This bill has been amended

Bill S3280-2013

Authorizes nurse practitioners to admit mentally ill patients

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

Details

Actions

  • 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

Meetings

Calendars

Votes

VOTE: COMMITTEE VOTE: - Mental Health and Developmental Disabilities - Apr 24, 2013
Ayes (7): Carlucci, Ball, Bonacic, Felder, Hannon, Zeldin, Adams
Ayes W/R (2): Seward, Latimer
Nays (2): Tkaczyk, Krueger

Memo

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 2010A.11550 - Referred to higher education

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: Immediately, with provisions.


Text

STATE OF NEW YORK ________________________________________________________________________ 3280 2013-2014 Regular Sessions IN SENATE 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
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
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
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,
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,
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
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
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-
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
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
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.

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