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Quality of care and treatment
Mental Hygiene (MHY) CHAPTER 27, TITLE E, ARTICLE 33
§ 33.03 Quality of care and treatment.

(a) Each patient in a facility and each person receiving services for
mental disability shall receive care and treatment that is suited to his
needs and skillfully, safely, and humanely administered with full
respect for his dignity and personal integrity.

(b) Subject to regulations of the commissioner, the director of a
facility shall require the following in order to assure protection of
patients in their care and treatment:

1. careful reexamination and evaluation of each patient not less than
once a year.

2. medical and dental evaluations and evaluations of mental
disabilities of inpatients by qualified professionals no less frequently
than once a year.

3. the order of a staff member operating within the scope of a
professional license for any treatment or therapy based on appropriate

4. consent for surgery, shock treatment, major medical treatment in
the nature of surgery, or the use of experimental drugs or procedures.

5. inclusion in the patient's clinical record of all written treatment
plans and notation of examinations, individualized treatment programs,
evaluations and reexaminations, orders for treatment, and specific
therapies, signed by the personnel involved.

(c) A patient who is removed, but not discharged, from a hospital to
receive medical or surgical care at a facility, at a hospital as defined
in article twenty-eight of the public health law, or at the offices of a
health care professional, shall remain subject to the provisions of
article nine of this chapter. During the period of time that the patient
is removed for the purpose of receiving such medical or surgical care,
all of the patient's rights enumerated by article nine of this chapter
shall be preserved. Nothing in this subdivision shall be construed to
affect the status or rights of a patient pursuant to article nine of
this chapter, who is removed, but not discharged from a hospital for
other purposes.

(d) The commissioner shall promulgate and administer regulations and
policies for the establishment of minimum standards for the active
programming of patients in adult psychiatric centers.

1. Such standards shall take into account the: medical, psychological,
social, vocational, educational and recreational needs of patients
including the specialized needs of patients such as those whose mental
illness is combined with chemical dependency or developmental
disability. The standards shall also take into account the type and mix
of programs required at a given facility, and the availability of
programming at a variety of times and locations.

2. Such standards shall include but not be limited to, a minimum
number of required hours of programming per patient per week and staff
requirements based on the type of programming and the needs of patients
served. Such standards shall provide for programming exemptions for
patients whose clinical or medical condition renders program
participation inappropriate and for the regular review of those
exemptions. Additionally, a patient may refuse participation in
programming provided however that such refusal is consistent with
applicable provisions of law. The regulations shall also provide for
routine evaluations of the implementation of scheduled programming as
well as its effect on identified patient needs.

* (e) 1. Notwithstanding the provisions of subdivisions four and five
of section twenty-nine hundred eighty-one of the public health law, the
commissioners of health, and developmental disabilities may approve and
authorize the use of a simplified advance health care directives form by
persons receiving supports and services from a provider of services
which is authorized to provide services pursuant to article sixteen of
this chapter. Such form shall specify, at the option of the principal,
what end-of-life treatment the person wishes to receive; may designate a
health care agent consistent with the provisions of this article; and
may, at the option of the principal, authorize the health care agent to
commence making decisions immediately upon the execution of the proxy,
provided that all such decisions made prior to a determination of
incapacity pursuant to section twenty-nine hundred eighty-three of the
public health law shall be made in direct consultation with the
principal and the attending physician; and provided, further, that if,
after such consultation, the principal disagrees with the agent's
proposed decision, the principal's wishes shall prevail; and provided,
further, that, in the case of any decision to withhold or withdraw
artificial nutrition or hydration, the principal's wishes must have been
recorded in the health care directive or stated in the presence of the
agent and the attending physician; and further, provided, that the
consultation among principal, agent and attending physician must be
summarized and recorded in the principal's medical record.

2. The simplified advance health care directives form, authorized by
paragraph one of this subdivision, shall be developed by the
commissioner of developmental disabilities, in consultation with the
commissioner of health, providers of service authorized to provide
services pursuant to article sixteen of this chapter, advocates,
including self-advocates, and parents and family members of persons
receiving services from such providers.

* NB Effective upon the date of the approval and availability of the
simplified advance health care directives form authorized by this
subdivision and repealed 2 years after such date.

* NB There are 2 sb (e)'s

* (e) Meals provided by a facility in furtherance of a person's right
to a balanced and nutritious diet, as required by section 33.02 of this
article, shall be served at appropriate times and in as normal a manner
as possible. Altering the composition or timing of regularly served
meals shall be prohibited for disciplinary or punishment purposes, the
convenience of the staff, or behavior modification. Restrictions may be
made for clinical reasons, pursuant to documentation by a qualified
professional, which shall specify the clinical justification for the
restriction and the time period that such restriction shall be in
effect, and which shall be included in the individual's written
treatment or services plan.

* NB There are 2 sb (e)'s