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CONNECTICUT'S COMMITMENT AND OTHER PROCEDURES FOR ADULTS AND
CHILDREN WITH MENTAL HEALTH CONDITIONS
A Summary Guide to Connecticut Mental Health Law
Prepared by: Jeanette C. Schreiber, Michelle Wilcox DeBarge, and Carolyn C. Brady
October 1, 1998 ©:Wiggin & Dana
SCOPE OF SUMMARY
Following is a summary of the criteria and procedures in Connecticut for commitment, voluntary hospitalization and
administration of involuntary medication applicable to adults and children with mental health conditions. This
summary provides general guidance concerning relevant issues and procedures. For specific guidance in individual
cases, consult the applicable statutes and contact risk management or legal counsel. Unless stated otherwise, all
citations refer to the Connecticut General Statutes, as revised through the 1998 Regular and June Special Session of
the General Assembly.
This summary does not include the provisions of Connecticut law concerning the commitment of children and youth
to DCF nor does it cover the criteria and procedures in Connecticut for court-ordered commitment of alcohol-and
drug-dependent persons.
Nothing contained in this guide is to be considered as the rendering of legal advice for specific cases, and readers are
responsible for obtaining such advice from their own legal counsel. This guide is intended for educational and
informational purposes only.
SUMMARY OF CONNECTICUT COMMITMENT AND OTHER PROCEDURES FOR ADULTS AND
CHILDREN WITH MENTAL HEALTH CONDITIONS
Table of Contents
I. DEFINITIONS
A. Age Classifications
B. Mental Condition
C. Parent
D. Informed Consent
E. Voluntary Patient
F. Involuntary Patient
II. EMERGENCY INVOLUNTARY HOSPITALIZATION
A. Physician Emergency Certificate (PEC)
B. Standard
C. Psychiatric Evaluation and Possible Release
D. Duration of Hospitalization
E. Right to Attorney and Probable Cause Hearing
F. Immediate Release by Hospital Director or Superintendent
III. 72 HOUR HOLDS
A. Adults (16 and Over)
B. Child (Under 16)
IV. INVOLUNTARY COMMITMENT BY COURT ORDER
A. Application for Involuntary Commitment
B. Jurisdiction
C. Opportunity to Seek Voluntary Status
D. Hearing
E. Legal Standards for Commitment
F. Hospital Transfer
G. Release
V. VOLUNTARY HOSPITALIZATION
A. Children Under 14
B. 14 and 15 Year Olds
C. Monthly Review
D. Adults (16 and Over)
VI. TREATMENT
A. Children (Under 16)
B. Adults (16 and Over)
C. Emergency Treatment
D. Outpatient Treatment of Minors
VII. INVOLUNTARY ADMINISTRATION OF MEDICATION
A. Emergency Medication
B. Involuntary Medication in Non-Emergency Situations
C. Internal Review Procedure
D. Appeal Procedures
VIII. CONSERVATORS
A. Application for Conservator
B. Types of Conservators
C. Permanent Conservator
D. Temporary Conservator
E. Removal of a Permanent Conservator
F. Termination of a Conservatorship
IX. QUESTIONS AND ANSWERS
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SUMMARY OF CONNECTICUT COMMITMENT AND OTHER PROCEDURES FOR ADULTS AND
CHILDREN WITH MENTAL HEALTH CONDITIONS 1
I. DEFINITIONS
Unless otherwise indicated, the following definitions are applicable. 2
A. Age Classifications.
Child or Children: any person or persons under 16 years of age. Sec. 17a-75.
a. 14 and 15 year olds: these Children have certain statutory rights pertaining to voluntary commitment that Children
under 14 do not have, as explained below in Section V.B.
Adult: any person 16 years of age and older.
B. Mental Condition.
Mental Disorder: a mental or emotional condition of a Child which has substantial adverse effects on a Child's
ability to function so as to jeopardize his or her health, safety or welfare or that of others, and specifically excludes
mental retardation. Sec. 17a-75.
Person with Psychiatric Disabilities or "Psychiatric Disabilities"3 any person who has a mental or emotional
condition which has substantial adverse effects on his or her ability to function and who requires care and treatment,
and [for purposes of commitment procedures] specifically excludes a person who is an alcohol-dependent person or
a drug-dependent person. Sec. 17a-495(c).
Gravely Disabled: when a person, as a result of mental or emotional impairment, is in danger of serious harm as a
result of an inability or failure to provide for his or her own basic human needs such as essential food, clothing,
shelter or safety and that hospital treatment is necessary and available and that such person is mentally incapable of
determining whether or not to accept such treatment because his judgment is impaired by his Psychiatric
Disabilities. Sec. 17a-495(b).
Dangerous to Himself or Herself or Others: when there is a substantial risk that physical harm will be inflicted by an
individual upon his or her own person or upon another person. Sec. 17a-495(b).
Direct Threat of Harm: when the patient's clinical history demonstrates a pattern of serious physical injury or lifethreatening injury to self or to others that is caused by the Psychiatric Disabilities with which the patient has been
diagnosed and is documented by objective medical and other factual evidence. Such evidence of a past pattern of
dangerous behavior shall be manifested in the patient's medical history and there shall exist a high probability that
the patient will inflict substantial harm on himself or others. Sec. 17a-540(l).
Medically Harmful: means capable of inflicting serious mental or physical injury on the patient, or producing in the
patient a disturbed mental state or impaired judgment that may be grossly detrimental to the patient's physical or
mental well-being. Sec. 17a-540(i).
C. Parent: the parent or legal guardian of a Child. DCF may be the court-ordered guardian of a Child following a
DCF commitment hearing pursuant to Sec. 46b-129. Sec. 17a-75.
D. Informed Consent: permission given competently and voluntarily after a patient has been informed of the reason
for treatment, the nature of the proposed treatment, the advantages or disadvantages of the treatment, medically
acceptable alternative treatment, the risks associated with receiving the proposed treatment and the risk of no
treatment. Sec. 17a-540(h).
E. Voluntary Patient: a patient 16 years old or over who applies in writing to and is admitted to a hospital for
observation, diagnosis or treatment of a Psychiatric Disability or a Mental Disorder, or a patient under 16 years old
whose Parent or legal guardian applies in writing to such hospital for admission of such patient. Secs. 17a-495(a);
17a-540(d). [Note: Although not specified within this statutory definition, a 14 or 15 year old Child may be a
"voluntary" patient who is admitted without the consent of his or her Parents under Sec. 17a-79. See discussion at
p.10.]
F. Involuntary Patient: a patient hospitalized pursuant to an order of the Probate Court after an appropriate hearing
or a patient hospitalized for emergency diagnosis, observation or treatment upon certification of a qualified
physician. Secs. 17a-495(a); 17a-540(e).
II. EMERGENCY INVOLUNTARY HOSPITALIZATION
If a physician determines that an individual is in need of immediate care for his/her Mental Disorder or Psychiatric
Disability and meets the standards for emergency commitment, then a hospital may involuntarily hospitalize the
individual based on a physician emergency certificate ("PEC"). The statutory procedures for emergency involuntary
hospitalization are similar for Children and Adults except as noted below.
A. Physician Emergency Certificate (PEC). The PEC shall contain:
the signature of a Connecticut-licensed physician;
the date the physician signed the PEC (the date cannot be more than three days prior to the date the PEC is delivered
to the hospital);
the physician's statement of findings, which must include the physician's opinion that the standards for a PEC
(described under B, below) have been met;
the date the physician examined the individual (which cannot be more than three days prior to the date of the
physician's signature). Secs. 17a-78(a); 17a-502(a).
B. Standard. The PEC must be based on the following standards.
Child (under 16) . The physician must determine that the Child is in need of immediate hospitalization for evaluation
or treatment of a Mental Disorder. Sec. 17a-78(a).
Adult (16 and over) . The physician must determine that the person has Psychiatric Disabilities and is Dangerous to
Himself or Herself or Others or Gravely Disabled, and is in need of immediate care and treatment in a hospital for
Persons with Psychiatric Disabilities. Sec. 17a-502(a).
C. Psychiatric Evaluation and Possible Release. Upon hospitalization, an individual must be examined by a
psychiatrist. If the psychiatrist determines that the individual does not meet the criteria for emergency
hospitalization, the individual must be released immediately. The examination must be done within:
Child (under 16) . 24 hours. Sec. 17a-78(b).
Adult (16 and over) . 48 hours. Sec. 17a-502(b).
D. Duration of Hospitalization. Unless a psychiatric evaluation or probable cause hearing results in an earlier
release, as described below, a person may be held for up to 15 days. A person may be held for longer than 15 days if
a hospital files an application for commitment of the person with the Probate Court during the initial 15 days.
PEC. A hospital may detain an individual for up to 15 days under a PEC. Secs. 17a-78(a); 17a-502(a).
Application for Commitment. If an application for commitment is filed with the Probate Court before the expiration
of the 15 days under a PEC, the individual may be hospitalized for up to an additional 15 days or until completion of
the probate proceedings, whichever occurs first. Secs. 17a-78(a); 17a-502(a).
A Child's Petition to Transfer to Superior Court. If a hospital has filed a commitment application for a Child and the
Child has petitioned the Probate Court to transfer the matter to the Superior Court, the hospital may continue to
detain the Child for up to an additional 25 days or until completion of court proceedings, whichever occurs first.
Sec. 17a-78(a).
E. Right to Attorney and Probable Cause Hearing. Promptly after hospitalization, the hospital must inform the
individual (if a Child, the Parent must also be informed) of the individual's right to (i) consult an attorney and (ii)
have a probable cause hearing. Secs. 17a-78(c), 17a-502(c).
Request for a Hearing. The individual or his attorney may request a hearing, in writing, to contest the involuntary
emergency hospitalization. The hospital must then notify the Probate Court promptly of the individual's request for
hearing. Secs. 17a-78(d), 17a-502(d).
Hearing within 72 Hours. Within 72 hours of receipt of request for hearing, the Probate Court must hold a probable
cause hearing. Secs. 17a-78(d), 17a-502(d).
Due Process Rights. At the hearing the individual has the right to be present, cross-examine witnesses, and be
represented by counsel. Secs. 17a-78(d), 17a-502(d).
Standard and Factors. The Probate Court must determine whether there is "probable cause" to involuntarily
hospitalize the individual. In making this determination, the Probate Court considers the following factors:
a. condition of the individual at the time of the admission;
b. condition of the individual at the time of the hearing;
c. the effects of medication; and
d. advisability of continued treatment based on testimony from the hospital staff. Secs. 17a-78(d), 17a-502(d).
Probate Court's Order. The Probate Court shall order immediate discharge if the emergency hospitalization is not
justified. Otherwise, the Probate Court may order the individual's hospitalization to continue for the duration of the
PEC or longer if an application for commitment has been filed. Secs. 17a-78(d), 17a-502(d).
F. Immediate Release by Hospital Director or Superintendent. The hospital director or superintendent must
immediately discharge any individual who is later found not to meet the standard for emergency hospitalization.
Secs. 17a-78(e), 17a-502(f).
III. 72 HOUR HOLDS
A. Adult (16 and Over) . A hospital may detain an Adult for up to 72 hours under the circumstances listed below in
order to examine the individual if there is reasonable or probable cause to believe the person "has Psychiatric
Disabilities and is Dangerous to Himself or Herself or Others or Gravely Disabled and is in need of immediate care
and treatment."
By Police Officer Detention. A police officer may take a person into custody and deliver such person to a general
hospital for emergency examination.
By Probate Court Ordered Examination. Upon application by any person, the Probate Court may issue a warrant and
order an emergency examination of such individual at a general hospital.
By Psychologist Issued Certificate. Any licensed psychologist may issue an emergency certificate authorizing an
emergency examination of such individual at a general hospital.
In all cases, the individual must be examined within twenty-four (24) hours. Sec. 17a-503.
B. Child (Under 16) . The mental health commitment statutes do not provide for a seventy-two (72) hour hold for
Children. However, child welfare provisions authorize a hospital or the Department of Children and Families
("DCF") to hold a child for up to ninety-six (96) hours in its custody in circumstances of suspected child abuse
and/or neglect. ("Child" is defined as a person under 18 years old for purposes of a 96-hour hold.)
Hospital. Upon the examination of a child by a physician, a hospital may hold the child in its custody for up to
ninety-six (96) hours if child abuse or neglect is suspected. Sec. 17a-101f.
DCF. DCF may hold a child in its custody for ninety-six (96) hours if DCF has probable cause to believe a child is
in imminent risk of physical harm from his surroundings and that immediate removal from such surroundings is
necessary to ensure the child's safety. DCF may remove the child from the child's surroundings and detain the child
for up to ninety-six (96) hours, during which time medical care, including an examination and diagnostic tests by a
physician, may be performed without the Parent's consent provided reasonable attempts have been made to obtain
consent of the child's Parent(s) or other person responsible for the care of such child. Sec. 17a-101g.
DCF (or another suitable agency or person) may also have temporary custody of a child4/ or youth5/ for up to ten
(10) days pursuant to a petition for commitment to DCF as a neglected, uncared for, or dependent child or youth.
Sec. 46b-129(b).
IV. INVOLUNTARY COMMITMENT BY COURT ORDER
Children (under 16): Sec. 17a-76.
Adults (16 and over): Sec. 17a-498.
A. Application for Involuntary Commitment.
Who May File. Any person may file an application for commitment. Secs. 17a-76(a), 17a-497(a).
Content of Application.6
a. Children (under 16) . The application must allege that the Child suffers from a Mental Disorder and is in need of
treatment. The application must also include the name and address of the hospital where commitment is sought. Sec.
17a-76.
b. Adults (16 and over) . The application must allege that the Adult has Psychiatric Disabilities and is Dangerous to
Himself or Herself or Others or Gravely Disabled. Sec. 17a-497(a).
B. Jurisdiction. The Probate Court for the town in which the Child or Adult resides, or in which he or she may be
located at the time of filing the application if his or her residence is out of state, has jurisdiction over commitment
matters for all persons, regardless of age. If the Child or Adult is hospitalized, the Probate Court for the town in
which the hospital is located has jurisdiction.
Transfer to Superior Court. For Children (under 16), an involuntary commitment proceeding may be transferred to
Superior Court. Secs. 17a-76(b)-(c).
C. Opportunity to Seek Voluntary Status. An Adult (16 and over) for whom involuntary commitment is sought must
be given an opportunity to seek voluntary status prior to a hearing on the application for commitment, in accordance
with the procedures set forth in Sec. 17a-498(e). A hospitalized Adult patient must be informed by hospital staff
within twenty-four (24) hours prior to the time a commitment application is filed that he or she may continue in the
hospital on a voluntary basis; any application submitted by the hospital must include a statement that such voluntary
status has been offered to the patient and refused. The statutes do not provide for similar procedures for Children
(under 16).
D. Hearing.
Time. The Probate Court must hold a hearing not more than 10 business days from the date the application was
filed.
a. Children (under 16) . If the matter is transferred to Superior Court, a hearing must be held within 10 days of
receipt by that court.
Notice. The Probate Court must give reasonable notice of the hearing.
a. Children (under 16. The Probate Court must give notice to the Child, Parent, and named hospital. The Probate
Court must also give notice to the Child's relatives, as the court deems advisable.
b. Adults (16 and over) . The Probate Court must give notice to the Adult and to the Adult's relatives and friends, as
the court deems advisable.
E. Legal Standards for Commitment. To commit an individual, the Probate Court must find by clear and convincing
evidence that:
Children (under 16) . The Child suffers from a Mental Disorder (defined in Sec. 17a-75), is in need of
hospitalization for treatment, such treatment is available, and hospitalization is the least restrictive available
alternative. Sec. 17a-77(e).
Adults (16 and over) . The Adult has Psychiatric Disabilities and is Dangerous to Himself or Herself or Others or
Gravely Disabled (as defined by Sec. 17a-495). The Probate Court must also consider whether or not a less
restrictive alternative is available. Sec. 17a-498(c).
F. Hospital Transfer.
Children (under 16) . Children who have been committed by a court order may be transferred to a different hospital
upon the written agreement of the superintendents of the respective institutions.
a. Agreement. The agreement must be executed in triplicate, sec. 17a-77(f), and approved by the Department of
Children and Families. Sec. 17a-511. Such agreement must be filed with the court that issued the commitment order
and with each institution. Sec. 17a-77(f).
b. Notice. The Parent or representative of the Child must receive notice of the transfer agreement. Sec. 17a-77(f).
c. Revocation or Modification of Transfer. The Child's Parent may file a written application with the court that made
the commitment order to have the transfer agreement revoked or modified. Such agreement shall stay the transfer
until a hearing and order by the court. Sec. 17a-77(f).
Adults (16 and over) . Adults who have been committed by court order may be transferred to a different hospital
upon: (i) court order or (ii) by written agreement of the superintendents of the respective institutions. Secs. 17a-510;
17a-511.
a. Court Order. The court that issued the commitment order may order that an Adult be transferred to a different
hospital within the state, if reasonable cause for such transfer is shown.
b. Agreement. The superintendents of the respective institutions may agree in writing to transfer an Adult. The
agreement must be executed in triplicate and approved by the Commissioner of Mental Health and Addiction
Services or, in the case of a person under 18, the Commissioner of Children and Families. The agreement must be
filed with the court that issued the commitment order and each institution.
c. Revocation or Modification of Transfer. The Adult's conservator or family member may file a written application
with the Probate Court to have the transfer agreement revoked or modified.
G. Release. A person, Child or Adult, who has been committed by court order shall be released whenever the
hospital concludes that the person is no longer in need of hospitalization. Secs. 17a-77(e) (Children); 17a-510
(Adults). A Child or Adult may also be released as follows:
Children (under 16) . A hospital must release an involuntarily committed Child at the end of the court-ordered
period of confinement which cannot exceed six (6) months, unless an application for recommitment has been filed
pursuant to Sec. 17a-77(g). Such recommitment may result in further commitment for up to an additional six (6)
months.
Adults (16 and over) . A hospital must release an involuntarily committed Adult upon court order following a
hearing requested by the patient or initiated by the court in accordance with Secs. 17a-510; 17a-498(g).
a. Annual Notice. A hospital must notify an Adult patient at least annually that the patient has a right to a further
hearing. If the patient requests a hearing, the hospital must file the request with the Probate Court. Sec. 17a-498(g).
b. List of Patients. A hospital must also provide the Probate Court monthly with a list of each Adult patient who has
been confined without release for one year since the patient's last annual review and the type of review each patient
received. The Probate Court may order examination of the patient by a physician and a further hearing regarding the
release of the patient may result. Sec. 17a-498(g).
V. VOLUNTARY HOSPITALIZATION
Children (under 16): Sec. 17a-79
Adults (16 and over): Sec. 17a-506
Children or Adults may be admitted on a voluntary basis for hospitalization for diagnosis and treatment of a Mental
Disorder or Psychiatric Disability. The standards for voluntary admissions and releases differ depending on whether
the individual is an Adult, a Child under 14, a Child 14 or over, or a Child in the custody of DCF.
A. Children Under 14. Sec. 17a-79.
Admission. A Child under 14 may be admitted to a hospital upon:
a. A Parent's written request. Sec. 17a-79(a).
b. If DCF has custody, the DCF Commissioner's request and the written agreement of appointed legal counsel,
provided that the Parent(s) must be notified. The Parent(s) of the Child must be notified within five (5) days of such
admission. If the whereabouts of such Parent(s) is unknown, then the nearest relative of the Child must be notified.
Sec. 17a-79(b).
Release. In either case, a hospital must release a Child upon a Parent's written request, unless a commitment
application is filed with the Probate Court in accordance with Section IV above.
Continuance of Hospitalization. A hospital may detain a Child for up to 5 business days to allow time to file a
commitment application and, if an application is filed, up to 15 days to allow time for a hearing (or up to 25 days if
the proceeding is transferred to Superior Court). Sec. 17a-79.
B. 14 and 15 Year Olds. Secs. 17a-79; 17a-80.
Admission. A 14 or 15 year old Child may be admitted to a hospital upon:
a. A Parent's written request. Sec. 17a-79(a)
b. A Child's written request without the consent of the Parent(s), provided that the Parent(s) is notified within five
(5) days of admission. If the whereabouts of such Parent(s) are unknown, then the Child's nearest relative must be
notified. Sec. 17a-79(a).
c. If DCF has custody, the DCF Commissioner's request, with the written agreement of appointed legal counsel and
the written consent of the Child. The Parent(s) must be notified within five (5) days of admission. If the whereabouts
of such Parent(s) is unknown, then the nearest relative to the Child must be notified. Sec. 17a-79(b).
Release.
a. Parental Custody. For a 14 or 15 year old Child admitted upon his or her Parent's written request, a hospital must
release the Child upon a Parent's written request. For a self-admitted 14 or 15 year old Child, a hospital must release
the Child upon the Child's own written request or upon the written request of the Parent. In either case, a hospital
may continue to hold a Child if a commitment application is filed with the Probate Court.
b. DCF Custody. If DCF has custody of a 14 or 15 year old Child, the hospital must release the Child upon a Parent's
written request unless DCF files an application for commitment. 7
Continuance of Hospitalization. A hospital may hold a Child for up to five (5) business days to allow time to file a
commitment application and, if an application is filed, up to 15 days to allow time for a hearing (or up to 25 days if
the proceeding is transferred to Superior Court). Sec. 17a-79(a).
Hearing. A 14 or 15 year old Child admitted to a hospital by a Parent who requests to leave the hospital, has a right
to a hearing at the Probate Court within 72 hours of the Child's written request. Sec. 17a-80.
Standard. The Child must be released unless the Probate Court finds clear and convincing evidence that continued
hospitalization is needed and available for treatment of the Child's Mental Disorder and there is no less restrictive
alternative.
C. Monthly Review. Every month the hospital must provide a list to the Probate Court of all Children admitted on a
voluntary basis under Sec. 17a-79 and hospitalized for a period of one year. Sec. 17a-80.
D. Adults (16 and Over) . Sec. 17a-506.
Formal Voluntary Admission. Any person may be admitted to a hospital upon the person's own written request. Sec.
17a-506(a). Patients admitted on a formal voluntary basis must be given notice at the time of admission that the
patient's ability to leave may be delayed for up to 3 business days from the date of a written request to leave to allow
for filing a commitment application, and that if such an application is filed, further delay may occur as permitted by
law.
a. Release. A hospital must release a formally admitted voluntary patient within 3 business days upon the Adult's
written request unless a commitment application is filed in accordance with Section IV above.
Continuance of Hospitalization. If a commitment application is filed, the hospital may hold such person for up to 15
days from the date of the patient's request to leave to allow for time for a hearing.
b. PEC. A PEC may not be issued for a formally admitted patient. Sec. 17a-506(e); see Blackburn v. Normandin,
1993 WL 394312 (Conn. Super. 1993).
Informal Voluntary Admission. A hospital may admit any person upon such person's own request without a formal
or written application if the hospital deems such person clinically suitable for admission, care and treatment. Sec.
17a-506(b).
a. Release. Informal Voluntary Patients are considered free to leave the hospital at any time.
b. PEC. If an Informal Voluntary Patient wishes to leave but meets the standards for emergency commitment, a PEC
may be written (see Section II above.)
Notification.
a. Next of Kin. A hospital must notify an Adult's next of kin of the Adult's admission and discharge if the Adult
consents in writing.
b. Conservator of Person. A hospital may admit any person with an appointed conservator of person upon such
person's own request, provided that the hospital notifies the conservator and the Probate Court within 5 business
days of admission. The Probate Court must arrange for a psychiatric examination by a court-appointed psychiatrist
to determine whether the Adult patient has given informed consent. The Probate Court may conduct a hearing to
determine whether to order the release of the Adult patient. Sec. 17a-506(c).
There is no provision in the commitment statutes for the admission of Adults (16 and over) upon a Parent's request.
Although 16 and 17 year old Adults may be in DCF custody, the commitment statutes do not provide for DCF to
admit 16 and 17 year olds on a voluntary basis.
VI. TREATMENT
The mental health statutes address when consent is required for the administration of various treatments and
procedures for both Children and Adults. Secs. 17a-81; 17a-540 to 17a-545. The administration of involuntary
medication is addressed specifically in Section VII below.
A. Children (Under 16) . There are two sources of statutory guidance on treatment of admitted children: section 17a81 in the children's commitment statutes and section 17a-540 et seq., the Patients' Bill of Rights. These statutes
overlap and are conflicting to some degree with respect to involuntary medication. Whether the hospital must obtain
consent before treating a Child under Section 17a-81 depends upon whether the Child is a Voluntary or Involuntary
Patient.
Voluntary Patient. If the Child is a Voluntary Patient, parental consent is required for treatment, except that
emergency treatment may be administered if consent is withheld or immediately unavailable and the physician
concludes that treatment is necessary to prevent serious harm to the child. Sec. 17a-81(a). The statute does not
define "treatment" for purposes of the exception.
Involuntary Patient. If the Child is an Involuntary Patient, the Child's consent or parental consent is not required for
medication or treatment. The written informed consent of (a) the Child's Parent, or (b) the Child's next of kin or (c) a
physician appointed by the Probate Court must be obtained to perform medical or surgical procedures. Sec. 17a81(b),(c).
Emergency Measures. A hospital may take "emergency measures" without parental consent, with respect to both
voluntary and involuntary child patients, if the head of the hospital in consultation with a physician, determines that
the condition of the patient is of an extremely critical nature. Sec. 17a-81.
Involuntary Medication. The Patients' Bill of Rights provides certain procedural protections for patients concerning
involuntary medication and medical and surgical procedures. "Patient" is defined in the Patients' Bill of Rights as
"any person" being treated in a facility for the diagnosis, observation or treatment of persons with disabilities.
"Persons with psychiatric disabilities" is defined to include adults and children suffering from mental disorders. The
Patient Bill of Rights therefore appears to apply to the treatment of children.
The Patients' Bill of Rights and Section 17a-81 are inconsistent, however, in their requirements for involuntary
medication: Section 17a-81 allows a hospital to administer medication to a minor admitted on an involuntary basis
without the consent of the parent or child, but the Patients' Bill of Rights requires the hospital to follow certain
procedures, as summarized in Section VII below. 8
B. Adults (16 and Over) . Except in an emergency, as a general rule, no medical or surgical procedures may be
performed without the informed consent of the patient or patient's conservator of person. Sec. 17a-543(b).
Patient Incapable of Giving Informed Consent. If the head of the hospital, in consultation with a physician,
determines that the condition of an Involuntary Patient who has not been declared incapable by a Probate Court is of
an extremely critical nature and such patient is incapable of informed consent, medical or surgical procedures may
be performed with the written informed consent of: (1) the patient's conservator or guardian, if he or she has one; (2)
such person's next of kin or (3) a qualified physician appointed by a judge of the Probate Court. Sec. 17a-543(b).
NOTE: Sec. 17a-543(b) does not contain a similar provision pertaining to obtaining informed consent on behalf of a
Voluntary Patient for medical or surgical procedures.
C. Emergency Treatment. The Patients' Bill of Rights, permits a hospital to provide treatment to Voluntary or
Involuntary Patients without the individual's consent, if the following standard is met:
if obtaining the consent would cause a medically harmful delay to a Voluntary or Involuntary Patient whose
condition is of an extremely critical nature, as determined by personal observation by a physician or the senior
clinician on duty. . . . Sec. 17a-543(b).
NOTE: In any case, it may be necessary to consult risk management or legal counsel to assure that appropriate
procedures are followed.
D. Outpatient Treatment of Minors. A psychiatrist or psychologist may provide outpatient mental health treatment to
a minor (under 18) 9 for up to six sessions without the notification or consent of a parent under the conditions
described below.
"Outpatient mental health treatment" is defined as "the treatment of mental disorders, emotional problems or
maladjustments with the object of (1) removing, modifying or retarding existing symptoms; (2) improving disturbed
patterns of behavior; and (3) promoting positive personality growth and development." It does not include
"prescribing or otherwise dispensing any medication which is a legend drug." Sec. 19a-14c(a).
Eligibility Standard. Before providing outpatient mental health treatment to a minor without parental notification or
consent, the provider must determine that: (a) requiring the consent or notification would cause the minor to reject
such treatment; (b) the treatment is clinically indicated; (c) failure to provide the treatment would be seriously
detrimental to the minor's well-being; (d) the minor knowingly and voluntarily sought such treatment; and (e) in the
opinion of the provider of treatment, the minor is mature enough to participate in the treatment productively. Sec.
19a-14c(b). A parent or guardian who is not notified of the outpatient mental health treatment is not liable for the
cost of the treatment. Sec. 19a-14c(d).
Minor's Consent. The provider must obtain a written statement signed by the minor stating that the minor: (a) is
voluntarily seeking such treatment; (b) has discussed with the provider the possibility of involving a parent or
guardian in the decision to pursue such treatment; (c) has determined it is not in his/her best interest to involve the
parent or guardian; and (d) has been given an adequate opportunity to question the provider regarding the course of
treatment. Sec. 19a-14c(b).
Continued Treatment After Six Sessions. Unless it would be seriously detrimental to the minor's well-being, the
provider must notify the minor after six sessions of treatment that parental notification is necessary in order to
continue treatment. If the provider determines that notification would be seriously detrimental, the provider may
continue treatment, but after every six sessions must reevaluate whether notification would be seriously detrimental.
The provider may not notify the parent or disclose any information about the treatment without the minor's consent.
Sec. 19a-14c(c).
VII. INVOLUNTARY ADMINISTRATION OF MEDICATION
As a general rule, a hospital may administer medication for the treatment of Psychiatric Disabilities only with the
Informed Consent of the patient. Sec. 17a-543(a). The hospital may administer medication involuntarily to a patient
only in limited circumstances and only if certain procedures are followed as outlined below. For purposes of the
statutes addressing involuntary medication and other patients' rights issues, the term "Person with Psychiatric
Disabilities" is specifically defined to include a person who is an alcohol-dependent or a drug-dependent person.
Secs. 17a-495(d); 17a-540.
A. Emergency Medication.
No consent required. A hospital may administer medication to a patient without the patient's consent if a staff
physician or a senior clinician on duty, who has personally observed the patient, determines that:
a. the patient is in an extremely critical condition, e.g., imminently harmful to himself or others; and
b. medication is indicated; and
c. following the non-emergency procedures outlined below to obtain the patient's consent would cause a Medically
Harmful delay. Sec. 17a-543(b). 10 /
B. Involuntary Medication in Non-Emergency Situations.
Determination of Patient's Capacity to Give Informed Consent. The head of the hospital, and two qualified
physicians must determine whether the patient is capable of giving Informed Consent to medication for the
treatment of the patient's Psychiatric Disabilities in a non-emergency situation. Depending on whether the patient is
deemed capable or incapable of providing Informed Consent, the hospital must follow an "internal review
procedure" and/or petition the Probate Court for authorization to administer the medication. Secs. 17a-543(e); 17a543(f).
a. Patients Capable of Giving Informed Consent. If the head of the hospital and two qualified physicians determine
that the patient is capable of giving Informed Consent, but the patient refuses to consent to medication, then the head
of the hospital and the two qualified physicians must determine whether:
there is no less intrusive beneficial treatment; and
without medication, the Psychiatric Disabilities with which the patient has been diagnosed will continue unabated;
and
without medication, the Psychiatric Disabilities place the patient or others in Direct Threat of Harm. Sec. 17a543(f)(1).
If all of the above criteria are met, the hospital may use the internal review procedure set forth below to determine
whether to administer the medication, and/or apply to the Probate Court for an order to authorize the administration
of medication. Sec. 17a-543(f)(1).
a) Duration of Probate Court Order Authorizing Medication. An order authorizing the administration of medication
to a patient capable of giving Informed Consent shall be effective for no more than one hundred and twenty (120)
days. Sec. 17a-543(f)(2).
b) Extending the Order. Upon application by the head of the hospital, the Probate Court will determine whether to
extend the order to administer medication to the patient without a hearing. The Probate Court may extend the order
for up to one hundred and twenty (120) days if the patient is hospitalized continuously for longer than the initial one
hundred and twenty (120) days and if the head of the hospital and two qualified physicians determine that:
i) the patient continues to be competent but refuses to consent to the medication;
ii) there is no less intrusive beneficial treatment; and
iii) without medication, the Psychiatric Disabilities with which the patient has been diagnosed will continue
unabated; and
iv) without medication, the patient or others will be in Direct Threat of Harm. Sec. 17a-543(f)(2).
b. Patients Incapable of Giving Informed Consent. If the head of the hospital and two qualified physicians determine
that the patient is incapable of giving Informed Consent to medication for the treatment of Psychiatric Disabilities,
and that such medication is necessary for the patient's treatment, to obtain authorization to administer the
medication, the hospital may (1) apply to the Probate Court for appointment of a conservator of the person with
specific authority to consent on the patient's behalf to the administration of medication, and/or (2) utilize the internal
review procedure. Sec. 17a-543(e)(1).
Obtaining a Conservator with Specific Authority. Sec. 17a-543(e)(1).
a) Appointment of a Conservator of Person. When the patient does not already have a conservator of person, the
hospital may apply to the Probate Court for appointment of a conservator of person (temporary or permanent).
b) Obtaining Specific Authority. The Probate Court must grant specific authority to the conservator to consent to the
administration of medication. If the patient already has a conservator of person who has not been granted specific
authority to consent to the administration of medication, such specific authority must be requested from the
appointing Probate Court.
c) Meeting with Conservator. The physician must meet with the patient and his/her conservator to review and
consider:
i) the patient's record;
ii) the risk and benefits from the medication;
iii) the likelihood and seriousness of adverse side effects;
iv) the preferences of the patient;
v) the patient's religious views; and
vi) the prognosis with and without medication.
d) Obtaining Consent. After meeting with the conservator, the attending physician must obtain the conservator's
written Informed Consent to the administration of medication. According to the Probate Court Administrator, if the
conservator refuses to consent, the hospital may either request an informal status conference with the Probate Court
or petition the Probate Court to remove the conservator.
e) Duration of Conservator's Specific Authority. The conservator's specific authority to consent to the administration
of medication may be effective for up to one hundred and twenty (120) days. Sec. 17a-543(e)(2).
f) Extending the Conservator's Specific Authority. Upon application by the head of the hospital, the Probate Court
may extend the conservator's specific authority to consent to the administration of medication to the patient without
a hearing for up to one hundred and twenty (120) days if:
i) the patient is hospitalized continuously for longer than the initial one hundred and twenty (120) days;
ii) the head of the hospital and two qualified physicians determine that the patient is still incapable of giving
Informed Consent to medication; and
iii) the head of the hospital and two qualified physicians determine that the medication is necessary for the patient's
treatment. Sec. 17a-543(e)(2).
Utilizing the Internal Review Procedure. In addition to, or as an alternative to, seeking appointment and specific
authority of a conservator, the hospital may utilize the internal review procedure set forth below. Sec. 17a-543(e)(1).
<\ol>
C. Internal Review Procedure.
The Connecticut General Statutes provide that a hospital may establish an internal review procedure to determine
whether to administer medication to patients involuntarily. Sec. 17a-543(d).
Requirements of Internal Review Procedure. The statutes require that the internal review procedure must provide the
following:
a. The hospital selects a person not employed by the hospital to act as the hearing officer who determines whether to
permit the administration of involuntary medication;
b. The patient's advocate must have a reasonable opportunity to discuss such selection with the hospital;
c. The hospital must give the patient written and oral notice of the right to available advocacy services;
d. The hospital must give notice to the patient and his/her advocate not less than 48 hours prior to the hearing.
e. The patient has the right to representation at the hearing;
f. The patient has a right to question any witness at the hearing, including, if requested, one or both of the qualified
physicians who made the determination of the patient's capacity to give Informed Consent and the necessity of
medication;
g. The hearing officer must render a written decision.
h. The hearing officer may authorize medication to be given without the patient's Informed Consent only if he/she
finds that:
For Patients Determined Incapable of Giving Informed Consent.
a) the patient is incapable of Informed Consent;
b) the medication is medically appropriate and necessary;
c) there is a substantial probability that without such medication the condition of the patient will rapidly deteriorate;
or
For Patients Determined Capable of Giving Informed Consent.
a) the patient, although capable of giving Informed Consent, is refusing to accept medically appropriate medication;
b) the patient poses a Direct Threat of Harm to self or others; and
c) there is no less intrusive beneficial treatment;
d) without medication the patient's Psychiatric Disabilities will continue unabated; and
e) there is substantial probability that without such medication the condition of the patient will rapidly deteriorate.
Duration of Internal Review Order. When administration of medication is ordered through the hospital's internal
review hearing, the hospital may administer the medication to the patient for a period of up to 30 days or until a
decision is made by the Probate Court, whichever is sooner. Sec. 17a-543(d).
D. Appeal Procedures.
Patient's Petition to Probate Court. If a decision has been made to administer involuntary medication to a patient
under the hospital's internal review procedures, the patient may petition the court to expedite a pending application
for a hearing with the Probate Court concerning involuntary medication. (See Section B. above.) If no such
application is pending, the patient may petition the Probate Court to hold a hearing to decide whether to allow the
administration of involuntary medication. The court must hold the hearing within 15 days of the patient's petition.
Sec. 17a-543(g).
Right to Appeal to Superior Court. As a general matter, any person, such as the hospital, conservator or patient may
appeal a Probate Court's decision to the Superior Court. Sec. 45a-186.
VIII. CONSERVATORS
A. Application for Conservator. Any person may petition the Probate Court for a finding that an adult person11 is
incapable and for an appointment of a conservator. The application must be filed in the Probate Court in the district
in which the respondent12 resides or is domiciled. Sec. 45a-648. 13
Contents of Application. The application must allege that the respondent is incapable of managing his or her affairs
or incapable of caring for him/herself.
B. Types of Conservators. There are two types of conservators: (1) conservator of the estate; or (2) conservator of
the person. Either type of conservator may be appointed as a permanent or temporary conservator. The primary
difference between a temporary and a permanent conservator is the duration of authority and the application process.
A temporary conservator is sought in emergency situations to avoid irreparable injury to the mental, physical health
or financial and legal affairs of the respondent; the temporary conservator's authority lasts for up to thirty (30) days.
Conservator of the Estate. A conservator of the estate is a representative appointed by the Probate Court for a
respondent determined to be incapable of managing his/her affairs. 14 Sec. 45a-644.
Duties. Among other duties, a conservator of the estate must file inventories of the respondent's estate with the
Probate Court, obtain appraisals of the respondent's property, manage the estate and pay the debts of the respondent.
Sec. 45a-655.
Conservator of the Person. A conservator of the person is a representative appointed by the Probate Court for a
respondent determined to be incapable of caring for him/herself. 15/ Sec. 45a-644.
Duties. Among other duties, a conservator of the person has an express duty and authority to give consent for the
respondent's medical or other professional care, counsel, treatment or service. The conservator does not have the
power or authority to cause the respondent to be committed to a hospital for the treatment of Psychiatric Disabilities.
Sec. 45a-656. As discussed above in Section V.D. a hospital may admit a person for whom a conservator has been
appointed upon the person's own request, provided the hospital notifies the Probate Court and the conservator within
five (5) business days of admission. Sec. 17a-506(c).
Note. A single representative may be appointed as both a conservator of the estate and of the person. The court may
limit the powers and duties of the conservator of the person or the conservator of the estate. In determining whether
to limit the conservator's authority, the court will consider "the abilities of the ward, the prior appointment of any
attorney-in-fact, health care agent, trustee or other fiduciary acting on behalf of the ward, and any other relevant
evidence." Sec. 45a-650(g).
C. Permanent Conservator.
Hearing. The Probate Court must hold a hearing within thirty (30) days after receipt of an application for a
conservator by the Probate Court unless continued for cause shown. Sec. 45a-649. At least seven (7) days before the
hearing date, the Probate Court must serve a citation to the following parties to appear before it:
the respondent, except that if service to the respondent would be detrimental to the health or welfare of the
respondent, service may be made on the respondent's attorney;
the respondent's spouse, (except in cases where the spouse is the applicant). If there is no spouse, then to the
respondent's children, parents, siblings or next of kin in that order of priority. 16
a. Respondent's Rights. The Probate Court must notify the respondent of the following:
nature and legal consequences of the involuntary representation sought;
the facts alleged in the application;
the time and place of the hearing;
the right to be present at the hearing;
and the right to be represented by counsel at his or her own expense. 17 Sec. 45a-649(b).
Note: If the respondent notifies the Probate Court that he/she wants to attend the hearing but is unable to do so
because of physical incapacity, the court must schedule the hearing on the application at a place accessible to the
respondent. If locating a convenient place is not practical, then the Probate Court judge must visit the respondent
before the hearing if he/she is in Connecticut.
b. Evidence. The evidence at the hearing must consist of:
the condition of the respondent;
a written report or testimony by one or more physicians licensed to practice medicine in the state who has examined
the respondent within 30 days preceding the hearing18; and
other relevant evidence such as, a summary of the physical and social functioning level or ability of the respondent,
and the availability of support services from the family, neighbors, community and any other appropriate source.
Sec. 45a-650(a).
c. Standard. The Probate Court will appoint a conservator of the person if the Probate Court finds by "clear and
convincing evidence" that the respondent is incapable of caring for him/herself unless it appears to the court that the
respondent is being cared for properly without a conservator. A conservator of the estate will be appointed if the
Probate Court finds by "clear and convincing" evidence that the respondent is incapable of managing his/her affairs
unless it appears to the court that such affairs are being managed properly without a conservator. Upon the
respondent's request, the Probate Court must issue a statement of its findings of fact within 30 days of the Probate
Court's decision. Sec. 45a-650(c) and (e).
d. Selecting a Conservator. The Probate Court may select a conservator nominated by the respondent if in the best
interests of the respondent. In determining whether a conservator is necessary and in selecting the conservator, the
court will consider whether the respondent has previously made arrangements for the care of his/her person or
affairs, such as a durable power of attorney, the appointment of a health care agent, or another document. Otherwise,
the Probate Court may appoint any qualified person, except a hospital or a nursing home, to serve as a conservator.
Secs. 45a-650(d); 45a-644(a) and (b).
e. Probate Bond. If the Probate Court appoints a conservator of the estate, the court must require the conservator to
issue a probate bond. The court may, if it deems it necessary for the protection of the respondent, require a probate
bond of any appointed conservator of the person.
D. Temporary Conservator. Any person deemed by the Probate Court to have sufficient interest in the welfare of the
respondent, including the head of a nonprofit hospital, may file an application for appointment of a temporary
conservator. The application process for the appointment of a temporary conservator is quicker in order to avoid
irreparable injury to the mental or physical health or financial or legal affairs of the respondent and a hearing may or
may not be required. The duties of a temporary conservator are identical to the duties of a permanent conservator as
listed in subsection A above. The appointment of a temporary conservator is valid only for up to thirty (30) days.
Sec. 45a-654.
Application. The application for a temporary conservator must be accompanied by a report signed by a Connecticutlicensed physician, stating that the physician has examined the respondent, the date of the exam (which may not be
more than three (3) days prior to presentation to the judge), and that in the physician's opinion the respondent is
incapable of managing his/her affairs or of caring for himself/herself, and the reasons for the opinion. 19 Sec. 45a654(b).
Standard. The Probate Court must find that: (1) the respondent is incapable; and (2) irreparable injury to the mental
or physical health or financial or legal affairs of the respondent will result if a temporary conservator is not
appointed.
Appointment Process. The Probate Court may appoint a temporary conservator in two ways: (1) ex parte, which
means on the basis of the application prior to holding a hearing; or (2) after giving notice and holding a hearing.
a. Ex Parte. After appointing a temporary conservator ex parte, the Court must immediately appoint an attorney to
the respondent. The Probate Court must also give notice to the respondent, the respondent's next of kin and his or
her attorney, and such notice must include the application and the decree appointing the temporary conservator. If
the respondent, the respondent's next of kin or the respondent's attorney requests a hearing, in writing, the Probate
Court must hold a hearing within seventy-two (72) hours of receipt of such request, excluding Saturdays, Sundays or
holidays, to confirm or revoke the appointment of the temporary conservator. Sec. 45a-654(c).
b. Hearing. If the Court determines that a pre-hearing appointment of a temporary conservator is not appropriate, but
finds substantial evidence that appointment of a temporary conservator may be necessary, the Probate Court must
hold a hearing. The hearing must be held within seventy-two (72) hours of receipt of the application not including
Saturdays, Sundays and holidays. Prior to the hearing, the Probate Court must appoint the respondent an attorney.
The Probate Court must also give notice to the respondent, the respondent's next of kin and his or her attorney. Sec.
45a-654(d).
E. Removal of a Permanent Conservator. The Probate Court upon its own motion, or upon the application and
complaint of any interested person, may remove a conservator. The Probate Court, after notice and a hearing, may
remove a conservator if the conservator:
becomes incapable of executing his/her trust;
neglects to perform the duties of his/her trust;
wastes the estate in the conservator's charge; or
fails to furnish any additional or substitute probate bond ordered by the court. Secs. 45a-242(a); 45a-199.
F. Termination of a Conservatorship. If the Probate Court, upon hearing and notice, determines that a ward20 is
capable of caring for him/herself or capable of managing his/her affairs, the court must order that the
conservatorship of the person or of the estate, as applicable, be terminated. If the court determines that the ward has
no assets except certain aid from the Department of Social Services, it may terminate the conservatorship of the
estate. Sec. 45a-660.
Review. The Probate Court must review each conservatorship at least every three years, and must either continue,
modify or terminate the order for conservatorship. Upon the court's request, the conservator, attorney for the ward,
and Connecticut-licensed physician must submit a written report to the court within forty-five (45) days of the
court's request. If the ward is unable to request or obtain an attorney, the court must appoint one. The court may hold
a hearing to determine the condition of the ward and if the conservator, attorney or physician requests a hearing, the
court must hold a hearing within thirty (30) days of such request. Sec. 45a-660(c) and (d).
IX. QUESTIONS AND ANSWERS21
Unless otherwise stated, the answers apply to Adults (persons 16 years old and over), under the general provisions
for commitment set forth in secs. 17a-495 to 17a-512. 22
Is a substance abuser a Person with Psychiatric Disabilities?
As discussed below in footnote 22, Public Act 95-257 substituted the term "Psychiatric Disabilities" for "mental
illness" in sec. 17a-495 and other mental health statutes applicable to Adults. Thus, an Adult formerly characterized
in the statutes as "mentally ill" is now characterized as a "Person with Psychiatric Disabilities."
For purposes of commitment, a person who is alcohol-dependent or drug-dependent, as defined in 17a-680, is not a
Person with Psychiatric Disabilities. For purposes of the Patients' Bill of Rights in secs. 17a-540 to 550, however, an
alcohol or drug-dependent person is a Person with Psychiatric Disabilities. Secs. 17a-680 et seq. cover voluntary and
involuntary commitment procedures for alcohol- or drug-dependent persons.
Does "dangerous to others" include danger to property?
No. "Dangerous to Himself or Herself or Others" refers to a substantial risk of physical harm to self or others, but
does not include risk of harm to property. Sec. 17a-495 states:
"Dangerous to Himself or Herself or Others" means there is a substantial risk that physical harm will be inflicted by
an individual upon his or her own person or upon another person.
What does "gravely disabled" mean?
"Gravely Disabled" means that a person, as a result of mental or emotional impairment, is in danger of serious harm
as a result of an inability or failure to provide for his or her own basic human needs such as essential food, clothing,
shelter or safety and that hospital treatment is necessary and available and that such person is mentally incapable of
determining whether or not to accept such treatment because his or her judgment is impaired by his or her
psychiatric disabilities. Sec. 17a-495.
How many days does the court have to hold a hearing once an application for commitment is filed?
The Probate Court must assign a time and place for a hearing to take place within 10 business days from the time the
application for commitment is filed. Sec. 17a-498(a).
In the case of Children (persons under 16 years old), if the application has been transferred from the Probate Court
to the Superior Court, the Superior Court must hold a hearing within 10 business days of receiving the application
from the Probate Court. Sec. 17a-77(a).
Without written consent, who is allowed to see the chart prior to the hearing?
Sec. 17a-498 requires that the respondent (the person for whom commitment is sought) or the respondent's counsel
be given access to the respondent's hospital record, in accordance with the statutory provisions governing the
psychiatric privilege (secs. 52-146d to 52-146i). Under sec. 52-146e(a), any records or communications coming
within that privilege generally may not be disclosed to anyone, including the respondent's counsel, without the
respondent's consent. Additionally, specialized federal and state confidentiality requirements govern disclosure of
HIV- or substance abuse-related information and require specific consent of the patient or the patient's
representative, using a specialized form, in order to disclose such information.
When practicable it is desirable to obtain the patient's written consent before disclosing information and records,
even if such disclosure is to the patient's attorney. If the patient is unable to consent, however, and disclosure is
necessary to facilitate the commitment process, access to records and information can be provided to the attorney as
needed to represent the patient. Special care must be taken regarding any disclosure of HIV-related and substance
abuse-related information.
What are the commitment criteria for children?
A court may order commitment of a Child after a hearing on the application, if it finds by clear and convincing
evidence that (i) the Child suffers from a Mental Disorder, (ii) the Child is in need of hospitalization for treatment,
(iii) such treatment is available, and (iv) such hospitalization is the least restrictive available alternative. Sec. 17a77(e).
"Mental Disorder" is defined by sec. 17a-75 as:
A mental or emotional condition which has substantial adverse effects on a child's ability to function so as to
jeopardize his or her health, safety or welfare or that of others, and specifically excludes mental retardation.
Note: The commitment statutes relating to Children may be subject to future legislation because they have not been
modified in the recent past as have the statutes relating to Adults.
If a person is on a PEC, can a second PEC be written?
During the time that the person is actually confined under the original PEC, a second PEC may be issued, but the
person may not be admitted or detained at any hospital for more than 15 days after the execution of the original
PEC. Only one other PEC may be issued within that original 15 day period. Sec. 17a-502(a).
As stated in sec. 17a-502(a):
In no event shall such person be admitted to or detained at any hospital, either public or private, for more than
fifteen days after the execution of the original emergency certificate on the basis of a new emergency certificate
executed at any time during the person's confinement pursuant to the original emergency certificate; and in no event
shall more than one subsequent emergency certificate be issued within fifteen days of the execution of the original
certificate.
Although not clear on the face of the statute, Wiggin and Dana maintains that this statute permits a hospital, when
transferring a patient to another hospital, to execute a second PEC bearing the name of the receiving hospital so long
as the second PEC does not extend beyond the original 15 day period.
Once a PEC is written, how many days does it hold for?
A hospital may detain a person for up to 15 days with a PEC.
Note: For a PEC to be valid, the date a Connecticut-licensed physician signed the PEC cannot be more than 3 days
prior to the date the PEC is delivered to the hospital.
How does a probable cause hearing differ from a commitment hearing?
A probable cause hearing held in accordance with sec. 17a-502, and a commitment hearing, held in accordance with
sec. 17a-498, differ in several important respects.
A. Initiation and Purpose.
A probable cause hearing is held at the request of a patient who has been confined in a hospital on an involuntary
emergency basis pursuant to a PEC. The purpose is to determine whether there is probable cause to conclude that the
person meets the standard for emergency confinement and should continue to be confined for the duration of the 15
day period under the PEC.
A commitment hearing is held as a matter of law whenever an application for commitment is filed; the person who
allegedly has Psychiatric Disabilities does not have to request the hearing. The purpose of the hearing is to
determine whether the person has Psychiatric Disabilities and should be committed for the duration of the condition
or until conversion to voluntary status.
B. Standard of Proof.
In a commitment hearing, the court must find by clear and convincing evidence that the person meets the criteria for
commitment. The clear and convincing standard is more stringent than the probable cause standard and requires
"reasonable certainty." Probable cause merely requires that the court find that there is a "reasonable belief" that the
criteria are met.
C. Other Procedural Requirements.
Generally, the commitment hearing has more formal procedural requirements, but in both types of hearings the
person has the right to be present, to cross-examine witnesses, and to be represented by counsel (including the right
to be represented by court-appointed counsel). Secs. 17a-498(a)-(c), 17a-502(d). Only the commitment hearing
requires the written testimony of two physicians. Sec. 17a-498(c).
When requested, how long does the court have to hold such a probable cause hearing?
A probable cause hearing on emergency involuntary confinement, must be held within 72 hours of the court's receipt
of the written request, excluding Saturdays, Sundays and holidays. Secs. 17a-502(d) (Adults); 17a-78(d) (Children).
May a temporary or permanent conservator of the person give permission to medicate against will?
Section VII of this outline summarizes medicating against the patient's will and obtaining the consent of the
conservator of the person.
As described in Section VII, sec. 17a-543(e) provides that a hospital may apply to the Probate Court for appointment
of a conservator of person with specific authority to consent to the administration of medication when the hospital
determines that the patient is incapable of giving Informed Consent. If a patient has a previously appointed
conservator of person, the hospital must apply to the Probate Court for specific authority for such conservator of
person to consent to the administration of medication. This statute does not specifically address temporary versus
permanent conservators of the person, and it appears that a temporary conservator of person may obtain such
specific authority to consent to the administration of medication. Note that a temporary conservator's authority lasts
only for up to 30 days. Sec. 45a-654.
At what age is a person considered an adult in a psychiatric facility?
A person is considered an Adult for purposes of commitment in a psychiatric facility at age 16. The commitment
statutes specifically define a "child" as a person under 16 years of age. Secs. 17a-75 et. seq.
What is a "72 hour hold"? Who writes it?
A "72 hour hold," in accordance with sec. 17a-503, is the detention of a person upon finding there is reasonable
belief or probable cause to believe that the person has Psychiatric Disabilities and is Dangerous to Himself or
Herself or Others or Gravely Disabled and in need of immediate care and treatment in a hospital, under the
following circumstances:
By Police Officer Detention. A police officer may take a person into custody and deliver such person to a general
hospital; or
By Court Ordered Examination. The Probate Court may issue a warrant and order an examination at a general
hospital upon application by any person; or
By Psychologist Issued Certificate. Any licensed psychologist may issue an emergency certificate authorizing the
emergency examination at a general hospital.
In all cases, there must be an emergency examination within 24 hours and release within 72 hours unless a PEC is
issued.
At what age is a person generally considered competent to sign in voluntarily to the hospital? Do his or her parents
also need to sign him or her in?
A 14 or 15 year old Child, who is not in DCF custody, may be admitted on a voluntary basis, solely upon the Child's
written request without the consent of his or her Parents. The Parents must be notified within 5 days of admission
and may request the Child's release. Upon such request, the hospital must release the Child or file for commitment.
The hospital may keep the Child for 5 business days from the request for release to allow time to complete the filing.
Sec. 17a-79(a).
When transferring an involuntary patient from one facility to another, who must approve such a transfer? Is the
procedure any different for children or youths?
An Adult committed by a court may be transferred either by (a) court order, or (b) by agreement. A Child may only
be transferred by agreement.
a. By Agreement. An Involuntary Patient may be transferred upon the agreement of the superintendents of the
respective institutions which must be signed in triplicate, subject to approval of the commissioner of mental health
or in the case of persons under 18, the commissioner of DCF. Such agreement must be filed with the Probate Court
that ordered the patient's commitment. As applicable, the Adult's conservator or family member or the Child's Parent
or guardian may make a written application to the Probate Court to have the agreement revoked or modified. When
transferring Children (persons under 16) who have been committed by court order, a hospital must notify the Child's
Parents before transferring the Child. Secs. 17a-77(f); 17a-511.
b. By Court Order. The Probate Court may, for reasonable cause shown, order any Adult patient confined in a
hospital for Persons with Psychiatric Disabilities be removed to another hospital for Persons with Psychiatric
Disabilities in the state. Sec. 17a-510.
The commitment statutes do not provide instructions regarding transferring a patient confined under a PEC.
Does the Probate Court have jurisdiction over the commitment of children and youths?
The Probate Court has jurisdiction of commitment matters for all persons, regardless of age. Secs. 17a-76, 17a-498.
Once an application for commitment of a Child (a person under 16) is filed in the Probate Court, the matter may be
transferred to the Superior Court, in accordance with sec. 17a-76(b)-(c).
What information MUST be included on a PEC?
The following information is required by sec. 17a-502(a):
Signature of a Connecticut-licensed physician;
Date of physician's signature (which should not be more than 3 days prior to its delivery to the person in charge of
the hospital).
Date of physician's examination of the person named in the PEC (which shall not be more than 3 days prior to date
of physician's signature on the PEC);
Physician's findings from the examination relative to physical and mental condition of the person;
History of the case, if known;
Physician's Statement that in his or her opinion the person examined has Psychiatric Disabilities and is Dangerous to
Himself or Herself or Others or Gravely Disabled and is in need of immediate care and treatment in a hospital for
Persons with Psychiatric Disabilities, stating reasons for opinion;
If a person has a conservator of the person, can he sign himself in voluntarily for treatment?
Yes, under sec. 17a-506(c), provided that the hospital admitting the person notifies the conservator and the Probate
Court which appointed the conservator within 5 business days of admission. The Probate Court must then appoint a
psychiatrist within 10 business days of such notice. The psychiatrist must examine the person within 10 business
days of the court's appointment. If the court concludes that the patient did not give Informed Consent to the
hospitalization, the court may on its own motion proceed in the same manner as applicable to an application for
commitment under sec. 17a-498.
What is the procedure for discharge when a patient is admitted on a voluntary status requests to leave?
There are three types of Voluntary Patients: (a) formally admitted Adult patients, (b) informally admitted Adult
patients, and (c) voluntarily admitted Children.
a. Formally Admitted Voluntary Adult Patients. A formally admitted voluntary Adult patient is a patient 16 years of
age or older who completes and signs an application admitting himself or herself into a hospital for the treatment of
Psychiatric Disabilities. If such patient requests in writing to leave the hospital, the hospital may detain the patient
for up to 3 business days to determine whether to file an application for commitment. Secs. 17a-506(a). As described
more fully in Section V.D. of this outline, if the hospital files an application for commitment, the hospital may
further detain a patient for up to 15 days from the date of the patient's written request to leave. Sec. 17a-506(e). If
the Probate Court concludes the patient should not be committed, then the hospital must immediately release the
patient. A hospital may not hold a formal Voluntary Patient under a PEC. Sec. 17a-506(e).
b. Informally Admitted Voluntary Adult Patients. An informally admitted voluntary Adult patient is a patient 16
years of age or older who does not sign or complete a formal application for admission to the hospital. If such a
patient requests to leave, the hospital may be required to release the patient immediately, unless a physician
emergency certificate ("PEC") is issued. While the statutes do not specifically address whether an informal
Voluntary Patient who has Psychiatric Disabilities, is Dangerous to Himself or Herself or Others or is Gravely
Disabled, may be detained pursuant to a PEC, Wiggin & Dana and a representative of the Office of the Attorney
General believe that the statutes permit a hospital to issue a PEC upon such patient who meets the commitment
criteria. In at least one case, the Office of Protection and Advocacy for Persons with Disabilities took a contrary
position, stating that a voluntary Adult patient who was informally admitted may not be held under a PEC.
c. Voluntarily Admitted Children. As described in detail in Section V of this outline, a voluntarily admitted Child is
any patient under 16 years of age who is either: (1) under the age of 14 and whose Parent or guardian requests in
writing his or her admission to a hospital for the treatment of a Mental Disorder; or (2) 14 or 15 years of age and
admits himself or herself upon his or her own written request or who is admitted upon his or her Parent's or
guardian's written request; or (3) in the Department of Children and Families custody and is admitted upon the
Commissioner's written request.
) Child Under Age 14.
For a Child under age 14, a hospital must release the Child upon the Parent's or guardian's written request unless a
commitment application is filed.
) Child Over 14.
For a Child 14 or 15 years old admitted upon his or her Parent's or guardian's request, the hospital must release the
Child upon a Parent's or guardian's written request. For a self-admitted 14 or 15 year old Child, the hospital must
release the child upon either the Child's own written request or the Parent's or guardian's written request. In either
case, as described below, the hospital may continue to hold the Child if a commitment application is filed.
) DCF Custody.
If DCF has custody of a Child, a hospital must release the Child upon the Parent's written request, unless DCF files
an application for commitment.
Note: As discussed in the Outline for a Child in DCF's custody to be admitted to a hospital, DCF must obtain the
Child's legal counsel's written consent and if the Child is over 14, the Child's consent. However, the statute does not
provide that a hospital may release a Child upon the request of the Child's legal counsel or of the Child, if the Child
is 14 years of age or older.
In each case, the hospital may detain the patient for up to 5 business days to allow time to file a commitment
application and if such application is filed, the hospital may further detain the patient for up to 15 days after receipt
of such application by the Probate Court in order to allow such application to be heard, or for up to 25 days if the
matter has been transferred to Superior Court.
How is a person determined incompetent? When may a conservator consent to a procedure on behalf of a patient?
a. The Connecticut statutes use the term "incapable" rather than "incompetent" to refer to a person for whom a
conservator has been appointed. Secs. 45a-644 et seq. As discussed in detail in Section VIII of this outline, any
person may petition the Probate Court for a finding that a person is incapable and for an appointment of a
conservator.
The application must allege that the respondent is incapable of caring for him/herself or incapable of managing
his/her affairs. These concepts are defined in Section VIII.
As discussed in Section VIII, the applicant may apply for a conservator of the estate or a conservator of the person
or both to be appointed for a respondent. Such conservator may be appointed as a temporary or permanent
conservator. For a permanent conservator, the Probate Court must give notice and hold a hearing within thirty (30)
days after receipt of the application. The Probate Court will appoint a conservator if the court finds by "clear and
convincing evidence" that the respondent is either incapable of caring for him/herself and incapable of managing
his/her affairs. For a temporary conservator, the Probate Court may act with or without holding a hearing, and the
temporary conservator's authority lasts for up to thirty (30) days. The court will appoint a temporary conservator if it
determines that irreparable injury to the mental or physical health of the respondent will result if a temporary
conservator is not appointed. Sec. 45a-654.
b. If a patient has been declared incapable of caring for him or herself and has a conservator of the person approved,
the conservator may consent in writing to medical or surgical procedures on behalf of the patient. Sec. 17a-543.
For the administration of medication, if the head of the hospital and two qualified physicians determine that the
person is incapable of giving informed consent and such medication is necessary to treat the patient's Psychiatric
Disabilities, the hospital may apply to the Probate Court for appointment of a conservator with specific authority to
consent to the administration of medication on the patient's behalf. If the patient already has a conservator of person,
the Probate Court must be requested to grant the conservator specific authority to consent to the administration of
medication. Sec. 17a-543(e)(1).
After meeting with the attending physician to review and consider numerous factors, as described in Section VII.B.,
the conservator must determine whether to give his/her written informed consent to the administration of
medication.
A conservator of the person's specific authority to consent to medication lasts for up to 120 days, but may be
extended for up to an additional 120 days upon application by the head of the hospital to the Probate Court.
ENDNOTES
1.
All citations are to the Connecticut General Statutes as revised through the 1998 Regular and June Special
Session of the General Assembly. Note that Public Act 95-257, in part, revises the terminology in the mental
health statutes applicable to adults, generally substituting the term "psychiatric disabilities" for the term "mental
illness." See §§ 48 - 53. Public Act 96-215 revised, in part, the Patients' Bill of Rights pertaining to involuntary
medication and established a task force to study involuntary outpatient commitment.
2.
Defined terms are capitalized throughout this outline.
3.
The statutes sometimes refer to "psychiatric disabilities" but do not specifically define this term. Borrowing
from the definition of "Person with Psychiatric Disabilities," "Psychiatric Disabilities" presumably means a
mental or emotional condition that has substantial adverse effects on a person's ability to function and requires
care and treatment and [for purposes of commitment procedures] specifically excludes alcohol or drug
dependency.
4.
For purposes of DCF commitment, "child" means any person under 16 years of age. Sec. 46b-120.
5.
For purposes of DCF commitment, "youth" means any person 16 to 18 years of age. Sec. 46b-120.
6.
Probate Court forms should be used to file an application for commitment. Form PC-800 applies to children;
Form PC-801 applies to adults.
7.
Although a 14 or 15 year old Child in DCF's custody and his or her legal counsel must consent to an admission,
the statute does not expressly state that a hospital must release such Child upon the Child's or the Child's legal
counsel's written request. Sec. 17a-79(b).
8.
It is our understanding, however, that the Patients' Bill of Rights was not originally intended to apply to
children. It is always preferable, however, to obtain consent for the administration of medications whenever
possible, whether the child is a voluntary or involuntary patient, due to the risks associated with medication.
9.
Section 19a-14c does not define the term minor. Therefore, the general definition in sec. 1-1d, which defines a
minor as a person under the age of 18, should apply. This differs from most statutes for mental health treatment
where 16 and 17 year old patients are considered to be adults.
10. Section 17a-543(a) provides that no patient shall receive medication without the patient's informed consent,
except in accordance with, among other subsections, subsection (b). Subsection (b) expressly provides that
"emergency treatment" may be provided without the consent of a patient with a psychiatric disability and refers
to medical or surgical procedures. Thus, it could be questioned whether the statute expressly permits emergency
administration of medication to a patient with a psychiatric disability. However, the Connecticut Superior
Court, in holding that a conservator's consent was not sufficient authority for a hospital to administer
psychotropic drugs to an unwilling patient in a non-emergency situation, acknowledged that nothing in its order
"should be interpreted to interfere with the right of [the hospital] to administer medications in emergency
situations under § 17a-543(b)." Doe v. Hunter, 44 Conn. Supp. 53 (1995). Conversations with the Attorney
General's Office also confirmed a hospital's right to administer medication in an emergency without the patient's
consent. Note: the specific authority of conservators concerning consent to medication was clarified in
subsequent legislation.
11. The conservator statutes do not apply to children. Sec. 45a-644(f).
12. "Respondent" means the person for whom an application for involuntary representation has been filed. Sec. 45a644(f).
13. The Probate Court may appoint a conservator on a voluntary or involuntary basis. Secs. 45a-646; 45a-648. Any
person may apply to the Probate Court for voluntary representation by a conservator to care for him/herself or to
manage his/her affairs. This Section VIII concerns the involuntary appointment of a conservator.
14. "Incapable of managing his or her affairs" means that a person has a mental, emotional or physical condition
resulting from mental illness, mental deficiency, physical illness or disability, chronic use of drugs or alcohol,
or confinement, which prevents that person from performing the functions inherent in managing his or her
affairs, and the person has property which will be wasted or dissipated unless proper management is provided,
or that funds are needed for the support, care or welfare of the person or those entitled to be supported by that
person and that the person is unable to take the necessary steps to obtain or provide funds which are needed for
the support, care or welfare of the person or those entitled to be supported by such person. Sec. 45a-644(d).
15. "Incapable of caring for one's self" means a mental, emotional or physical condition resulting from mental
illness, mental deficiency, physical illness or disability, chronic use of drugs or alcohol, or confinement, which
results in the person's inability to provide medical care for physical and mental health needs, nutritious meals,
clothing, safe and adequately heated and ventilated shelter, personal hygiene and protection from physical abuse
or harm and which results in endangerment to such person's health. Sec. 45a-644(c)
16. The Probate Court must also order notice, as it directs, to certain other individuals, such as: the applicant; the
person in charge of the welfare of the town where the respondent resides; and the person in charge of the
hospital, nursing home or other institution, if the respondent is in a hospital, nursing home or other institution.
Sec. 45a-649(a).
17. If the respondent is unable to request or obtain counsel for any reason, the Probate Court must appoint an
attorney to represent the respondent. If the respondent is unable to pay for the services of the appointed
attorney, the reasonable compensation of the attorney will be paid by the Judicial Department or the Probate
Court Administration Fund.
18. The Probate Court may waive the requirement that medical evidence be presented if it is shown that: (1) the
evidence is impossible to obtain because of the absence of the respondent or his or her refusal to be examined;
or (2) the alleged incapacity is not medical in nature. If the medical evidence requirement is waived, the Probate
Court must make a specific finding stating why medical evidence was not required. Sec. 45a-650(a).
19. The Probate Court may waive the requirement that medical evidence be presented if it is shown that the
evidence is impossible to obtain because of the refusal of the respondent to be examined by a physician. If the
medical evidence requirement is waived, the Probate Court may accept other competent evidence in view of
medical evidence, and the Probate Court must: (1) make a specific finding in any decree issued on the
application stating why medical evidence was not required; and (2) if a hearing has not been held, schedule a
hearing within seventy-two (72) hours of the decree. Sec. 45a-654(e).
20. "Ward" means a person for whom involuntary representation is granted. Sec. 45a-644(h).
21. Terms defined in Section I are capitalized throughout this section.
22. All citations reference provisions of the General Statutes of Connecticut as revised through the 1998 Regular
and June Special Session of the General Assembly and as amended by Public Acts 95-257 and 96-215. Public
Act 95-257, in part, revised the terminology applicable to Adults in the mental health statutes, generally
substituting the term "Psychiatric Disabilities" for the term "mental illness." Public Act 95-257, secs. 48 - 53.
Public Act 96-215 revised, in part, the Patients' Bill of Rights pertaining to involuntary medication and
established a task force to study involuntary outpatient commitment.