senate Bill S4525B

Amended

Authorizes nurse practitioners to admit mentally ill patients

download pdf

Sponsor

Co-Sponsors

Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
view actions

actions

  • 11 / Apr / 2011
    • REFERRED TO MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
  • 06 / Jun / 2011
    • 1ST REPORT CAL.1003
  • 07 / Jun / 2011
    • 2ND REPORT CAL.
  • 13 / Jun / 2011
    • AMENDED 4525A
  • 13 / Jun / 2011
    • ADVANCED TO THIRD READING
  • 16 / Jun / 2011
    • AMENDED ON THIRD READING 4525B
  • 24 / Jun / 2011
    • COMMITTED TO RULES
  • 04 / Jan / 2012
    • REFERRED TO MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES
  • 23 / Jan / 2012
    • 1ST REPORT CAL.89
  • 24 / Jan / 2012
    • 2ND REPORT CAL.
  • 30 / Jan / 2012
    • ADVANCED TO THIRD READING
  • 14 / Feb / 2012
    • PASSED SENATE
  • 14 / Feb / 2012
    • DELIVERED TO ASSEMBLY
  • 14 / Feb / 2012
    • REFERRED TO MENTAL HEALTH
  • 05 / Mar / 2012
    • RECALLED FROM ASSEMBLY
  • 05 / Mar / 2012
    • RETURNED TO SENATE
  • 05 / Mar / 2012
    • VOTE RECONSIDERED - RESTORED TO THIRD READING
  • 05 / Mar / 2012
    • AMENDED ON THIRD READING 4525C
  • 25 / Apr / 2012
    • REPASSED SENATE
  • 25 / Apr / 2012
    • RETURNED TO ASSEMBLY
  • 25 / Apr / 2012
    • REFERRED TO HIGHER EDUCATION

Summary

Authorizes nurse practitioners to admit a patient to an inpatient mental health unit on a voluntary or involuntary basis.

do you support this bill?

Bill Details

Versions:
S4525
S4525A
S4525B
S4525C
Legislative Cycle:
2011-2012
Current Committee:
Assembly Higher Education
Law Section:
Mental Hygiene Law
Laws Affected:
Amd ยงยง1.03, 9.05, 9.27, 9.37, 9.40, 9.55, 9.57 & 9.60, Ment Hyg L
Versions Introduced in 2009-2010 Legislative Cycle:
A11650

Sponsor Memo

BILL NUMBER:S4525B

TITLE OF BILL:
An act
to amend the mental hygiene law, in relation to authorizing nurse
practitioners to admit a patient to an inpatient mental health unit on
a voluntary or involuntary basis

PURPOSE OR GENERAL IDEA OF BILL:
The purpose of his legislation is to allow a nurse practitioner,
acting within their lawful scope of practice, to admit a patient to
an inpatient mental health unit on a voluntary or involuntary basis.

SUMMARY OF SPECIFIC PROVISIONS:
Section 1.03 of the mental hygiene law is amended by adding a new
subdivision 9-a which defines "nurse practitioner". The seotion
heading, the opening paragraph of subdivision (a) and subdivision (b)
of section 9.05 of the mental hygiene law, as renumbered by chapter
978 of the laws of 1977, is amended to include nurse practitioners as
having the authority to admit a patient to an inpatient mental health
unit.

JUSTIFICATION:
Most inpatient admissions currently occur through a psychiatrist.
However, since there is a shortage of psychiatrists in certain areas
of the State, trained nurse practitioners in the specialty of
psychiatry should have the ability to admit patients on a voluntary
or involuntary basis. This legislation would allow nurse
practitioners, acting within their lawful scope of practice, to admit
a patient to an inpatient mental health unit on a voluntary or
involuntary basis.

PRIOR LEGISLATIVE HISTORY:
None.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
Immediately, with provisions.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4525--B
    Cal. No. 1003

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             April 11, 2011
                               ___________

Introduced  by  Sens.  McDONALD,  MONTGOMERY  --  read twice and ordered
  printed, and when printed to be committed to the Committee  on  Mental
  Health  and Developmental Disabilities -- reported favorably from said
  committee, ordered to first  and  second  report,  amended  on  second
  report,  ordered  to  a third reading, and to be reprinted as amended,
  retaining its place in the order of third reading -- again amended and
  ordered reprinted, retaining its place in the order of third reading

AN ACT to amend the mental hygiene law, in relation to authorizing nurse
  practitioners to admit a patient to an inpatient mental health unit on
  a voluntary or involuntary basis

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 1.03 of the mental hygiene law is amended by adding
a new subdivision 9-a to read as follows:
  9-A.  "NURSE PRACTITIONER" MEANS A CERTIFIED NURSE PRACTITIONER ACTING
WITHIN  HIS  OR  HER  LAWFUL  SCOPE  OF  PRACTICE  PURSUANT  TO  SECTION
SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW.
  S 2. The section heading, the opening paragraph of subdivision (a) and
subdivision  (b) of section 9.05 of the mental hygiene law, such section
as renumbered by chapter 978 of the laws of 1977, are amended to read as
follows:
  Examining physicians and NURSE PRACTITIONERS AND medical certificates.
  A person is disqualified from acting  as  an  examining  physician  OR
NURSE PRACTITIONER in the following cases:
  (b)  A  certificate,  as  required by this article, must show that the
person is mentally ill and shall be  based  on  an  examination  of  the
person alleged to be mentally ill made within ten days prior to the date
of  admission.  The  date  of  the certificate shall be the date of such
examination. All certificates shall contain the facts and  circumstances
upon  which  the  judgment  of  the physicians OR NURSE PRACTITIONERS is
based and shall show that the condition of the person examined  is  such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03971-06-1

S. 4525--B                          2

that  he  OR  SHE needs involuntary care and treatment in a hospital and
such other information as the commissioner may by regulation require.
  S 3.  Subdivisions (a), (d), (e) and (i) of section 9.27 of the mental
hygiene  law,  subdivision  (i) as amended by chapter 847 of the laws of
1987 and such section as renumbered by chapter 978 of the laws of  1977,
are amended to read as follows:
  (a)  The  director  of  a hospital may receive and retain therein as a
patient any person alleged to be mentally ill and in need of involuntary
care and treatment upon [the] TWO certificates [of two examining  physi-
cians],   EACH   COMPLETED   BY   AN  EXAMINING  PHYSICIAN  OR  A  NURSE
PRACTITIONER, accompanied by an application for the  admission  of  such
person.  The  examination  may  be  conducted jointly but each examining
physician OR NURSE PRACTITIONER shall execute a separate certificate.
  (d) Before an examining physician OR NURSE PRACTITIONER completes  the
certificate  of  examination of a person for involuntary care and treat-
ment, he OR SHE shall consider alternative forms of care  and  treatment
that might be adequate to provide for the person's needs without requir-
ing  involuntary  hospitalization.  If  the examining physician OR NURSE
PRACTITIONER knows that the person he OR SHE is examining  for  involun-
tary care and treatment has been under prior treatment, he OR SHE shall,
insofar as possible, consult with the physician or psychologist furnish-
ing  such  prior  treatment  prior to completing his OR HER certificate.
Nothing in this section shall prohibit  or  invalidate  any  involuntary
admission made in accordance with the provisions of this chapter.
  (e)  The  director  of the hospital where such person is brought shall
cause such person to be examined forthwith by a physician, OTHER THAN AN
EXAMINING PHYSICIAN WHOSE CERTIFICATE ACCOMPANIED THE  APPLICATION,  who
shall  be a member of the psychiatric staff of such hospital [other than
the original examining  physicians  whose  certificate  or  certificates
accompanied  the  application and, if]. IF such person is found to be in
need of involuntary care and treatment, he OR SHE may be admitted there-
to as a patient as herein provided.
  (i) After an application for  the  admission  of  a  person  has  been
completed  [and both physicians have examined such person and separately
certified either], AND TWO SEPARATE CERTIFICATES, EACH COMPLETED  BY  AN
EXAMINING  PHYSICIAN  OR  A  NURSE  PRACTITIONER, SHOW that he or she is
mentally ill and in need of involuntary care and treatment in  a  hospi-
tal, ANY EXAMINING physician OR NURSE PRACTITIONER MAKING SUCH A CERTIF-
ICATION is authorized to request peace officers, when acting pursuant to
their  special duties, or police officers, who are members of an author-
ized police department or force or of a sheriff's  department,  to  take
into  custody  and transport such person to a hospital for determination
by the director whether such person qualifies for admission pursuant  to
this  section.  Upon  the request of [either] ANY EXAMINING physician OR
NURSE PRACTITIONER MAKING SUCH A CERTIFICATION, an ambulance service, as
defined by subdivision two of section three thousand one of  the  public
health  law,  is  authorized  to transport such person to a hospital for
determination by the director whether such person qualifies  for  admis-
sion pursuant to this section.
  S  4.  Subdivisions  (a),  (b)  and  (c) of section 9.37 of the mental
hygiene law, subdivision (a) as amended by chapter 723 of  the  laws  of
1989,  subdivision (c) as amended by chapter 230 of the laws of 2004 and
such section as renumbered by chapter 978  of  the  laws  of  1977,  are
amended to read as follows:
  (a)  The  director  of  a  hospital, upon application by a director of
community services or an examining physician duly designated by  him  or

S. 4525--B                          3

her,  may  receive and care for in such hospital as a patient any person
who, in the opinion of the director of community services or the  direc-
tor's  designee, has a mental illness for which immediate inpatient care
and treatment in a hospital is appropriate and which is likely to result
in serious harm to himself or herself or others.
  The  need  for immediate hospitalization shall be confirmed by a staff
physician OR NURSE PRACTITIONER of  the  hospital  prior  to  admission.
Within  seventy-two  hours,  excluding  Sunday  and holidays, after such
admission, if such patient is to be  retained  for  care  and  treatment
beyond such time and he or she does not agree to remain in such hospital
as  a  voluntary patient, the certificate of another examining physician
OR NURSE PRACTITIONER who is a member of the psychiatric  staff  of  the
hospital  that  the patient is in need of involuntary care and treatment
shall be filed with the hospital. From the time of his or her  admission
under  this section the retention of such patient for care and treatment
shall be subject to the provisions  for  notice,  hearing,  review,  and
judicial  approval  of  continued  retention  or  transfer and continued
retention provided by this article for the admission  and  retention  of
involuntary   patients,   provided   that,  for  the  purposes  of  such
provisions, the date of admission of the patient shall be deemed  to  be
the  date when the patient was first received in the hospital under this
section.
  (b) The application for  admission  of  a  patient  pursuant  to  this
section  shall  be  based  upon  a personal examination by a director of
community services or his OR HER designee. It shall be  in  writing  and
shall  be  filed  with  the director of such hospital at the time of the
patient's reception, together with a statement in a form  prescribed  by
the commissioner giving such information as he OR SHE may deem appropri-
ate.
  (c) Notwithstanding the provisions of subdivision (b) of this section,
in  counties  with  a  population  of  less than two hundred thousand, a
director of community services who is a licensed  psychologist  pursuant
to  article  one  hundred fifty-three of the education law or a licensed
clinical social worker pursuant to article one hundred fifty-four of the
education law but who is not a physician may apply for the admission  of
a  patient  pursuant  to this section without a medical examination by a
designated physician, if a hospital approved by the commissioner  pursu-
ant  to  section 9.39 of this article is not located within thirty miles
of the patient, and the  director  of  community  services  has  made  a
reasonable  effort to locate a designated examining physician but such a
designee is not immediately available  and  the  director  of  community
services,  after personal observation of the person, reasonably believes
that he OR SHE may have a mental illness which is likely  to  result  in
serious  harm  to  himself  OR  HERSELF or others and inpatient care and
treatment of such person in a hospital may be appropriate. In the  event
of  an  application  pursuant  to this subdivision, a STAFF physician OR
NURSE PRACTITIONER of the receiving hospital shall examine  the  patient
and  shall  not  admit  the patient unless he or she determines that the
patient has a mental illness for  which  immediate  inpatient  care  and
treatment  in a hospital is appropriate and which is likely to result in
serious harm to himself OR HERSELF or others. If the patient  is  admit-
ted,  the  need  for hospitalization shall be confirmed by another staff
physician OR NURSE PRACTITIONER within twenty-four hours. An application
pursuant to this subdivision shall be in writing and shall be filed with
the director of such hospital at the time of  the  patient's  reception,
together  with  a  statement  in  a  form prescribed by the commissioner

S. 4525--B                          4

giving such information as he OR SHE may deem appropriate,  including  a
statement  of  the efforts made by the director of community services to
locate a designated examining physician prior to making  an  application
pursuant to this subdivision.
  S  5.    Subdivision  (a) of section 9.37 of the mental hygiene law is
amended to read as follows:
  (a) The director of a hospital, upon  application  by  a  director  of
community  services  or an examining physician duly designated by him OR
HER, may receive and care for in such hospital as a patient  any  person
who,  in the opinion of the director of community services or his OR HER
designee, has a mental illness for which immediate  inpatient  care  and
treatment  in a hospital is appropriate and which is likely to result in
serious harm to himself OR HERSELF or TO others[; "likelihood of serious
harm" shall mean:
  1. substantial risk of physical  harm  to  himself  as  manifested  by
threats  of  or  attempts  at  suicide  or  serious bodily harm or other
conduct demonstrating that he is dangerous to himself, or
  2. a substantial risk of physical harm to other persons as  manifested
by  homicidal  or  other  violent behavior by which others are placed in
reasonable fear or serious physical harm].
  The need for immediate hospitalization shall be confirmed by  a  staff
physician  OR  NURSE  PRACTITIONER  of  the hospital prior to admission.
Within seventy-two hours, excluding  Sunday  and  holidays,  after  such
admission,  if  such  patient  is  to be retained for care and treatment
beyond such time and he OR SHE does not agree to remain in such hospital
as a voluntary patient, the certificate of another  examining  physician
OR  NURSE  PRACTITIONER  who is a member of the psychiatric staff of the
hospital that the patient is in need of involuntary care  and  treatment
shall  be filed with the hospital. From the time of his OR HER admission
under this section the retention of such patient for care and  treatment
shall  be  subject  to  the  provisions for notice, hearing, review, and
judicial approval of  continued  retention  or  transfer  and  continued
retention  provided  by  this article for the admission and retention of
involuntary  patients,  provided  that,  for  the   purposes   of   such
provisions,  the  date of admission of the patient shall be deemed to be
the date when the patient was first received in the hospital under  this
section.
  S  6.   Subdivisions (b) and (c) of section 9.40 of the mental hygiene
law, as added by chapter 723 of the laws of 1989, are amended to read as
follows:
  (b) The director shall cause examination of such persons to be  initi-
ated  by  a staff physician OR NURSE PRACTITIONER of the program as soon
as practicable [and in any event within], BUT NO LONGER THAN  six  hours
after  the  person  is  received into the program's emergency room. Such
person may be retained for observation, care and treatment, and  further
examination  for  up  to twenty-four hours if, at the conclusion of such
examination, such physician OR NURSE PRACTITIONER determines  that  such
person  may  have a mental illness for which immediate observation, care
and treatment in a comprehensive psychiatric emergency program is appro-
priate, and which is likely to result in serious harm to the  person  or
others.
  (c)  No person shall be involuntarily retained in accordance with this
section for more than twenty-four hours, unless (i) within that time the
determination of the INITIAL examining staff physician OR NURSE  PRACTI-
TIONER  has  been  confirmed  after  examination by another physician OR
NURSE PRACTITIONER who is a member  of  the  psychiatric  staff  of  the

S. 4525--B                          5

program  and (ii) the person is admitted to an extended observation bed,
as such term is defined in section 31.27 of this chapter. At the time of
admission to an extended observation bed, such person  shall  be  served
with  written  notice of his OR HER status and rights as a patient under
this section. Such notice shall contain the patient's name.  The  notice
shall  be  provided to the same persons and in the manner as if provided
pursuant to subdivision (a) of section 9.39  of  this  article.  Written
requests for court hearings on the question of need for immediate obser-
vation,  care  and  treatment shall be made, and court hearings shall be
scheduled and held, in the manner provided pursuant to  subdivision  (a)
of  section  9.39  of  this  article,  provided  however, if a person is
removed or admitted to a hospital pursuant to subdivision (e) or (f)  of
this  section the director of such hospital shall be substituted for the
director of the comprehensive psychiatric emergency program in all legal
proceedings regarding the continued retention of the person.
  S 7. Section 9.55 of the mental hygiene law, as amended by chapter 598
of the laws of 1994, is amended to read as follows:
S 9.55 Emergency admissions for immediate observation, care  and  treat-
         ment; powers of qualified psychiatrists OR NURSE PRACTITIONERS.
  A qualified psychiatrist OR NURSE PRACTITIONER shall have the power to
direct the removal of any person[,] whose treatment for a mental illness
he  or  she is either supervising or providing in a facility licensed or
operated by the office of mental health, which does not  have  an  inpa-
tient  psychiatric  service,  to a hospital approved by the commissioner
pursuant to subdivision (a) of section 9.39 of  this  article  or  to  a
comprehensive  psychiatric  emergency  program,  if he or she determines
upon examination of such person that  such  person  appears  to  have  a
mental  illness for which immediate observation, care and treatment in a
hospital is appropriate and which is likely to result  in  serious  harm
[to  himself  or  herself  or others] AS DEFINED IN SECTION 9.01 OF THIS
ARTICLE.  Upon the request of such qualified psychiatrist OR NURSE PRAC-
TITIONER, peace officers, when acting pursuant to their special  duties,
or police officers[,] who are members of an authorized police department
or force or of a sheriff's department shall take into custody and trans-
port  any  such  person. Upon the request of a qualified psychiatrist OR
NURSE PRACTITIONER an ambulance service, as defined by  subdivision  two
of section three thousand one of the public health law, is authorized to
transport  any such person. Such person may then be admitted to a hospi-
tal in accordance with the provisions of section 9.39 of this article or
to a comprehensive psychiatric emergency program in accordance with  the
provisions of section 9.40 of this article.
  S 8. Section 9.55 of the mental hygiene law, as amended by chapter 847
of the laws of 1987, is amended to read as follows:
S 9.55 Emergency  admissions  for immediate observation, care and treat-
         ment; powers of qualified psychiatrists OR NURSE PRACTITIONERS.
  A qualified psychiatrist OR NURSE PRACTITIONER shall have the power to
direct the removal of any person[,] whose treatment for a mental illness
he OR SHE is either supervising or providing in a facility  licensed  or
operated  by  the  office of mental health, which does not have an inpa-
tient psychiatric service, to a hospital approved  by  the  commissioner
pursuant  to  subdivision  (a)  of section 9.39 of this article, OR TO A
COMPREHENSIVE PSYCHIATRIC EMERGENCY PROGRAM if he OR SHE determines upon
examination of such person that such person appears  to  have  a  mental
illness  for which immediate observation, care and treatment in a hospi-
tal is appropriate and which is likely to result  in  serious  harm  [to
himself  or  others], as defined in section [9.39] 9.01 of this article.

S. 4525--B                          6

Upon the request of such qualified psychiatrist OR  NURSE  PRACTITIONER,
peace  officers, when acting pursuant to their special duties, or police
officers[,] who are members of an authorized police department or  force
or  of  a sheriff's department shall take into custody and transport any
such person. Upon the request of a qualified psychiatrist OR NURSE PRAC-
TITIONER an ambulance service, as defined by subdivision two of  section
three  thousand one of the public health law, is authorized to transport
any such person. Such person may then be admitted in accordance with the
provisions of section 9.39 of this article.
  S 9. Section 9.57 of the mental hygiene law, as amended by chapter 598
of the laws of 1994, is amended to read as follows:
S 9.57 Emergency admissions for immediate observation, care  and  treat-
           ment;  powers  of  emergency room physicians OR NURSE PRACTI-
           TIONERS.
  A physician OR NURSE PRACTITIONER who has  examined  a  person  in  an
emergency  room  or  provided  emergency  medical  services at a general
hospital, as defined in article twenty-eight of the public  health  law,
which  does not have an inpatient psychiatric service, or a physician OR
NURSE PRACTITIONER who has examined a person in a comprehensive  psychi-
atric emergency program shall be authorized to request that the director
of  the  program  or  hospital,  or  the director's designee, direct the
removal of such person to a hospital approved by the commissioner pursu-
ant to subdivision (a) of section 9.39 of this article or to  a  compre-
hensive psychiatric emergency program, if the physician OR NURSE PRACTI-
TIONER  determines  upon  examination  of  such  person that such person
appears to have a mental illness for which immediate care and  treatment
in  a  hospital  is appropriate and which is likely to result in serious
harm [to himself or others] AS DEFINED IN SECTION 9.01 OF THIS  ARTICLE.
Upon the request of the physician OR NURSE PRACTITIONER, the director of
the  program  or  hospital  or the director's designee, is authorized to
direct peace officers, when acting pursuant to their special duties,  or
police officers[,] who are members of an authorized police department or
force  or  of  a sheriff's department to take into custody and transport
any such person. Upon the request of  an  emergency  room  physician,  A
NURSE  PRACTITIONER,  or the director of the program or hospital, or the
director's designee, an ambulance service, as defined by subdivision two
of section three thousand one of the public health law, is authorized to
take into custody and transport any such person. Such person may then be
admitted to a hospital in accordance with the provisions of section 9.39
of this article or to a comprehensive psychiatric emergency  program  in
accordance with the provisions of section 9.40 of this article.
  S  10.  Section  9.57 of the mental hygiene law, as amended by chapter
847 of the laws of 1987, is amended to read as follows:
S 9.57 Emergency admissions for immediate observation, care  and  treat-
           ment;  powers  of  emergency room physicians OR NURSE PRACTI-
           TIONERS.
  A physician OR NURSE PRACTITIONER who has  examined  a  person  in  an
emergency  room  or  provided  emergency  medical  services at a general
hospital, as defined in article twenty-eight of the public  health  law,
which  does  not have an inpatient psychiatric service, shall be author-
ized to request that the director of the hospital, or his OR HER  desig-
nee,  direct  the  removal  of such person to a hospital approved by the
commissioner pursuant to subdivision (a) of section 9.39 of  this  arti-
cle,  if the physician OR NURSE PRACTITIONER determines upon examination
of such person that such person appears to have  a  mental  illness  for
which  immediate  care  and  treatment  in a hospital is appropriate and

S. 4525--B                          7

which is likely to result in serious harm [to  himself  or  others],  as
defined  in section [9.39] 9.01 of this article. Upon the request of the
physician OR NURSE PRACTITIONER, the director of the hospital or his  OR
HER designee, is authorized to direct peace officers, when acting pursu-
ant  to  their special duties, or police officers, who are members of an
authorized police department or force or of a  sheriff's  department  to
take  into custody and transport any such person. Upon the request of an
emergency room physician, A NURSE PRACTITIONER, or the director  of  the
hospital,  or  his  OR HER designee, an ambulance service, as defined by
subdivision two of section three thousand one of the public health  law,
is  authorized  to take into custody and transport any such person. Such
person may then be admitted in accordance with the provisions of section
9.39 of this article.
  S 11. Subparagraph (v) of paragraph 1 and paragraphs 3 and 4 of subdi-
vision (e) and subdivisions (h), (i), (k) and (n) of section 9.60 of the
mental hygiene law, as amended and paragraph 4  of  subdivision  (e)  as
added  by  chapter  158  of  the  laws  of  2005, are amended to read as
follows:
  (v) a qualified psychiatrist  OR  NURSE  PRACTITIONER  who  is  either
supervising the treatment of or treating the subject of the petition for
a mental illness; or
  (3)  The  petition shall be accompanied by an affirmation or affidavit
of a physician OR NURSE PRACTITIONER, who shall not be  the  petitioner,
stating either that:
  (i)  such  physician OR NURSE PRACTITIONER has personally examined the
subject of the petition no more than ten days prior to the submission of
the petition, recommends assisted outpatient treatment for  the  subject
of  the  petition,  and is willing and able to testify at the hearing on
the petition; or
  (ii) no more than ten days prior to the filing of the  petition,  such
physician OR NURSE PRACTITIONER, or his or her designee, has made appro-
priate attempts but has not been successful in eliciting the cooperation
of  the subject of the petition to submit to an examination, such physi-
cian OR NURSE PRACTITIONER has reason to suspect that the subject of the
petition meets the criteria for assisted outpatient treatment, and  such
physician  OR  NURSE  PRACTITIONER  is  willing  and able to examine the
subject of the petition and testify at the hearing on the petition.
  (4) In counties with a population of less than seventy-five  thousand,
the  affirmation or affidavit required by paragraph three of this subdi-
vision may be made by a  physician  OR  NURSE  PRACTITIONER  who  is  an
employee  of the office.  The office is authorized to make available, at
no cost to the county, a qualified physician OR NURSE  PRACTITIONER  for
the  purpose of making such affirmation or affidavit consistent with the
provisions of such paragraph.
  (h) Hearing. (1) Upon receipt of the petition, the court shall fix the
date for a hearing. Such date shall be no later than three days from the
date such petition  is  received  by  the  court,  excluding  Saturdays,
Sundays  and  holidays.  Adjournments  shall  be permitted only for good
cause shown. In granting adjournments, the court shall consider the need
for further examination by a physician  OR  NURSE  PRACTITIONER  or  the
potential  need  to provide assisted outpatient treatment expeditiously.
The court shall cause the subject of  the  petition,  any  other  person
receiving  notice pursuant to subdivision (f) of this section, the peti-
tioner, the physician OR NURSE PRACTITIONER whose affirmation or affida-
vit accompanied the petition, and such other persons as  the  court  may
determine to be advised of such date. Upon such date, or upon such other

S. 4525--B                          8

date  to  which  the  proceeding  may be adjourned, the court shall hear
testimony and, if it be deemed advisable and the subject of the petition
is available, examine the subject of the petition in or out of court. If
the  subject  of the petition does not appear at the hearing, and appro-
priate attempts to elicit the attendance of the subject have failed, the
court may conduct the hearing in the subject's absence.  In  such  case,
the  court  shall set forth the factual basis for conducting the hearing
without the presence of the subject of the petition.
  (2) The court shall not order assisted outpatient treatment unless  an
examining  physician  OR  NURSE  PRACTITIONER,  who  recommends assisted
outpatient treatment and has personally  examined  the  subject  of  the
petition no more than ten days before the filing of the petition, testi-
fies  in  person  at  the  hearing. Such physician OR NURSE PRACTITIONER
shall state the facts and  clinical  determinations  which  support  the
allegation  that  the subject of the petition meets each of the criteria
for assisted outpatient treatment.
  (3) If the subject of the petition has refused to  be  examined  by  a
physician  OR  NURSE  PRACTITIONER, the court may request the subject to
consent to an examination by a physician OR NURSE PRACTITIONER appointed
by the court. If the subject of the petition does not  consent  and  the
court  finds  reasonable  cause  to  believe that the allegations in the
petition are true, the court may order peace officers,  acting  pursuant
to  their  special  duties,  or  police  officers  who are members of an
authorized police department or force, or of a sheriff's  department  to
take  the  subject of the petition into custody and transport him or her
to a hospital for examination by a physician. Retention of  the  subject
of the petition under such order shall not exceed twenty-four hours. The
examination  of  the  subject  of  the  petition may be performed by the
physician OR NURSE PRACTITIONER whose affirmation or affidavit  accompa-
nied the petition pursuant to paragraph three of subdivision (e) of this
section,  if  such physician OR NURSE PRACTITIONER is privileged by such
hospital or otherwise authorized by such hospital  to  do  so.  If  such
examination is performed by another physician OR NURSE PRACTITIONER, the
examining physician OR NURSE PRACTITIONER may consult with the physician
OR  NURSE  PRACTITIONER  whose  affirmation or affidavit accompanied the
petition as to whether the  subject  meets  the  criteria  for  assisted
outpatient treatment.
  (4)  A physician OR NURSE PRACTITIONER who testifies pursuant to para-
graph two of this subdivision shall state: (i) the facts  which  support
the  allegation that the subject meets each of the criteria for assisted
outpatient treatment, (ii) that the treatment is the  least  restrictive
alternative,  (iii)  the  recommended assisted outpatient treatment, and
(iv) the rationale for the recommended assisted outpatient treatment. If
the recommended assisted outpatient treatment includes medication,  such
physician's  OR  NURSE PRACTITIONER'S testimony shall describe the types
or classes of medication which should be authorized, shall describe  the
beneficial  and  detrimental physical and mental effects of such medica-
tion, and shall recommend whether such medication should be  self-admin-
istered or administered by authorized personnel.
  (5)  The  subject  of the petition shall be afforded an opportunity to
present evidence, to call witnesses on his or her behalf, and to  cross-
examine adverse witnesses.
  (i)  Written  treatment  plan.  (1) The court shall not order assisted
outpatient treatment unless a physician OR NURSE PRACTITIONER  appointed
by  the appropriate director, in consultation with such director, devel-
ops and provides to the court a proposed  written  treatment  plan.  The

S. 4525--B                          9

written  treatment plan shall include case management services or asser-
tive community treatment team services to provide care coordination. The
written treatment plan also shall include all categories of services, as
set  forth  in  paragraph  one of subdivision (a) of this section, which
such physician OR NURSE PRACTITIONER recommends that the subject of  the
petition  receive.  All  service  providers  shall be notified regarding
their inclusion in the written treatment plan. If the written  treatment
plan  includes medication, it shall state whether such medication should
be self-administered or administered by authorized personnel, and  shall
specify type and dosage range of medication most likely to provide maxi-
mum  benefit  for  the  subject.  If the written treatment plan includes
alcohol or substance abuse  counseling  and  treatment,  such  plan  may
include  a  provision  requiring  relevant testing for either alcohol or
illegal substances provided  the  physician's  OR  NURSE  PRACTITIONER'S
clinical  basis for recommending such plan provides sufficient facts for
the court to find (i) that such person  has  a  history  of  alcohol  or
substance  abuse  that  is clinically related to the mental illness; and
(ii) that such testing is necessary to  prevent  a  relapse  or  deteri-
oration which would be likely to result in serious harm to the person or
others.  If  a  director  is  the petitioner, the written treatment plan
shall be provided to the court no later than the date of the hearing  on
the  petition. If a person other than a director is the petitioner, such
plan shall be provided to the court no later than the date  set  by  the
court pursuant to paragraph three of subdivision (j) of this section.
  (2) The physician OR NURSE PRACTITIONER appointed to develop the writ-
ten  treatment plan shall provide the following persons with an opportu-
nity to actively participate  in  the  development  of  such  plan:  the
subject  of  the petition; the treating physician OR NURSE PRACTITIONER,
if any; and upon the request of the subject of the petition, an individ-
ual significant to the subject including any relative, close  friend  or
individual  otherwise  concerned with the welfare of the subject. If the
subject of the petition has executed a health care proxy, the  appointed
physician  OR  NURSE PRACTITIONER shall consider any directions included
in such proxy in developing the written treatment plan.
  (3) The court shall not order assisted outpatient treatment  unless  a
physician OR NURSE PRACTITIONER appearing on behalf of a director testi-
fies  to  explain the written proposed treatment plan. Such physician OR
NURSE PRACTITIONER shall state the  categories  of  assisted  outpatient
treatment recommended, the rationale for each such category, facts which
establish that such treatment is the least restrictive alternative, and,
if  the  recommended assisted outpatient treatment plan includes medica-
tion, such physician OR NURSE PRACTITIONER  shall  state  the  types  or
classes  of medication recommended, the beneficial and detrimental phys-
ical and mental effects of such medication, and whether such  medication
should  be  self-administered  or  administered by an authorized profes-
sional. If the subject of the petition has executed a health care proxy,
such physician OR NURSE PRACTITIONER shall state the consideration given
to any directions included in  such  proxy  in  developing  the  written
treatment  plan.  If a director is the petitioner, testimony pursuant to
this paragraph shall be given at the  hearing  on  the  petition.  If  a
person  other than a director is the petitioner, such testimony shall be
given on the date set by the court pursuant to paragraph three of subdi-
vision (j) of this section.
  (k) Petition for additional periods of treatment. Within  thirty  days
prior  to  the  expiration of an order of assisted outpatient treatment,
the appropriate director or the current petitioner, if the current peti-

S. 4525--B                         10

tion was filed pursuant to subparagraph (i) or (ii) of paragraph one  of
subdivision  (e) of this section, and the current petitioner retains his
or her original status pursuant  to  the  applicable  subparagraph,  may
petition  the court to order continued assisted outpatient treatment for
a period not to exceed one year from the expiration date of the  current
order.  If the court's disposition of such petition does not occur prior
to the expiration date of the current order,  the  current  order  shall
remain  in  effect  until such disposition. The procedures for obtaining
any order pursuant to this subdivision shall be in accordance  with  the
provisions  of the foregoing subdivisions of this section; provided that
the time restrictions included in paragraph four of subdivision  (c)  of
this section shall not be applicable. The notice provisions set forth in
paragraph  six  of  subdivision (j) of this section shall be applicable.
Any court order requiring periodic blood tests  or  urinalysis  for  the
presence  of  alcohol  or illegal drugs shall be subject to review after
six months by the physician OR  NURSE  PRACTITIONER  who  developed  the
written treatment plan or another physician OR NURSE PRACTITIONER desig-
nated by the director, and such physician OR NURSE PRACTITIONER shall be
authorized  to  terminate such blood tests or urinalysis without further
action by the court.
  (n) Failure to comply with assisted outpatient treatment. Where in the
clinical judgment of a physician OR NURSE PRACTITIONER, (i) the assisted
outpatient, has failed or refused to comply with the assisted outpatient
treatment, (ii) efforts were made to solicit compliance, and (iii)  such
assisted  outpatient may be in need of involuntary admission to a hospi-
tal pursuant to section 9.27 of this article or  immediate  observation,
care  and  treatment  pursuant  to section 9.39 or 9.40 of this article,
such physician OR NURSE PRACTITIONER may request the director of  commu-
nity  services, the director's designee, or any physician OR NURSE PRAC-
TITIONER designated by the director of community  services  pursuant  to
section  9.37  of  this  article, to direct the removal of such assisted
outpatient to an appropriate hospital for an examination to determine if
such person has a mental illness for which hospitalization is  necessary
pursuant  to section 9.27, 9.39 or 9.40 of this article. Furthermore, if
such assisted outpatient refuses to take medications as required by  the
court order, or he or she refuses to take, or fails a blood test, urina-
lysis,  or  alcohol  or  drug  test as required by the court order, such
physician OR NURSE PRACTITIONER may consider  such  refusal  or  failure
when  determining whether the assisted outpatient is in need of an exam-
ination to determine whether he or she has a mental  illness  for  which
hospitalization  is  necessary.  Upon  the  request of such physician OR
NURSE PRACTITIONER, the director, the director's designee, or any physi-
cian OR NURSE PRACTITIONER designated pursuant to section 9.37  of  this
article,  may  direct  peace  officers, acting pursuant to their special
duties, or police officers who  are  members  of  an  authorized  police
department  or  force  or of a sheriff's department to take the assisted
outpatient into custody and transport him or her to the hospital operat-
ing the assisted outpatient treatment program or to any hospital author-
ized by the director of community services to receive such persons. Such
law enforcement officials shall  carry  out  such  directive.  Upon  the
request  of  such  physician  OR  NURSE  PRACTITIONER, the director, the
director's designee, or any physician OR NURSE  PRACTITIONER  designated
pursuant  to  section  9.37  of  this  article, an ambulance service, as
defined by subdivision two of section three thousand one of  the  public
health  law,  or  an  approved mobile crisis outreach team as defined in
section 9.58 of this article shall be authorized to  take  into  custody

S. 4525--B                         11

and  transport  any  such  person to the hospital operating the assisted
outpatient treatment program, or to any other hospital authorized by the
director of community services to receive such persons. Any director  of
community  services,  or  designee,  shall  be  authorized to direct the
removal of an assisted outpatient who is present in his or her county to
an appropriate hospital, in  accordance  with  the  provisions  of  this
subdivision,  based  upon a determination of the appropriate director of
community services directing the removal  of  such  assisted  outpatient
pursuant  to  this subdivision. Such person may be retained for observa-
tion, care and treatment and further examination in the hospital for  up
to  seventy-two  hours  to  permit  a physician OR NURSE PRACTITIONER to
determine whether such person has a mental illness and  is  in  need  of
involuntary  care and treatment in a hospital pursuant to the provisions
of this article. Any continued involuntary retention  in  such  hospital
beyond  the  initial seventy-two hour period shall be in accordance with
the provisions of this article relating to the involuntary admission and
retention of a person. If at any time during the seventy-two hour period
the person is determined not  to  meet  the  involuntary  admission  and
retention  provisions of this article, and does not agree to stay in the
hospital as a voluntary or informal patient, he or she must be released.
Failure to comply with an order of assisted outpatient  treatment  shall
not be grounds for involuntary civil commitment or a finding of contempt
of court.
  S 12. This act shall take effect immediately; provided, however, that:
  a.  The  amendments  to  subdivision (a) of section 9.37 of the mental
hygiene law made by section four of this act shall  be  subject  to  the
expiration  and  reversion of such subdivision pursuant to section 21 of
chapter 723 of the laws of 1989, as amended, when  upon  such  date  the
provisions of section five of this act shall take effect;
  b.  The  amendments to subdivisions (b) and (c) of section 9.40 of the
mental hygiene law made by section six of this act shall not affect  the
repeal of such section and shall be deemed repealed therewith;
  c.  The amendments to sections 9.55 and 9.57 of the mental hygiene law
made by sections seven and nine of this act  shall  be  subject  to  the
expiration  and  reversion  of  such  sections pursuant to section 21 of
chapter 723 of the laws of 1989, as amended, when  upon  such  date  the
provisions of sections eight and ten of this act shall take effect; and
  d.  The  amendments  to section 9.60 of the mental hygiene law made by
section eleven of this act shall not affect the repeal of  such  section
and shall be deemed repealed therewith.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.