Most emergency departments in California are not "designated" 5150 facilities. So what is the legal basis for keeping you there, sometimes overnight, while someone phones around for a bed? There is a statute for exactly that, and it has a clock.
The short answer: yes, for up to 24 hours, and only if four conditions are met. A general acute care hospital or acute psychiatric hospital "that is not a county-designated facility pursuant to Section 5150," its licensed staff, or a physician providing emergency services there "is not civilly or criminally liable for detaining a person if all of the following conditions exist during the detention": (1) you "cannot be safely released from the hospital because, in the opinion of the treating physician and surgeon, or a clinical psychologist" with the required privileges, you, "as a result of a mental health disorder," present "a danger to themselves, or others," or are "gravely disabled"; (2) the staff or physician "have made, and documented, repeated unsuccessful efforts to find appropriate mental health treatment for the person"; (3) you are "not detained beyond 24 hours"; and (4) "there is probable cause for the detention."¹ Past eight hours, two more conditions apply: the transfer "has been delayed because of the need for continuous and ongoing care, observation, or treatment that the hospital is providing," and a physician or clinical psychologist has found that you are "still a danger to themselves, or others, or is gravely disabled."¹ The time is not lost: a person detained under the section "shall be credited for the time detained, up to 24 hours, if the person is placed on a subsequent 72-hour hold."¹ And you "retain their legal rights regarding consent for medical treatment."¹
What the section is, and is not
Section 1799.111 is not a hold in the Lanterman-Petris-Short sense. It is an immunity: it says the non-designated hospital and its clinicians are "not civilly or criminally liable for detaining a person" if the conditions are met.¹ The 72-hour hold itself is a different thing — the authority of a peace officer, designated-facility staff, a mobile crisis team member or a county-designated professional, "upon probable cause," to "take, or cause to be taken, the person into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county."² The ER hold exists to bridge the gap between a decision that you cannot safely leave and the moment a designated facility takes you.
The bridge has walls. Both 24-hour tests turn on a clinician's opinion that, "as a result of a mental health disorder," you present a danger to yourself or others or are gravely disabled — the same three grounds as a 5150.¹ "Gravely disabled" carries the definition in section 5008(h)(1).¹ What is a 5150 hold? →
The four conditions, and the two more after eight hours
- Cannot be safely released — a treating physician or a privileged clinical psychologist has formed that opinion on the three statutory grounds.¹
- Documented, repeated, unsuccessful efforts to find appropriate mental health treatment.¹ Not one phone call: the word is "repeated," and it must be documented. This is the paragraph to ask about.
- Not beyond 24 hours.¹
- Probable cause for the detention.¹ Section 1799.111 does not say what probable cause means. For the 5150 decision, the person deciding "shall consider available relevant information about the historical course of the person's mental disorder" — including evidence from family and from the person themselves — and "shall not be limited to consideration of the danger of imminent harm";² ³ and the emergency-care statute refers to "probable cause for detention, as defined in Section 5150.05,"⁴ which supports reading the two the same way.
After eight hours, the hospital must also be able to show that the transfer "has been delayed because of the need for continuous and ongoing care, observation, or treatment that the hospital is providing," and that a physician or clinical psychologist has found you "still" dangerous or gravely disabled.¹
Release, and who decides
The section carries a second immunity, for what a person does after release: the hospital is not liable for the released person's actions if the person was not admitted on a 5150 and the release was "authorized by a physician and surgeon or a clinical psychologist" who determined, "based on a face-to-face examination of the person detained, that the person does not present a danger to themselves or others and is not gravely disabled."¹ A clinical psychologist qualifies only with "a collaborative treatment relationship with the physician and surgeon" and "only after the clinical psychologist has consulted with the physician and surgeon"; if they disagree, "the detention shall be maintained unless the hospital's medical director overrules the decision of the physician and surgeon opposing the release," and both must record their findings.¹ In practice that is how release from the hold is decided. The examination that grounds any of these opinions "may be conducted using telehealth."¹
What you keep
- Consent to medical treatment. "Persons detained under this section shall retain their legal rights regarding consent for medical treatment."¹ A 24-hour ER hold is not authority to medicate you against your will. Can they medicate me against my will? →
- Seclusion and restraint rules. The section "does not affect the responsibility" of the hospital "to comply with all state laws and regulations pertaining to the use of seclusion and restraint and psychiatric medications for psychiatric patients."¹ Restraint and seclusion →
- Credit for time. If a 5150 follows, the ER hours count, up to 24.¹ The 72-hour period itself "begins at the time when the person is first detained";² the credit provision makes explicit what "first detained" might otherwise leave to argument, and caps it at 24.
- Emergency care. The hospital's duty to screen and stabilize a psychiatric emergency medical condition is separate and continues. Can the ER turn me away in a psychiatric emergency? →
When the 24 hours run out
The section gives the hospital no immunity past 24 hours — and since every condition must "exist during the detention," a detention that runs past 24 hours arguably forfeits it for the whole period.¹ By then one of four things has happened: a designated facility has accepted you and a 5150 is written, with the ER time credited;¹ ² a clinician has examined you face to face and authorized release;¹ you have agreed to stay as a voluntary patient; or you are still there — and the immunity has run out. If you are still there without a 5150 after 24 hours, ask, in these words, "Under what authority am I being held?" and ask for the patients' rights advocate. Once a person is on a hold, the facility must notify the county patients' rights advocate if the person "has not been released within 72 hours of the involuntary detention."² Who is the patients' rights advocate? →
Worked example
A man is brought to a community hospital's emergency department by his sister at 9 p.m. after telling her he intends to end his life. The ER physician finds him a danger to himself and cannot safely release him.¹ The hospital is not a designated facility. The social worker calls the county's designated units; all are full, and each call is documented.¹ At 5 a.m., eight hours in, the physician re-examines him — still a danger to himself — and notes that his transfer is delayed because he needs the continuous observation the hospital is providing.¹ At 2 p.m. a bed opens; a 5150 is written at the receiving facility, and the seventeen hours in the ER are credited against the 72.¹ ² Had the physician instead found at 5 a.m., face to face, that he was no longer a danger, release would have been authorized.¹
Q&A
Q: They kept me in the ER for two days. Is that legal? A: Section 1799.111 covers no more than 24 hours.¹ After that the hospital needs different authority — a 5150 written by someone authorized to write one,² or your agreement to stay. Ask which.
Q: Can the ER give me medication I do not want during the hold? A: The section preserves "legal rights regarding consent for medical treatment" and the rules on psychiatric medications.¹ Can they medicate me against my will? →
Q: Does the ER time count toward the 72 hours? A: Yes, up to 24 hours, if a 5150 follows.¹
Q: I came in voluntarily. Can they still hold me? A: The section speaks only of "a person at the hospital" whom a clinician has found cannot be safely released;¹ nothing in it turns on how you arrived. Separately, once your written consent to treatment and transfer is documented — or where there is no evidence of probable cause — a hospital "shall not require a person who voluntarily seeks care to be in custody pursuant to Section 5150 … as a condition of accepting a transfer."⁴ Can the ER turn me away in a psychiatric emergency? →
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Sources
Cal. Health & Safety Code §1799.111 — (a) "a licensed general acute care hospital, as defined in subdivision (a) of Section 1250, that is not a county-designated facility pursuant to Section 5150 of the Welfare and Institutions Code, a licensed acute psychiatric hospital, as defined in subdivision (b) of Section 1250, that is not a county-designated facility pursuant to Section 5150 …, licensed professional staff of those hospitals, or any physician and surgeon, providing emergency medical services in any department of those hospitals to a person at the hospital is not civilly or criminally liable for detaining a person if all of the following conditions exist during the detention: (1) The person cannot be safely released from the hospital because, in the opinion of the treating physician and surgeon, or a clinical psychologist with the medical staff privileges, clinical privileges, or professional responsibilities provided in Section 1316.5, the person, as a result of a mental health disorder, presents a danger to themselves, or others, or is gravely disabled. For purposes of this paragraph, 'gravely disabled' has the same definition as in paragraph (1) of subdivision (h) of Section 5008 of the Welfare and Institutions Code. (2) The hospital staff, treating physician and surgeon, or appropriate licensed mental health professional, have made, and documented, repeated unsuccessful efforts to find appropriate mental health treatment for the person. (3) The person is not detained beyond 24 hours. (4) There is probable cause for the detention"; (b) "If the person is detained pursuant to subdivision (a) beyond eight hours, but less than 24 hours, both of the following additional conditions shall be met: (1) A discharge or transfer for appropriate evaluation or treatment for the person has been delayed because of the need for continuous and ongoing care, observation, or treatment that the hospital is providing. (2) In the opinion of the treating physician and surgeon, or a clinical psychologist …, the person, as a result of a mental health disorder, is still a danger to themselves, or others, or is gravely disabled"; (c) the second immunity, "for the actions of a person detained up to 24 hours in those hospitals … after that person's release from the detention at the hospital," if (c)(1) "The person has not been admitted to a licensed general acute care hospital or a licensed acute psychiatric hospital for evaluation and treatment pursuant to Section 5150" and (c)(2) the release is "authorized by a physician and surgeon or a clinical psychologist … who determines, based on a face-to-face examination of the person detained, that the person does not present a danger to themselves or others and is not gravely disabled," "In order for this paragraph to apply to a clinical psychologist, the clinical psychologist shall have a collaborative treatment relationship with the physician and surgeon," the consultation requirement, and "In the event of a clinical or professional disagreement regarding the release of a person subject to the detention, the detention shall be maintained unless the hospital's medical director overrules the decision of the physician and surgeon opposing the release"; (d) examinations "may be conducted using telehealth"; (e) "This section does not affect the responsibility of a general acute care hospital or an acute psychiatric hospital to comply with all state laws and regulations pertaining to the use of seclusion and restraint and psychiatric medications for psychiatric patients. Persons detained under this section shall retain their legal rights regarding consent for medical treatment"; (f) "A person detained under this section shall be credited for the time detained, up to 24 hours, if the person is placed on a subsequent 72-hour hold pursuant to Section 5150 of the Welfare and Institutions Code" — california.public.law.
Cal. Welfare & Institutions Code §5150 — (a) the authority of a peace officer, a designated facility's staff, a mobile crisis team member or a county-designated professional, "upon probable cause," to "take, or cause to be taken, the person into custody for a period of up to 72 hours for assessment, evaluation, and crisis intervention, or placement for evaluation and treatment in a facility designated by the county for evaluation and treatment and approved by the State Department of Health Care Services. The 72-hour period begins at the time when the person is first detained"; (b) the decision-maker "shall apply the provisions of Section 5150.05, and shall not be limited to consideration of the danger of imminent harm"; (k) "A facility to which a person who is involuntarily detained pursuant to this section is transported shall notify the county patients' rights advocate, as defined in Section 5500, if a person has not been released within 72 hours of the involuntary detention" — california.public.law. See also §5151(a), the designated facility "may detain the person for evaluation and treatment for a period not to exceed 72 hours from the time that the person was first detained pursuant to Section 5150" — california.public.law.
Cal. Welfare & Institutions Code §5150.05 — (a) the person determining probable cause "shall consider available relevant information about the historical course of the person's mental disorder if the authorized person determines that the information has a reasonable bearing on the determination"; (b) that information "includes evidence presented by the person who has provided or is providing mental health or related support services …, evidence presented by one or more members of the family of that person, and evidence presented by the person subject to a determination … or anyone designated by that person" — california.public.law.
Cal. Health & Safety Code §1317(f) — "A general acute care hospital or acute psychiatric hospital shall not require a person who voluntarily seeks care to be in custody pursuant to Section 5150 of the Welfare and Institutions Code as a condition of accepting a transfer of that person after his or her written consent for treatment and transfer is documented or in the absence of evidence of probable cause for detention, as defined in Section 5150.05 of the Welfare and Institutions Code" — california.public.law.
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