Relates to competency exams, service of charges, petitions to modify or vacate orders, profiling requirements and modifying physician and advertising and testimony standards.
Ayes (63): Adams, Addabbo, Avella, Ball, Bonacic, Boyle, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Espaillat, Farley, Felder, Flanagan, Fuschillo, Gallivan, Gianaris, Gipson, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Hoylman, Kennedy, Klein, Krueger, Lanza, Larkin, Latimer, LaValle, Libous, Little, Marcellino, Marchione, Martins, Maziarz, Montgomery, Nozzolio, O'Brien, O'Mara, Parker, Peralta, Perkins, Ranzenhofer, Ritchie, Rivera, Robach, Sampson, Sanders, Savino, Serrano, Seward, Skelos, Smith, Squadron, Stavisky, Stewart-Cousin, Tkaczyk, Valesky, Young, Zeldin
TITLE OF BILL: An act to amend the public health law and the education law, in relation to enforcing compliance with clinical competency exams, simplifying service of charges, limiting petitions to modify or vacate orders, profiling requirements of self-insured physicians, modifying physician and advertising and testimonial standards; to amend the public health law, in relation to expanding the applicability of penalties for willful violations of the commissioner of health's orders; and to amend chapter 58 of the laws of 2008, amending the elder law and other laws relating to reimbursement to particular provider pharmacies and prescription drug coverage, in relation to the effectiveness of certain provisions thereof
Purpose: This bill would enhance patient safety and bring efficiencies to the disciplinary process for physicians, physician assistants and specialist assistants by: (1) strengthening enforcement of clinical competency remediation recommendations; (2) permitting notice of disciplinary proceedings conducted by the Office of Professional Conduct (OPMC) of the Department of Health (DOH) to be served by mail; (3) requiring written specification in cases when the Board of Regents (Regents) determines to allow reinstatement of a physician if contrary to OPMC's recommendation, and (4) clarifying standards for advertising by medical professionals. In addition; the bill would allow DOH to impose penalties for violations of orders and regulations under the Public Health Law and regulations consistent with those available to local boards of health and health officers.
Summary of Provisions:
Section 1 of the bill would add new Public Health Law (PHL) 230(7)(d) to allow a Committee on Professional Conduct (Committee) to order compliance with the remediation recommendations of a clinical competency examination pursuant to PHL § 230(7)(c). The Committee could also refer the case to the Director of OPMC for presentation to an investigative committee if it determines that there are no reasonable conditions or limitations that could be imposed upon the licensee that would sufficiently mitigate the licensee's incompetence.
Section 2 of the bill would amend Education Law § 6530(5) to provide that to have been found incompetent as the result of an examination conducted under PHL § 230(7)(c) is "professional misconduct" if a Committee determines that there is no practical remediation for such incompetence.
Section 3 of the bill would amend Education Law § 6530(15) to expand the definition of professional misconduct to include failure to comply with remediation recommendations made as the result of an examination conducted under PHL § 230(7)(c) and ordered by a Committee.
Section 4 of the bill would amend PHL § 230(l 0)(d)(i) to provide that the State Board for Professional Medical Conduct (Board) may serve a copy of the charges and the notice of hearing by means other than personal service.
Section 5 of the bill would amend PHL § 230(10)(q) to eliminate the opportunity to seek restoration of a license by OPMC when an application for restoration can be made to Regents.
Section 6 of the bill would amend Education Law § 6511 to provide that if the Regents, in considering an application to restore a license that had been revoked, does not act consistent with the recommendation of OPMC, its decision must set forth its justification for departing from such recommendation.
Section 7 of the bill would amend P1-IL § 2995-a(3) to make a technical correction.
Section 8 of the bill would amend Education Law § 6530(27) to make the restrictions on advertising consistent with those currently included in the Rules of the Board of Regents, 8 NYCRR 29 1(b)(12)
Section 9 of the bill would amend P1--IL § 1241(2) to create penalties for willful violations of Commissioner's orders and permit fines to be levied against individuals who violate Commissioner's orders.
Section 10 of the bill would make the current version of PHL § 12-b(2) permanent.
PHL § 12-b provides that willful violations of the PHL, regulations under the PHL, municipal regulations, orders of local boards of health or orders of health officers are subject to the assessment of a S10,000 penalty or up to a year in prison.
PHL § 230(1) establishes the State Board for Professional Medical Conduct within DOH and authorizes it to investigate complaints of physician professional misconduct, as defined in the New York State Education Law §§ 6530 and 6531.
PHL § 230(7)(a) authorizes the Board, through its Committees on Professional Conduct, to conduct disciplinary proceedings against physicians, medical residents, physician assistants and special assistants.
PHL § 230(7)(a) authorizes a Committee on Professional Conduct to direct that a licensee submit to a medical or psychiatric examination if there is reason to believe the licensee may be impaired by alcohol, drugs, physical disability or mental disability.
PHL § 230(7)(c) authorizes a Committee on Professional Conduct to direct a licensee to undergo a clinical competency examination when there is reason to believe that his or her competency is an issue. The examiner is chosen by the Board with the advice of the licensee and OPMC, and the licensee may also obtain another evaluation from the examiner of his or her choice.
PHL § 230(10)(a) requires the Board, through OPMC, to investigate any complaint it receives, regardless of the source, and authorizes the investigation of suspected professional misconduct on its own initiative
PHL § 230(10)(c) provides that the Board shall set the time and place of a hearing and dictates the contents of a notice of hearing
PHL § 230(10)(d)(i) provides that to initiate a professional misconduct hearing, the Board must serve a copy of the charges and a notice of hearing upon a licensee by personal services at least 30 days before a scheduled heating.
PHL § 230(10)(d)(i) requires that when professional misconduct proceedings are commenced, a copy of the charges and the notice of hearing must be provided to the licensee either by: (1) personal service at least 30 days prior to the hearing, or (2) registered or certified mail service to the licensee's last known address at least 15 days prior to the hearing, if and only if attempts at personal service have been made and have been unsuccessful
PHL § 230(10)(q) provides that at any time subsequent to the conclusion of a professional misconduct proceeding that results in a Board determination and order, the licensee may file a petition with the Director of OPMC to have the determination and order modified or vacated, but only if based on new evidence. If the Director determines that the information submitted by the licensee, if it were available at an earlier time, could likely have led to a different result, the Director and the licensee may jointly petition the Chair of the Board for Professional Medical Conduct to vacate or modify the determination and order.
Education Law § 6511 provides that a licensee whose license has been revoked may petition the Regents to restore the license, but based on broader Regents discretion, without statutory delineation of limiting criteria Pursuant to the Regents' regulations, that Board will not entertain a petition prior to the passage of a specific period of time. At present, a former licensee may petition the Regents beginning three years after the license is revoked
Education Law 6530(27) defines as professional misconduct a physician's use of a patient testimonial regardless of whether the testimonial is truthful, not misleading, not fraudulent or not deceptive. Demonstrations, dramatizations, or other portrayals of professional practice in advertising on radio or television are also prohibited.
Education Law § 6502(5) requires that each physician maintain a current address on file with SED.
Section 29.1(b)(12) of Title 8 NYCRR provides that: (1) testimonials, demonstrations, dramatizations or other portrayals of professional practice in advertising may be used if the patient authorizes the portrayal in writing; (2) there is appropriate disclosure to avoid misleading the audience as to the patient's identity; (3) reasonable disclaimers are included; and (4) testimonials may not be fictional.
Legislative History: The proposed amendments to Education Law 6530(27) were included as part of legislation proposed in 2008, but were not enacted. The remaining proposals are new
Statement in Support:
The Board, within the DOH, administers the disciplinary process for physicians, physician assistants and specialist assistants. OPMC investigates allegations of professional misconduct, and an investigation Committee of the Board determines if charges should be issued. If so, the Board will issue a notice of charges. The licensee is entitled to a hearing before a Committee on Professional Conduct and an administrative review officer, who issues findings of fact and conclusions of law and, if appropriate, imposes a penalty. The licensee may seek administrative review from the Administrative Review Board (ARB) and, if the ARB affirms the administrative review officer's determination, to judicial review This bill would institute several refinements
First, while the Board currently is authorized to order a licensee to undergo a clinical competency examination, it cannot compel remediation in deficit areas or to take action if non-remediable incompetence is found. The bill would authorize a Committee, after affording a licensee notice and an opportunity to be heard, to order compliance with the remediation recommendations of a clinical competency examination. In addition, upon determining that there are no reasonable conditions or limitations that could be imposed upon a licensee that would sufficiently mitigate the licensee's incompetence, the bill would authorize the Committee to refer the case to the Director of OPMC for presentation to an investigative committee. This is necessary to allow the Board to address the licensee's incompetence and protect the patient public from those who are discovered to be incompetent yet refuse or are not capable of remediation.
Second, OPMC must attempt personal service of a copy of misconduct charges and the notice of hearing before it can serve process by mail. By adding alternative methods of service in addition to personal service, the expenditure of funds and use of staff resources would be reduced. Additionally, in many instances, licensees likely would receive notice sooner.
Third, the bill would allow a licensee to seek restoration of a license by OPMC until such time as he or she is able to petition the Regents for the restoration. Because licensees would still have an avenue available to seek restoration, this proposal would have minimal impact to them. Additionally, this bill would enhance patient protection by requiring the Board of Regents to provide a written justification for departing from an OPMC recommendation relating to an individual's application for restoration of a license.
Fourth, the bill revises Education Law § 6530(27), consistent with SED regulations, to provide that testimonials, demonstrations, dramatizations or other portrayals of professional practice in advertising may be used if the patient authorizes the portrayal in writing, there is appropriate disclosure to avoid misleading the audience as to the patient's identity, reasonable disclaimers are included, and testimonials may not be fictional. This amendment is consistent with the 2010 Second Circuit decision in Alexander v Cczhtli, 598 F .3d 79 (2d Cir 2010), cert. denied, 131 S. Ct. 820 (2010). in that case, the court affirmed the invalidation of limitations on endorsements and testimonials in attorney advertising which constituted commercial speech protected under the First Amendment.
Finally, this bill would amend PHL § 12-b so that there is consistency in enforcement. Currently, under . 12-b(2), willful violations of municipal public health laws or regulations or orders of local boards of health or health officers are punishable by up to a year of imprisonment, a fine not exceeding $10,000, or both. This bill would amend PHL § I 2-b(2) so that these penalties could be levied against individuals that violate Commissioner's orders.
Budget Implications: This bill would have no fiscal impact to the State, except that the proposed amendments relating to service by mail is likely to lead to savings. DOH spent 548,000 in 2010-11 on service of process, and estimates that the proposed amendments would reduce this amount between 60 and 80 percent
Effective Date: This bill would take effect 60 days after enactment except §§ 7, 9, and 10 would take effect immediately
STATE OF NEW YORK ________________________________________________________________________ 4527--A 2013-2014 Regular Sessions IN SENATE April 8, 2013 ___________Introduced by Sen. HANNON -- (at request of the Department of Health) -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law and the education law, in relation to enforcing compliance with clinical competency exams, simplifying service of charges, limiting petitions to modify or vacate orders, profiling requirements of self-insured physicians, modifying physician and advertising and testimonial standards; to amend the public health law, in relation to expanding the applicability of penalties for will- ful violations of the commissioner of health's orders; and to amend chapter 58 of the laws of 2008, amending the elder law and other laws relating to reimbursement to particular provider pharmacies and prescription drug coverage, in relation to the effectiveness of certain provisions thereof THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 7 of section 230 of the public health law is amended by adding a new paragraph (d) to read as follows: (D) (I) A COMMITTEE ON PROFESSIONAL CONDUCT, ON NOTICE TO THE LICENSEE AND AFTER AFFORDING THE LICENSEE AND THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT AN OPPORTUNITY TO BE HEARD, SHALL HAVE THE AUTHORITY TO ORDER THE LICENSEE TO COMPLY WITH RECOMMENDED REMEDIATION ARISING FROM THE EXAMINATIONS IN PARAGRAPH (C) OF THIS SUBDIVISION. (II) IF A COMMITTEE ON PROFESSIONAL CONDUCT WHEN CONSIDERING THE RESULTS OF A CLINICAL COMPETENCY EXAMINATION PURSUANT TO PARAGRAPH (C) OF THIS SUBDIVISION DETERMINES THAT THE LICENSEE IS INCOMPETENT AND THAT THERE IS NO PRACTI- CAL REMEDIATION FOR SUCH INCOMPETENCE, IT MAY REFER THE CASE TO THE DIRECTOR OF THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT FOR THE DIREC- TOR'S CONSIDERATION OF WHETHER TO PRESENT TO AN INVESTIGATION COMMITTEE PURSUANT TO SUBPARAGRAPH (IV) OF PARAGRAPH (A) OF SUBDIVISION TEN OFEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09282-07-3 S. 4527--A 2
THIS SECTION FOR ITS CONCURRENCE ON CHARGES PURSUANT TO PARAGRAPH (B) OF SUBDIVISION FIVE OF SECTION SIXTY-FIVE HUNDRED THIRTY OF THE EDUCATION LAW. S 2. Subdivision 5 of section 6530 of the education law, as added by chapter 606 of the laws of 1991, is amended to read as follows: 5. (A) Practicing the profession with incompetence on more than one occasion; OR (B) BEING FOUND TO BE INCOMPETENT BY AN EXAMINATION WHICH HAS OCCURRED PURSUANT TO PARAGRAPH (C) OF SUBDIVISION SEVEN OF SECTION TWO HUNDRED THIRTY OF THE PUBLIC HEALTH LAW WHEN THE RESULTS OF THE EXAMINATION DEMONSTRATE THAT THERE ARE NO REASONABLE CONDITIONS OR LIMITATIONS THAT COULD BE IMPOSED UPON THE LICENSEE THAT WOULD SUFFICIENTLY MITIGATE SUCH INCOMPETENCE. S 3. Subdivision 15 of section 6530 of the education law, as added by chapter 606 of the laws of 1991, is amended to read as follows: 15. (A) Failure to comply with an order issued pursuant to subdivision seven, paragraph (a) of subdivision ten, and subdivision seventeen of section two hundred thirty of the public health law; OR (B) FAILURE TO COMPLY WITH REMEDIATION RECOMMENDATIONS ARISING FROM AN EXAMINATION WHEN AN EXAMINATION HAS OCCURRED PURSUANT TO PARAGRAPH (C) OF SUBDIVISION SEVEN OF SECTION TWO HUNDRED THIRTY OF THE PUBLIC HEALTH LAW, WHEN SUCH COMPLIANCE HAS BEEN ORDERED BY A COMMITTEE ON PROFES- SIONAL CONDUCT PURSUANT TO PARAGRAPH (D) OF SUBDIVISION SEVEN OF SECTION TWO HUNDRED THIRTY OF THE PUBLIC HEALTH LAW. S 4. Subparagraph (i) of paragraph (d) of subdivision 10 of section 230 of the public health law, as amended by chapter 477 of the laws of 2008, is amended to read as follows: (i) A copy of the charges and the notice of the hearing shall be served BY THE BOARD on the licensee EITHER (A) personally
[by the board]at least thirty days before the hearing [. If personal service cannot be made after due diligence and such fact is certified under oath, a copy of the charges and the notice of hearing shall be served]; OR (B) by registered or certified mail to the licensee's [last known]CURRENT RESIDENTIAL OR PRACTICE address [by the board]; MAILED at least [fifteen]THIRTY days before the hearing; OR (C) BY REGISTERED OR CERTI- FIED MAIL TO THE LICENSEE'S CURRENT REGISTRATION ADDRESS PURSUANT TO SECTION SIXTY-FIVE HUNDRED TWO OF THE EDUCATION LAW OR THE LICENSEE'S MOST RECENT MAILING ADDRESS ON FILE WITH THE NEW YORK STATE EDUCATION DEPARTMENT PURSUANT TO THE NOTIFICATION REQUIREMENT SET FORTH IN SUBDI- VISION FIVE OF SUCH SECTION, MAILED AT LEAST FORTY-FIVE DAYS BEFORE THE HEARING; OR (D) BY FIRST CLASS MAIL TO AN ATTORNEY, LICENSED TO PRACTICE IN THE STATE OF NEW YORK, WHO HAS APPEARED ON BEHALF OF THE LICENSEE IN THE MATTER BEFORE THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT MAILED AT LEAST THIRTY DAYS BEFORE THE HEARING. IN THE EVENT A COPY OF THE CHARG- ES ARE SERVED THROUGH EITHER CLAUSES (A), (B), OR (C) OF THIS SUBPARA- GRAPH, THEN THE BOARD SHALL ALSO SERVE THE ATTORNEY, LICENSED TO PRAC- TICE IN THE STATE OF NEW YORK, WHO HAS REQUESTED IN WRITING SERVICE ON BEHALF OF THE LICENSEE IN THE MATTER BEFORE THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT AT LEAST THIRTY DAYS BEFORE THE HEARING. S 5. Paragraph (q) of subdivision 10 of section 230 of the public health law, as added by chapter 477 of the laws of 2008, is amended to read as follows: (q) [At any time subsequent]SUBSEQUENT to the final conclusion of a professional misconduct proceeding against a licensee, whether upon the determination and order of a hearing committee issued pursuant to para- graph (h) of this subdivision or upon the determination and order of theS. 4527--A 3
administrative review board issued pursuant to paragraph (d) of subdivi- sion four of section two hundred thirty-c of this title, the licensee may file a petition with the director, requesting vacatur or modifica- tion of the determination and order. IF THE DETERMINATION AND ORDER DID NOT INCLUDE THE PENALTY OF LICENSE REVOCATION, THE PETITION MAY BE FILED AT ANY TIME. IF THE DETERMINATION AND ORDER INCLUDED A SANCTION OF LICENSE REVOCATION, THE PETITION MAY BE FILED AT ANY TIME PRIOR TO SUCH TIME AS THE LICENSEE IS AUTHORIZED, PURSUANT TO SECTION SIXTY-FIVE HUNDRED ELEVEN OF THE EDUCATION LAW, THE RULES OF THE BOARD OF REGENTS AND THE REGULATIONS OF THE COMMISSIONER OF EDUCATION TO SEEK BOARD OF REGENTS RESTORATION OF THE REVOKED LICENSE. The director shall, after reviewing the matter and after consulting with department counsel, determine in the reasonable exercise of his or her discretion whether there is new and material evidence that was not previously available which, had it been available, would likely have led to a different result, or whether circumstances have occurred subsequent to the original determination that warrant a reconsideration of the measure of discipline. Upon determining that such evidence or circumstances exist, the director shall have the authority to join the licensee in an appli- cation to the chairperson of the state board for professional medical conduct to vacate or modify the determination and order, as the director may deem appropriate. Upon the joint application of the licensee and the director, the chairperson shall have the authority to grant or deny such application. S 6. Section 6511 of the education law, as amended by chapter 542 of the laws of 2000, is amended to read as follows: S 6511. Penalties for professional misconduct. The penalties which may be imposed by the board of regents on a present or former licensee found guilty of professional misconduct (under the definitions and proceedings prescribed in sections sixty-five hundred nine and sixty-five hundred ten of this
[article]SUBPART) are: (1) censure and reprimand, (2) suspension of license, (a) wholly, for a fixed period of time; (b) partially, until the licensee successfully completes a course of retraining in the area to which the suspension applies; (c) wholly, until the licensee successfully completes a course of therapy or treat- ment prescribed by the regents; (3) revocation of license, (4) annulment of license or registration, (5) limitation on registration or issuance of any further license, (6) a fine not to exceed ten thousand dollars, upon each specification of charges of which the respondent is determined to be guilty, (7) a requirement that a licensee pursue a course of education or training, and (8) a requirement that a licensee perform up to one hundred hours of public service, in a manner and at a time and place as directed by the board. The board of regents may stay such penalties in whole or in part, may place the licensee on probation and may restore a license which has been revoked, provided, in the case of licensees subject to section two hundred thirty of the public health law, notice that the board is considering such restoration is given to the office of professional medical conduct at least thirty days before the date on which such restoration shall be considered. Upon the recom- mendation of the office of professional medical conduct, the board of regents may deny such restoration. IN THE EVENT THAT THE BOARD, WHEN CONSIDERING SUCH RESTORATION, ELECTS TO ACT IN A MANNER INCONSISTENT WITH ANY RECOMMENDATION OF THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT, THE BOARD SHALL INCLUDE AN EXPLICIT JUSTIFICATION FOR DEPARTING FROM SUCH RECOMMENDATION IN ITS WRITTEN DETERMINATION. Any fine imposed pursuant to this section or pursuant to subdivision two of sectionS. 4527--A 4
sixty-five hundred ten of this
[article]SUBPART may be sued for and recovered in the name of the people of the state of New York in an action brought by the attorney general. In such action the findings and determination of the board of regents or of the violations committee shall be admissible evidence and shall be conclusive proof of the violation and the penalty assessed. S 7. Subdivision 3 of section 2995-a of the public health law, as added by chapter 542 of the laws of 2000, is amended to read as follows: 3. Each physician who is self-insured for professional medical malp- ractice shall periodically report to the department on forms and in the time and manner required by the commissioner the information specified in paragraph [(f)](E) of subdivision one of this section, except that the physician shall report the dollar amount (to the extent of the physician's information and belief) for each judgment, award and settle- ment and not a level of significance or context. S 8. Subdivision 27 of section 6530 of the education law, as added by chapter 606 of the laws of 1991, is amended to read as follows: 27. Advertising or soliciting for patronage that is not in the public interest. (a) Advertising or soliciting not in the public interest shall include, but not be limited to, advertising or soliciting that: (i) is false, fraudulent, deceptive, OR misleading [, sensational, or flamboy- ant]; (ii) represents intimidation or undue pressure; (iii) [uses testimonials; (iv)]guarantees any service; [(v)](IV) makes any claim relating to professional services or products or the costs or price therefor which cannot be substantiated by the licensee, who shall have the burden of proof; [(vi)](V) makes claims of professional superiority which cannot be substantiated by the licensee, who shall have the burden of proof; or [(vii)](VI) offers bonuses or inducements in any form other than a discount or reduction in an established fee or price for a professional service or product. (b) The following shall be deemed appropriate means of informing the public of the availability of professional services: (i) informational advertising not contrary to the foregoing prohibitions; and (ii) the advertising in a newspaper, periodical or professional direc- tory or on radio [or], television, OR THE INTERNET of fixed prices, or a stated range of prices, for specified routine professional services, provided that if there is an additional charge for related services which are an integral part of the overall service being provided by the licensee, the advertisement shall so state, and provided further that the advertisement indicates the period of time for which the advertised prices shall be in effect. (c)(i) All licensees placing advertisements shall maintain, or cause to be maintained, an exact copy of each advertisement, transcript, tape or video tape thereof as appropriate for the medium used, for a period of one year after its last appearance. This copy shall be made avail- able for inspection upon demand of the department of health; (ii) A licensee shall not compensate or give anything of value to rep- resentatives of the press, radio, television or other communications media in anticipation of or in return for professional publicity in a news item [;]. (d) [No demonstrations, dramatizations or other portrayals of profes- sional practice shall be permitted in advertising on radio or tele- vision;]TESTIMONIALS, DEMONSTRATIONS, DRAMATIZATIONS, OR OTHER PORTRAY-S. 4527--A 5
ALS OF PROFESSIONAL PRACTICE ARE PERMITTED PROVIDED THAT THEY OTHERWISE COMPLY WITH THE LAWS OF PROFESSIONAL MEDICAL CONDUCT AND FURTHER PROVIDED THAT THE FOLLOWING CONDITIONS ARE SATISFIED: (I) THE PATIENT EXPRESSLY AUTHORIZES THE PORTRAYAL IN WRITING; (II) THE APPROPRIATE DISCLOSURE IS INCLUDED TO PREVENT ANY MISLEADING INFORMATION OR IMAGERY AS TO THE IDENTITY OF THE PATIENT; (III) REASONABLE DISCLAIMERS ARE INCLUDED AS TO ANY STATEMENTS MADE OR RESULTS ACHIEVED IN A PARTICULAR MATTER; (IV) THE USE OF FICTIONAL SITUATIONS OR CHARACTERS MAY BE USED IF NO TESTIMONIALS ARE INCLUDED; AND (V) FICTIONAL PATIENT TESTIMONIALS ARE NOT PERMITTED. S 9. Section 32 of part A of chapter 58 of the laws of 2008, amending the elder law and other laws relating to reimbursement to particular provider pharmacies and prescription drug coverage, as amended by section 26 of part A of chapter 59 of the laws of 2011, is amended to read as follows: S 32. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after April 1, 2008; provided however, that sections one, six-a, nineteen, twenty, twenty-four, and twenty-five of this act shall take effect July 1, 2008; provided however that sections sixteen
[, seventeen]and eighteen of this act shall expire April 1, 2014; provided, however, that the amendments made by section twenty-eight of this act shall take effect on the same date as section 1 of chapter 281 of the laws of 2007 takes effect; provided further, that sections twenty-nine, thirty, and thirty-one of this act shall take effect October 1, 2008; provided further, that section twenty-seven of this act shall take effect January 1, 2009; and provided further, that section twenty-seven of this act shall expire and be deemed repealed March 31, 2014; and provided, further, however, that the amendments to subdivision 1 of section 241 of the education law made by section twen- ty-nine of this act shall not affect the expiration of such subdivision and shall be deemed to expire therewith and provided that the amendments to section 272 of the public health law made by section thirty of this act shall not affect the repeal of such section and shall be deemed repealed therewith. S 10. This act shall take effect immediately; provided that sections one, two, three, four, five, six and eight of this act shall take effect on the sixtieth day after this act shall have become a law.