In the 1990s, the General Assembly amended the Virginia Code to remove the ability of private hospitals to prescreen individuals having a psychiatric emergency for the purposes of determining if criteria are met for a temporary detention order (TDO). Virginia Code (§§ 37.2-808, 37.2-809, and 37.2-809.1) was amended to require third-party community services boards (CSB) to conduct all psychiatric prescreen evaluations for involuntary behavioral health treatment. The Code was also amended to require that the certified preadmission screening clinician cannot have any conflict of interest in the location where the individual is being evaluated or where the individual would be held under temporary detention.

For many years hospital systems have advocated to have their own staff conduct these legal evaluations. Hospitals with dedicated psychiatric units within their emergency departments, like Riverside Medical Center, have communicated that their staff provide duplicative services as CSB certified pre-admission screening clinicians, and by allowing hospital staff to conduct the evaluation for a TDO, it will speed up access to care and reduce burden on the patient, hospital, law enforcement, and CSB staff. CSBs have communicated concerns that outcomes of the evaluations conducted by facility staff are not clinically objective, the assessment would not be comprehensive, least restrictive options would not be adequately explored, and that the power differential between non-medical and medical staff would influence clinical decision making. There are also concerns about potential conflict of interest as medical staff working for a private facility could hypothetically use the authority to assess for TDO eligibility to inappropriately remove individuals in crisis from their emergency department (ED).

Multiple bills allowing private hospital staff to conduct prescreen assessments for the purposes of temporary detention were introduced and failed to pass in prior sessions. However, in 2024, SB 34 was passed to create a pilot project where a single hospital in the City of Hampton would employ “certified evaluators" who can conduct evaluations for adults in a behavioral health crisis to determine if they meet civil commitment criteria for a TDO.

The pilot project began July 1, 2024, at which time, Riverside Hospital became responsible for conducting and managing all code mandated emergency services (ES) functions, to include the pre-admission screening evaluation, bed search using the bed registry, ensuring all least restrictive alternatives have been exhausted, and contacting the Regional, Education, Assessment, Crisis Services, and Habilitation program (REACH) if a patient has a developmental disability. SB 34 also created new reporting responsibilities. Additional reporting requirements were included in the memorandum of understanding (MOU) between Riverside and DBHDS.