ENFORCE MGL CH. 52 -AN ACT RELATIVE TO SUBSTANCE USE, TREATMENT - HOSPITAL HOLDS
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On March 14, 2016, Massachusetts passed and published MGL, Ch. 52 - Sessions Law and Acts of 2016:
AN ACT RELATIVE TO SUBSTANCE USE, TREATMENT, EDUCATION AND PREVENTION - With an emergency preamble:
"Whereas, The deferred operation of this act would tend to defeat its purpose, which is to increase forthwith the availability of substance use treatment, education and prevention, therefore, it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience."
Specifically, Section 51½:
(b) A person presenting in an acute-care hospital or a satellite emergency facility who is reasonably believed by the treating clinician to be experiencing an opiate-related overdose, or who has been administered naloxone prior to arriving at the hospital or facility, shall receive a substance abuse evaluation within 24 hours of receiving emergency room services. A substance abuse evaluation shall conclude with a diagnosis of the status and nature of the patient’s substance use disorder, using standardized definitions as set forth in the Diagnostic and Statistical Manual of Mental Disorders as published by the American Psychiatric Association a diagnosis of a mental or behavioral disorder due to the use of psychoactive substances, as defined and coded by the World Health Organization. Each patient shall be presented with the findings of the evaluation in person and in writing, and the findings shall include recommendations for further treatment, if necessary, with an assessment of the appropriate level of care needed. Findings from the evaluation shall be entered into the patient’s medical record.
[No acute-care hospital or satellite emergency facility shall permit early discharge, defined as less than 24 hours after presentation or before the conclusion of a substance abuse evaluation], whichever occurs sooner. If a patient does not receive an evaluation within 24 hours, the treating clinician shall note in the medical record the reason the evaluation did not take place and authorize the discharge of the patient.
We (Heroin is killing my town, Inc.) have been getting a large number of reports of hospitals releasing patients immediately following an overdose.
Moreover, my family was directly affected by Leominster Health Alliance Hospital's failure to adhere to the mandate. My niece, Julia Raposa, suffered an initial overdose September 29, 2016 and was discharged within an hour and a half upon presenting to the ED by way of ambulance and after receiving a life saving dose of Narcan from the EMTs. I was unable to get to the hospital in time before her release and she died of a subsequent overdose on October 9, 2016, because services were not rendered as prescribed under the law at the onset of her initial overdose on September 29th.
If Leominster Health Alliance Hospital had followed this mandate, I would have been able to respond in time, and our family would have sought a Section 35 while she was being held while awaiting and undergoing the mandated evaluation; as we previously did following her overdose on Jan. 26, 2016. At that particular time, she was transported to Nashoba Valley Hospital and they followed the mandate appropriately, thus resulting in a successful intervention, which lead to a period of sobriety for 6 months prior to her death.
Please note the lead language within the text of the law:
"No acute-care hospital or satellite emergency facility shall permit early discharge..."
Next note the definitions: Early discharge is "defined as less than 24 hours after admission or before the conclusion of a substance abuse evaluation..."
The word "shall" in legalese is to mean that there is no other alternative in following this law and it is not meant to be followed in how it is percieved to mean. The meaning is plain.
When used in statutes, contracts, or the like, the word "shall" is generally imperative or mandatory.[Independent School Dist. v. Independent School Dist., 170 N.W.2d 433, 440 (Minn. 1969)]
"In common, or ordinary parlance, and in its ordinary signification, the term 'shall' is a word of command, and one which has always, or which must be given a compulsory meaning; as denoting obligation. It has a peremptory meaning, and it is generally imperative or mandatory. It has the invariable significance of excluding the idea of discretion, and has the significance of operating to impose a duty which may be enforced, particularly if public policy is in favor of this meaning, or when addressed to public officials, or where a public interest is involved, or where the public or persons have rights which ought to be exercised or enforced, unless a contrary intent appears; but the context ought to be very strongly persuasive before it is softened into a mere permission," etc.[People v. O'Rourke, 124 Cal. App. 752, 759 (Cal. App. 1932)]
Since this law has gone into effect, many of the Hospital Administrations across the Commonwealth are deliberately failing to adhere to the practice of this mandate. We need this law and vital tool to be enforced as a common practice within the medical community, if we are to make any real and significant progress in fighting the epidemic.
It is my understanding that hospitals argue consent, but that is not how the law is written and consent is addressed under Section 51½(c) and should only be considered after the prescribed steps are taken in Section 51½(b), which requires the 24 hour hold and evaluation.
Your constutients demand an immediate call to action on this issue to enforce this law across the Commonwealth in uniformity to prevent further unnecessary and preventable opioid overdose deaths.
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