Advanced Search

Regulation Of Health Interventions For Persons With Mental Disorders

Original Language Title: Regolamentazione Degli Interventi Sanitari Per Persone Con Disturbi Mentali

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now for only USD$40 per month.
Microsoft Word - D057-2009.doc

SAN MARINO



We the Captains Regent of the Most Serene Republic of San Marino


In view of article 4 of the Constitutional Law no.185 / 2005 and Article 6 of Qualified Law
186/2005;
Promulgate and publish the following ordinary law approved by the Great and General Council
its meeting on 23 April 2009.


LAW 27 April 2009 57


HEALTHCARE REGULATORY ACTIONS FOR PEOPLE WITH MENTAL DISORDERS



Art.
1 (Principles)

Interventions for diagnostic tests, treatment and rehabilitation of mental disorders
are normally volunteers; Also for these interventions to be found valid consent and
informed by the data.
The mandatory health interventions are regulated by this law; the purpose of such
intervention is solely to allow medical treatment for serious mental disorders.
Every compulsory medical intervention, referred to in the preceding paragraph, being intended to
affect inalienable rights, requires legal protection.



Art.2 (Patient Rights)

The patient, even when subjected to obligatory health treatment (TSO),
secures the rights enshrined in the "Convention for the Protection of Human Rights and Dignity of Being Human
about the applications of Biology and medicine ", signed at Oviedo on 4
April 1997 and ratified by Decree 26 February 1998 n. 45.


Art. 3
(Patient Protection)

The restriction of individual liberty of the person subject to Compulsory Health Treatment
is exclusively aimed at the need to put in place an effective therapeutic treatment
for the care of people with severe mental disorders.
The person concerned to the TSO is protected as follows:
a) is entitled to an adequate and individualized treatment, in respect of the person, both from a point of
medical-health and environmental benefits, which is why the TSO
inpatient hospital procedure may be carried out only in authorized facilities;
B) without prejudice to the guarantee of being able to communicate with the outside, a possible restriction
must be decided by the doctor in charge of the treatment, for the sole purpose of enabling a better
conduct of the therapeutic program. Any restriction must be reported
in the medical record by the doctor, with the motivation and the indication of the beginning and the end of
restrictive measure;
C) you must always be assured the patient's right to communicate with counsel, with whom
has parental responsibility and with the Commission for the Protection of Mental Health (CTSM).
The visits are arranged with the nursing staff according to the rules of the shelter structure;
D) you have the right to appeal with the CTSM against the decisions and actions taken by health
as described in this Act. The patient has right to legal counsel who,
in the absence of the designation of a knowledgeable attorney, is assured by the lawyer of office;
E) you are entitled to receive a correct and complete information on their disease, prognosis,
treatment and anything else connected to it; also it is guaranteed the right to confidentiality
;
F) the restriction of individual liberty must be carried out for the sole purpose of allowing
the proper conduct of the therapeutic program and should be used for the time deemed strictly necessary
, preserving the patient's safety or third. The means of physical restraint
must be used only by prescription and only in order to avoid
possible injury to the patient or to others, if it emerges all attempts to persuade the patient to accept
hospitalization or therapy. During the period when the patient is contained, its social and health personnel
has the obligation to provide the necessary care and groped to get
adherence to therapeutic plan;
G) the medical record must contain an indication of the beginning, the end and the grounds of
restraint. It also needs to be established at the Mental Health Services (SSM) a register
where the restraint measures will be annotated with the above mentioned elements;
the records must be carried out by the doctor who orders the restraint;
H) the patient who has not been disabled or incompetent maintains its civil capacity. The
CTSM may appoint a provisional liquidator, if it is necessary to protect the interests of the patient's economic
, whose term will expire at the end of the TSO;

I) the judge who orders the measure of TSO, directly or through SSM, assumes the task of informing
admission, the legal representative. In the case of foreign nationals
residents in the Republic, the information will be communicated to the authorities competent for
territory or to the corresponding consulate;
L) CTSM follows the course of the mandatory health interventions, in order to protect the rights and dignity of the person
, through the reports of the manager of the SSM, which has the power to request the medical records
and all the necessary information. It also has the power to appoint one or more experts
office to assess directly the conditions of the person concerned by the
mandatory measure, including through visits to the places where we have applied the TSO.


Art. 4
(Commission for the Protection of Mental Health)

And 'it established the Commission for the Protection of Mental Health (CTSM).
The CTSM comprises:
1) by a Law Commissioner, who presides;
2) by a medical specialist in psychiatry;
3) by a social worker.
The members referred to in items 2) and 3) are appointed by the Executive Committee of the Institute
Health and Social Security, together with the alternate members, appointed from outside of the SSM staff, for a period of three years
, renewable at maturity and not revocable.
The CTSM has the following skills:
a) regularly monitor the implementation of the TSO, receiving reports of the police and
relations manager of TSO doctor. The CTSM also monitors
in the manner laid down in Article 3 in order to uphold the rights and dignity of those who are subjected to
TSO;
B) appoint a temporary curator in order to protect the economic and financial interests
of the person subject to the TSO;
C) to consider and decide on appeals, which Jurisdictional organ of first instance;
D) suspend or modify the implementation of TSO deemed illegal or harmful to the dignity of the person
.
The CTSM based at the Single Court, meeting at the request of the President and
employs its staff. The actions undertaken must be entered in a special register which
confidential nature, as the files of the proceedings.
The CTSM must draw up and approve its own rules of procedure.


Art. 5
(Compulsory Health Assessment)

The Compulsory Health Assessment (ASO) aims to assess whether the conditions of a person
, which is allegedly suffering from a mental disorder, and that because of this disorder,
waste the necessary diagnostic or therapeutic measures , are such as to require a
Compulsory Health treatment (TSO) under the conditions established by this law.
Signaling the need for an ASO should be sent to the SSM, the doctor or
by health authorities or by the police.
The doctor of the SSM, gathered the necessary information and made the findings that the case
requires, if checks that the conditions of the subject so require a medical examination required
, requires an ASO, on plain paper, the tutelary judge.
In the request the anamnestic with reasons why
believe that the person is suffering from a serious mental disorder, and that requires an intervention health
, and indicate what action has been undertaken to groped a medical examination should be described
voluntary; the request must be specified if the situation is urgent to consider the measure.
The tutelary judge verified the requirements of the law, with validation decree requesting ASO
, sending it to the Gendarmerie and the SSM. The Police and health authorities are concerned
they agree, within their respective powers, on the implementation of the measure.
In particular to the Forces competes the ability to stop the subject, if necessary also
with the introduction stall where the latter has, in order to make possible
the ASO. Also it is the duty of the police to protect the individual's safety and public safety
, including through inspection of the person or the environment in order to seek
any proper and improper weapons.
Health responsible for assessing the clinical case, the attempt to seek the cooperation of the subject
in order to arrive at a possible treatment plan and implement the measures urgent therapeutic
if you make it absolutely necessary to protect the '
safety of the person concerned or third parties.
Made the ASO, the Police and the SSM doctor draw up, each for

Own competence, a report to the tutelary judge indicating whether the certification is
happened and how. In the medical report of the SSM will be given the clinical conclusions
has been reached through the initial medical and any resulting therapeutic project.
The tutelary judge, in turn, must send the acts, within five working days, the President of CTSM
.
In the event that, during the ASO, there is a need to proceed to a TSO, the doctor who
is conducting the investigation must immediately activate the necessary procedures, as
provisions of article 6.


Art. 6
(Compulsory Health Treatment)

The obligatory health treatment is validated by the tutelary judge
when the following conditions exist:
1) based on the contents of the medical report of the SSM, deems the presence of alterations psychic
which require urgent therapeutic measures;
2) as a result of mental disorder the patient is not able to judge their state of health
and refuse to undergo the necessary diagnostic tests or therapeutic measures;
3) there is the absence of the conditions and circumstances that allow you to enable timely
appropriate health measures outside of an obligatory health treatment.
The TSO request must be made by a physician of the ISS. This request, to be sent to the tutelary judge
, must contain medical history information indicating the psychological disorders mentioned
suffers the person concerned and the diagnostic orientation in which are specified the reasons for which the person concerned
waste treatment. The request also must contain a statement of the program
therapeutic, in inpatient or outpatient, act to address the clinical situation.
The possible need for urgent action must always be stated explicitly.
The proposed TSO must be validated by a psychiatrist of the SSM, which must
personally visit the patient, to formulate a diagnostic orientation and a program suitable therapeutic
. It must locate, in the case of a TSO in inpatient, a suitable
structure that embraces the patient, pointing in the validation certification.
The demand for TSO and validation should be sent jointly to the tutelary judge who
right to request additional information to doctors proponents.
If the judge is legitimate demand for TSO issues a decree that validates a
Compulsory Health Treatment:
1-hospital, the maximum term of fifteen days, renewable on a reasoned application by the doctor
who validated the request TSO;
2-of-hospital, with a maximum duration of three months, renewable on a reasoned application by the doctor
controller.
The tutelary judge immediately send the decree to the Mental Health Service.
The same decree is sent, via the Gendarmerie, even to the police to give effect to the measure
, cooperating to the extent applicable.
The Police are responsible for execution of the order, in collaboration with health
, with the aim to protect the data subject, the safety of third parties and public safety, providing
, following inspection to the assessment of the presence and requisition for
custody of dangerous objects or weapons. Officials authorized to draw up report
respective command, which will send a communication to the tutelary judge.
While running the TSO health have, however, the obligation to groped to get
consent to the treatment by the patient. Health must provide for
necessary treatments during all phases of implementation of the measure, being able to use the facilities and
ISS structures deemed appropriate and shall be identified in the medical record a report. Must finally
, send a further report on the implementation of the measure to the tutelary judge.
The Police notify the measure to the Office of Attorney and the possible
. The health collaborate with the Police, by providing adequate information on the
TSO treatment.
If the circumstances so require, the Police may implement
restraint measures, in collaboration with health, with the purposes described in Article 3,
second paragraph f).
The tutelary judge, within five working days, must send a copy of the TSO
documentation to the President of CTSM.
The tutelary judge, should it deem it necessary, send to the President of the CTSM

Request for the appointment of a provisional liquidator, in order to protect the assets of the person concerned by the measure
TSO.


Art. 7
(obligatory health treatment in outpatient regime (tsoe))

The obligatory health treatment in outpatient regime (tsoe)
is validated by the tutelary judge, by decree, when clinical conditions meet the criteria for a TSO
but suggest the most appropriate medical treatment in outpatient regime.
The outpatient treatment must be found suitable to address the clinical situation and
requires the assistance of a family or social support and cooperation, however slight, to the person concerned
, to ensure the administration of proper treatment.
The tsoe can take place as a result of a TSO in inpatient settings, where
continuation of the therapeutic program.
The tsoe request must include a report, showing the name of the doctor
controller, the clinical condition of the patient and the reasons which suggest that
necessitating such action. The doctor of the SSM, which required the activation of the measure
tsoe, must formulate a treatment plan, it can refer to each end of the structure and personnel of the Service
. The request and the validation follow the mode described in Article 6.
Admission to outpatient regime is to be made only in public facilities or credited
.
The tutelary judge issues the decree within five days of arrival of the request, always
as described in Article 6.
The head of tsoe doctor will draw up a report on the
same treatment, every month, sending it to the tutelary judge and the President of CTSM.
It must also communicate to the institutions themselves, in the shortest possible time, when the decay
TSO conditions changing treatment in voluntary scheme.
The head of tsoe doctor must give prompt notice to the tutelary judge
when conditions do not allow to continue treatment in outpatient regime,
motivating the TSO request in inpatient settings. This request must be formulated and validated
in the manner described in Article 6.
During tsoe the patient may be assisted by a doctor of his choice.
The TSO-hospital does not apply to individuals resident outside the territory.


Art. 8
(obligatory health treatment in hospital inpatient)

The tutelary judge issues this order in the cases and with the methods described in Article 6.

The person affected by the measure will be moved to a structure enabled to receive
TSOs, indicated in the validation certificate. The period of TSO will be established, within the limits of
this law, according to the current regulations of the country where there is the hospital that
receive the sick.
The Police and health are required to provide assistance in accordance with their
skills, at all stages of the TSO, as described in Article 6.
The doctor in charge of the structure where the patient is admitted has the chance to
ask the referring physician of the SSM an extension of the measure, using a short
report showing the clinical condition and the reasons for the request. The doctor of the SSM,
in turn, will forward the request to the tutelary judge who has the power to accept
extending the TSO. The doctor in charge of the structure where the patient is admitted, if
lapse of the conditions required, the TSO will give the physician immediate notice of termination
of the SSM that is bound to follow the clinical course of the TSO, by posting, at the end of same, a
brief report to the tutelary judge and the President of CTSM.


Art.
9 (Common provisions)

The TSO is a measure that can be taken only in the presence of a mental disorder
involving alteration of judgment and / or by the individual critics.
For this reason, the implementation of a TSO implies the need for a re-evaluation on the suitability of the person concerned
keep any driving license, gun license or hunting permit.
The doctor of the SSM, responsible for the TSO is required to assess, in the course of treatment and,
however, within seven days after the end of the same, if the person concerned retains the requirements
psycho-physical necessary to maintain the 'suitability for the licenses referred to in the previous paragraph.
In the event it is deemed appropriate to suspend one or more of the licenses in question, the SSM doctor will

Required to send a brief report to the tutelary judge and the President of CTSM, indicating a
term not exceeding six months, within which to re-evaluate the case.
The president of CTSM promptly give notice to the Director of Medicine
Base and the Commander of the Gendarmerie to undertake acts of
license suspension and the ratings in the first paragraph, their respective powers.
Measure will not be shown in clinical diagnosis.
The Gendarmerie, within its competence, arrange for temporary storage
any weapons.
If the SSM doctor considers that the person concerned to the TSO
measure has again reached the necessary requirements to gain eligibility for driver's license and / or the port
arms or hunting license, required to send promptly reporting the tutelary judge and the president of
CTSM to activate the process available to regain the licenses in question.


Art. 10
(Opposition and Appeals)

Against the actions undertaken by the nursing staff or the tutelary judge,
the patient or any other interested person may file an objection by means of a written appeal on plain paper
to CTSM, which must rule on the matter within ten days of receipt of the application itself .
The patient may be assisted by a legal advisor or by the lawyer of office.
An appeal against the decisions of CTSM, the patient or any interested person may file
appeal within three working days of formal notice, the Judge of Appeal that will
decide within fifteen days from the filing of the appeal.
The presentation of opposition or appeal does not have suspensive effect on the acts and decisions disputed
.



Art.11 (Implementation of Compulsory Health Treatment)

In order to permit the mandatory medical treatment of serious mental disorders, the person concerned
must be transferred to suitable structure enabled. It is therefore necessary to define a
agreement with the authorities or the institutions of the Italian Republic, aimed at recognition of
valid certifications and work of each person affected by the San Marino
procedure under this provision and to allow the subsequent activity of Law Enforcement
on their respective territories.
Waiting for each person affected by the TSO measure is transferred to a
enabled the structure, it is necessary to realize, or health services or otherwise present in
San Marino, a special structure for temporary shelter including at least two
beds, as well as the training of health personnel for the necessary assistance to the patient.
It mandates the State Congress to present appropriate delegated decree
by the sixth month after the publication of this law, which has about the purposes provided for in this Article
.


Art.
12 (Entry into force)

This Law shall enter into force on the fifteenth day following that of its legal publication
.



Our Residence, this day of 27 April 2009/1708 dFR





THE CAPTAINS REGENT Massimo Cenci - Oscar Mina






THE SECRETARY OF STATE FOR INTERNAL AFFAIRS Valeria Ciavatta