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A05841 Summary:

BILL NOA05841B
 
SAME ASSAME AS S02103-B
 
SPONSORGottfried
 
COSPNSRWeinstein, Sayegh, Steck, Simon, Cusick, Barron, Abinanti, Cook, Glick, Vanel, Lunsford, Cahill, Rosenthal L, Pichardo, Richardson, Bronson, Zebrowski, Thiele, Williams, Bichotte Hermelyn, Carroll, Fall, Gallagher, Forrest, Cruz, Stirpe, Nolan, Clark, Colton, Perry, Santabarbara, Hunter, Jackson, Zinerman, Griffin, Kelles, Jacobson, Fernandez, Galef, Otis, Wallace, Meeks, Sillitti
 
MLTSPNSR
 
Add §280-d, Pub Health L
 
Relates to the use of psychotropic medications in nursing homes and adult care facilities; imposes limits as to time and documentation; requires informed consent under certain circumstances.
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A05841 Actions:

BILL NOA05841B
 
02/26/2021referred to health
03/01/2021reported referred to codes
03/01/2021reported referred to rules
03/01/2021reported
03/02/2021rules report cal.27
03/02/2021ordered to third reading rules cal.27
03/04/2021amended on third reading 5841a
03/09/2021passed assembly
03/09/2021delivered to senate
03/09/2021REFERRED TO HEALTH
01/05/2022DIED IN SENATE
01/05/2022RETURNED TO ASSEMBLY
01/05/2022ordered to third reading cal.190
01/25/2022amended on third reading 5841b
04/05/2022passed assembly
04/05/2022delivered to senate
04/05/2022REFERRED TO HEALTH
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A05841 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A5841B
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to the use of psycho- tropic medications in nursing homes and adult care facilities   PURPOSE OR GENERAL IDEA OF BILL: to require an enhanced level of informed consent before psychotropic medication can be prescribed for patients in nursing homes or adult care facilities.   SUMMARY OF SPECIFIC PROVISIONS: Would add a new section 280-c to article 2-A of the Public Health Law to detail the information that must be provided before a health care professional may prescribe a psychotropic medication to a patient in a nursing home or an adult care facility and require a written infounded consent before the initial order or prescription, or before an increase in the dose or duration of an existing order or prescription. The bill accommodates the need of patients who lack capacity and have lawful representation by a health care agent or surrogate. It provides notification within 48 hours of an order for a psychotropic medication to family members who have requested and are lawfully permitted to receive such notice. It establishes requirements for record keeping in relation to such medication orders and the contingent informed consent. Finally, the bill allows for an emergency order for psychotropic medica- tion where it is necessary to protect the life, health or safety of a nursing home patient or others in the nursing home, with prompt notifi- cation to lawful representatives and family members lawfully permitted to receive such notice   JUSTIFICATION: Under section 2803-c(3) of the Public Health Law, patients residing in nursing homes have the right to be fully informed of their condition and any proposed treatment, to refuse treatment, and to be free from chemi- cal restraints unless such a prescription is consistent with certain requirements that limit duration and guide use necessitated by an emer- gency. Psychotropic medications are drugs that affect brain activities associated with mental processes and behavior including antipsychotics, antidepressants, antianxiety drugs and hypnotics. Spurred by published reports, the Assembly Committee on Health held a public hearing in February 2015 to examine the use of psychotropic drugs in nursing homes. Consensus emerged that in far too many instances, psychotropic drugs are used without a differential diagnosis of mental illness, in order to quiet and calm patients who may be simply upset or excitable. Given that activities and diversions have been proven to effectively reduce disruptions related to simple anxiety, dementia and emotional upset, it is not in many patients' interest to expose them to the dangerous side effects of psychotropic drugs which include cognitive decline and addiction. This bill would require that before such drugs are ordered for a patient in a nursing home or an adult care facility, the patient or their lawful surrogate be fully informed of the nature and seriousness of his or her condition, the anticipated benefit from the medication, the dosage and duration of the prescription, the probability, nature and degree of side effects, the reasonable alternatives to the drug and why the health care professional prefers the drug in this instance, and that the patient has the right to refuse consent for the drug, or later to revoke their consent. The consent would be written. Adult care facilities, including assisted living and adult homes, share many similarities with nursing homes in terms of the needs, vulnerabili- ty and isolation of the residents. It is appropriate to extend the protections of this legislation to adult care facility residents, yet limit the emergency order to nursing homes. Allowing family members beyond those who are already the health care agent or surrogate for the patient to require notification adds another layer of accountability and assures that patients' quality of life will be protected and optimized. Reference: Left Behind: The Impact Of The Failure To Fulfill The Promise of The National Campaign To Improve Dementia Care; Long Term Community Care Coalition; 12/22/2014.   PRIOR LEGISLATIVE HISTORY: 2015-2016: A.7351- passed Assembly 2017-2018: A. 5332 passed Assembly   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: 180 days after enactment provided that the Commissioner may make regu- lations beforehand that would become effective at the same time as the law.
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A05841 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         5841--B
                                                                Cal. No. 190
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 26, 2021
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED,  WEINSTEIN, SAYEGH, STECK, SIMON,
          CUSICK, ABINANTI, COOK, GLICK, VANEL, LUNSFORD, CAHILL,  L. ROSENTHAL,
          RICHARDSON,  BRONSON,  ZEBROWSKI, THIELE, WILLIAMS, BICHOTTE HERMELYN,
          CARROLL, FALL, GALLAGHER, FORREST, CRUZ, STIRPE, NOLAN, CLARK, COLTON,
          PERRY,  SANTABARBARA,  HUNTER,  JACKSON,  ZINERMAN,  GRIFFIN,  KELLES,
          JACOBSON,  FERNANDEZ, GALEF, SILLITTI -- read once and referred to the
          Committee on Health -- reported and referred to the Committee on Codes
          -- reported and referred to the Committee on Rules -- amended  on  the
          special  order of third reading, ordered reprinted as amended, retain-
          ing its place on the special order of third reading --  ordered  to  a
          third  reading,  amended and ordered reprinted, retaining its place on
          the order of third reading
 
        AN ACT to amend the public health law, in relation to the use of psycho-
          tropic medications in nursing homes and adult care facilities
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  The  public health law is amended by adding a new section
     2  280-d to read as follows:
     3    § 280-d. Use of psychotropic medications in nursing  homes  and  adult
     4  care facilities. 1. As used in this section:
     5    (a)  "psychotropic  medication" means a drug that affects brain activ-
     6  ities associated with mental processes and behavior, including, but  not
     7  limited to, antipsychotics, antidepressants, antianxiety drugs or anxio-
     8  lytics, and hypnotics;
     9    (b)  "lawful  representative" means, where a patient lacks capacity to
    10  consent to health care, a person authorized to consent on behalf of  the
    11  patient,  including,  but not limited to, a health care agent authorized
    12  by a health care proxy under article twenty-nine-C of this chapter or  a
    13  surrogate under article twenty-nine-CC of this chapter;
    14    (c)  "increase"  when  used in relation to an order for a psychotropic
    15  medication, means an increase of the dosage or duration of  the  medica-
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00036-04-2

        A. 5841--B                          2
 
     1  tion  above  the  dosage  or  duration  covered  by the currently active
     2  consent;
     3    (d)  "health  care  professional"  means  a  health care professional,
     4  licensed, certified or authorized to practice under title eight  of  the
     5  education  law,  acting  within his or her lawful scope of practice, who
     6  has authority to order a psychotropic medication; and
     7    (e) "patient" means an individual who is a resident of  a  residential
     8  health care facility as defined in article twenty-eight of this chapter,
     9  or  an  adult  care facility certified under section four hundred sixty-
    10  one-b of the social services law.
    11    2. (a) An order for a psychotropic medication in a nursing home  shall
    12  include the dosage, frequency, and duration of the order which shall not
    13  exceed  fourteen days. A health care professional, who is employed by or
    14  contracted with a  nursing  home  or  adult  care  facility  to  provide
    15  services  to  facility residents,  or who provides services on site in a
    16  nursing home or adult care facility, may not  prescribe  or  increase  a
    17  prescription for a psychotropic medication for a patient in such facili-
    18  ty unless the health care professional has obtained the written informed
    19  consent  of  the  patient  or the patient's lawful representative, or is
    20  acting pursuant to an order under  this  section,  or  is  acting  under
    21  subdivision  three  of  this  section. Where a patient lacks capacity to
    22  consent to health care and lacks a lawful representative, a prescription
    23  or increase of a prescription under this section  shall  be  subject  to
    24  subdivision  four  of  section twenty-nine hundred ninety-four-g of this
    25  chapter as if the patient were an inpatient of a  general  hospital.  To
    26  constitute  informed consent, the following disclosure shall be given to
    27  the patient or, where the patient lacks capacity to  consent  to  health
    28  care,  the  patient's  lawful  representative,  in  a clear and explicit
    29  manner:
    30    (i) the reason for the medication, including the nature  and  serious-
    31  ness of the patient's illness, disorder or condition that the medication
    32  is intended to treat;
    33    (ii)  the  anticipated  benefit  from  the medication, and the dosage,
    34  frequency, and duration of the order;
    35    (iii) the probability of side effects and  significant  risks  of  the
    36  medication,  including  the nature, degree, and duration of such effects
    37  and reasonably known risks;
    38    (iv) the reasonable alternative treatments to the proposed  medication
    39  and  the  reason  that the health care professional prefers the proposed
    40  medication in this instance; and
    41    (v) that the patient or lawful representative has the right to consent
    42  or refuse consent to use of the proposed medication, and that if  he  or
    43  she  consents,  he or she has the right to revoke his or her consent for
    44  any reason, at any time, including a  description  of  how  the  consent
    45  shall be revoked.
    46    (b)  The  health  care  professional  shall  document in the patient's
    47  medical record the date and time that the  informed  consent  disclosure
    48  was  provided,  and to whom and by whom it was provided, and include the
    49  written consent.
    50    (c) Where the patient's medical record notes that a family member  has
    51  requested  notification  of medication orders or prescriptions, and such
    52  notification is otherwise lawful, the  health  care  professional  shall
    53  cause   notice   to   be   provided  within  forty-eight  hours  of  the
    54  prescription, order, or increase of an order or prescription under  this
    55  section.  Such  notice shall not be provided if the patient specifically
    56  requests that the family member not be given notification.

        A. 5841--B                          3
 
     1    3. A health care professional is not required to obtain consent  under
     2  this  section to issue an order for use of a psychotropic medication for
     3  a patient in a nursing home where it is necessary  in  an  emergency  to
     4  protect against an immediate threat to the life, health or safety of the
     5  patient  or another person.  The medication must be the most appropriate
     6  available means of reducing that threat, with the  least  risk  of  harm
     7  considering  the  patient's  condition or disorder. The order shall only
     8  apply, in the absence of consent, during the emergency. Where  an  order
     9  is made under this subdivision, the health care professional shall imme-
    10  diately  record  the  use of the psychotropic medication, the reason for
    11  the use, and the dosage, in the  patient's  medical  record;  and  shall
    12  promptly  notify  the patient or the patient's lawful representative who
    13  would have had the authority to consent, and any family member  required
    14  to  be  notified under this section and record such notifications in the
    15  patient's medical record.
    16    4. This section does not increase the lawful scope of practice of  any
    17  health care professional and does not diminish or impair any requirement
    18  for or regulation of consent to health care treatment.
    19    5. The commissioner may make regulations to implement this section.
    20    § 2. This act shall take effect on the one hundred eightieth day after
    21  it  shall  have become a law. Effective immediately, the commissioner of
    22  health is authorized to make regulations  and  take  any  other  actions
    23  necessary to implement section 280-d of the public health law.
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