HB 2372: Assisted Community Treatment; Medication; Administration; Registered Nurses; Community Paramedicine Program; Health Care Professionals

A BILL FOR AN ACT

RELATING TO ASSISTED COMMUNITY TREATMENT.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that subjects of assisted community treatment orders must be taken to an emergency room or admitted to a hospital and be attended by a psychiatrist or advanced practice registered nurse to receive court ordered treatment.  However, mentally ill individuals who are subject to these orders and refuse to be transported to an emergency room or hospital, and whose actions do not rise to the level of necessitating the initiation of emergency transportation to psychiatric or other designated facility, cannot access the treatment they desperately need.

     The legislature further finds that the city and county of Honolulu's community outreach and response engagement (CORE) program provides ongoing outreach and treatment to the homeless population in the field using an ambulance equipped with medical supplies.  Through the CORE program, state licensed paramedics and registered nurses are able to develop ongoing relationships with the clients they serve and can carry out assisted community treatment orders by administering treatment ordered by a qualified psychiatric examiner.

     The legislature therefore finds that qualified paramedics licensed by the State and other qualified medical staff participating in a community paramedicine program approved by the department of health should be able to administer court ordered treatment, including the administration of prescription drugs.  Allowing personnel and staff to administer treatment outside of a hospital setting can facilitate the administration of life saving treatment for persons subject to an assisted community treatment order.

     Accordingly, the purpose of this Act is to facilitate the administration of assisted community treatment orders by authorizing registered nurses and qualified state-licensed health care professionals participating in a community paramedicine program approved by the department of health who are operating as part of a county program to administer prescription medication prescribed as part of an assisted community treatment order treatment plan in settings other than a hospital, psychiatric facility, or other designated facility.

     SECTION 2.  Chapter 334, Hawaii Revised Statutes, is amended by adding a new section to part VIII to be appropriately designated and to read as follows:

     "§334-     Administration of assisted community treatment; county programs.  A registered nurse licensed under section 457‑7 or a qualified state-licensed health care professional participating in a community paramedicine program pursuant to section 321-224.4 may administer reasonable and appropriate medication or medications specifically authorized by a court order to a person subject to an order in a location other than a hospital, psychiatric facility, or other facility designated by the director if:

     (1)  The subject of the order consents to the administration of the medication or medications;

     (2)  The administration of the medication or medications is consistent with accepted medical standards and the court order, including the written treatment plan submitted pursuant to section 334-126(g);

     (3)  The registered nurse or qualified state-licensed health care professional knows that the person is subject to an order;

     (4)  The registered nurse or qualified state-licensed health care professional is working within their scope of practice;

     (5)  The registered nurse or qualified state-licensed health care professional is providing treatment through a county program, including a county community outreach program or community paramedicine program; and

     (6)  The location is equipped with medical supplies and designed specifically to administer prehospital or community paramedicine care to patients."

     SECTION 3.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect on July 1, 3000.

Report Title:

Assisted Community Treatment; Medication; Administration; Registered Nurses; Community Paramedicine Program; Health Care Professionals

Description:

Authorizes registered nurses and qualified state-licensed health care professionals who are participating in a community paramedicine program approved by the Department of Health who are licensed by the State to administer medication as part of an assisted community treatment order's treatment plan to the subject of the order, under certain circumstances.  Effective 7/1/3000.  (HD1)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

A BILL FOR AN ACT

relating to assisted community treatment.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  The legislature finds that subjects of assisted community treatment orders must be taken to an emergency room or admitted to a hospital and be attended by a psychiatrist or advanced practice registered nurse to receive court ordered treatment.  However, mentally ill individuals who are subject to these orders and refuse to be moved, and whose actions do not to rise to the level of necessitating the initiation of emergency transportation to psychiatric or other designated facility, cannot access the treatment they desperately need.

     The legislature further finds that the city and county of Honolulu's community outreach and response engagement (CORE) program provides ongoing outreach and treatment to the homeless population in the field using an ambulance equipped with medical supplies.  Through the CORE program, state licensed paramedics and registered nurses are able to develop ongoing relationships with the clients they serve and can carry out assisted community treatment orders by administering treatment ordered by a qualified psychiatric examiner.

     The legislature therefore finds that qualified paramedics licensed by the State and other qualified medical staff should be able to administer court ordered treatment, including the administration of prescription drugs.  Allowing personnel and staff to administer treatment outside of a hospital can facilitate the administration of life saving treatment for persons subject to an assisted community treatment order.

     Accordingly, the purpose of this Act is to facilitate the administration of assisted community treatment orders by authorizing registered nurses and licensed paramedics who are operating as part of a county program to administer prescription medication prescribed as part of an assisted community treatment order treatment plan in settings other than a hospital, psychiatric facility, or other designated facility.

     SECTION 2.  Chapter 334, Hawaii Revised Statutes, is amended by adding a new section to part VIII to be appropriately designated and to read as follows:

     "§334-     Administration of assisted community treatment; county programs.  A registered nurse licensed under section 457-7 or qualified paramedic licensed under section 453-34 may administer reasonable and appropriate medication or medications specifically authorized by a court order to a person subject to an order in a location other than a hospital, psychiatric facility, or other facility designated by the director if:

     (1)  The administration of the medication or medications is consistent with accepted medical standards and the court order, including the written treatment plan submitted pursuant to section 334-126(g);

     (2)  The registered nurse or paramedic knows that the person is subject to an order;

     (3)  The registered nurse or paramedic are working within their scope of practice;

     (4)  The registered nurse or paramedic is providing treatment through a county program, including a county community outreach program; and

     (5)  The location is equipped with medical supplies and designed specifically to administer prehospital care to patients."

     SECTION 3.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect upon its approval.

Report Title:

Assisted Community Treatment; Medication; Administration; Registered Nurses; Paramedics

Description:

Authorizes registered nurses and qualified paramedics licensed by the State to administer medication as part of an assisted community treatment order's treatment plan to the subject of the order, under certain circumstances.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

STAND. COM. REP. NO.  367-26

Honolulu, Hawaii

                , 2026

RE:   H.B. No. 2372

      H.D. 1

Honorable Nadine K. Nakamura

Speaker, House of Representatives

Thirty-Third State Legislature

Regular Session of 2026

State of Hawaii

Madame:

     Your Committee on Health, to which was referred H.B. No. 2372 entitled:

"A BILL FOR AN ACT RELATING TO ASSISTED COMMUNITY TREATMENT,"

begs leave to report as follows:

     The purpose of this measure is to authorize registered nurses and licensed paramedics who are operating as part of a county program to administer prescription medication prescribed as part of an assisted community treatment order treatment plan in settings other than a hospital, psychiatric facility, or other designated facility.

     Your Committee received testimony in support of this measure from the Department of Community Services of the City and County of Honolulu; Honolulu Emergency Services Department of the City and County of Honolulu; CARES; and one individual.  Your Committee received testimony in opposition to this measure from the Hawaii Disability Rights Center; The Institute for Human Services, Inc.; and one individual.  Your Committee received comments on this measure from the Department of the Attorney General and Department of Health.

     Your Committee finds that subjects of assisted community treatment orders must be taken to an emergency room or admitted to a hospital and be attended by a psychiatrist or advanced practice registered nurse to receive court-ordered treatment.  However, mentally ill individuals who are subject to these orders and refuse to be moved, and whose actions do not to rise to the level of necessitating the initiation of emergency transportation to a psychiatric or other designated facility, cannot access the treatment they desperately need.  Your Committee further finds that state licensed registered nurses and other state licensed health care professionals who are participating in a community paramedicine program that has been approved by the Department of Health are able to develop ongoing relationships with the clients they serve and can carry out assisted community treatment orders by administering treatment ordered by a qualified psychiatric examiner.

     Your Committee notes the concerns raised in testimony by the Department of the Attorney General and Department of Health that this measure may unintentionally be interpreted to authorize the administration of treatment without the consent of the subject of an assisted community treatment order.  Your Committee recognizes that the current process of requiring that the administration of treatment over the objection of the subject occur in a hospital setting is necessary to protect the safety of the subject and the health care provider administering the medication.  Your Committee further notes the Department of Health's concerns that while paramedics are authorized to administer medication, this authorization is limited to medication that is included in the Emergency Medical Services Department of Health Standing Orders and that administration of medication not included in those orders could result in a paramedic operating outside of the scope of their practice.

     Your Committee notes the testimony of the Emergency Services Department and Department of Community Services of the City and County of Honolulu that the current method of administering medication to subjects of an assisted community treatment order often requires significant law enforcement and hospital resources as these individuals may need to be detained by police officers, transported to an appropriate hospital facility, held for evaluation of the subject by a qualified psychiatric examiner, or monitored until medication has been administered.  Your Committee recognizes that limiting administration of medication to the subject of an order in a non-hospital setting to situations where the subject consents to the administration may not address the concerns raised by the City and County of Honolulu.  Accordingly, your Committee respectfully requests that your Committee on Judiciary & Hawaiian Affairs, should it deliberate on this measure, to consider the necessity of limiting the types of situations in which medication may be administered.

     Accordingly, your Committee has amended this measure by:

     (1)  Authorizing qualified state-licensed health care professionals who are participating in a community paramedicine program that has been approved by the Department of Health, rather than licensed paramedics, to administer medication pursuant to an assisted community treatment order;

     (2)  Requiring the subject of an assisted community treatment order to consent to the administration of medicine before a registered nurse or state-licensed health care professional may administer the medication;

     (3)  Clarifying that a registered nurse or state-licensed health care professional may administer treatment if the treatment is provided through a community paramedicine program in addition to a county community outreach program;

     (4)  Clarifying that the location where medication may be administered must be designed specifically to administer community paramedicine care in addition to prehospital care;

     (5)  Changing the effective date to July 1, 3000, to encourage further discussion; and

     (6)  Making technical, nonsubstantive amendments for the purposes of clarity, consistency, and style.

     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 2372, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 2372, H.D. 1, and be referred to your Committee on Judiciary & Hawaiian Affairs.

Respectfully submitted on behalf of the members of the Committee on Health,