The state law worksheet:
what your state decides, not your hospital
A handful of intern-year actions are governed neither by national guidelines nor by hospital policy but by state statute — and they differ, sometimes dramatically, across a state line you can see from the parking lot. Material written for one state must never travel as though it were general; this session refuses to. It is a worksheet: the questions are national, every answer is yours to fill in, with the people at your institution who actually know.
Why this session
The intern who “knows” the 72-hour hold from a different state’s television dramas, the resident who assumes the surrogate hierarchy is the same everywhere, the new prescriber who has never heard of the state’s monitoring-database mandate — each is one busy night from a real problem, and none of it is their fault: nobody told them which facts were state facts. This session’s single move is to make the category visible. Once an intern knows which questions are state questions, the answers are an hour’s work with the right guests — and the habit of asking “is this a state thing?” travels for a whole career, across every state line a physician licensed in multiple states will ever cross.
What interns leave with
- The category itself: which intern-year actions are governed by state law rather than hospital policy or national guidance.
- A completed worksheet — their state’s actual answers, filled in during the session with institutional counsel and the relevant services.
- The lookup reflex: where state answers live — the health department, the medical board, hospital legal and compliance — and who to call at 2 a.m. when the question is live.
- The multistate caution: licensure in a second state means a second set of answers, not an extension of the first.
The format
This session should never be run from this page alone. The page supplies the question list; the answers come from your institution’s authorities, live in the room — GME or hospital counsel for the legal frame, psychiatry for the hold process as it actually runs, social work and case management for reporting and surrogate mechanics, and pharmacy for the prescribing rules. Walk the worksheet question by question; the guests answer for your state; interns fill in their copies. The completed worksheet — reviewed by counsel — becomes a program document, updated annually, because statutes move. Print the blank version for every intern; the day they rotate to a hospital across a state line, hand them a fresh one.
The worksheet — the questions your state answers
Crisis, capacity, and who decides
| The question | Why it matters at 2 a.m. |
|---|---|
| What is our state’s involuntary psychiatric hold — its name, its duration, who may initiate it, and how it actually gets executed in this hospital? | The suicidal patient who wants to leave is a statutory situation, not a judgment call — and the famous “72 hours” is a different number, with different rules, in different states. |
| Is there a separate substance-use commitment process here, and what triggers it? | Some states have one; many do not. Knowing which kind of state you are in changes the 2 a.m. options. |
| What is the statutory surrogate hierarchy when a patient without capacity has no documented decision-maker — and which advance-directive and portable-orders forms does our state recognize? | Who decides for the unbefriended patient — spouse? adult child? which first? — is a state list, not a hospital custom, and the against-medical-advice session’s “who decides?” question ends here. |
| What are our state’s duty-to-warn or duty-to-protect rules when a patient threatens someone? | Mandatory in some states, permitted in others, shaped differently in each — and the moment it applies is never a good moment to start researching. |
Consent
| The question | Why it matters |
|---|---|
| Which services may a minor consent to without a parent in our state — sexually transmitted infection care, behavioral health, substance-use treatment, reproductive care — and at what ages? | The seventeen-year-old in the clinic asking for confidential testing is a state-statute situation the intern must not improvise. |
| What are our state’s HIV testing consent and disclosure rules? | States differ on consent mechanics and on what disclosure duties follow a result. |
| Is expedited partner therapy legal here, for which infections, and how does our clinic actually execute it? | Treating a partner sight-unseen is explicitly legal in most states, restricted in some — the map is the answer, and it changes. |
Prescribing
| The question | Why it matters |
|---|---|
| When does our state mandate checking the prescription-monitoring database, and how does that check fit our workflow? | Many states require the check before controlled prescriptions — the habit belongs in the e-prescribing flow from the EMR session, and the mandate’s scope is state-specific. |
| What state rules shape controlled-substance prescribing — day limits for acute opioid prescriptions, required counseling or forms? | Several states cap first prescriptions or add requirements the federal rules do not. |
Death
| The question | Why it matters |
|---|---|
| Who may pronounce death and who completes the death certificate here — which parts, on what timeline, in which system? | The hospital-machine session taught the sequence; the signatures and deadlines are state law, and certificates done wrong bounce back onto grieving families. |
| What are our state and county’s medical-examiner referral triggers? | The report-first list — unexpected deaths, procedural deaths, falls, custody — is jurisdictional, and lines stay in until the answer is known. |
| How does autopsy consent work here, and who may give it? | The offer is the attending’s conversation; the consent mechanics are statutory. |
Mandatory reporting
| The question | Why it matters |
|---|---|
| What must we report, to whom, on what timeline: child abuse or neglect, elder and vulnerable-adult abuse, intimate-partner violence, specific wounds and injuries, certain communicable diseases, impaired drivers? | Reporting duties are state statutes with real timelines, and they differ in surprising ways — intimate-partner violence reporting, for instance, is mandatory in some states and deliberately not in others. The intern needs the list, the phone numbers, and the social-work partnership that carries most reports in practice. |
Pocket card
- Ask the category question: “is this a state thing?” Holds · surrogates · minors · HIV · EPT · PDMP · death · reporting.
- The famous 72 hours is a different number in different states. Learn yours, not television’s.
- The surrogate hierarchy is a statute, not a custom.
- Keep the completed worksheet in your badge holder. Recheck it yearly — statutes move.
- 2 a.m. lifelines: hospital counsel on call · psychiatry · social work · your senior.
- New state, new worksheet. Always.
Notes
This page is a facilitation framework and deliberately contains no legal answers: nothing on it states any state’s law, and nothing on it is legal advice. Complete the worksheet with your institution’s counsel and relevant services, have counsel review it, and update it annually. When a live situation arises, use your institution’s on-call legal and administrative resources — not a memory of a teaching session. Last reviewed July 2026.