senate Bill S3280A

2013-2014 Legislative Session

Authorizes nurse practitioners to admit mentally ill patients on a voluntary basis

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 08, 2014 referred to mental health and developmental disabilities
Jun 21, 2013 committed to rules
Jun 17, 2013 amended on third reading (t) 3280a
Apr 30, 2013 advanced to third reading
Apr 29, 2013 2nd report cal.
Apr 24, 2013 1st report cal.434
Jan 31, 2013 referred to mental health and developmental disabilities

Bill Amendments

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S3280 - Bill Details

See Assembly Version of this Bill:
A4886A
Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§9.01, 9.13 & 9.15, Ment Hyg L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S4525C, A1603A
2009-2010: A11650

S3280 - Bill Texts

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

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BILL NUMBER:S3280

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

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

SUMMARY OF PROVISIONS:

Section 1.03 of the mental hygiene law is amended by adding a new
subdivision 9-a which defines "nurse practitioner", The section
heading, the opening paragraph of subdivision (a) and subdivision (b)
of section 9.05 of the mental hygiene law, as renumbered by chapter
97a of the laws of 1977, is amended to include nurse practitioners as
having the authority to admit a patient to an inpatient mental health
unit.

EXISTING LAW: None.

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

LEGISLATIVE HISTORY: 2011-2012- S.4525-C - Passed the Senate 2010-
A.11550 - Referred to higher education

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately, with provisions.

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

                                  3280

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 31, 2013
                               ___________

Introduced  by Sen. CARLUCCI -- read twice and ordered printed, and when
  printed to be committed to the Committee on Mental Health and Develop-
  mental Disabilities

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
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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07409-01-3

S. 3280                             2

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
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

S. 3280                             3

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
giving such information as he OR SHE may deem appropriate,  including  a
statement  of  the efforts made by the director of community services to

S. 3280                             4

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
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,

S. 3280                             5

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.
Upon  the  request of such qualified psychiatrist OR NURSE PRACTITIONER,

S. 3280                             6

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
which  is  likely  to  result in serious harm [to himself or others], as

S. 3280                             7

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
date  to  which  the  proceeding  may be adjourned, the court shall hear

S. 3280                             8

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
written treatment plan shall include case management services or  asser-

S. 3280                             9

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-
tion  was filed pursuant to subparagraph (i) or (ii) of paragraph one of

S. 3280                            10

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
and transport any such person to the  hospital  operating  the  assisted

S. 3280                            11

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.

Co-Sponsors

S3280A (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A4886A
Current Committee:
Law Section:
Mental Hygiene Law
Laws Affected:
Amd §§9.01, 9.13 & 9.15, Ment Hyg L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S4525C, A1603A
2009-2010: A11650

S3280A (ACTIVE) - Bill Texts

view summary

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

view sponsor memo
BILL NUMBER:S3280A

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

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

SUMMARY OF PROVISIONS:

Section one of the bill amends section 9.01 of the mental hygiene law
to define a qualified nurse practitioner as an individual licensed
pursuant to the education law and certified as a nurse practitioner
with a certificate in the specialty of psychiatry.

Section two of the bill amends the mental hygiene to provide that when
a written application for voluntary admission requires an examination
of the patient and a confirmation that the patient has a mental
illness for which care and treatment in a facility is appropriate,
such evaluation and confirmation can be made by a physician or a
qualified nurse practitioner.

EXISTING LAW: None.

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

LEGISLATIVE HISTORY: 2011-2012- S.4525-C - Passed the Senate 2010-
A.11550 - Referred to higher education

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately, with provisions.

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

                                 3280--A
    Cal. No. 434

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 31, 2013
                               ___________

Introduced  by Sens. CARLUCCI, AVELLA -- 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,  ordered  to a 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 basis

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

  Section 1. Section 9.01 of the mental hygiene law is amended by adding
a new ninth undesignated paragraph to read as follows:
  "QUALIFIED NURSE PRACTITIONER" MEANS AN INDIVIDUAL  LICENSED  PURSUANT
TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW AND CERTIFIED AS
A  NURSE  PRACTITIONER PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF THE
EDUCATION LAW WITH A CERTIFICATE IN THE SPECIALTY OF PSYCHIATRY.
  S 2. Subdivision (a) of section 9.13 of the  mental  hygiene  law,  as
amended  by  chapter  465  of  the  laws  of 1992, is amended to read as
follows:
  (a) The director of any hospital may receive as  a  voluntary  patient
any suitable person in need of care and treatment, who voluntarily makes
written  application  therefor. TO THE EXTENT THAT SUCH WRITTEN APPLICA-
TION REQUIRES AN EXAMINATION OF THE PATIENT AND  CONFIRMATION  THAT  THE
PATIENT  HAS  A  MENTAL ILLNESS FOR WHICH CARE AND TREATMENT IN A MENTAL
HOSPITAL IS APPROPRIATE, SUCH EVALUATION AND CONFIRMATION SHALL BE  MADE
BY  EITHER  A PHYSICIAN OR A QUALIFIED NURSE PRACTITIONER. If the person
is under sixteen years of age, the person may be received as a voluntary
patient only on the application of the parent, legal guardian, or  next-
of-kin  of  such  person, or, subject to the terms of any court order or
any instrument executed pursuant to section three hundred  eighty-four-a

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD07409-02-3

S. 3280--A                          2

of  the  social  services  law, a social services official or authorized
agency with care and custody of  such  person  pursuant  to  the  social
services  law, the director of the division for youth, acting in accord-
ance with section five hundred nine of the executive law, or a person or
entity having custody of the person pursuant to an order issued pursuant
to  section  seven  hundred  fifty-six or one thousand fifty-five of the
family court act. If the person is over sixteen and under eighteen years
of age, the director may, in his discretion, admit such person either as
a voluntary patient on his own application or on the application of  the
person's  parent,  legal guardian, next-of-kin, or, subject to the terms
of any court order or any instrument executed pursuant to section  three
hundred  eighty-four-a  of  the  social  services law, a social services
official or authorized agency with  care  and  custody  of  such  person
pursuant  to  the  social services law, the director of the division for
youth, acting in accordance with section five hundred nine of the execu-
tive law, provided that such person knowingly and voluntarily  consented
to  such  application  in  accordance  with such section, or a person or
entity having custody of the person pursuant to an order issued pursuant
to section seven hundred fifty-six or one  thousand  fifty-five  of  the
family court act.
  S  3. Section 9.15 of the mental hygiene law, as renumbered by chapter
978 of the laws of 1977, is amended to read as follows:
S 9.15 Informal admissions.
  The director of any hospital approved by  the  commissioner  for  such
purpose  may  receive therein as an informal patient any suitable person
in need of care and treatment requesting admission thereto. Such  person
may  be  admitted as a patient without making formal or written applica-
tion therefor and any such patient shall be free to leave such  hospital
at  any  time  after  such  admission. TO THE EXTENT THAT SUCH ADMISSION
REQUIRES AN EXAMINATION OF THE PATIENT AND CONFIRMATION THAT THE PATIENT
HAS A MENTAL ILLNESS FOR WHICH CARE AND TREATMENT IN A  MENTAL  HOSPITAL
IS APPROPRIATE, SUCH EVALUATION AND CONFIRMATION SHALL BE MADE BY EITHER
A PHYSICIAN OR A QUALIFIED NURSE PRACTITIONER.
  S 4. This act shall take effect immediately.

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