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A06934 Summary:

BILL NOA06934
 
SAME ASNo Same As
 
SPONSORGunther
 
COSPNSRLunsford, Jacobson, Ramos
 
MLTSPNSR
 
Amd Ment Hyg L, generally
 
Expands the scope of practice of psychiatric nurse practitioners; makes conforming changes in the mental hygiene law.
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A06934 Actions:

BILL NOA06934
 
05/09/2023referred to higher education
01/03/2024referred to higher education
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A06934 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A6934
 
SPONSOR: Gunther
  TITLE OF BILL: An act to amend the mental hygiene law, in relation to the scope of practice of psychiatric nurse practitioners   PURPOSE OR GENERAL IDEA OF BILL: To conform the mental hygiene law with the existing scope of practice of nurse practitioners (NP) certified in psychiatry, thus permitting such psychiatric nurse practitioners to complete admissions to licensed mental health facilities, Without, in anyway, altering NP scope of prac- tice.   SUMMARY OF SPECIFIC PROVISIONS: Sections 1 and 2 of the bill amend Mental.Hygiene Law sections 1.03 and 9.01 to add definitions of the terms nurse practitioner, psychia- tric.nurse practitioner, and qualified nurse practitioner. Sections 3 through 12 of the bill amends various provisions of the Mental Hygiene Law to clarify the orders, forms, and processes that may be completed by a psychiatric nurse practitioner within a mental health. setting. Section 13 of the bill provides an immediate effective date.   JUSTIFICATION: There are currently more than 30,000 individuals who are registered as NPs with the New York State Education Department. NPs practice independ- ently and autonomously; and possess full prescribing authority - includ- ing controlled substances. Almost 15% of individuals licensed as NPs completed specialized training in and possess a SED certification for psychiatry. Yet, these professionals are underutilized due to adminis- trative bathers imposed by New York State law. Psychiatric NPs ("NPPs") have specialized training in the assessment and treatment of mental illness. This training includes an emphasis on those symptoms that place individuals with mental illness at an increased risk of being or becoming a danger to themselves or others, which may neces- sitate either voluntary or involuntary hospitalization. NPPs provide access to both urban and rural populations and are often the only psychiatric care providers to Medicaid recipients in many those areas: They provide care to high volume patients in the government programs. (Medicaid Managed Care, Child Health Plus and Family Health Plus). It is widely acknowledged that - particularly following the COVID-19 pandemic -- New York continues to face a mental health crisis. It is imperative that the State ensures that there is greater access to psychiatric care, and NPPs are standing ready to fill this role. NPPs have decades of experience taking the-lead in providing care to patients in mental health facilities, and the ability to admit patients with a serious mental illness is within the NP's lawful scope of practice, but due to language used in the Mental Hygiene Law, NPs may not issue certificates or orders that result in a patient being admitted. This legislation clarifies within the relevant sections of the Mental Hygiene Law that both physicians and NPPs are authorized to admit mental health patients' on a voluntary and involuntary basis. This clarificatiOn is consistent with the Governor's efforts to expand access and encourage reopening of inpatient psychiatric beds. Even if the Governor's initi- ative is adopted, the ability to staff facilities and admit patients in crisis and need of care will be thwarted unless NPPs are appropriately utilized. This legislation in no way changes the existing scope of practice of a NP under Article 139 of the Education Law, but rather is wholly consist- ent with current law and State Education Department regulations pertain- ing to NPs with a. psychiatry specialty.   PRIOR LEGISLATIVE HISTORY: New bill   FISCAL IMPLICATIONS: This bill would have no fiscal impact on the State or local governments.   EFFECTIVE DATE: Immediately.
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A06934 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6934
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                       May 9, 2023
                                       ___________
 
        Introduced  by M. of A. GUNTHER -- read once and referred to the Commit-
          tee on Higher Education
 
        AN ACT to amend the mental hygiene law, in  relation  to  the  scope  of
          practice of psychiatric nurse practitioners
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Subdivision 48 of section 1.03 of the mental  hygiene  law,
     2  as  added  by  chapter  223  of the laws of 1992, is amended and two new
     3  subdivisions 13 and 14 are added to read as follows:
     4    13. "Nurse practitioner" means a nurse practitioner certified pursuant
     5  to section sixty-nine hundred ten of the education law, practicing with-
     6  in his or her scope of practice.
     7    14. "Psychiatric nurse practitioner" means a nurse practitioner certi-
     8  fied by the department of education as a psychiatric nurse practitioner.
     9    48.  "Practitioner"  shall  mean  a  physician,  nurse   practitioner,
    10  dentist,  podiatrist,  veterinarian,  scientific  investigator, or other
    11  person licensed, or otherwise  permitted  to  dispense,  administer,  or
    12  conduct research with respect to a controlled substance in the course of
    13  a  licensed  professional practice or research licensed pursuant to this
    14  article.  Such person shall be deemed a "practitioner" only as  to  such
    15  substances,  or  conduct relating to such substances, as is permitted by
    16  his license, permit, or otherwise permitted by law.
    17    § 2. Section 9.01 of the mental hygiene law, as amended by chapter 723
    18  of the laws of 1989 and the 7th undesignated  paragraph  as  amended  by
    19  chapter 595 of the laws of 2000, is amended to read as follows:
    20  § 9.01 Definitions.
    21    As used in this article:
    22    (a)  "in  need of care and treatment" means that a person has a mental
    23  illness for which in-patient care and treatment in a hospital is  appro-
    24  priate.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10908-01-3

        A. 6934                             2
 
     1    (b)  "in  need  of involuntary care and treatment" means that a person
     2  has a mental illness for which care and treatment  as  a  patient  in  a
     3  hospital  is essential to such person's welfare and whose judgment is so
     4  impaired that he is unable to understand the  need  for  such  care  and
     5  treatment.
     6    (c)  "likelihood  to  result  in serious harm" or "likely to result in
     7  serious harm" means [(a)]:
     8    1. a substantial risk of physical harm to the person as manifested  by
     9  threats  of  or  attempts  at  suicide  or  serious bodily harm or other
    10  conduct demonstrating  that  the  person  is  dangerous  to  himself  or
    11  herself[,]; or
    12    [(b)] 2. a substantial risk of physical harm to other persons as mani-
    13  fested by homicidal or other violent behavior by which others are placed
    14  in reasonable fear of serious physical harm.
    15    (d)  "need for retention" means that a person who has been admitted to
    16  a hospital pursuant to this article is in need of involuntary  care  and
    17  treatment in a hospital for a further period.
    18    (e)  "record"  of  a  patient  shall consist of admission, transfer or
    19  retention papers and orders, and  accompanying  data  required  by  this
    20  article and by the regulations of the commissioner.
    21    (f)  "director  of community services" means the director of community
    22  services for the mentally disabled appointed pursuant to article  forty-
    23  one of this chapter.
    24    (g)  "qualified  psychiatrist"  means a physician licensed to practice
    25  medicine in New York state who:
    26    [(a)] 1. is a diplomate  of  the  American  board  of  psychiatry  and
    27  neurology or is eligible to be certified by that board; or
    28    [(b)]  2.  is certified by the American osteopathic board of neurology
    29  and psychiatry or is eligible to be certified by that board.
    30    (h) "qualified psychiatric nurse  practitioner"  means  a  psychiatric
    31  nurse  practitioner who has received a relevant board certification from
    32  a national accrediting body or is  eligible  to  be  certified  by  such
    33  board.
    34    §  3. Section 9.05 of the mental hygiene law, as renumbered by chapter
    35  978 of the laws of 1977, is amended to read as follows:
    36  § 9.05 Examining physicians or nurse practitioners and  medical  certif-
    37           icates.
    38    (a)  A person is disqualified from acting as an examining physician or
    39  nurse practitioner in the following cases:
    40    1. if he or she is a relative of the person applying for the admission
    41  or of the person alleged to be mentally ill.
    42    2. if he or she is a manager, trustee, visitor,  proprietor,  officer,
    43  director,  or stockholder of the hospital in which the patient is hospi-
    44  talized or to which it is proposed  to  admit  such  person,  except  as
    45  otherwise provided in this chapter, or if he has any pecuniary interest,
    46  directly or indirectly, in such hospital, provided that receipt of fees,
    47  privileges,  or  compensation for treating or examining patients in such
    48  hospital shall not be deemed to be a pecuniary interest.
    49    3. if he or she is on the staff of a proprietary facility to which  it
    50  is proposed to admit such person.
    51    (b)  A  certificate,  as  required by this article, must show that the
    52  person is mentally ill and shall be  based  on  an  examination  of  the
    53  person alleged to be mentally ill made within ten days prior to the date
    54  of  admission.  The  date  of  the certificate shall be the date of such
    55  examination. All certificates shall contain the facts and  circumstances
    56  upon which the judgment of the examining physicians or nurse practition-

        A. 6934                             3
 
     1  ers is based and shall show that the condition of the person examined is
     2  such that he needs involuntary care and treatment in a hospital and such
     3  other information as the commissioner may by regulation require.
     4    §  4.  Subdivision  (a), paragraph 11 of subdivision (b), and subdivi-
     5  sions (d), (e) and (i) of section 9.27 of the mental hygiene law, subdi-
     6  visions (a), (d) and (e) as renumbered by chapter 978  of  the  laws  of
     7  1977,  paragraph  11  of  subdivision (b) as added by chapter 343 of the
     8  laws of 1985, and subdivision (i) as amended by chapter 847 of the  laws
     9  of 1987, are amended to read as follows:
    10    (a)  The  director  of  a hospital may receive and retain therein as a
    11  patient any person alleged to be mentally ill and in need of involuntary
    12  care and treatment upon the certificates of  two  examining  physicians,
    13  nurse  practitioners, or a combination thereof, accompanied by an appli-
    14  cation for  the  admission  of  such  person.  The  examination  may  be
    15  conducted jointly but each examining physician and/or nurse practitioner
    16  shall execute a separate certificate.
    17    11.  a qualified psychiatrist or psychiatric nurse practitioner who is
    18  either supervising the treatment of or treating such person for a mental
    19  illness in a facility licensed or  operated  by  the  office  of  mental
    20  health.
    21    (d)  Before an examining physician or nurse practitioner completes the
    22  certificate of examination of a person for involuntary care  and  treat-
    23  ment,  he  or she shall consider alternative forms of care and treatment
    24  that might be adequate to provide for the person's needs without requir-
    25  ing involuntary hospitalization. If the  examining  physician  or  nurse
    26  practitioner  knows  that the person he or she is examining for involun-
    27  tary care and treatment has been under prior treatment, he or she shall,
    28  insofar as possible, consult with the physician, nurse practitioner,  or
    29  psychologist  furnishing such prior treatment prior to completing his or
    30  her certificate. Nothing in this section shall  prohibit  or  invalidate
    31  any involuntary admission made in accordance with the provisions of this
    32  chapter.
    33    (e)  The  director  of the hospital where such person is brought shall
    34  cause such person to be examined forthwith by a physician or nurse prac-
    35  titioner who shall be a member of the psychiatric staff of such hospital
    36  other than the original examining physicians and/or nurse  practitioners
    37  whose  certificate  or  certificates accompanied the application and, if
    38  such person is found to be in need of involuntary care and treatment, he
    39  or she may be admitted thereto as a patient as herein provided.
    40    (i) After an application for  the  admission  of  a  person  has  been
    41  completed  and  [both]  the  physicians  and/or nurse practitioners have
    42  examined such person and separately certified that he or she is mentally
    43  ill and in need of involuntary care and treatment in a hospital,  either
    44  physician or nurse practitioner is authorized to request peace officers,
    45  when  acting  pursuant  to their special duties, or police officers, who
    46  are members of an authorized police department or force or  of  a  sher-
    47  iff's  department,  to  take into custody and transport such person to a
    48  hospital for determination by the director whether such person qualifies
    49  for admission pursuant to this  section.  Upon  the  request  of  either
    50  physician  or  nurse  practitioner,  an ambulance service, as defined by
    51  subdivision two of section three thousand one of the public health  law,
    52  is  authorized  to transport such person to a hospital for determination
    53  by the director whether such person qualifies for admission pursuant  to
    54  this section.
    55    §  5.  Subdivisions  (a) and (c) of section 9.37 of the mental hygiene
    56  law, subdivision (a) as amended by chapter 723 of the laws of 1989,  and

        A. 6934                             4
 
     1  subdivision  (c)  as  amended  by  chapter  230 of the laws of 2004, are
     2  amended to read as follows:
     3    (a)  The  director  of  a  hospital, upon application by a director of
     4  community services or an examining physician or nurse practitioner  duly
     5  designated by him or her, may receive and care for in such hospital as a
     6  patient  any  person  who,  in  the opinion of the director of community
     7  services or the director's designee, has  a  mental  illness  for  which
     8  immediate  inpatient care and treatment in a hospital is appropriate and
     9  which is likely to result in serious  harm  to  himself  or  herself  or
    10  others.
    11    The  need  for immediate hospitalization shall be confirmed by a staff
    12  physician or nurse practitioner of  the  hospital  prior  to  admission.
    13  Within  seventy-two  hours,  excluding  Sunday  and holidays, after such
    14  admission, if such patient is to be  retained  for  care  and  treatment
    15  beyond such time and he or she does not agree to remain in such hospital
    16  as  a  voluntary patient, the certificate of another examining physician
    17  or nurse practitioner who is a member of the psychiatric  staff  of  the
    18  hospital  that  the patient is in need of involuntary care and treatment
    19  shall be filed with the hospital. From the time of his or her  admission
    20  under  this section the retention of such patient for care and treatment
    21  shall be subject to the provisions  for  notice,  hearing,  review,  and
    22  judicial  approval  of  continued  retention  or  transfer and continued
    23  retention provided by this article for the admission  and  retention  of
    24  involuntary   patients,   provided   that,  for  the  purposes  of  such
    25  provisions, the date of admission of the patient shall be deemed  to  be
    26  the  date when the patient was first received in the hospital under this
    27  section.
    28    (c) Notwithstanding the provisions of subdivision (b) of this section,
    29  in counties with a population of  less  than  two  hundred  thousand,  a
    30  director  of  community services who is a licensed psychologist pursuant
    31  to article one hundred fifty-three of the education law  or  a  licensed
    32  clinical social worker pursuant to article one hundred fifty-four of the
    33  education law but who is not a physician or nurse practitioner may apply
    34  for  the  admission  of  a  patient  pursuant  to this section without a
    35  medical examination by a designated physician or nurse practitioner,  if
    36  a hospital approved by the commissioner pursuant to section 9.39 of this
    37  article  is  not  located  within  thirty  miles of the patient, and the
    38  director of community services has made a reasonable effort to locate  a
    39  designated examining physician or nurse practitioner but such a designee
    40  is  not  immediately  available  and the director of community services,
    41  after personal observation of the person, reasonably believes that he or
    42  she may have a mental illness which is likely to result in serious  harm
    43  to himself or herself or others and inpatient care and treatment of such
    44  person  in a hospital may be appropriate. In the event of an application
    45  pursuant to this subdivision, a physician or nurse practitioner  of  the
    46  receiving  hospital  shall  examine  the patient and shall not admit the
    47  patient unless he or she  determines  that  the  patient  has  a  mental
    48  illness  for  which immediate inpatient care and treatment in a hospital
    49  is appropriate and which is likely to result in serious harm to  himself
    50  or herself or others. If the patient is admitted, the need for hospital-
    51  ization  shall  be confirmed by another staff physician or nurse practi-
    52  tioner within twenty-four hours. An application pursuant to this  subdi-
    53  vision  shall be in writing and shall be filed with the director of such
    54  hospital at the time of the patient's reception, together with a  state-
    55  ment in a form prescribed by the commissioner giving such information as
    56  he  or  she  may  deem appropriate, including a statement of the efforts

        A. 6934                             5
 
     1  made by the director of community services to locate a designated  exam-
     2  ining  physician  or  nurse  practitioner prior to making an application
     3  pursuant to this subdivision.
     4    §  6.  Subdivision  (a)  of section 9.37 of the mental hygiene law, as
     5  amended by chapter 251 of the laws  of  1972,  is  amended  to  read  as
     6  follows:
     7    (a)  The  director  of  a  hospital, upon application by a director of
     8  community services or an examining physician or nurse practitioner  duly
     9  designated by him or her, may receive and care for in such hospital as a
    10  patient  any  person  who,  in  the opinion of the director of community
    11  services or his or her designee, has a mental illness for which  immedi-
    12  ate  inpatient care and treatment in a hospital is appropriate and which
    13  is likely to result in serious harm to himself  or  herself  or  others;
    14  "likelihood of serious harm" shall mean:
    15    1.  substantial  risk  of physical harm to himself or herself as mani-
    16  fested by threats of or attempts at suicide or serious  bodily  harm  or
    17  other conduct demonstrating that he or she is dangerous to himself[,] or
    18  herself; or
    19    2.  a substantial risk of physical harm to other persons as manifested
    20  by homicidal or other violent behavior by which  others  are  placed  in
    21  reasonable fear [or] of serious physical harm.
    22    The  need  for immediate hospitalization shall be confirmed by a staff
    23  physician or nurse practitioner of  the  hospital  prior  to  admission.
    24  Within  seventy-two  hours,  excluding  Sunday  and holidays, after such
    25  admission, if such patient is to be  retained  for  care  and  treatment
    26  beyond such time and he or she does not agree to remain in such hospital
    27  as  a  voluntary patient, the certificate of another examining physician
    28  or nurse practitioner who is a member of the psychiatric  staff  of  the
    29  hospital  that  the patient is in need of involuntary care and treatment
    30  shall be filed with the hospital. From the time of his or her  admission
    31  under  this section the retention of such patient for care and treatment
    32  shall be subject to the provisions  for  notice,  hearing,  review,  and
    33  judicial  approval  of  continued  retention  or  transfer and continued
    34  retention provided by this article for the admission  and  retention  of
    35  involuntary   patients,   provided   that,  for  the  purposes  of  such
    36  provisions, the date of admission of the patient shall be deemed  to  be
    37  the  date when the patient was first received in the hospital under this
    38  section.
    39    § 7. Subdivision (a) of section 9.39 of the  mental  hygiene  law,  as
    40  amended  by  chapter  789  of  the  laws  of 1985, is amended to read as
    41  follows:
    42    (a) The director of any hospital maintaining adequate staff and facil-
    43  ities for the observation, examination, care, and treatment  of  persons
    44  alleged  to  be mentally ill and approved by the commissioner to receive
    45  and retain patients pursuant to this  section  may  receive  and  retain
    46  therein  as a patient for a period of fifteen days any person alleged to
    47  have a mental illness for which immediate observation, care, and  treat-
    48  ment in a hospital is appropriate and which is likely to result in seri-
    49  ous harm to himself or herself or others. "Likelihood to result in seri-
    50  ous harm" as used in this article shall mean:
    51    1.  substantial  risk  of physical harm to himself or herself as mani-
    52  fested by threats of or attempts at suicide or serious  bodily  harm  or
    53  other conduct demonstrating that he or she is dangerous to himself[,] or
    54  herself; or

        A. 6934                             6
 
     1    2.  a substantial risk of physical harm to other persons as manifested
     2  by homicidal or other violent behavior by which  others  are  placed  in
     3  reasonable fear of serious physical harm.
     4    The  director  shall cause to be entered upon the hospital records the
     5  name of the person or persons, if any, who have brought such  person  to
     6  the  hospital and the details of the circumstances leading to the hospi-
     7  talization of such person.
     8    The director shall admit such person pursuant  to  the  provisions  of
     9  this section only if a staff physician or psychiatric nurse practitioner
    10  of  the  hospital upon examination of such person finds that such person
    11  qualifies under the requirements of this section. Such person shall  not
    12  be  retained  for  a period of more than forty-eight hours unless within
    13  such period such finding  is  confirmed  after  examination  by  another
    14  physician or psychiatric nurse practitioner who shall be a member of the
    15  psychiatric  staff  of the hospital. Such person shall be served, at the
    16  time of admission, with written notice of his or her status  and  rights
    17  as a patient under this section. Such notice shall contain the patient's
    18  name.  At  the  same time, such notice shall also be given to the mental
    19  hygiene legal service and personally  or  by  mail  to  such  person  or
    20  persons,  not to exceed three in number, as may be designated in writing
    21  to receive such notice by the person alleged to be mentally ill.  If  at
    22  any  time  after  admission,  the  patient, any relative, friend, or the
    23  mental hygiene legal service gives notice to the director in writing  of
    24  request for court hearing on the question of need for immediate observa-
    25  tion, care, and treatment, a hearing shall be held as herein provided as
    26  soon  as practicable but in any event not more than five days after such
    27  request is received, except that the commencement of such hearing may be
    28  adjourned at the request of the patient. It shall be  the  duty  of  the
    29  director  upon  receiving  notice of such request for hearing to forward
    30  forthwith a copy of such notice with a record  of  the  patient  to  the
    31  supreme  court  or  county  court  in  the county where such hospital is
    32  located. A copy of such notice and record shall also  be  given  to  the
    33  mental hygiene legal service. The court which receives such notice shall
    34  fix  the  date  of  such  hearing  and cause the patient or other person
    35  requesting the hearing, the director, the mental hygiene  legal  service
    36  and  such other persons as the court may determine to be advised of such
    37  date. Upon such date, or upon such other date to  which  the  proceeding
    38  may  be adjourned, the court shall hear testimony and examine the person
    39  alleged to be mentally ill, if it be  deemed  advisable  in  or  out  of
    40  court,  and  shall render a decision in writing that there is reasonable
    41  cause to believe that the patient has a mental illness for which immedi-
    42  ate inpatient care and treatment in a hospital is appropriate and  which
    43  is  likely to result in serious harm to himself or herself or others. If
    44  it be determined that there is such reasonable cause,  the  court  shall
    45  forthwith  issue  an order authorizing the retention of such patient for
    46  any such purpose or purposes in the hospital for a period not to  exceed
    47  fifteen  days  from the date of admission. Any such order entered by the
    48  court shall not be deemed to be an  adjudication  that  the  patient  is
    49  mentally ill, but only a determination that there is reasonable cause to
    50  retain the patient for the purposes of this section.
    51    §  8.  Subdivisions  (b) and (c) of section 9.40 of the mental hygiene
    52  law, subdivision (b) as amended by section 2 of part PPP of  chapter  58
    53  of  the laws of 2020, and subdivision (c) as added by chapter 723 of the
    54  laws of 1989, are amended to read as follows:
    55    (b)  The  director  shall  cause  examination  of  such  persons   not
    56  discharged  after  the  provision  of triage and referral services to be

        A. 6934                             7
 
     1  initiated by a staff physician or psychiatric nurse practitioner of  the
     2  program  as  soon as practicable and in any event within six hours after
     3  the person is received into the program's emergency  room.  Such  person
     4  may  be  retained for observation, care, and treatment and further exam-
     5  ination for up to twenty-four hours if, at the conclusion of such  exam-
     6  ination,  such  physician  or  psychiatric nurse practitioner determines
     7  that such person may have a mental illness for which immediate  observa-
     8  tion,  care,  and  treatment  in  a  comprehensive psychiatric emergency
     9  program is appropriate, and which is likely to result in serious harm to
    10  the person or others.
    11    (c) No person shall be involuntarily retained in accordance with  this
    12  section for more than twenty-four hours, unless (i) within that time the
    13  determination  of  the  examining  staff  physician or psychiatric nurse
    14  practitioner has been confirmed after examination by  another  physician
    15  or  psychiatric  nurse  practitioner  who is a member of the psychiatric
    16  staff of the program and (ii) the person  is  admitted  to  an  extended
    17  observation  bed, as such term is defined in section 31.27 of this chap-
    18  ter. At the time of admission  to  an  extended  observation  bed,  such
    19  person  shall  be  served  with  written notice of his or her status and
    20  rights as a patient under this section. Such notice  shall  contain  the
    21  patient's  name. The notice shall be provided to the same persons and in
    22  the manner as if provided pursuant to subdivision (a) of section 9.39 of
    23  this article. Written requests for court hearings  on  the  question  of
    24  need  for  immediate  observation, care and treatment shall be made, and
    25  court hearings shall be scheduled  and  held,  in  the  manner  provided
    26  pursuant  to  subdivision  (a) of section 9.39 of this article, provided
    27  however, if a person is removed or admitted to a  hospital  pursuant  to
    28  subdivision  (e)  or  (f)  of this section the director of such hospital
    29  shall be substituted for the director of the  comprehensive  psychiatric
    30  emergency  program  in  all  legal  proceedings  regarding the continued
    31  retention of the person.
    32    § 9. Paragraph 2 of subdivision (d) of  section  9.51  of  the  mental
    33  hygiene  law,  as  amended by section 1 of part NNN of chapter 58 of the
    34  laws of 2020, is amended to read as follows:
    35    (2)  Proper  treatment  of  the  individual's  psychiatric   condition
    36  requires  in-patient  care and treatment under the direction of a physi-
    37  cian or psychiatric nurse practitioner; and
    38    § 10. Section 9.55 of the mental hygiene law, as  amended  by  chapter
    39  598 of the laws of 1994, is amended to read as follows:
    40  § 9.55 Emergency  admissions for immediate observation, care, and treat-
    41             ment; powers of qualified psychiatrists and psychiatric nurse
    42             practitioners.
    43    A qualified psychiatrist or qualified psychiatric  nurse  practitioner
    44  shall  have  the power to direct the removal of any person, whose treat-
    45  ment for a mental illness he or she is either supervising  or  providing
    46  in  a facility licensed or operated by the office of mental health which
    47  does not have an inpatient psychiatric service, to a  hospital  approved
    48  by  the commissioner pursuant to subdivision (a) of section 9.39 of this
    49  article or to a comprehensive psychiatric emergency program,  if  he  or
    50  she  determines upon examination of such person that such person appears
    51  to have a mental illness  for  which  immediate  observation,  care  and
    52  treatment  in a hospital is appropriate and which is likely to result in
    53  serious harm to himself or herself or others. Upon the request  of  such
    54  qualified  psychiatrist  or  qualified  psychiatric  nurse practitioner,
    55  peace officers, when acting pursuant to their special duties, or  police
    56  officers, who are members of an authorized police department or force or

        A. 6934                             8
 
     1  of a sheriff's department shall take into custody and transport any such
     2  person.  Upon  the  request  of  a  qualified  psychiatrist or qualified
     3  psychiatric nurse practitioner, an  ambulance  service,  as  defined  by
     4  subdivision  two of section three thousand one of the public health law,
     5  is authorized to transport any such person.  Such  person  may  then  be
     6  admitted to a hospital in accordance with the provisions of section 9.39
     7  of  this  article or to a comprehensive psychiatric emergency program in
     8  accordance with the provisions of section 9.40 of this article.
     9    § 11. Section 9.55 of the mental hygiene law, as  amended  by  chapter
    10  847 of the laws of 1987, is amended to read as follows:
    11  § 9.55 Emergency  admissions for immediate observation, care, and treat-
    12             ment; powers of qualified psychiatrists and qualified psychi-
    13             atric nurse practitioners.
    14    A qualified psychiatrist or qualified psychiatric  nurse  practitioner
    15  shall  have  the power to direct the removal of any person, whose treat-
    16  ment for a mental illness he or she is either supervising  or  providing
    17  in  a facility licensed or operated by the office of mental health which
    18  does not have an inpatient psychiatric service, to a  hospital  approved
    19  by  the commissioner pursuant to subdivision (a) of section 9.39 of this
    20  article, if he or she determines upon examination of  such  person  that
    21  such  person appears to have a mental illness for which immediate obser-
    22  vation, care and treatment in a hospital is  appropriate  and  which  is
    23  likely  to  result  in  serious harm to himself or herself or others, as
    24  defined in section 9.39 of this article. Upon the request of such quali-
    25  fied psychiatrist or qualified  psychiatric  nurse  practitioner,  peace
    26  officers,  when acting pursuant to their special duties, or police offi-
    27  cers, who are members of an authorized police department or force or  of
    28  a  sheriff's  department  shall take into custody and transport any such
    29  person. Upon the  request  of  a  qualified  psychiatrist  or  qualified
    30  psychiatric  nurse  practitioner,  an  ambulance  service, as defined by
    31  subdivision two of section three thousand one of the public health  law,
    32  is  authorized  to  transport  any  such person. Such person may then be
    33  admitted in accordance with the provisions of section 9.39 of this arti-
    34  cle.
    35    § 12. Section 9.57 of the mental hygiene law, as  amended  by  chapter
    36  598 of the laws of 1994, is amended to read as follows:
    37  § 9.57 Emergency  admissions  for immediate observation, care and treat-
    38             ment; powers of emergency  room  physicians  and  psychiatric
    39             nurse practitioners.
    40    A  physician  or  psychiatric  nurse  practitioner  who has examined a
    41  person in an emergency room or provided emergency medical services at  a
    42  general  hospital,  as  defined  in  article  twenty-eight of the public
    43  health law, which does not have an inpatient psychiatric service,  or  a
    44  physician or psychiatric nurse practitioner who has examined a person in
    45  a  comprehensive  psychiatric  emergency  program shall be authorized to
    46  request that the director of the program or hospital, or the  director's
    47  designee,  direct  the  removal of such person to a hospital approved by
    48  the commissioner pursuant to subdivision (a) of  section  9.39  of  this
    49  article  or  to  a  comprehensive  psychiatric emergency program, if the
    50  physician or psychiatric nurse practitioner determines upon  examination
    51  of  such  person  that  such person appears to have a mental illness for
    52  which immediate care and treatment in  a  hospital  is  appropriate  and
    53  which  is  likely  to  result  in  serious harm to himself or herself or
    54  others. Upon the request of the physician or psychiatric  nurse  practi-
    55  tioner,  the  director  of  the  program  or hospital, or the director's
    56  designee, is authorized to direct peace officers, when  acting  pursuant

        A. 6934                             9
 
     1  to  their  special  duties,  or  police  officers, who are members of an
     2  authorized police department or force or of a  sheriff's  department  to
     3  take  into custody and transport any such person. Upon the request of an
     4  emergency  room  physician  or  psychiatric  nurse  practitioner, or the
     5  director of the program or hospital,  or  the  director's  designee,  an
     6  ambulance  service, as defined by subdivision two of section three thou-
     7  sand one of the public health law, is authorized to  take  into  custody
     8  and  transport  any  such  person. Such person may then be admitted to a
     9  hospital in accordance with the provisions of section 9.39 of this arti-
    10  cle or to a comprehensive psychiatric emergency  program  in  accordance
    11  with the provisions of section 9.40 of this article.
    12    §  13.  Section  9.57 of the mental hygiene law, as amended by chapter
    13  847 of the laws of 1987, is amended to read as follows:
    14  § 9.57 Emergency admissions for immediate observation, care  and  treat-
    15             ment;  powers  of  emergency  room physicians and psychiatric
    16             nurse practitioners.
    17    A physician or psychiatric  nurse  practitioner  who  has  examined  a
    18  person  in an emergency room or provided emergency medical services at a
    19  general hospital, as defined  in  article  twenty-eight  of  the  public
    20  health  law, which does not have an inpatient psychiatric service, shall
    21  be authorized to request that the director of the hospital,  or  his  or
    22  her  designee,  direct the removal of such person to a hospital approved
    23  by the commissioner pursuant to subdivision (a) of section 9.39 of  this
    24  article,  if  the physician or psychiatric nurse practitioner determines
    25  upon examination of such person that  such  person  appears  to  have  a
    26  mental  illness  for which immediate care and treatment in a hospital is
    27  appropriate and which is likely to result in serious harm to himself  or
    28  herself  or others, as defined in section 9.39 of this article. Upon the
    29  request of the physician or psychiatric nurse practitioner, the director
    30  of the hospital, or his or her designee, is authorized to  direct  peace
    31  officers,  when acting pursuant to their special duties, or police offi-
    32  cers, who are members of an authorized police department or force or  of
    33  a  sheriff's  department  to  take  into  custody and transport any such
    34  person. Upon the request of an emergency room physician  or  psychiatric
    35  nurse  practitioner,  or  the  director  of  the hospital, or his or her
    36  designee, an ambulance service, as defined by subdivision two of section
    37  three thousand one of the public health law, is authorized to take  into
    38  custody  and transport any such person. Such person may then be admitted
    39  to a hospital in accordance with the provisions of section 9.39 of  this
    40  article.
    41    §  14.  Paragraph  2  of subdivision (d) of section 9.58 of the mental
    42  hygiene law, as amended by chapter 230 of the laws of 2004,  is  amended
    43  to read as follows:
    44    (2)   "Qualified  mental  health  professional"  shall mean a licensed
    45  psychologist, registered professional nurse,  licensed  clinical  social
    46  worker  or  a  licensed  master social worker under the supervision of a
    47  physician, psychiatric nurse  practitioner,  psychologist,  or  licensed
    48  clinical social worker.
    49    §  15.  Subparagraph (iii) of paragraph 4 of subdivision (c), subpara-
    50  graph (v) of paragraph 1 and paragraphs 3  and  4  of  subdivision  (e),
    51  paragraphs  1, 2, 3 and 4 of subdivision (h), subdivision (i), paragraph
    52  2 of subdivision (k), and subdivision (n) of section 9.60 of the  mental
    53  hygiene  law,  subparagraph  (iii) of paragraph 4 of subdivision (c) and
    54  paragraph 2 of subdivision (h) as amended by section 2 of subpart  H  of
    55  part UU of chapter 56 of the laws of 2022, subparagraph (v) of paragraph
    56  1  and paragraph 3 of subdivision (e), paragraphs 1, 3 and 4 of subdivi-

        A. 6934                            10
 
     1  sion (h), and subdivision (i) as amended by chapter 158 of the  laws  of
     2  2005,  paragraph  4  of subdivision (e) as amended by chapter 382 of the
     3  laws of 2015, and paragraph 2 of subdivision (k) and subdivision (n)  as
     4  amended  by  chapter  1  of  the  laws  of  2013, are amended to read as
     5  follows:
     6    (iii) notwithstanding subparagraphs (i) and (ii)  of  this  paragraph,
     7  resulted in the issuance of a court order for assisted outpatient treat-
     8  ment which has expired within the last six months, and since the expira-
     9  tion  of the order, the person has experienced a substantial increase in
    10  symptoms of mental illness and such  symptoms  substantially  interferes
    11  with  or  limits  one  or  more major life activities as determined by a
    12  director of community services who previously was required to coordinate
    13  and monitor the care of any individual who was subject to  such  expired
    14  assisted outpatient treatment order. The applicable director of communi-
    15  ty  services  or  their  designee shall arrange for the individual to be
    16  evaluated by a physician  or  psychiatric  nurse  practitioner.  If  the
    17  physician  or  psychiatric  nurse  practitioner determines court ordered
    18  services are clinically necessary and the least restrictive option,  the
    19  director of community services may initiate a court proceeding[.]; and
    20    (v)  a  qualified  psychiatrist or qualified psychiatric nurse practi-
    21  tioner who is either  supervising  the  treatment  of  or  treating  the
    22  subject of the petition for a mental illness; or
    23    (3)  The  petition shall be accompanied by an affirmation or affidavit
    24  of a physician or psychiatric nurse practitioner, who shall not  be  the
    25  petitioner, stating either that:
    26    (i)  such  physician  or psychiatric nurse practitioner has personally
    27  examined the subject of the petition no more than ten days prior to  the
    28  submission of the petition, recommends assisted outpatient treatment for
    29  the  subject  of the petition, and is willing and able to testify at the
    30  hearing on the petition; or
    31    (ii) no more than ten days prior to the filing of the  petition,  such
    32  physician  or  psychiatric nurse practitioner or his or her designee has
    33  made appropriate attempts but has not been successful in  eliciting  the
    34  cooperation  of the subject of the petition to submit to an examination,
    35  such physician or psychiatric nurse practitioner has reason  to  suspect
    36  that  the subject of the petition meets the criteria for assisted outpa-
    37  tient treatment, and such physician or psychiatric nurse practitioner is
    38  willing and able to examine the subject of the petition and  testify  at
    39  the hearing on the petition.
    40    (4)  In  counties  with a population of less than eighty thousand, the
    41  affirmation or affidavit required by paragraph three of this subdivision
    42  may be made by a physician or psychiatric nurse practitioner who  is  an
    43  employee  of  the office. The office is authorized to make available, at
    44  no cost to the county, a qualified physician or psychiatric nurse  prac-
    45  titioner  for  the  purpose  of  making  such  affirmation  or affidavit
    46  consistent with the provisions of such paragraph.
    47    (1) Upon receipt of the petition, the court shall fix the date  for  a
    48  hearing.  Such date shall be no later than three days from the date such
    49  petition is received by the  court,  excluding  Saturdays,  Sundays  and
    50  holidays.  Adjournments shall be permitted only for good cause shown. In
    51  granting adjournments, the court shall consider  the  need  for  further
    52  examination  by  a  physician  or  psychiatric nurse practitioner or the
    53  potential need to provide assisted outpatient  treatment  expeditiously.
    54  The  court  shall  cause  the  subject of the petition, any other person
    55  receiving notice pursuant to subdivision (f) of this section, the  peti-
    56  tioner,  the  physician or psychiatric nurse practitioner whose affirma-

        A. 6934                            11

     1  tion or affidavit accompanied the petition, and such  other  persons  as
     2  the  court  may determine to be advised of such date. Upon such date, or
     3  upon such other date to which the proceeding may be adjourned, the court
     4  shall  hear  testimony and, if it be deemed advisable and the subject of
     5  the petition is available, examine the subject of the petition in or out
     6  of court. If the subject of the petition does not appear at the hearing,
     7  and appropriate attempts to elicit the attendance of  the  subject  have
     8  failed,  the  court may conduct the hearing in the subject's absence. In
     9  such case, the court shall set forth the factual  basis  for  conducting
    10  the hearing without the presence of the subject of the petition.
    11    (2)  The court shall not order assisted outpatient treatment unless an
    12  examining physician or psychiatric nurse  practitioner,  who  recommends
    13  assisted outpatient treatment and has personally examined the subject of
    14  the  petition  no  more than ten days before the filing of the petition,
    15  testifies in person or by video  conference  at  the  hearing.  Provided
    16  however,  a  physician  or  psychiatric nurse practitioner shall only be
    17  authorized to testify by video conference when it has  been:  (i)  shown
    18  that  diligent  efforts  have been made to attend such hearing in person
    19  and the subject of the petition consents to the physician or psychiatric
    20  nurse practitioner testifying by video conference;  or  (ii)  the  court
    21  orders  the  physician  or  psychiatric nurse practitioner to testify by
    22  video conference upon a finding of good cause. Such physician or psychi-
    23  atric nurse practitioner shall state the  facts  and  clinical  determi-
    24  nations  which  support  the allegation that the subject of the petition
    25  meets each of the criteria for assisted outpatient treatment.
    26    (3) If the subject of the petition has refused to  be  examined  by  a
    27  physician  or  psychiatric nurse practitioner, the court may request the
    28  subject to consent to an examination by a physician or psychiatric nurse
    29  practitioner appointed by the court. If the subject of the petition does
    30  not consent and the court finds reasonable cause  to  believe  that  the
    31  allegations  in  the  petition are true, the court may order peace offi-
    32  cers, acting pursuant to their special duties, or  police  officers  who
    33  are  members  of an authorized police department or force, or of a sher-
    34  iff's department to take the subject of the petition  into  custody  and
    35  transport  him  or  her  to a hospital for examination by a physician or
    36  psychiatric nurse practitioner. Retention of the subject of the petition
    37  under such order shall not exceed twenty-four hours. The examination  of
    38  the subject of the petition may be performed by the physician or psychi-
    39  atric  nurse practitioner whose affirmation or affidavit accompanied the
    40  petition pursuant to paragraph three of subdivision (e) of this section,
    41  if such physician or psychiatric nurse  practitioner  is  privileged  by
    42  such hospital or otherwise authorized by such hospital to do so. If such
    43  examination is performed by another physician or psychiatric nurse prac-
    44  titioner,  the examining physician or psychiatric nurse practitioner may
    45  consult with the  physician  or  psychiatric  nurse  practitioner  whose
    46  affirmation  or  affidavit  accompanied  the  petition as to whether the
    47  subject meets the criteria for assisted outpatient treatment.
    48    (4) A physician or psychiatric nurse practitioner who testifies pursu-
    49  ant to paragraph two of this subdivision  shall  state:  (i)  the  facts
    50  which support the allegation that the subject meets each of the criteria
    51  for  assisted outpatient treatment, (ii) that the treatment is the least
    52  restrictive  alternative,  (iii)  the  recommended  assisted  outpatient
    53  treatment,  and  (iv)  the rationale for the recommended assisted outpa-
    54  tient  treatment.  If  the  recommended  assisted  outpatient  treatment
    55  includes  medication,  such physician's or psychiatric nurse practition-
    56  er's testimony shall describe the types or classes of  medication  which

        A. 6934                            12
 
     1  should  be  authorized,  shall  describe  the beneficial and detrimental
     2  physical and mental effects of  such  medication,  and  shall  recommend
     3  whether  such  medication should be self-administered or administered by
     4  authorized personnel.
     5    (i)  Written  treatment  plan.  (1) The court shall not order assisted
     6  outpatient treatment unless a physician or psychiatric nurse practition-
     7  er appointed by the appropriate  director,  in  consultation  with  such
     8  director,  develops  and provides to the court a proposed written treat-
     9  ment plan. The written treatment  plan  shall  include  case  management
    10  services  or assertive community treatment team services to provide care
    11  coordination. The written treatment plan also shall include all  catego-
    12  ries  of  services,  as set forth in paragraph one of subdivision (a) of
    13  this section, which such physician  or  psychiatric  nurse  practitioner
    14  recommends that the subject of the petition receive. All service provid-
    15  ers shall be notified regarding their inclusion in the written treatment
    16  plan.  If the written treatment plan includes medication, it shall state
    17  whether such medication should be self-administered or  administered  by
    18  authorized personnel, and shall specify type and dosage range of medica-
    19  tion  most  likely  to  provide  maximum benefit for the subject. If the
    20  written treatment plan includes alcohol or  substance  abuse  counseling
    21  and  treatment,  such  plan  may  include a provision requiring relevant
    22  testing for either alcohol or illegal  substances  provided  the  physi-
    23  cian's or psychiatric nurse practitioner's clinical basis for recommend-
    24  ing  such  plan provides sufficient facts for the court to find (i) that
    25  such person has a history of alcohol or substance abuse  that  is  clin-
    26  ically  related  to  the  mental  illness; and (ii) that such testing is
    27  necessary to prevent a relapse or deterioration which would be likely to
    28  result in serious harm to the person or others. If  a  director  is  the
    29  petitioner, the written treatment plan shall be provided to the court no
    30  later  than  the  date of the hearing on the petition. If a person other
    31  than a director is the petitioner, such plan shall be  provided  to  the
    32  court  no  later  than  the  date set by the court pursuant to paragraph
    33  three of subdivision (j) of this section.
    34    (2) The physician  or  psychiatric  nurse  practitioner  appointed  to
    35  develop  the  written treatment plan shall provide the following persons
    36  with an opportunity to actively participate in the development  of  such
    37  plan: the subject of the petition; the treating physician or psychiatric
    38  nurse  practitioner,  if any; and upon the request of the subject of the
    39  petition, an individual significant to the subject including  any  rela-
    40  tive, close friend or individual otherwise concerned with the welfare of
    41  the  subject.  If the subject of the petition has executed a health care
    42  proxy, the appointed physician or psychiatric nurse  practitioner  shall
    43  consider any directions included in such proxy in developing the written
    44  treatment plan.
    45    (3)  The  court shall not order assisted outpatient treatment unless a
    46  physician or psychiatric nurse practitioner appearing  on  behalf  of  a
    47  director  testifies to explain the written proposed treatment plan. Such
    48  physician or psychiatric nurse practitioner shall state  the  categories
    49  of  assisted  outpatient  treatment  recommended, the rationale for each
    50  such category, facts which establish that such treatment  is  the  least
    51  restrictive  alternative,  and,  if  the recommended assisted outpatient
    52  treatment plan includes medication, such physician or psychiatric  nurse
    53  practitioner shall state the types or classes of medication recommended,
    54  the beneficial and detrimental physical and mental effects of such medi-
    55  cation,  and  whether  such  medication  should  be self-administered or
    56  administered by an authorized professional. If the subject of the  peti-

        A. 6934                            13

     1  tion  has  executed  a  health care proxy, such physician or psychiatric
     2  nurse practitioner shall state the consideration given to any directions
     3  included in such proxy in developing the written treatment  plan.  If  a
     4  director  is  the petitioner, testimony pursuant to this paragraph shall
     5  be given at the hearing on the petition. If a person other than a direc-
     6  tor is the petitioner, such testimony shall be given on the date set  by
     7  the  court  pursuant  to  paragraph  three  of  subdivision  (j) of this
     8  section.
     9    (2) Within thirty days prior to the expiration of an order of assisted
    10  outpatient treatment, the appropriate director or the current  petition-
    11  er,  if  the  current petition was filed pursuant to subparagraph (i) or
    12  (ii) of paragraph one of  subdivision  (e)  of  this  section,  and  the
    13  current  petitioner  retains  his or her original status pursuant to the
    14  applicable subparagraph, may  petition  the  court  to  order  continued
    15  assisted  outpatient  treatment for a period not to exceed one year from
    16  the expiration date of the current order. If the court's disposition  of
    17  such petition does not occur prior to the expiration date of the current
    18  order,  the current order shall remain in effect until such disposition.
    19  The procedures for obtaining any  order  pursuant  to  this  subdivision
    20  shall be in accordance with the provisions of the foregoing subdivisions
    21  of  this  section; provided that the time restrictions included in para-
    22  graph four of subdivision (c) of this section shall not  be  applicable.
    23  The  notice  provisions set forth in paragraph six of subdivision (j) of
    24  this section shall be applicable. Any  court  order  requiring  periodic
    25  blood  tests  or urinalysis for the presence of alcohol or illegal drugs
    26  shall be subject to review after six months by the physician or  psychi-
    27  atric  nurse  practitioner  who  developed the written treatment plan or
    28  another physician or psychiatric nurse practitioner  designated  by  the
    29  director,  and such physician or psychiatric nurse practitioner shall be
    30  authorized to terminate such blood tests or urinalysis  without  further
    31  action by the court.
    32    (n) Failure to comply with assisted outpatient treatment. Where in the
    33  clinical  judgment of a physician or psychiatric nurse practitioner, (i)
    34  the assisted outpatient[,] has failed or  refused  to  comply  with  the
    35  assisted outpatient treatment, (ii) efforts were made to solicit compli-
    36  ance,  and  (iii) such assisted outpatient may be in need of involuntary
    37  admission to a hospital pursuant to section  9.27  of  this  article  or
    38  immediate  observation,  care, and treatment pursuant to section 9.39 or
    39  9.40 of this article, such physician or psychiatric  nurse  practitioner
    40  may  request  the appropriate director of community services, the direc-
    41  tor's designee, or  any  physician  or  psychiatric  nurse  practitioner
    42  designated  by  the  director  of community services pursuant to section
    43  9.37 of this article, to direct the removal of such assisted  outpatient
    44  to  an  appropriate  hospital  for  an  examination to determine if such
    45  person has a mental  illness  for  which  hospitalization  is  necessary
    46  pursuant to section 9.27, 9.39, or 9.40 of this article. Furthermore, if
    47  such  assisted outpatient refuses to take medications as required by the
    48  court order, or he or she refuses to take, or fails a blood test, urina-
    49  lysis, or alcohol or drug test as required  by  the  court  order,  such
    50  physician or psychiatric nurse practitioner may consider such refusal or
    51  failure  when  determining whether the assisted outpatient is in need of
    52  an examination to determine whether he or she has a mental  illness  for
    53  which  hospitalization  is necessary. Upon the request of such physician
    54  or psychiatric nurse practitioner, the appropriate director, the  direc-
    55  tor's  designee,  or  any  physician  or  psychiatric nurse practitioner
    56  designated pursuant to section 9.37 of this article,  may  direct  peace

        A. 6934                            14

     1  officers,  acting  pursuant  to their special duties, or police officers
     2  who are members of an authorized police department  or  force  or  of  a
     3  sheriff's  department,  to take the assisted outpatient into custody and
     4  transport  him  or her to the hospital operating the assisted outpatient
     5  treatment program or to any  hospital  authorized  by  the  director  of
     6  community  services  to receive such persons. Such law enforcement offi-
     7  cials shall carry out such directive. Upon the request of such physician
     8  or psychiatric nurse practitioner, the appropriate director, the  direc-
     9  tor's  designee,  or  any  physician  or  psychiatric nurse practitioner
    10  designated pursuant to  section  9.37  of  this  article,  an  ambulance
    11  service,  as defined by subdivision two of section three thousand one of
    12  the public health law, or an approved mobile crisis  outreach  team,  as
    13  defined  in  section  9.58  of this article, shall be authorized to take
    14  into custody and transport any such person to the hospital operating the
    15  assisted outpatient treatment program, or to any other hospital  author-
    16  ized  by  the appropriate director of community services to receive such
    17  persons. Any director of community services, or the director's designee,
    18  shall be authorized to direct the removal of an assisted outpatient  who
    19  is  present  in his or her county to an appropriate hospital, in accord-
    20  ance with the provisions of this subdivision, based upon a determination
    21  of the appropriate director of community services directing the  removal
    22  of  such  assisted  outpatient pursuant to this subdivision. Such person
    23  may be retained for observation, care, and treatment and  further  exam-
    24  ination  in  the hospital for up to seventy-two hours to permit a physi-
    25  cian or psychiatric nurse practitioner to determine whether such  person
    26  has a mental illness and is in need of involuntary care and treatment in
    27  a  hospital  pursuant  to  the provisions of this article. Any continued
    28  involuntary retention in such hospital beyond  the  initial  seventy-two
    29  hour  period  shall be in accordance with the provisions of this article
    30  relating to the involuntary admission and retention of a person.  If  at
    31  any time during the seventy-two hour period the person is determined not
    32  to meet the involuntary admission and retention provisions of this arti-
    33  cle,  and  does  not  agree  to  stay  in the hospital as a voluntary or
    34  informal patient, he or she must be released. Failure to comply with  an
    35  order of assisted outpatient treatment shall not be grounds for involun-
    36  tary civil commitment or a finding of contempt of court.
    37    §  16.  Subdivisions  (d),  (e) and (f) of section 33.04 of the mental
    38  hygiene law, subdivisions (d) and (f) as added by  chapter  779  of  the
    39  laws of 1977, and subdivisions (d) and (f) as renumbered and subdivision
    40  (e)  as  amended by chapter 334 of the laws of 1980, are amended to read
    41  as follows:
    42    (d) Restraint shall be [effected] affected only by written order of  a
    43  physician or psychiatric nurse practitioner after a personal examination
    44  of the patient except in an emergency situation, as provided by subdivi-
    45  sion (e) of this section. The order shall set forth the facts justifying
    46  the  restraint  and  shall  specify  the nature of the restraint and any
    47  conditions for maintaining the restraint. The order shall also set forth
    48  the time of expiration of the authorization, with such  order  to  apply
    49  for  a  period  of  no more than four hours, provided, however, that any
    50  such order imposing restraint after nine o'clock p.m. may  extend  until
    51  nine  o'clock a.m. of the next day.  A full record of restraint, includ-
    52  ing all signed orders of physicians or psychiatric nurse  practitioners,
    53  shall  be  kept in the patient's file and shall be subject to inspection
    54  by authorized persons.
    55    (e) If an emergency situation exists in which the patient is  engaging
    56  in  activity  that presents an immediate danger to himself or herself or

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     1  others and a physician is not immediately available,  restraint  may  be
     2  [effected]  affected only to the extent necessary to prevent the patient
     3  from injuring himself or herself or  others  at  the  direction  of  the
     4  senior  member  of  the  staff who is present.   The senior staff member
     5  shall cause a physician or psychiatric nurse practitioner  to  be  imme-
     6  diately  summoned  and  shall record the time of the call and the person
     7  contacted.   Pending the arrival of a  physician  or  psychiatric  nurse
     8  practitioner, the patient shall be kept under constant supervision. If a
     9  physician or psychiatric nurse practitioner does not arrive within thir-
    10  ty  minutes  of being summoned, the senior staff member shall record any
    11  such delay in the patient's clinical record  and  also  place  into  the
    12  patient's  clinical record a written description of the facts justifying
    13  the emergency restraint which shall specify the nature of the  restraint
    14  and  any conditions for maintaining the restraint until the arrival of a
    15  physician or  psychiatric  nurse  practitioner,  the  reasons  why  less
    16  restrictive  forms  of restraint were not used, and a description of the
    17  steps taken to assure that the patient's needs, comfort, and safety were
    18  properly cared for. Such physician  or  psychiatric  nurse  practitioner
    19  shall place in the clinical record an explanation for any such delay.
    20    (f) During the time that a patient is in restraint, he or she shall be
    21  monitored to see that his or her physical needs, comfort, and safety are
    22  properly  cared  for.  An assessment of the patient's condition shall be
    23  made at least once every thirty minutes or at more frequent intervals as
    24  directed by a physician or psychiatric nurse practitioner.  The  assess-
    25  ment  shall  be  recorded and placed in the patient's file. A patient in
    26  restraint shall be released from restraint at  least  every  two  hours,
    27  except  when  asleep.  If at any time a patient upon being released from
    28  restraint makes no overt gestures that would threaten  serious  harm  or
    29  injury to himself or herself or others, restraint shall not be reimposed
    30  and  a  physician or psychiatric nurse practitioner shall be immediately
    31  notified. Restraint shall not be reimposed in such situation unless,  in
    32  the  physician's  or psychiatric nurse practitioner's professional judg-
    33  ment, release would be harmful to the patient or others.
    34    § 17. This act shall take effect immediately; provided, however,  that
    35  the amendments to:
    36    a.  subdivision  (a) of section 9.37 of the mental hygiene law made by
    37  section five of this act shall be subject to the expiration  and  rever-
    38  sion  of  such  subdivision pursuant to section 21 of chapter 723 of the
    39  laws of 1989, as amended, when upon such date the provisions of  section
    40  six of this act shall take effect;
    41    b.  subdivisions (b) and (c) of section 9.40 of the mental hygiene law
    42  made by section eight of this act shall not affect the  repeal  of  such
    43  section and shall be deemed repealed therewith;
    44    c.  section 9.55 of the mental hygiene law made by section ten of this
    45  act shall be subject to the expiration and  reversion  of  such  section
    46  pursuant  to  section 21 of chapter 723 of the laws of 1989, as amended,
    47  when upon such date the provisions of section eleven of this  act  shall
    48  take effect;
    49    d.  section  9.57  of the mental hygiene law made by section twelve of
    50  this act shall be subject  to  the  expiration  and  reversion  of  such
    51  section  pursuant  to  section 21 of chapter 723 of the laws of 1989, as
    52  amended, when upon such date the provisions of section thirteen of  this
    53  act shall take effect; and
    54    e.  subparagraph (iii) of paragraph 4 of subdivision (c), subparagraph
    55  (v) of paragraph 1 and paragraphs 3 and 4 of subdivision (e), paragraphs
    56  1, 2, 3 and 4 of subdivision (h), subdivision (i), paragraph 2 of subdi-

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     1  vision (k), and subdivision (n) of section 9.60 of  the  mental  hygiene
     2  law  made  by section fifteen of this act shall not affect the repeal of
     3  such section and shall be deemed repealed therewith.
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