| (a) In accordance with 25 TAC Chapter 404, Subchapter
E, all individuals voluntarily admitted to a CSU for treatment of
mental illness or SED have the right to be discharged within four
hours of a request for release unless the individual's treating physician,
(or another physician, if the treating physician, is not available)
determines that there is cause to believe the individual might meet
the criteria for emergency detention.
(b) When a CSU staff member is informed that a voluntarily-admitted
individual wants to leave the CSU, or the individual's LAR or adult
caregiver requests the individual be discharged, the CSU staff member
must, in accordance with Texas Health and Safety Code §572.004
and 25 TAC Chapter 404, Subchapter E:
(1) inform the individual, and the individual's LAR
or adult caregiver, if applicable, that the request must be in writing
and signed, timed, and dated by the requestor; if the request for
discharge is verbal, then the four hours begins at the time of a verbal
request and must be documented in the medical record. Inform the individual
or the individual's LAR of the potential four-hour delay from the
time of the verbal request;
(2) assist the individual as soon as possible, with
documenting the verbal request for discharge or creating a written
request for discharge and presenting the request to the individual
for the individual's signature; and
(3) inform the LAR or adult caregiver to submit written
approval to the CSU administrator, or administrator's designee, for
the CSU treating physician to discharge an individual younger than
18 years of age if the LAR or adult caregiver signed for the individual's
admission to the CSU.
(c) If a voluntarily-admitted individual, or the individual's
LAR or adult caregiver, if applicable, submits a verbal or written
request for discharge from a CSU, the CSU staff member must:
(1) immediately notify the treating physician, or another
CSU physician if the treating physician is not available, of the request
after the request becomes known to the CSU; and
(2) file the request in the individual's medical record.
(d) If the physician, notified in subsection (b) of
this section, and in accordance with Texas Health and Safety Code §572.004,
does not have reasonable cause to believe that the individual may
meet the criteria for court-ordered inpatient mental health services
or emergency detention, the treating physician must discharge the
individual within the four-hour time frame described in subsection
(b) of this section.
(e) If the physician, notified in subsection (b) of
this section, and in accordance with Texas Health and Safety Code §572.004,
has reasonable cause to believe that the individual may meet criteria
for court-ordered inpatient mental health services or emergency detention,
the physician must examine the individual as soon as possible, but
no later than 24 hours after the individual requests discharge from
the CSU.
(1) If the physician conducting the examination described
in this subsection determines that the individual does not meet criteria
for court-ordered inpatient mental health services or emergency detention,
the treating physician must discharge the individual upon completion
of the examination.
(2) If a physician does not examine an individual for
involuntary treatment criteria within 24 hours after the individual
requests CSU discharge, the treating physician must discharge the
individual even if the physician believes the individual may meet
criteria for court-ordered inpatient mental health services or emergency
services.
(f) If the physician conducting the examination described
in subsection (e) of this section determines that the voluntarily-admitted
individual meets the criteria for court-ordered inpatient mental health
services or emergency detention, a CSU physician must, by 4:00 p.m.
on the next business day, in accordance with Texas Health and Safety
Code §572.004:
(1) file an application for court-ordered inpatient
mental health services or emergency detention within 24 hours after
the individual requests discharge from the CSU, and obtain a court
order for further detention of the individual; or
(2) discharge the individual.
(g) If the CSU treating physician intends to detain
a voluntarily-admitted individual and file an application to obtain
a court order for further detention of the individual, a physician
must in accordance with Texas Health and Safety Code §572.004:
(1) notify the individual of such intention; and
(2) document the reasons for the decision to detain
the individual in the individual's medical record.
(h) A CSU treating physician is not required, in accordance
with Texas Health and Safety Code §572.004, to complete the discharge
process described in this section if the voluntarily-admitted individual
makes a written statement to withdraw the request for discharge.
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