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

                                 4525--A
    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

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.
                                                           LBD03971-04-1
              

S. 4525--A                          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 A PHYSICIAN OR A NURSE PRACTITIONER,  accompa-
nied by an application for the admission of such person. The examination
may  be  conducted jointly but each examining physician OR NURSE PRACTI-
TIONER 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], AND TWO SEPARATE CERTIFICATES, EACH COMPLETED BY AN  EXAMIN-
ING  PHYSICIAN  OR A NURSE PRACTITIONER, SHOW that he or she is mentally
ill and in need  of  involuntary  care  and  treatment  in  a  hospital,
[either]  ANY  EXAMINING  physician  OR NURSE PRACTITIONER MAKING SUCH A
CERTIFICATION is authorized  to  request  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 such person to a hospital for  deter-
mination  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 ambu-
lance 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  quali-
fies for admission 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--A                          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, HERSELF or others. If the patient is  admitted,
the  need for hospitalization shall be confirmed by another staff physi-
cian 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--A                          4

giving  such  information as he may deem appropriate, including a state-
ment 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, HERSELF  or  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--A                          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 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 pursu-
ant to subdivision (a) of section 9.39 of this article. Written requests
for court hearings on the question of need  for  immediate  observation,
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 admit-
ted 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  PRACTITION-
           ERS.
  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  PRACTITION-
           ERS.
  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 inpatient
psychiatric service, to a hospital approved by the commissioner pursuant
to  subdivision  (a) of section 9.39 of this article, OR TO A COMPREHEN-
SIVE PSYCHIATRIC EMERGENCY PROGRAM if he OR SHE determines upon examina-
tion of such person that such person appears to have  a  mental  illness
for  which  immediate  observation,  care and treatment in a hospital is

S. 4525--A                          6

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.  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  PRACTI-
TIONER  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

S. 4525--A                          7

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 [9.39] 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
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
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-

S. 4525--A                          8

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
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

S. 4525--A                          9

by the appropriate director, in consultation with such director,  devel-
ops  and  provides  to  the court a proposed written treatment plan. The
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.

S. 4525--A                         10

  (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-
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

S. 4525--A                         11

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
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:
  1.  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;
  2.  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;
  3.  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 six and eight of this act shall take effect; and
  4.  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.

                            
                    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.

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

                                 4525--C
    Cal. No. 89

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             April 11, 2011
                               ___________

Introduced  by  Sens.  McDONALD,  CARLUCCI, 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 -- recommitted to the Committee  on  Mental  Health  and
  Developmental Disabilities in accordance with Senate Rule 6, sec. 8 --
  reported  favorably  from  said committee, ordered to first and second
  report, ordered to a third reading, passed by Senate and delivered  to
  the  Assembly, recalled, vote reconsidered, restored to third reading,
  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:

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

                                                           LBD03971-08-2

S. 4525--C                          2

  (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
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. 4525--C                          3

  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
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

S. 4525--C                          4

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
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,  such
section  as renumbered by chapter 978 of the laws of 1977, 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

S. 4525--C                          5

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
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

S. 4525--C                          6

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.
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

S. 4525--C                          7

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
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

S. 4525--C                          8

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
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-

S. 4525--C                          9

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
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

S. 4525--C                         10

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-
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-

S. 4525--C                         11

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
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.