Discuss the PEC and CEC process.

PEC, are physician emergency certificate, is the involuntary and emergent detaining of a patient for 72 hours. The process to obtain a PEC includes a licensed PMHNP acting in according with their collaborative practice agreement in addition to a verbal agreement from their physician to execute the certificate. This certificate should be implemented after an examination of the patient that is suffering from mental illness, substance or addiction abuse or disorders. The exam may be conducted in person or by telehealth and should have medical clearance prior to admission to a mental health facility.  PEC and CEC Process in Louisiana Essay Paper

CEC, or coroner’s emergency certificate, is a second independent examination by the coroner or a deputy that is a required condition for a person to continue confinement. This is completed within 72 hours of admission.

PEC requirements:

“(a) The date of the physician’s, physician assistants, psychiatric mental health nurse practitioners, other nurse practitioner’s or psychologist’s examination of the person, which shall not be more than seventy-two hours prior to the date of the signature of the certificate.

(b) The objective findings of the physician, physician assistant when acting in accordance with their respective clinical practice guidelines, psychiatric mental health nurse practitioner, other nurse practitioner who acts in accordance with a collaborative practice agreement and receives verbal approval for executing the certificate from his collaborating physician, or psychologist relative to the physical or mental condition of the person, leading to the conclusion that the person is dangerous to self or others or is gravely disabled as a result of a substance-related or addictive disorder or mental illness. PEC and CEC Process in Louisiana Essay Paper

(c) The history of the case, if known.

(d) The determination of whether the person examined is in need of immediate care and treatment in a treatment facility because the patient is any of the following:

(i) Dangerous to himself.

(ii) Dangerous to others.

(iii) Gravely disabled.

(e) That the person is unwilling or unable to seek voluntary admission.

(3) The certificate shall be dated and executed under the penalty of perjury, but need not be notarized. The certificate shall be valid for seventy-two hours and shall be delivered to the director of the treatment facility where the person is to be further evaluated and treated.

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(4) In the case of an emergency certificate issued pursuant to an examination conducted by telemedicine pursuant to Paragraph (1) of this Subsection and Paragraph (J)(1) of this Section, the licensed healthcare professional present during the actual examination shall be responsible for obtaining, recording, and attaching to the emergency certificate the following information regarding the video conference:

(a) The date.

(b) The starting and ending times.

(c) The names of all persons who were in the room and the type of license issued to the health care professional.

(d) The physical address of both the examining psychiatrist and the patient when the video conference was conducted” (Louisiana Legislature RS 28:53, 2011).

How long are each valid?

A PEC is valid for 72 hours. A CEC can be applicable for up to 15 days (Louisiana Legislature RS 28:53, 2011).

What documentation is necessary if a PEC is issued during a Telehealth visit?

A PEC may be conducted by telehealth. A video conference must be conducted and an accurate assessment must be able to be conducted. A telemedicine certificate should state:

The date of the PMHNP examination of the patient and cannot be more than 72 hours prior to the date of the signature of the certificate.
The PMHNP findings of the patient that should include the mental or physical condition. This examination should entail information that is warranting the PEC, such as a danger to self or others or is gravely disabled as a result of mental illness or substance abuse.
If known, a history of the case
Indication if immediate care of the patient is needed and if treatment in a treatment facility because the patient is either:
A danger to self or others
Gravely disabled
The patient is unwilling or unable to seek voluntary admission to a treatment facility (Louisiana Legislature RS 28.53, 2011).
What happens if a patient is not safe for discharge when the CEC expires?

Louisiana Legislature RS 28:53 (2011) states that a second certificate may be issued if a patient is examined within 72 hours prior to termination of the initial 15 day period and certified that the patient is a danger to self, others, or gravely disabled. There also must be documentation stating the patient is likely to improve during the extended period. A patient must be informed of the extension, how long, and what reasons were indicated for the extension. The nearest relative or designated responsible party shall also be notified (Louisiana Legislature RS 28:53, 2011).  PEC and CEC Process in Louisiana Essay Paper

What are the patient’s rights during this process?

Louisiana Legislature RS 28: 171 (2011) discussed the law and rights of patients in a treatment facility. Patients in an inpatient facility will not be deprived of any rights, benefits, or privileges allows by law, such as civil service rights. Patients in a treatment facility will be given uncensored communication by mail, phone, or visitation but may be restricted by the treatment facility director if there is cause to do so. Patients that are under an emergency certificate should not receive surgical or electroshock therapy without the written consent of the patient unless it is of a critical nature that is life threatening. All patients have a right to wear their own clothes along with keeping personal possessions that including toiletry items unless it is deemed inappropriate medically. Patients have a right to spend a “reasonable” sum of money to make small purchases. If the patient cannot afford any items, these items should be supplied by the facility. Every patient has the right to be employed at an occupation that is useful depending on the facility, a right to sell the products of their person skill at the discretion of the treatment facility, and a patient has the right to be discharged once their condition improves. All patients have a right to engage a private attorney and an informal court hearing if requested. All patients have a right to a treatment plan, examination by a PMHNP or provider. Further, patients will only receive medication documented by a provider order. Every patient has a right at their own expense to be visited and examined by a provider designated by the patient or family member or interested party. That designee may also consult with the treatment team and facility. Finally, any patient practicing a well-recognized religious method of healing under the care of an accredited provider should not be ordered “medically treated” unless he is, as a result of a mental disorder, a danger to self or others (Louisiana Legislature R.S. 28.171). In addition, Louisiana Legislature (2011) R.S 28.63 states all patients admitted by emergency certificate will be informed of their rights in writing when admitted.

References

Louisiana State Legislature, Admission by emergency certificate, extensions, payment for services

rendered, RS 28.53. (2011) http://legis.la.gov/Legis/law.aspx?d=85245

Louisiana State Legislature, Part VI. Rights of persons suffering from mental illness and

substance-related or addictive disorders, RS 28.171. (2011)

http://legis.la.gov/legis/Law.aspx?d=85105

 PEC and CEC Process in Louisiana

The physician emergency certificate (PEC) is an involuntary and emergent detaining of patients for 72 hours. The 2017 revised statutes of Louisiana title 28 (Mental Health), §53, provide guidelines under which admission can be made through an emergency certificate. These guidelines also include extensions and payment for services rendered. According to the law, a person suffering from mental illness or substance-related disorder may be detained under an emergency certificate for observation, diagnosis, and treatment for not more than 15 days. A patient can be detained for more than 15 days only if a second emergency certificate is provided. For the second PEC to be provided, a physician must provide an assessment in writing within 72 hours of terminating the first certificate that the patient still remains dangerous to himself or others. Verbal approval for the execution of the emergency certificate by any physician or physician’s assistant acting within their respective clinical guidelines or psychiatric mental health nurse practitioner, other nurse practitioners; should be done so only after an actual test showing that the patient in question is still dangerous or gravely disabled.

The emergency certificate constitutes legal authority to transport a patient to a treatment facility and permits the director of the center to detain the patient for diagnosis and treatment for a period bot exceeding 15 days. Upon reception of the patient under an emergency certificate, the director of the facility should immediately notify the coroner of the parish. The notification should include the patient’s name and other details such as birth and the names of certified physicians. The coroner will then have 72 hours to independently examine the patient before issuing a coroner emergency certificate (CEC). CEC is a necessary precondition for the continued detainment of the patient. If the coroner determines that the person isn’t a proper subject for emergency admission, then then the individual shall not be detained any further in the facility and shall be discharged by ted rector forthwith.

Reference

Louisiana State Legislature, Admission by emergency certificate; extension; payment for services rendered. LA Rev Stat § 28:53 (2017). https://law.justia.com/codes/louisiana/2017/code-revisedstatutes/title-28/rs-28-53/

PEC and CEC Process in Louisiana Essay Paper