The Ethical Use of 1013s in Georgia and Client’s Rights

What is a 1013?

In my observation there is a fair amount of misunderstanding about what a “1013” is and what it is authorizing mental health professionals and law enforcement or Peace Officers to do.

The purpose of this certificate (1013) is to authorize transportation to an “emergency receiving facility.”  This form also includes a report of the “peace officer or other person providing transportation.” I think that the language on this form is very important. It speaks to the intent of the form and its appropriate use.

Autonomy

Counseling professional ethics require us to consider our client’s “autonomy.”  Autonomy is the client’s right to choose the direction of their life, their treatment and to exercise their free will. The term “autonomy” is one of the values described in the preamble of the American Counseling Association Code of Ethics. In my understanding, respecting someone’s autonomy means trying to advocate, support and preserve their rights to freedom and independence as much as possible.

Authorization to Use the 1013 Form

There seems to be a lack of general knowledge about the rights of those individuals being involuntarily transported to an admitting facility based upon and for the purpose of addressing their mental health symptoms including suicidal and homicidal actions or intent. The treatment purpose is for crisis stabilization, if they continue to exhibit the symptoms that led to the 1013 being completed. One of the key factors that can go wrong at the outset is whether or not the form is being misused by the Clinician, including how they manage the assessment of the person’s risk factors.

In February 2013, Licensed Professional Counselors in the state of Georgia were legally authorized with the ability to complete form 1013. This form is a certificate authorizing transportation of a person that “appears to be mentally ill…requiring involuntary treatment.”

This is a listing of those who are authorized to complete the 1013:

  • Licensed Physicians;
  • Licensed Psychologists;
  • Licensed Clinical Social Workers (LCSW);
  • Licensed Professional Counselors (LPC);
  • Advance Practice Registered Nurses (APRN):
  • Clinical Nurse Specialists in Psychiatric/Mental Health (CNS); or
  • Physician’s Assistants (PA).

The Language on the 1013

The 1013 form includes very clear criteria for its use and execution. The criteria that the “mentally ill” person needs to meet include the following:

  • “A. presents a substantial risk of imminent harm to self or others as manifested by recent overt acts or recent expressed threats of violence which present a probability of physical injury to self or to other persons; OR
  • B. appears to be so unable to care for his/her own physical health and safety as to create an imminently life-endangering crisis.”

These risk factors need to be present at the time of evaluation of the individual who appears to be mentally ill. The Mental Health Provider completing the form is required to list their observations. These observations should justify the completion of the form itself. There is also a section where the Clinician selects from the following checklist and provides an example. The checklist is as follows…

“This individual:

  • ___ Has committed/expressed recent overt acts/threats toward others.
  • ___ Has committed/expressed recent acts/threats of violence to self.
  • ___ Presents an imminently life endangering crisis to self  because he/she is unable to care for his/her own health and safety.

For example: ___________________________________________________________________.”

The language on the 1013 form states that the transporting Peace Officer has a responsibility to make diligent efforts to take the “above named individual into custody,” within 72 hours after receiving the certificate. Typically, they are executed quickly due to the imminent risk. The 1013 certificate expires 7 days after it has been executed. The form is to be provided to the receiving facility.

The transportation can be provided by family or friends if it is deemed safe to do so. However, this does not mean that the “Peace Officer,” is relieved of their responsibility to provide the transportation if it is requested.

The 1014 – Involuntary Hold

It is important to know that the person (patient) should be reassessed by the admitting facility and that the form that the physician (doctor) has to complete is called the 1014. It is the “Physician’s Certification Authorizing Transfer to Evaluating Facility.” It has to be completed within 48 hours of the arrival of the person (patient) to the emergency receiving facility and they must still meet the imminent risk categories described in sections A and B above in the discussion about the 1013.

The 1015 – Right to a Hearing based on the Assertion of Being Held Illegally

When a person is held involuntarily, they are to be informed of their rights to a hearing using the form 1015 which is the “Notice of Admission and Right to Hearing.” This form lets the person (patient) state that they believe that they are being held illegally and it represents the “writ of habeas corpus,” which invokes your right to be seen by a judge if you believe your rights (civil liberties) are being violated.

Often the direct assessment for the 1014 is being completed by someone representing the doctor. Then that information is reviewed with the doctor and he or she helps to make a determination. It authorizes the person (patient) to stay at the facility for up to 5 days not including weekends and holidays.

Non-Maleficence and Beneficence

As counselors we are to “do no harm” also known as “non-maleficence.” The challenge of involuntarily committing someone for transportation to a receiving facility for treatment is that the process itself involves emotional distress for clients as well as a loss of freedom.

We are also supposed to “do good” also known as “beneficence.” When we make a decision to complete at 1013 or 1014 it is supposed to be for the client/patient/consumer’s greatest good. For me that means that I think this step (completing a 1013) is necessary to save my client’s life or to prevent them from harming someone else.

When this privilege is misused (and I believe it is misused), it can be for various reasons, by different parties for various reasons:

  • A Clinician who is not competent in their assessment of imminent risk or would rather complete a 1013 for the primary purpose of limiting their liability, rather than its intended purpose.
  • A parent who requests a 1013 based on a child or adolescent not following the parent’s commands at home. The child may have, for example, thrown a plate at the wall or shoved a family member.
  • A receiving facility extending the 1014 “hold” longer than necessary based on the person’s admitting symptoms when the “patient” no longer meets criteria to be held involuntarily. The reasons vary but the most common reasons seems to be…
    • potentially due to common practices in the admitting facility to maintain their patient census; and/or
    • a patient’s “good” health insurance benefits; and/or
    • a lack of knowledge by the admitting facility’s staff about the rights of the patient.

As stated above, the receiving facility has a responsibility to evaluate the “patient,” and then complete a 1014 for the purpose of extending the “hold” on the client for the purpose of continued evaluation and stabilization, if the person (patient) has not voluntarily signed themselves in for treatment (a 1012).

The 1012 – Transfer to Voluntary Status

A 1012 is a document/form that transitions the person (patient) to voluntary status. When a person signs themselves in voluntarily that status does not expire until they are discharged from treatment. However it is important to note that the doctor/physician determines when they are eligible for discharge. When a person chooses to transition to voluntary status they should also be informed using the form 1011 which is “Notice of Voluntary Patient’s Right to Request Discharge.” So in other words, they must be informed about their rights when and if they transition to voluntary status.

The 1010 – Request for Discharge from Voluntary Status

If the person (patient) wants to be released from their 1012 (voluntary admission status) they can complete a form 1010, which is a request for discharge. The doctor has 72 hours, not including Sundays and holidays to either discharge the person (patient) or they can file a 1021 requesting a court hearing for continued involuntary treatment before the expiration of the 1014 (involuntary 5 day hold for inpatient evaluation); or the prior to the expiration of the 1010 (the request for release to which the doctor has 72 hours to respond).

The 1021 – Right to a Court Hearing based on Voluntary Status

The 1021 involves a court hearing during which the person’s (patient’s) case is reviewed. They have a right to an attorney and other representatives to attend and give testimony in their case.

Our Ethical Responsibility

The power, right, privilege and responsibility involved with involuntarily transporting someone to the hospital to be evaluated potentially for an involuntary or voluntary stay is quite serious.

Those who are working in hospital settings and those who are initiating the entire process should consider the potential benefits and risks. If you are not taking steps solely for the purposes of the person’s (patient’s) safety or the safety of someone else…in a manner that involves imminent risk, then you have to closely consider the risk factors to the person you are assessing and/or treating.

Our competency, as it relates to completing 1013s, initiates this process. Once they arrive at the admitting facility, we are entrusting that the institution and all of its various representatives will also do what is best for the person (patient).

I am including the word “person” alongside the word “patient” to personally remind us all of the person-hood of the individuals we serve. It could be any one of us being assessed based on what we are exhibiting in our behaviors, expressed emotions, and our actions. You must ask yourself – would you feel respected if you were receiving the treatment that you are providing to others?

Copyright © 2016 Ruby Blow. All rights reserved.


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Ethics
  • Lynne H Berkstresser

    An excellent and thoughtful presentation that greatly contributed to my understanding of the entire process. Thank you, Ruby.

  • Ruby Blow

    Thank you for reading it Lynne and thank you for your comment!

  • Heather P

    I have a question, when the patient is an adult and is 1013 into a facility, then released when she can’t sign her name, dress herself or do basic things like use a phone to call anyone. How do they determine that she is safe to be on her own? I am a concerned mother that works and my daughter was released when she can’t even speak a clear sentence or dress herself.

  • Ruby Blow

    I’m sorry to hear this Heather P. I can’t comment on specific cases because I don’t know what the hospital’s rationale was and why they made the decision that they did. You should communicate with the hospital to find out more from them.