Amd Ment Hyg L, generally; amd S6, Chap 560 of 1994
Enacts "Kendra's Law"; enhances the supervision and coordination of care of persons with mental illness in community-based settings by providing assisted outpatient treatment; provides for the establishment of assisted outpatient treatment as a permanent mode of treatment, improved coordination of care for mentally ill persons living in the community, the expansion of the use of conditional release in psychiatric hospitals, and the improved dissemination of information between and among mental health providers and general hospital emergency rooms.
STATE OF NEW YORK
________________________________________________________________________
8477--A
1999-2000 Regular Sessions
IN ASSEMBLY
May 21, 1999
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Silver,
Connelly, Brennan, Hoyt, Higgins, Parment, Abbate, Boyland, Canes-
trari, Cook, Destito, DiNapoli, Dinowitz, Gantt, Greene, Gunther,
Harenberg, Lafayette, Matusow, Mayersohn, Mazzarelli, Pheffer, Sidik-
man, Tokasz, Weprin) -- (at request of the Governor) -- read once and
referred to the Committee on Mental Health, Mental Retardation and
Developmental Disabilities -- reported and referred to the Committee
on Rules -- Rules Committee discharged, bill amended, ordered
reprinted as amended and recommitted to the Committee on Rules
AN ACT to amend the mental hygiene law, in relation to enhancing the
supervision and coordination of care of persons with mental illness in
community-based settings by providing assisted outpatient treatment
and to amend chapter 560 of the laws of 1994 amending the judiciary
law and the mental hygiene law relating to establishing a pilot
program of involuntary outpatient treatment, in relation to the effec-
tiveness of such chapter and providing for the repeal of such
provision on the expiration thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as "Kendra's
2 Law".
3 § 2. Legislative findings. The legislature finds that there are
4 mentally ill persons who are capable of living in the community with the
5 help of family, friends and mental health professionals, but who, with-
6 out routine care and treatment, may relapse and become violent or
7 suicidal, or require hospitalization. The legislature further finds
8 that there are mentally ill persons who can function well and safely in
9 the community with supervision and treatment, but who without such
10 assistance, will relapse and require long periods of hospitalization.
11 The legislature further finds that some mentally ill persons, because
12 of their illness, have great difficulty taking responsibility for their
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
A LBD08318-09-9
A. 8477--A 2
1 own care, and often reject the outpatient treatment offered to them on a
2 voluntary basis. Family members and caregivers often must stand by help-
3 lessly and watch their loved ones and patients decompensate. Effective
4 mechanisms for accomplishing these ends include: the establishment of
5 assisted outpatient treatment as a mode of treatment; improved coordi-
6 nation of care for mentally ill persons living in the community; the
7 expansion of the use of conditional release in psychiatric hospitals;
8 and the improved dissemination of information between and among mental
9 health providers and general hospital emergency rooms.
10 The legislature further finds that if such court-ordered treatment is
11 to achieve its goals, it must be linked to a system of comprehensive
12 care, in which state and local authorities work together to ensure that
13 outpatients receive case management and have access to treatment
14 services. The legislature therefore finds that assisted outpatient
15 treatment as provided in this act is compassionate, not punitive, will
16 restore patients' dignity, and will enable mentally ill persons to lead
17 more productive and satisfying lives.
18 The legislature further finds that many mentally ill persons are more
19 likely to enjoy recovery from non-dangerous, temporary episodes of
20 mental illness when they are engaged in planning the nature of the medi-
21 cations, programs or treatments for such episodes with assistance and
22 support from family, friends and mental health professionals. A health
23 care proxy executed pursuant to article 29-C of the public health law
24 provides mentally ill persons with a means to accept individual respon-
25 sibility for their own continuing mental health care by providing
26 advance directives concerning their wishes as to medications, programs
27 or treatments that they feel are appropriate when they are temporarily
28 unable to make mental health care decisions. The legislature therefore
29 finds that the voluntary use of such proxies should be encouraged so as
30 to minimize the need for involuntary mental health treatment.
31 § 3. Section 7.17 of the mental hygiene law is amended by adding a new
32 subdivision (f) to read as follows:
33 (f) (1) The commissioner shall appoint program coordinators of
34 assisted outpatient treatment, who shall be responsible for the over-
35 sight and monitoring of assisted outpatient treatment programs estab-
36 lished pursuant to section 9.60 of this chapter. Directors of community
37 services of local governmental units shall work in conjunction with such
38 program coordinators to coordinate the implementation of assisted outpa-
39 tient treatment programs.
40 (2) The oversight and monitoring role of the program coordinator of
41 the assisted outpatient treatment program shall include each of the
42 following:
43 (i) that each assisted outpatient receives the treatment provided for
44 in the court order issued pursuant to section 9.60 of this chapter;
45 (ii) that existing services located in the assisted outpatient's
46 community are utilized whenever practicable;
47 (iii) that a case manager or assertive community treatment team is
48 designated for each assisted outpatient;
49 (iv) that a mechanism exists for such case manager, or assertive
50 community treatment team, to regularly report the assisted outpatient's
51 compliance, or lack of compliance with treatment, to the director of the
52 assisted outpatient treatment program; and
53 (v) that assisted outpatient treatment services are delivered in a
54 timely manner.
55 (3) The commissioner shall develop standards designed to ensure that
56 case managers or assertive community treatment teams have appropriate
A. 8477--A 3
1 training and have clinically manageable caseloads designed to provide
2 effective case management or other care coordination services for
3 persons subject to a court order under section 9.60 of this chapter.
4 (4) Upon review or receiving notice that services are not being deliv-
5 ered in a timely manner, the program coordinator shall require the
6 director of such assisted outpatient treatment program to immediately
7 commence corrective action and inform the program coordinator of such
8 corrective action. Failure of a director to take corrective action shall
9 be reported by the program coordinator to the commissioner of mental
10 health, as well as to the court which ordered the assisted outpatient
11 treatment.
12 § 4. The opening paragraph of section 9.47 of the mental hygiene law
13 is designated subdivision (a) and a new subdivision (b) is added to read
14 as follows:
15 (b) All directors of community services shall be responsible for the
16 filing of petitions for assisted outpatient treatment pursuant to para-
17 graph (vi) of subdivision (e) of section 9.60 of this article, for the
18 receipt and investigation of reports of persons who are alleged to be in
19 need of such treatment and for coordinating the delivery of court
20 ordered services with program coordinators, appointed by the commission-
21 er of mental health, pursuant to subdivision (f) of section 7.17 of this
22 chapter. In discharge of the duties imposed by subdivision (b) of
23 section 9.60 of this article, directors of community services may
24 provide services directly, or may coordinate services with the offices
25 of the department or may contract with any public or private provider to
26 provide services for such programs as may be necessary to carry out the
27 duties imposed pursuant to this subdivision.
28 § 5. The mental hygiene law is amended by adding a new section 9.48 to
29 read as follows:
30 § 9.48 Duties of directors of assisted outpatient treatment programs.
31 (a)(1) Directors of assisted outpatient treatment programs established
32 pursuant to section 9.60 of this article shall provide a written report
33 to the program coordinators, appointed by the commissioner of mental
34 health pursuant to subdivision (f) of section 7.17 of this chapter,
35 within three days of the issuance of a court order. The report shall
36 demonstrate that mechanisms are in place to ensure the delivery of
37 services and medications as required by the court order and shall
38 include, but not be limited to the following:
39 (i) a copy of the court order;
40 (ii) a copy of the written treatment plan;
41 (iii) the identity of the case manager or assertive community treat-
42 ment team, including the name and contact data of the organization which
43 the case manager or assertive community treatment team member repres-
44 ents;
45 (iv) the identity of providers of services; and
46 (v) the date on which services have commenced or will commence.
47 (2) The directors of assisted outpatient treatment programs shall
48 ensure the timely delivery of services described in paragraph one of
49 subdivision (a) of section 9.60 of this article pursuant to any court
50 order issued under such section. Directors of assisted outpatient treat-
51 ment programs shall immediately commence corrective action upon receiv-
52 ing notice from program coordinators, that services are not being
53 provided in a timely manner. Such directors shall inform the program
54 coordinator of such corrective action.
55 (b) Directors of assisted outpatient treatment programs shall submit
56 quarterly reports to the program coordinators regarding the assisted
A. 8477--A 4
1 outpatient treatment program operated or administered by such director.
2 The report shall include the following information:
3 (i) the names of individuals served by the program;
4 (ii) the percentage of petitions for assisted outpatient treatment
5 that are granted by the court;
6 (iii) any change in status of assisted outpatients, including but not
7 limited to the number of individuals who have failed to comply with
8 court ordered assisted outpatient treatment;
9 (iv) a description of material changes in written treatment plans of
10 assisted outpatients;
11 (v) any change in case managers;
12 (vi) a description of the categories of services which have been
13 ordered by the court;
14 (vii) living arrangements of individuals served by the program includ-
15 ing the number, if any, who are homeless;
16 (viii) any other information as required by the commissioner of mental
17 health; and
18 (ix) any recommendations to improve the program locally or statewide.
19 § 6. The mental hygiene law is amended by adding a new section 9.60 to
20 read as follows:
21 § 9.60 Assisted outpatient treatment.
22 (a) Definitions. For purposes of this section, the following defi-
23 nitions shall apply:
24 (1) "assisted outpatient treatment" shall mean categories of outpa-
25 tient services which have been ordered by the court pursuant to this
26 section. Such treatment shall include case management services or
27 assertive community treatment team services to provide care coordi-
28 nation, and may also include any of the following categories of
29 services: medication; periodic blood tests or urinalysis to determine
30 compliance with prescribed medications; individual or group therapy; day
31 or partial day programming activities; educational and vocational train-
32 ing or activities; alcohol or substance abuse treatment and counseling
33 and periodic tests for the presence of alcohol or illegal drugs for
34 persons with a history of alcohol or substance abuse; supervision of
35 living arrangements; and any other services within a local or unified
36 services plan developed pursuant to article forty-one of this chapter,
37 prescribed to treat the person's mental illness and to assist the person
38 in living and functioning in the community, or to attempt to prevent a
39 relapse or deterioration that may reasonably be predicted to result in
40 suicide or the need for hospitalization.
41 (2) "director" shall mean the director of a hospital licensed or oper-
42 ated by the office of mental health which operates, directs and super-
43 vises an assisted outpatient treatment program, or the director of
44 community services of a local governmental unit, as such term is defined
45 in section 41.03 of this chapter, which operates, directs and supervises
46 an assisted outpatient treatment program.
47 (3) "director of community services" shall have the same meaning as
48 provided in article forty-one of this chapter.
49 (4) "assisted outpatient treatment program" shall mean a system to
50 arrange for and coordinate the provision of assisted outpatient treat-
51 ment, to monitor treatment compliance by assisted outpatients, to evalu-
52 ate the condition or needs of assisted outpatients, to take appropriate
53 steps to address the needs of such individuals, and to ensure compliance
54 with court orders.
55 (5) "assisted outpatient" or "patient" shall mean the person under a
56 court order to receive assisted outpatient treatment.
A. 8477--A 5
1 (6) "subject of the petition" or "subject" shall mean the person who
2 is alleged in a petition, filed pursuant to the provisions of this
3 section, to meet the criteria for assisted outpatient treatment.
4 (7) "correctional facility" or "local correctional facility" shall
5 have the same meaning as defined in section two of the correction law.
6 (8) "health care proxy" and "health care agent" shall have the same
7 meaning as defined in article 29-C of the public health law.
8 (9) "program coordinator" shall mean an individual appointed by the
9 commissioner of mental health, pursuant to subdivision (f) of section
10 7.17 of this chapter, who is responsible for the oversight and monitor-
11 ing of assisted outpatient treatment programs.
12 (b) The director of a hospital licensed or operated by the office of
13 mental health may operate, direct and supervise an assisted outpatient
14 treatment program as provided in this section, upon approval by the
15 commissioner of mental health. The director of community services of a
16 local governmental unit shall operate, direct and supervise an assisted
17 outpatient treatment program as provided in this section, upon approval
18 by the commissioner of mental health. Directors of community services of
19 local governmental units shall be permitted to satisfy the provisions of
20 this subdivision through the operation of joint assisted outpatient
21 treatment programs. Nothing in this subdivision shall be interpreted to
22 preclude the combination or coordination of efforts between and among
23 local governmental units and hospitals in providing and coordinating
24 assisted outpatient treatment.
25 (c) Criteria for assisted outpatient treatment. A patient may be
26 ordered to obtain assisted outpatient treatment if the court finds that:
27 (1) the patient is eighteen years of age or older; and
28 (2) the patient is suffering from a mental illness; and
29 (3) the patient is unlikely to survive safely in the community without
30 supervision, based on a clinical determination; and
31 (4) the patient has a history of lack of compliance with treatment for
32 mental illness that has:
33 (i) at least twice within the last thirty-six months been a signif-
34 icant factor in necessitating hospitalization in a hospital, or receipt
35 of services in a forensic or other mental health unit of a correctional
36 facility or a local correctional facility, not including any period
37 during which the person was hospitalized or incarcerated immediately
38 preceding the filing of the petition or;
39 (ii) resulted in one or more acts of serious violent behavior toward
40 self or others or threats of, or attempts at, serious physical harm to
41 self or others within the last forty-eight months, not including any
42 period in which the person was hospitalized or incarcerated immediately
43 preceding the filing of the petition; and
44 (5) the patient is, as a result of his or her mental illness, unlikely
45 to voluntarily participate in the recommended treatment pursuant to the
46 treatment plan; and
47 (6) in view of the patient's treatment history and current behavior,
48 the patient is in need of assisted outpatient treatment in order to
49 prevent a relapse or deterioration which would be likely to result in
50 serious harm to the patient or others as defined in section 9.01 of this
51 article; and
52 (7) it is likely that the patient will benefit from assisted outpa-
53 tient treatment; and
54 (8) if the patient has executed a health care proxy as defined in
55 article 29-C of the public health law, that any directions included in
A. 8477--A 6
1 such proxy shall be taken into account by the court in determining the
2 written treatment plan.
3 (d) Nothing herein shall preclude a person with a health care proxy
4 from being subject to a petition pursuant to this chapter and consistent
5 with article 29-C of the public health law.
6 (e) Petition to the court. (1) A petition for an order authorizing
7 assisted outpatient treatment may be filed in the supreme or county
8 court in the county in which the subject of the petition is present or
9 reasonably believed to be present. A petition to obtain an order author-
10 izing assisted outpatient treatment may be initiated only by the follow-
11 ing persons:
12 (i) any person eighteen years of age or older with whom the subject of
13 the petition resides; or
14 (ii) the parent, spouse, sibling eighteen years of age or older, or
15 child eighteen years of age or older of the subject of the petition; or
16 (iii) the director of a hospital in which the subject of the petition
17 is hospitalized; or
18 (iv) the director of any public or charitable organization, agency or
19 home providing mental health services to the subject of the petition in
20 whose institution the subject of the petition resides; or
21 (v) a qualified psychiatrist who is either supervising the treatment
22 of or treating the subject of the petition for a mental illness; or
23 (vi) the director of community services, or his or her designee, or
24 the social services official, as defined in the social services law, of
25 the city or county in which the subject of the petition is present or
26 reasonably believed to be present; or
27 (vii) a parole officer or probation officer assigned to supervise the
28 subject of the petition.
29 (2) The petition shall state:
30 (i) each of the criteria for assisted outpatient treatment as set
31 forth in subdivision (c) of this section;
32 (ii) facts which support such petitioner's belief that the person who
33 is the subject of the petition meets each criterion, provided that the
34 hearing on the petition need not be limited to the stated facts; and
35 (iii) that the subject of the petition is present, or is reasonably
36 believed to be present, within the county where such petition is filed.
37 (3) The petition shall be accompanied by an affirmation or affidavit
38 of a physician, who shall not be the petitioner, and shall state either
39 that:
40 (i) such physician has personally examined the person who is the
41 subject of the petition no more than ten days prior to the submission of
42 the petition, he or she recommends assisted outpatient treatment for the
43 subject of the petition, and he or she is willing and able to testify at
44 the hearing on the petition; or
45 (ii) no more than ten days prior to the filing of the petition, such
46 physician or his or her designee has made appropriate attempts to elicit
47 the cooperation of the subject of the petition but has not been success-
48 ful in persuading the subject to submit to an examination, that such
49 physician has reason to suspect that the subject of the petition meets
50 the criteria for assisted outpatient treatment, and that such physician
51 is willing and able to examine the subject of the petition and testify
52 at the hearing on the petition.
53 (f) Service. The petitioner shall cause written notice of the petition
54 to be given to the subject of the petition and a copy thereof shall be
55 given personally or by mail to the persons listed in section 9.29 of
56 this article, the mental hygiene legal service, the current health care
A. 8477--A 7
1 agent appointed by the subject of the petition, if any such agent is
2 known to the petitioner, the appropriate program coordinator, the appro-
3 priate director of community services, if such director is not the peti-
4 tioner.
5 (g) Right to counsel. The subject of the petition shall have the right
6 to be represented by the mental hygiene legal service, or other counsel
7 at the expense of the subject of the petition, at all stages of a
8 proceeding commenced under this section.
9 (h) Hearing. (1) Upon receipt by the court of the petition submitted
10 pursuant to subdivision (e) of this section, the court shall fix the
11 date for a hearing at a time not later than three days from the date
12 such petition is received by the court, excluding Saturdays, Sundays and
13 holidays. Adjournments shall be permitted only for good cause shown. In
14 granting adjournments, the court shall consider the need for further
15 examination by a physician or the potential need to provide assisted
16 outpatient treatment expeditiously. The court shall cause the subject of
17 the petition, any other person receiving notice pursuant to subdivision
18 (f) of this section, the petitioner, the physician whose affirmation or
19 affidavit accompanied the petition, the appropriate director, and such
20 other persons as the court may determine to be advised of such date.
21 Upon such date, or upon such other date to which the proceeding may be
22 adjourned, the court shall hear testimony and, if it be deemed advisable
23 and the subject of the petition is available, examine the subject
24 alleged to be in need of assisted outpatient treatment in or out of
25 court. If the subject of the petition does not appear at the hearing,
26 and appropriate attempts to elicit the attendance of the subject have
27 failed, the court may conduct the hearing in such subject's absence. If
28 the hearing is conducted without the subject of the petition present,
29 the court shall set forth the factual basis for conducting the hearing
30 without the presence of the subject of the petition.
31 (2) The court shall not order assisted outpatient treatment unless an
32 examining physician, who has personally examined the subject of the
33 petition within the time period commencing ten days before the filing of
34 the petition, testifies in person at the hearing.
35 (3) If the subject of the petition has refused to be examined by a
36 physician, the court may request the subject to consent to an examina-
37 tion by a physician appointed by the court. If the subject of the peti-
38 tion does not consent and the court finds reasonable cause to believe
39 that the allegations in the petition are true, the court may order peace
40 officers, acting pursuant to their special duties, or police officers
41 who are members of an authorized police department or force, or of a
42 sheriff's department to take the subject of the petition into custody
43 and transport him or her to a hospital for examination by a physician.
44 Retention of the subject of the petition under such order shall not
45 exceed twenty-four hours. The examination of the subject of the petition
46 may be performed by the physician whose affirmation or affidavit accom-
47 panied the petition pursuant to paragraph three of subdivision (e) of
48 this section, if such physician is privileged by such hospital or other-
49 wise authorized by such hospital to do so. If such examination is
50 performed by another physician of such hospital, the examining physician
51 shall be authorized to consult with the physician whose affirmation or
52 affidavit accompanied the petition regarding the issues of whether the
53 allegations in the petition are true and whether the subject meets the
54 criteria for assisted outpatient treatment.
55 (4) A physician who testifies pursuant to paragraph two of this subdi-
56 vision shall state the facts which support the allegation that the
A. 8477--A 8
1 subject meets each of the criteria for assisted outpatient treatment,
2 and the treatment is the least restrictive alternative, the recommended
3 assisted outpatient treatment, and the rationale for the recommended
4 assisted outpatient treatment. If the recommended assisted outpatient
5 treatment includes medication, such physician's testimony shall describe
6 the types or classes of medication which should be authorized, shall
7 describe the beneficial and detrimental physical and mental effects of
8 such medication, and shall recommend whether such medication should be
9 self-administered or administered by authorized personnel.
10 (5) The subject of the petition shall be afforded an opportunity to
11 present evidence, to call witnesses on behalf of the subject, and to
12 cross-examine adverse witnesses.
13 (i) (1) Written treatment plan. The court shall not order assisted
14 outpatient treatment unless an examining physician appointed by the
15 appropriate director develops and provides to the court a proposed writ-
16 ten treatment plan. The written treatment plan shall include case
17 management services or assertive community treatment teams to provide
18 care coordination. The written treatment plan also shall include all
19 categories of services, as set forth in paragraph one of subdivision (a)
20 of this section, which such physician recommends that the subject of the
21 petition should receive. If the written treatment plan includes medica-
22 tion, it shall state whether such medication should be self-administered
23 or administered by authorized personnel, and shall specify type and
24 dosage range of medication most likely to provide maximum benefit for
25 the subject. If the written treatment plan includes alcohol or
26 substance abuse counseling and treatment, such plan may include a
27 provision requiring relevant testing for either alcohol or illegal
28 substances provided the physician's clinical basis for recommending such
29 plan provides sufficient facts for the court to find (i) that such
30 person has a history of alcohol or substance abuse that is clinically
31 related to the mental illness; and (ii) that such testing is necessary
32 to prevent a relapse or deterioration which would be likely to result in
33 serious harm to the person or others. In developing such a plan, the
34 physician shall provide the following persons with an opportunity to
35 actively participate in the development of such plan: the subject of the
36 petition; the treating physician; and upon the request of the patient,
37 an individual significant to the patient including any relative, close
38 friend or individual otherwise concerned with the welfare of the
39 subject. If the petitioner is a director, such plan shall be provided to
40 the court no later than the date of the hearing on the petition.
41 (2) The court shall not order assisted outpatient treatment unless a
42 physician testifies to explain the written proposed treatment plan. Such
43 testimony shall state the categories of assisted outpatient treatment
44 recommended, the rationale for each such category, facts which establish
45 that such treatment is the least restrictive alternative, and, if the
46 recommended assisted outpatient treatment includes medication, the types
47 or classes of medication recommended, the beneficial and detrimental
48 physical and mental effects of such medication, and whether such medica-
49 tion should be self-administered or administered by an authorized
50 professional. If the petitioner is a director such testimony shall be
51 given at the hearing on the petition.
52 (j) Disposition. (1) If after hearing all relevant evidence, the court
53 finds that the subject of the petition does not meet the criteria for
54 assisted outpatient treatment, the court shall dismiss the petition.
55 (2) If after hearing all relevant evidence, the court finds by clear
56 and convincing evidence that the subject of the petition meets the
A. 8477--A 9
1 criteria for assisted outpatient treatment, and there is no appropriate
2 and feasible less restrictive alternative, the court shall be authorized
3 to order the subject to receive assisted outpatient treatment for an
4 initial period not to exceed six months. In fashioning the order, the
5 court shall specifically make findings by clear and convincing evidence
6 that the proposed treatment is the least restrictive treatment appropri-
7 ate and feasible for the subject. The order shall state the categories
8 of assisted outpatient treatment, as set forth in subdivision (a) of
9 this section, which the subject is to receive, and the court may not
10 order treatment that has not been recommended by the examining physician
11 and included in the written treatment plan for assisted outpatient
12 treatment as required by subdivision (i) of this section.
13 (3) If after hearing all relevant evidence the court finds by clear
14 and convincing evidence that the subject of the petition meets the
15 criteria for assisted outpatient treatment, and the court has yet to be
16 provided with a written proposed treatment plan and testimony pursuant
17 to subdivision (i) of this section, the court shall order the director
18 of community services to provide the court with such plan and testimony
19 no later than the third day, excluding Saturdays, Sundays and holidays,
20 immediately following the date of such order. Upon receiving such plan
21 and testimony, the court may order assisted outpatient treatment as
22 provided in paragraph two of this subdivision.
23 (4) A court may order the patient to self-administer psychotropic
24 drugs or accept the administration of such drugs by authorized personnel
25 as part of an assisted outpatient treatment program. Such order may
26 specify the type and dosage range of such psychotropic drugs and such
27 order shall be effective for the duration of such assisted outpatient
28 treatment.
29 (5) If the petitioner is the director of a hospital that operates an
30 assisted outpatient treatment program, the court order shall direct the
31 hospital director to provide or arrange for all categories of assisted
32 outpatient treatment for the assisted outpatient throughout the period
33 of the order. For all other persons, the order shall require the direc-
34 tor of community services of the appropriate local governmental unit to
35 provide or arrange for all categories of assisted outpatient treatment
36 for the assisted outpatient throughout the period of the order.
37 (6) The director or his or her designee shall apply to the court for
38 approval before instituting a proposed material change in the assisted
39 outpatient treatment order unless such change is contemplated in the
40 order. Non-material changes may be instituted by the assisted outpatient
41 treatment program without court approval. For the purposes of this
42 subdivision, a material change shall mean an addition or deletion of a
43 category of assisted outpatient treatment from the order of the court,
44 or any deviation without the patient's consent from the terms of an
45 existing order relating to the administration of psychotropic drugs.
46 Any such application for approval shall be served upon those persons
47 required to be served with notice of a petition for an order authorizing
48 assisted outpatient treatment.
49 (k) Applications for additional periods of treatment. If the director
50 determines that the condition of such patient requires further assisted
51 outpatient treatment, the director shall apply prior to the expiration
52 of the period of assisted outpatient treatment ordered by the court for
53 a second or subsequent order authorizing continued assisted outpatient
54 treatment for a period not to exceed one year from the date of the
55 order. The procedures for obtaining any order pursuant to this subdivi-
56 sion shall be in accordance with the provisions of the foregoing subdi-
A. 8477--A 10
1 visions of this section, provided that the time period included in
2 subparagraphs (i) and (ii) of paragraph four of subdivision (c) of this
3 section shall not be applicable in determining the appropriateness of
4 additional periods of assisted outpatient treatment. Any court order
5 requiring periodic blood tests or urinalysis for the presence of alcohol
6 or illegal drugs shall be subject to review after six months by the
7 physician who developed the written treatment plan or another physician
8 designated by the director, and such physician shall be authorized to
9 terminate such blood tests or urinalysis without further action by the
10 court.
11 (l) Application for an order to stay, vacate or modify. In addition to
12 any other right or remedy available by law with respect to the order for
13 assisted outpatient treatment, the patient, mental hygiene legal
14 service, or anyone acting on the patient's behalf may apply on notice to
15 the appropriate director and the original petitioner, to the court to
16 stay, vacate or modify the order.
17 (m) Appeals. Review of an order issued pursuant to this section shall
18 be had in like manner as specified in section 9.35 of this article.
19 (n) Failure to comply with assisted outpatient treatment. Where in the
20 clinical judgment of a physician, the patient has failed or has refused
21 to comply with the treatment ordered by the court, and in the physi-
22 cian's clinical judgment, efforts were made to solicit compliance, and,
23 in the clinical judgment of such physician, such patient may be in need
24 of involuntary admission to a hospital pursuant to section 9.27 of this
25 article, or for whom immediate observation, care and treatment may be
26 necessary pursuant to section 9.39 or 9.40 of this article, such physi-
27 cian may request the director, the director's designee, or persons
28 designated pursuant to section 9.37 of this article, to direct the
29 removal of such patient to an appropriate hospital for an examination to
30 determine if such person has a mental illness for which hospitalization
31 is necessary pursuant to section 9.27, 9.39 or 9.40 of this article.
32 Furthermore, if such assisted outpatient refuses to take medications as
33 required by the court order, or he or she refuses to take, or fails a
34 blood test, urinalysis, or alcohol or drug test as required by the court
35 order, such physician may consider such refusal or failure when deter-
36 mining whether the assisted outpatient is in need of an examination to
37 determine whether he or she has a mental illness for which hospitaliza-
38 tion is necessary. Upon the request of such physician, the director, the
39 director's designee, or persons designated pursuant to section 9.37 of
40 this article, may direct peace officers, when acting pursuant to their
41 special duties, or police officers who are members of an authorized
42 police department or force or of a sheriff's department to take into
43 custody and transport any such person to the hospital operating the
44 assisted outpatient treatment program or to any hospital authorized by
45 the director of community services to receive such persons. Such law
46 enforcement officials shall carry out such directive. Upon the request
47 of such physician, the director, the director's designee, or person
48 designated pursuant to section 9.37 of this article, an ambulance
49 service, as defined by subdivision two of section three thousand one of
50 the public health law, or an approved mobile crisis outreach team as
51 defined in section 9.58 of this article shall be authorized to take into
52 custody and transport any such person to the hospital operating the
53 assisted outpatient treatment program, or to any other hospital author-
54 ized by the director of community services to receive such persons. Such
55 person may be retained for observation, care and treatment and further
56 examination in the hospital for up to seventy-two hours to permit a
A. 8477--A 11
1 physician to determine whether such person has a mental illness and is
2 in need of involuntary care and treatment in a hospital pursuant to the
3 provisions of this article. Any continued involuntary retention in such
4 hospital beyond the initial seventy-two hour period shall be in accord-
5 ance with the provisions of this article relating to the involuntary
6 admission and retention of a person. If at any time during the seventy-
7 two hour period the person is determined not to meet the involuntary
8 admission and retention provisions of this article, and does not agree
9 to stay in the hospital as a voluntary or informal patient, he or she
10 must be released. Failure to comply with an order of assisted outpatient
11 treatment shall not be grounds for involuntary civil commitment or a
12 finding of contempt of court.
13 (o) Effect of determination that a person is in need of assisted
14 outpatient treatment. The determination by a court that a patient is in
15 need of assisted outpatient treatment under this section shall not be
16 construed as or deemed to be a determination that such patient is inca-
17 pacitated pursuant to article eighty-one of this chapter.
18 (p) False petition. A person making a false statement or providing
19 false information or false testimony in a petition or hearing under this
20 section is subject to criminal prosecution pursuant to article one
21 hundred seventy-five or article two hundred ten of the penal law.
22 (q) Exception. Nothing in this section shall be construed to affect
23 the ability of the director of a hospital to receive, admit, or retain
24 patients who otherwise meet the provisions of this article regarding
25 receipt, retention or admission.
26 (r) Educational materials. The office of mental health, in consulta-
27 tion with the office of court administration, shall prepare educational
28 and training materials on the use of this section, which shall be made
29 available to local governmental units as defined in article forty-one of
30 this chapter, providers of services, judges, court personnel, law
31 enforcement officials and the general public.
32 § 7. Subdivision (h) of section 9.61 of the mental hygiene law, as
33 amended by chapter 338 of the laws of 1999, is amended to read as
34 follows:
35 (h) Applications for additional periods of treatment. If the director
36 of such hospital determines that the condition of such patient requires
37 further involuntary outpatient treatment, the director shall apply prior
38 to the earlier of April first, two thousand or the expiration of the
39 period of involuntary outpatient treatment ordered by the court for an
40 order authorizing continued involuntary outpatient treatment for a peri-
41 od not to exceed one hundred eighty days from the date of the order. The
42 procedures for obtaining any order pursuant to this subdivision shall be
43 in accordance with the provisions of the foregoing subdivisions of this
44 section. The period for further involuntary outpatient treatment author-
45 ized by any subsequent order under this subdivision shall not exceed one
46 hundred eighty days from the date of the order. [Provided, further]
47 Notwithstanding any other provision of law, any order authorizing invol-
48 untary outpatient treatment, issued pursuant to this section shall
49 expire on [August tenth, nineteen hundred ninety-nine, unless otherwise
50 provided by law] or before September thirtieth, two thousand.
51 § 8. Section 6 of chapter 560 of the laws of 1994, amending the judi-
52 ciary law and the mental hygiene law relating to establishing a pilot
53 program of involuntary outpatient treatment, as amended by chapter 338
54 of the laws of 1999, is amended to read as follows:
A. 8477--A 12
1 § 6. This act shall take effect immediately and shall expire [August
2 10, 1999] September 30, 2000 when upon such date the provisions of this
3 act shall be deemed repealed.
4 § 9. Section 9.61 of the mental hygiene law, as added by chapter 678
5 of the laws of 1994, is renumbered section 9.63.
6 § 10. Paragraph 1 of subdivision (e) of section 29.15 of the mental
7 hygiene law, as amended by chapter 789 of the laws of 1985, is amended
8 to read as follows:
9 1. In the case of an involuntary patient on conditional release, the
10 director may terminate the conditional release and order the patient to
11 return to the facility at any time during the period for which retention
12 was authorized, if, in the director's judgment, the patient needs in-pa-
13 tient care and treatment and the conditional release is no longer appro-
14 priate; provided, however, that in any such case, the director shall
15 cause written notice of such patient's return to be given to the mental
16 hygiene legal service. [If, at any time prior to the expiration of thir-
17 ty days from the date of return to the facility, he or any relative or
18 friend or the mental hygiene legal service gives notice in writing to
19 the director of request for hearing on the question of the suitability
20 of such patient's return to the facility, a hearing shall be held pursu-
21 ant to the provisions of this chapter relating to the involuntary admis-
22 sion of a person] The director shall cause the patient to be retained
23 for observation, care and treatment and further examination in a hospi-
24 tal for up to seventy-two hours if a physician on the staff of the
25 hospital determines that such person may have a mental illness and may
26 be in need of involuntary care and treatment in a hospital pursuant to
27 the provisions of article nine of this chapter. Any continued retention
28 in such hospital beyond the initial seventy-two hour period shall be in
29 accordance with the provisions of this chapter relating to the involun-
30 tary admission and retention of a person. If at any time during the
31 seventy-two hour period the person is determined not to meet the invol-
32 untary admission and retention provisions of this chapter, and does not
33 agree to stay in the hospital as a voluntary or informal patient, he or
34 she must be released, either conditionally or unconditionally.
35 § 11. Section 29.19 of the mental hygiene law, as amended by chapter
36 843 of the laws of 1980, is amended to read as follows:
37 § 29.19 Powers and duties of peace officers acting pursuant to their
38 special duties and police officers to apprehend, restrain, and
39 transport persons to facilities.
40 A person who has been committed or admitted to a department facility
41 or a hospital licensed or operated by the office of mental health and
42 who has been reported as escaped therefrom or from lawful custody, or
43 who resists or evades lawful custody; and any patient for whom the
44 director of a hospital operated by the office of mental health, or the
45 director's designee, has terminated a conditional release and ordered
46 such patient to return to such facility; and any patient for whom a
47 director of an assisted outpatient treatment program, as defined in
48 subdivision (a) of section 9.60 of this chapter, or the director's
49 designee, or anyone designated pursuant to section 9.37 of this chapter,
50 has directed the removal to a hospital pursuant to subdivision (n) of
51 section 9.60 of this chapter, may be apprehended, restrained, trans-
52 ported to, and returned to such school or hospital by any peace officer,
53 acting pursuant to his special duties, or any police officer who is a
54 member of an authorized police department or force or of a sheriff's
55 department, and it shall be the duty of any such officer to assist any
56 representative of a department or licensed facility, or an assisted
A. 8477--A 13
1 outpatient treatment program, to take into custody any such person or
2 patient upon the request of such representative, director or designee.
3 § 12. Subdivisions (b) and (d) of section 33.13 of the mental hygiene
4 law, as amended by chapter 912 of the laws of 1984, are amended to read
5 as follows:
6 (b) The commissioners may require that statistical information about
7 patients or clients be reported to the offices. [Names of patients
8 treated at out-patient or non-residential facilities, at hospitals
9 licensed by the office of mental health and at general hospitals shall
10 not be required as part of any such reports.]
11 (d) Nothing in this section shall prevent the electronic or other
12 exchange of information concerning patients or clients, including iden-
13 tification, between and among (i) facilities or others providing
14 services for such patients or clients pursuant to an approved local or
15 unified services plan, as defined in article forty-one of this chapter,
16 or pursuant to agreement with the department, and (ii) the department or
17 any of its licensed or operated facilities. [Information] Furthermore,
18 subject to the prior approval of the commissioner of mental health,
19 hospital emergency services licensed pursuant to article twenty-eight of
20 the public health law shall be authorized to exchange information
21 concerning patients or clients electronically or otherwise with other
22 hospital emergency services licensed pursuant to article twenty-eight of
23 the public health law and/or hospitals licensed or operated by the
24 office of mental health; provided that such exchange of information is
25 consistent with standards, developed by the commissioner of mental
26 health, which are designed to ensure confidentiality of such informa-
27 tion. Additionally, information so exchanged shall be kept confidential
28 and any limitations on the release of such information imposed on the
29 party giving the information shall apply to the party receiving the
30 information.
31 § 13. Subdivision (a) of section 41.13 of the mental hygiene law is
32 amended by adding two new paragraphs 15 and 16 to read as follows:
33 15. administer, supervise or operate any assisted outpatient treatment
34 program of a local governmental unit pursuant to section 9.60 of this
35 chapter and provide that all necessary services are planned for and made
36 available for individuals committed under the program.
37 16. identify and plan for the provision of care coordination, emergen-
38 cy services, and other needed services for persons who are identified as
39 high-need patients, as such term is defined by the commissioner of
40 mental health.
41 § 14. Subdivision (c) of section 47.03 of the mental hygiene law, as
42 added by chapter 789 of the laws of 1985, is amended to read as follows:
43 (c) To provide legal services and assistance to patients or residents
44 and their families related to the admission, retention, and care and
45 treatment of such persons, to provide legal services and assistance to
46 subjects of a petition or patients subject to section 9.60 of this chap-
47 ter, and to inform patients or residents, their families and, in proper
48 cases, others interested in the patients' or residents' welfare of the
49 availability of other legal resources which may be of assistance in
50 matters not directly related to the admission, retention, and care and
51 treatment of such patients or residents;
52 § 15. (a) Within amounts appropriated therefor, the commissioner of
53 mental health shall provide grants to each county and the city of New
54 York, which shall be used by each such county or city, to provide medi-
55 cation, and other services necessary to prescribe and administer medica-
56 tion to treat mental illness during the pendency of a medical assistance
A. 8477--A 14
1 eligibility determination. Such eligibility determination shall be
2 completed in a timely and expeditious manner as required by applicable
3 regulations of the commissioner of health. Counties or the city shall
4 use such grants to provide medications prescribed to treat mental
5 illness for individuals for whom the process of applying for medical
6 assistance benefits has been commenced prior to or within one week of
7 discharge or release and who: (1) are discharged from a hospital, as
8 defined in section 1.03 of the mental hygiene law, or (2) have received
9 services in or from a forensic or similar mental health unit of a
10 correctional facility or local correctional facility as defined in
11 section two of the correction law.
12 (b) Such grants to provide medications shall be subject to the commis-
13 sioner's approval and supervision of an efficient and effective plan
14 submitted by a county or the city of New York. Such plans shall include,
15 but not be limited to, the following: (i) the process by which the coun-
16 ty or the city of New York will improve the timely and expeditious
17 filing of medical assistance applications and coordinate the filing of
18 applications for other public benefits for which the population
19 described in subdivision (a) of this section may be eligible; (ii) the
20 process by which medications prescribed to treat mental illness for such
21 individuals will be available at or near the time of release or
22 discharge; (iii) a specific description of the process by which such
23 individuals will be referred to a county or city provider, or a provider
24 which contracts with the county or city, to provide medication at or
25 near the time of release or discharge; and (iv) the process to provide
26 information necessary for the New York state office of mental health to
27 file appropriate medical assistance claims.
28 (c) Further, upon application of a county or the city of New York, and
29 within the amounts appropriated therefor, the commissioner of mental
30 health shall be authorized to provide grants to such county or city to
31 be used to assist the local governmental units, as defined in section
32 41.03 of the mental hygiene law, in the development of plans pursuant to
33 subdivision (b) of this section, or to be used at local correctional
34 facilities to improve the coordination between the individuals defined
35 in subdivision (a) of this section and the appropriate county represen-
36 tative or other individual who will provide the psychiatric medications
37 available under this program as determined in the plans approved in
38 subdivision (b) of this section, and to assist such individuals in
39 applying for medical assistance and other public benefits. The commis-
40 sioner of mental health is hereby authorized to promulgate and adopt
41 rules and regulations necessary to implement this section.
42 § 16. Report and evaluation. The commissioner of mental health shall
43 issue an interim report on or before January 1, 2003 and a final report
44 on or before March 1, 2005. Such reports shall be submitted to the
45 governor and the chairpersons of the senate and assembly mental health
46 committees, and shall include information concerning the characteristics
47 and demographics of assisted outpatients; the incidence of homelessness,
48 hospitalization and incarceration of patients before assisted outpatient
49 treatment to the extent available, and information on such incidence
50 during assisted outpatient treatment; outcomes of judicial proceedings,
51 including the percentage of petitions for assisted outpatient treatment
52 that are granted by the court; referral outcomes, including the time
53 frames for service delivery; reasons for closed cases; utilization of
54 existing and new services; and recommendations for changes in statute.
55 § 17. Separability clause. If any clause, sentence, paragraph, section
56 or part of this act shall be adjudged by any court of competent juris-
A. 8477--A 15
1 diction to be invalid, such judgment shall not affect, impair or invali-
2 date the remainder thereof, but shall be confined in its operation to
3 the clause, sentence, paragraph, section or part thereof directly
4 involved in the controversy in which such judgment shall have been
5 rendered.
6 § 18. This act shall take effect immediately, provided that section
7 fifteen of this act shall take effect April 1, 2000, provided, further,
8 that subdivision (e) of section 9.60 of the mental hygiene law as added
9 by section six of this act shall be effective 90 days after this act
10 shall become law; and that this act shall expire and be deemed repealed
11 June 30, 2005; and, provided, further, that the amendments to section
12 9.61 of the mental hygiene law made by section seven of this act shall
13 not affect the expiration of such section and shall be deemed to expire
14 therewith.
