days.
(b)	The respondent shall be present at the hearing, unless the respondent's counsel waives the respondent's presence with the consent of the court.  A subpoena may be issued to compel the respondent's presence at a hearing.  The petitioner and the proposed outpatient treatment physician or designee may be present and may provide testimony.
(c)	Certified copies of reports and findings of physicians and psychologists and medical records of previous and current treatment are admissible in evidence.
(d)	At the hearing to determine the necessity and appropriateness of outpatient commitment, the respondent need not, but may, be represented by counsel.  However, if the court determines that the legal or factual issues raised are of such complexity that the assistance of counsel is necessary for an adequate presentation of the merits or that the respondent is unable to speak for the respondent, the court may continue the case for not more than five days and order the appointment of counsel for an indigent respondent.
(e)	Hearings may be held at the area facility in which the respondent is being treated, if it is located within the judge's district court district as defined in G.S. 7A-133, or in the judge's chambers.  A hearing shall not be held in a regular courtroom, over objection of the respondent, if in the discretion of a judge, a more suitable place is available.
(f)	The hearing shall be closed to the public unless the respondent requests otherwise.
(g)	A copy of all documents admitted into evidence and a transcript of the proceedings shall be furnished to the respondent on request by the clerk upon the direction of a district court judge.  If the client is indigent, the copies shall be provided at State expense.
(h)	To support an outpatient commitment order, the court shall find by clear, cogent, and convincing evidence that the respondent meets the criteria specified in G.S. 122C-208.4(d)(1).  The court shall record the facts that support its findings and shall show on the order the center or physician who is responsible for the management and supervision of the respondent's outpatient commitment.
"§ 122C-280.9.  Inpatient commitment; district court hearing.
(a)	A hearing shall be held in district court within 10 days of the day the respondent is taken into law enforcement custody pursuant to G.S. 122C-280.1(e), 122C-280.2, or  122C-280.3.  A continuance of not more than five days may be granted upon motion of:
(1)	The court;
(2)	Respondent's counsel; or
(3)	The State, sufficiently in advance to avoid movement of the respondent.
(b)	The attorney, who is a member of the staff of the Attorney General assigned to one of the State's facilities for the mentally ill or the psychiatric service of the University of North Carolina Hospitals at Chapel Hill, shall represent the State's interest at commitment hearings, rehearings, and supplemental hearings held for respondents admitted pursuant to this Part at the facility to which the attorney is assigned.
In addition, the Attorney General may designate an attorney who is a member of the Attorney General's staff to represent the State's interest at any commitment hearing, rehearing, or supplemental hearing held in a place other than at one of the State's facilities for the mentally ill or the psychiatric service of the University of North Carolina Hospitals at Chapel Hill.
(c)	The respondent shall be represented by counsel of the respondent's choice; or if the respondent is indigent within the meaning of G.S. 7A-450 or refuses to retain counsel if financially able to do so, the respondent shall be represented by counsel appointed by the court.
(d)	With the consent of the court, counsel for the respondent may in writing waive the presence of the respondent.
(e)	Certified copies of reports and findings of physicians and psychologists and previous and current medical records are admissible in evidence, but the respondent's right to confront and cross-examine witnesses shall not be denied.
(f)	Hearings may be held in an appropriate room not used for treatment of clients at the facility in which the respondent is being treated if it is located within the judge's district court district as defined in G.S. 7A-133 or in the judge's chambers.  A hearing shall not be held in a regular courtroom, over objection of the respondent, if, in the discretion of a judge, a more suitable place is available.
(g)	The hearing shall be closed to the public unless the respondent requests otherwise.
(h)	A copy of all documents admitted into evidence and a transcript of the proceedings shall be furnished to the respondent on request by the clerk upon the direction of a district court judge.  If the respondent is indigent, the copies shall be provided at State expense.
(i)	To support an inpatient commitment order, the court shall find by clear, cogent, and convincing evidence that the respondent is mentally ill and dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b.  The court shall record the facts that support its findings.
"§ 122C-280.10.  Venue of district court hearing when respondent held at a 24-hour facility pending hearing.
(a)	In all cases where the respondent is held at a 24-hour facility pending hearing as provided in G.S. 122C-280.9, unless the respondent through counsel objects to the venue, the hearing shall be held in the county in which the facility is located.  Upon objection to venue, the hearing shall be held in the county where the petition was initiated.
(b)	An official of the facility shall immediately notify the clerk of superior court of the county in which the facility is located of a determination to hold the respondent pending hearing.  That clerk shall request transmittal of all documents pertinent to the proceedings from the clerk of superior court where the proceedings were initiated.  The requesting clerk shall assume all duties set forth in G.S. 122C-280.5.  The requesting clerk shall appoint as counsel for indigent respondents the counsel provided for in G.S. 122C-280.9(c).
"§ 122C-280.11.  Disposition.
(a)	If an examining physician or eligible psychologist has recommended outpatient commitment and the respondent has been released pending the district court hearing, the court may make one of the following dispositions:
(1)	If the court finds by clear, cogent, and convincing evidence that the respondent is mentally retarded and mentally ill; that the respondent is capable of surviving safely in the community with available supervision from family, friends, or others; that based on respondent's treatment history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined in G.S. 122C-3(11); and that the respondent's current mental status or the nature of respondent's illness limits or negates the respondent's ability to make an informed decision to seek voluntarily or comply with recommended treatment, it may order outpatient commitment to the area authority for a period not in excess of 90 days.
(2)	If the court does not find that the respondent meets the criteria of commitment set out in subdivision (1) of this subsection, the respondent shall be discharged and the facility at which the respondent was last a client so notified.
(b)	If the respondent has been held in a 24-hour facility pending the district court hearing pursuant to G.S. 122C-280.9, the court may make one of the following dispositions:
(1)	If the court finds by clear, cogent, and convincing evidence that the respondent is mentally retarded and mentally ill; that the respondent is capable of surviving safely in the community with available supervision from family, friends, or others; that based on respondent's psychiatric history, the respondent is in need of treatment in order to prevent further disability or deterioration that would predictably result in dangerousness as defined by G.S. 122C-3(11); and that the respondent's current mental status or the nature of the respondent's illness limits or negates the respondent's ability to make an informed decision voluntarily to seek or comply with recommended treatment, it may order outpatient commitment to the area authority for a period not in excess of 90 days.
(2)	If the court finds by clear, cogent, and convincing evidence that the respondent is mentally retarded and because of a mental illness is dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., it may order inpatient commitment under the supervision of the area authority where respondent resides for a period not in excess of 90 days.  The area authority shall determine the most appropriate facility for the client's inpatient treatment.  An individual who is mentally retarded and because of a mental illness is dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., may also be committed to a combination of inpatient and outpatient commitment under the supervision of the area authority for a period not in excess of 90 days.  If the court orders inpatient commitment for a respondent who is under an outpatient commitment order, the outpatient commitment is terminated; and the clerk of the superior court of the county where the district court hearing is held shall send a notice of the inpatient commitment to the clerk of superior court where the outpatient commitment was being supervised.
(3)	If the court does not find that the respondent meets either of the commitment criteria set out in subdivisions (1) and (2) of this subsection, the respondent shall be discharged, and the facility in which the respondent was last a client so notified.
(4)	Before ordering any outpatient commitment, the court shall make findings of fact as to the availability of outpatient treatment.  The court shall also show on the order the area authority who is to be responsible for the management and supervision of the respondent's outpatient commitment.  When an outpatient commitment order is issued for a respondent held in a 24-hour facility, the court may order the respondent held at the facility for no more than 72 hours in order for the facility to notify the designated area authority of the treatment needs of the respondent.  The clerk of court in the county where the facility is located shall send a copy of the outpatient commitment order to the designated area authority.  If the outpatient commitment will be supervised in a county other than the county where the commitment originated, the court shall order venue for further court proceedings to be transferred to the county where the outpatient commitment will be supervised.  Upon an order changing venue, the clerk of superior court in the county where the commitment originated shall transfer the file to the clerk of superior court in the county where the outpatient commitment is to be supervised.
"§ 122C-280.12.  Appeal.
Judgment of the district court is final.  Appeal may be had to the Court of Appeals by the State or by any party on the record as in civil cases.  Appeal does not stay the commitment unless so ordered by the Court of Appeals.  The Attorney General represents the State's interest on appeal.  The district court retains limited jurisdiction for the purpose of hearing all reviews, rehearings, or supplemental hearings allowed or required under this Part.
"§ 122C-280.13.  Duties for follow-up on commitment order.
(a)	Unless prohibited by Chapter 90 of the General Statutes, if the commitment order directs outpatient treatment, the physician at the area authority may prescribe or administer, or the area authority may administer, to the respondent reasonable and appropriate medication and treatment that are consistent with accepted medical standards.
(1)	If the respondent fails to comply or clearly refuses to comply with all or part of the prescribed treatment, the area authority shall make all reasonable effort to solicit the respondent's compliance.  These efforts shall be documented and reported to the court with a request for a supplemental hearing.
(2)	If the respondent fails to comply, but does not clearly refuse to comply, with all or part of the prescribed treatment after reasonable effort to solicit the respondent's compliance, the area authority shall issue a custody order to a law enforcement officer or any other person authorized under G.S. 122C-251 to take the respondent into custody for the purpose of examination.  The law enforcement officer shall turn the respondent over to the custody of the area authority who shall conduct the examination and then release the respondent.  The law enforcement officer may wait during the examination and return the respondent to the respondent's home, or to a designated 24-hour facility if directed by the physician or eligible psychologist, after the examination.  An examination conducted under this subsection in which a physician or eligible psychologist determines that the respondent meets the criteria for inpatient commitment may be substituted for the first examination required by G.S. 122C-280.4.
(3)	In no case may the respondent be physically forced to take medication or forcibly detained for treatment unless the respondent poses an immediate danger to self or others.  In these cases, inpatient commitment proceedings shall be initiated.
(4)	At any time that the area authority finds that the respondent no longer meets the criteria set out in G.S. 122C-280.4(d)(1), the area authority shall so notify the court and the case shall be terminated.
(5)	Any individual who has knowledge that a respondent on outpatient commitment has become dangerous to self, as defined by G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., may initiate an inpatient commitment as provided in this Part.  If the respondent is committed as an inpatient, the outpatient commitment shall be terminated and notice sent by the clerk of court in the county where the respondent is committed as an inpatient to the clerk of court of the county where the outpatient commitment is being supervised.
(b)	If the respondent on outpatient commitment intends to move or moves to another county within the State, the designated area authority shall request that the clerk of court in the county where the outpatient commitment is being supervised calendar a supplemental hearing.
(c)	If the respondent moves to another state or to an unknown location, the designated area authority shall notify the clerk of superior court of the county where the outpatient commitment is supervised and the outpatient commitment shall be terminated.
(d)	If the commitment order directs inpatient treatment, the physician attending the respondent may administer to the respondent reasonable and appropriate medication and treatment that are consistent with accepted medical standards.  The attending physician shall release or discharge the respondent in accordance with G.S. 122C-280.17.
"§ 122C-280.14.  Supplemental hearings.
(a)	Upon receipt of a request for a supplemental hearing, the clerk shall calendar a hearing to be held within 14 days and notify, at least 72 hours before the hearing, the petitioner, the respondent, the respondent's attorney, if any, and the area authority.  The clerk shall notify the respondent at least 72 hours before the hearing by personally serving on the respondent an order to appear.  Other persons shall be notified as provided in G.S. 122C-280.5(d).
(b)	The procedures for the hearing shall follow G.S. 122C-280.8.
(c)	In supplemental hearings for alleged noncompliance, the court shall determine whether the respondent has failed to comply and, if so, the causes for noncompliance.  If the court determines that the respondent has failed or refused to comply, it may:
(1)	Upon finding probable cause to believe that the respondent is mentally retarded and because of a mental illness is dangerous to self, as defined in G.S. 122C-3(11)a., or others, as defined in G.S. 122C-3(11)b., order an examination by the same or different physician or eligible psychologist as provided in G.S. 122C-280.4(c) in order to determine the necessity for continued outpatient or inpatient commitment;
(2)	Reissue or change the outpatient commitment order in accordance with G.S. 122C-280.11; or
(3)	Discharge the respondent from the order and dismiss the case.
(d)	At the supplemental hearing for a respondent who has moved or intends to move to another county, the court shall determine if the respondent meets the criteria for outpatient commitment set out in G.S. 122C-280.4(d)(1).  If the court determines that the respondent no longer meets the criteria for outpatient commitment, it shall discharge the respondent from the order and dismiss the case.  If the court determines that the respondent continues to meet the criteria for outpatient commitment, it shall continue the outpatient commitment but shall designate the area authority at the respondent's new residence to be responsible for the management or supervision of the respondent's outpatient commitment.  The court shall order the respondent to appear for treatment at the address of the treatment center of the newly designated area authority and shall order venue for further court proceedings under the outpatient commitment to be transferred to the new county of supervision.  Upon an order changing venue, the clerk of court in the county where the outpatient commitment has been supervised shall transfer the records regarding the outpatient commitment to the clerk of court in the county where the commitment will be supervised.  Also, the clerk of court in the county where the outpatient commitment has been supervised shall send a copy of the court's order directing the continuation of outpatient treatment under new supervision to the newly designated area authority.
(e)	Any time during the term of an outpatient commitment order or conditional release from an inpatient commitment, a respondent may apply to the court for a supplemental hearing for the purpose of discharge from the order.  The application shall be made in writing by the respondent to the clerk of superior court of the county where the commitment is being supervised.  At the supplemental hearing, the court shall determine whether the respondent continues to meet the criteria specified in G.S. 122C-280.4(d)(1).  The court may either reissue or change the commitment order or discharge the respondent and dismiss the case.
(f)	At supplemental hearings requested pursuant to G.S. 122C-280.17(a) for transfer from inpatient to outpatient commitment, the court shall determine whether the respondent meets the criteria for either inpatient or outpatient commitment.  If the court determines that the respondent continues to meet the criteria for inpatient commitment, it shall order the continuation of the original commitment order.  If the court determines that the respondent meets the criteria for outpatient commitment, it shall order outpatient commitment to the area authority for a period of time not in excess of 90 days.  If the court finds that the respondent does not meet either criteria, the respondent shall be discharged and the case dismissed.
"§ 122C-280.15.  Outpatient commitment; rehearings.
(a)	Fifteen days before the end of the initial or subsequent periods of outpatient commitment, if the area authority determines that the respondent continues to meet the criteria specified in G.S. 122C-280.4(d)(1), it shall so notify the clerk of superior court of the county where the outpatient commitment is supervised.  If the respondent no longer meets the criteria, the area authority shall so notify the clerk who shall dismiss the case.  The clerk, at least 10 days before the end of the commitment period, on order of the district court, shall calendar the rehearing.
(b)	Notice and procedures of rehearings are governed by the same procedures as initial hearings, and the respondent has the same rights the respondent had at the initial hearing, including the right to appeal.
(c)	If the court finds that the respondent no longer meets the criteria of G.S. 122C-280.4(d)(1), it shall unconditionally discharge the respondent.  A copy of the discharge order shall be furnished by the clerk to the designated area authority.  If the respondent continues to meet the criteria of G.S. 122C-280.4(d)(1), the court may order outpatient commitment for an additional period not in excess of 180 days.
"§ 122C-280.16.  Inpatient commitment; rehearings for respondents.
(a)	Fifteen days before the end of the initial inpatient commitment period, if the attending physician in consultation with the area authority determines that commitment of a respondent beyond the initial period will be necessary, the physician shall so notify the clerk of superior court of the county in which the facility is located.  The clerk, at least 10 days before the end of the initial period, on order of a district court judge of the district court district as defined in G.S. 7A-133 in which the facility is located, shall calendar the rehearing.
(b)	Rehearings shall be held at the facility in which the respondent is receiving treatment.  The judge is a judge of the district court of the district court district as defined in G.S. 7A-133 in which the facility is located or a district court judge temporarily assigned to that district.
(c)	Notice and proceedings of rehearings are governed by the same procedures as initial hearings and the respondent has the same rights the respondent had at the initial hearing including the right to appeal.
(d)	At rehearings the court may make the same dispositions authorized in G.S. 122C-280.11(b) except that a second commitment order may be for an additional period not in excess of 180 days.
(e)	Fifteen days before the end of the second commitment period and annually thereafter, the attending physician shall review and evaluate the condition of each respondent in consultation with the area authority; and if the physician determines that a respondent is in continued need of inpatient commitment or, in the alternative, in need of outpatient commitment, or a combination of both, the physician shall so notify the respondent, the respondent's counsel, and the clerk of superior court of the county in which the facility is located.  Unless the respondent through counsel files with the clerk a written waiver of the respondent's right to a rehearing, the clerk, on order of a district court judge of the district in which the facility is located, shall calendar a rehearing for not later than the end of the current commitment period.  The procedures and standards for the rehearing are the same as for the first rehearing.  No third or subsequent inpatient recommitment order shall be for a period longer than one year.
(f)	At any rehearings, the court has the option to order outpatient commitment for a period not in excess of 180 days in accordance with the criteria specified in G.S. 122C-280.4(d)(1) and following the procedures as specified in this Article.
"§ 122C-280.17.  Release and conditional release; judicial review.
(a)	The attending physician shall discharge a committed respondent unconditionally at any time the physician determines that the respondent is no longer in need of inpatient commitment.  However, if the attending physician determines that the respondent meets the criteria for outpatient commitment as defined in G.S. 122C-280.4(d)(1), the physician may request the clerk to calendar a supplemental hearing to determine whether an outpatient commitment order shall be issued.  The attending physician may also release a respondent conditionally for periods not in excess of the remaining days of the inpatient commitment on specified medically appropriate conditions.  Violation of the conditions is grounds for return of the respondent to the releasing facility.  A law enforcement officer, on request of the attending physician or qualified crisis services professional, shall take a conditional releasee into custody and return this person to the facility in accordance with G.S. 122C-205.  Notice of discharge and of conditional release shall be furnished to the clerk of superior court of the county of commitment and of the county in which the facility is located.
(b)	Prior to discharge or release of a committed respondent from a 24-hour facility that is not operated by the respondent's area authority, the attending physician shall plan jointly with the respondent's area authority.  If the area authority has a single portal plan pursuant to G.S. 122C-132, the planning shall be carried out pursuant to the plan."
Sec. 20.  This act becomes effective January 1, 1996, and applies to commitments on or after that date.